Antenatal Practices Ineffective at Prevention of Plasmodium falciparum Malaria during Pregnancy in a Sub-Saharan Africa Region, Nigeria

Abstract

Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 103/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 103 vs. secundi- (92.14 ± 4.72) × 103 vs. multigravidae (65.22 ± 20.17) × 103; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 103 vs. multiparous (67.50 ± 20.97) × 103 was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ2 = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ2 = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765–12.135)) and users (66.7% vs. 33.3%, χ2 = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693–23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery.

Pregnancy-associated Malaria, Challenges and Prospects in Sub-Saharan Africa

“…Provision of ITNs during ANC is needed in some areas. Also reviews of aspects of counselling and sensitizations during ANC to incorporate malaria preventive strategies may be needed in some settings as was the case in our study at District Hospital, Ogrute, Enugu State, Nigeria [72]. At that hospital, not only was there need for provision of ITNs, there was need for sensitization on benefits of ITNs usage.…”

“…ITNs usage, IPTp and effective management of malarial cases) to prevention and management of PAM recommended by WHO [71] is greatly dependent on antenatal care provision for effective delivery. Though ITNs distribution, acquisition and usage by pregnant women can happen without interference from antenatal service providers, studies have indicated needs for counselling on ITNs ownership and usage [72]. Promotion of ITNs usage among pregnant women taking together with the other two antenatal care-rooted recommendations during antenatal may be more cost effective than otherwise.…”

“…One reason for the failures is antenatal service provision and patronage. In some settings, pregnant women attend antenatal clinics for the first time during the third trimester [72], thereby greatly reducing the chances of receiving three or more IPTp-SP as recommended. In some settings where antenatal attendance is high, availability of SP to serve three or more doses recommended intake by pregnant women becomes another limiting factor [74].…”

“…Antenatal care in some regions are ineffective at preventing PAM [72]; PAM is either not effectively incorporated as a major target of ANC, or commitment to existing policy is poor [75]. Where antenatal service provision is poor, the objectives of WHO and other partners will not be achieved.…”

“…Antenatal care linked design to enhance effective usage of ITNs by pregnant women, infants and newborn is another aspect that may be explored; non-patronage of ITNs and skewed usage pattern has been observed in some settings. In some settings, younger ladies usually primigravidae and secundigravidae who are also at greater risk for severe malaria health outcome were less likely to own and use ITNs [72]. Thus, localized studies incorporating into ANC designs to improve ITNs usage by pregnant women, such as counselling on why and how to use ITNs, may help improve pregnancy outcomes.…”