High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study

Abstract

Background Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. Methods We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). Conclusion The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Prevalence of and factors associated with placental malaria in the White Nile State: a cross-sectional study

“…In Ghana, one out of every five pregnant women in the antenatal care clinic had a P. falciparum infection [18]. Mangusho et al have shown that 26.1% of pregnant women in Uganda had P. falciparum malaria [11]. Recently, in their meta-analysis of 24 studies (n = 14,087 pregnant women), Boltena et al [19] indicated that the pooled prevalence of malaria in sub-Saharan Africa was 33.0%.…”

“…However, primiparas were reported to be associated with placental malaria in the Blue Nile state in Sudan [4]. In Uganda, a recent study reported no association between age and malaria during pregnancy [11]. In Nigeria [5] and in West Ethiopia [6] malaria during pregnancy was associated with age and parity.…”

“…It is worth mentioning that the efficiency of ITN in preventing malaria during pregnancy might not be optimal in areas characterized by unstable malaria transmission; this would include Sudan [22,24,25]. A recent study showed that pregnant women in Uganda who did not use ITN were at higher risk of having malaria infection [11].…”

“…Several recent studies have shown a high burden of malaria infection among pregnant women in sub-Saharan African countries [4][5][6][7][8][9], including Sudan [1,10]. Recently, Mangusho et al have shown that 26.1% of pregnant women in Uganda had P. falciparum malaria [11]. Moreover, recent reports in sub-Saharan Africa have shown that malaria infection during pregnancy is associated with poor maternal and perinatal effects including maternal anemia and low birth weight [2].…”

Attitudes and Behaviors Around Preventative Measures Against Malaria During Pregnancy in The Luwero District of Uganda

“…Difficulty fighting off infections and potential neurological problems are also harmful effects of malaria in pregnancy (5). In Uganda, the prevalence of malaria in pregnancy ranges from as low as 8.9% to as high as 50% depending on the region (6). The standard of care for IPTp in Uganda is for women to receive at least two doses of SP/Fansidar during their second and third trimester (7).…”