Prevalence, risk factors and effects of placental malaria in the UMTH, Maiduguri, North-eastern, Nigeria: A cross-sectional study

Abstract

Most of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period.

Placental malarial parasitaemia and pregnancy outcome among parturients in a tertiary hospital in South- South Nigeria

“…The lower prevalence reported in this study may be due to the effective malaria control measures employed in the population, which include sulphadoxine -pyrimethamine 20 Several studies have shown that parity influences susceptibility to placental malaria with primigravidae being more susceptible compared to multigravidae. 19,24,25 In this study, higher parity did not confer any protection and this was consistent with the observations of Bako et al, 6 SuleOdu et al, 8 and Ofori et al 24 This finding was not surprising as same proportion of women across the various parities (nulliparous, primiparous and multiparous) used ITNs and also had at least 2 doses of IPT.…”

“…Similar findings have been reported by Bako et al 6 and Gilles et al 26 in Maiduguri and Burkina Faso respectively. Some of the mothers might have cleared the peripheral parasitaemia at the time of delivery mostly due to the use of IPT and case management of malaria in pregnancy and such mothers had negative malaria parasite even in the presence of placental parasitaemia.…”

“…[6][7][8][9] Various studies have linked placental malaria to maternal anaemia. 18,24 However, in this study, there was no significant association between placental malaria and maternal anaemia when controlled for the other confounding variables, using the multivariate logistic regression model.…”

“…13 The World Health Organization (WHO) has recommended a three prong approach to the prevention and control of malaria during pregnancy in areas of stable transmission through the use of intermittent preventive (IPT) of asymptomatic pregnant women, use of insecticide treated nets (ITNs) and prompt and effective case management of acute malaria in pregnancy. 14 Although there have been some studies demonstrating how placental parasitaemia adversely affect pregnancy outcome in some parts of the country, 6,8,9,15 none has been conducted in Akwa Ibom State, South -South Nigeria. Considering the endemic nature of the disease in the State and the impact it could have on both mother and the fetus, this study was necessary to determine the prevalence of placental malaria and its influence on pregnancy outcome especially during the peri-partum period when preventive measures would have already been instituted.…”

“…[4][5] Although often asymptomatic, especially in immune women, malaria has been implicated in several studies as a cause of some unfavourable pregnancy outcomes. [6][7][8][9] These outcomes include anemia in pregnancy, fetal anemia, miscarriage, intra-uterine fetal death, premature labour and congenital malaria. The adverse consequences are mainly as a result of sequestration of parasitized erythrocytes present in the placental intervillous spaces, to chondroitin sulphate A (CSA) in the placenta.…”