Greener Journal of Epidemiology and Public Health

Vol. 7(1), pp. 18-22, 2019

ISSN: 2354-2381

Copyright ©2019, the copyright of this article is retained by the author(s)

DOI Link: https://doi.org/10.15580/GJEPH.2019.2.072219140

http://gjournals.org/GJEPH

 

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Prevalence of Malaria Parasitemia among Pregnant Women Attending Ante-Natal Clinic at Bingham University Teaching Hospital Plateau State

 

 

1Sarah Silas, 2*Lynn Maori, 2Maikudi Haruna, 2Grace Audu 3Sunday Liman Irmiya, 4Abdullateef Jimoh 5Samira David, 6Atahiru Adamu and 7Nuhu Mohammed

 

 

1.     Heamatology Department, State Specialist Hospital Gombe, Nigeria

2.     Medical Microbiology Department, State Specialist Hospital Gombe, Nigeria.

3.     General Hospital Bogoro, Bauchi State.

4.     World Health Organization, Abuja.

5.     Department of Microbiology, University of Jos, Plateau State

6.     General Studies Department School of Nursing and Midwifery, Gombe, Nigeria.

7.     Snakebite Treatment and Research Hospital Kaltungo, Gombe State

 

 

 

ARTICLE INFO

ABSTRACT

 

Article No.: 072219140

Type: Research

DOI: 10.15580/GJEPH.2019.2.072219140

 

 

In this study a prevalence of 29.1% malaria parasitemia among pregnant women attending Bingham University Teaching Hospital (BUTH) was recorded. The study also showed that multigravidae had the highest prevalence of malaria parasitemia 18.8%, followed by primigravidae who had the lowest prevalence of 10.3%. The age group of 26 to 30 years had the highest prevalence of 11.5% followed by the age group of 31 to 35 years (8.5%) while the least prevalence of 0.6% was in the age group of 41 to 45 years. Women in their first trimester had 2.4% prevalence followed by women in their second trimester who had the prevalence of 12.1% and those in their third trimester had the prevalence rate of 14.9%. The study also shows the result of pregnant women who use long-lasting insecticide treated nets had the highest prevalence of 17.0% while those who do not use the long-lasting insecticide treated nets had the lowest prevalence of 12.1%.  At the end of the study the result showed the prevalence rate of 29.1% of malaria parasitemia. Pregnancy is among other factors affecting the prevalence of malaria in pregnant women which is due to low immunity during pregnancy.

 

Submitted: 22/07/2019

Accepted:  27/07/2019

Published: 06/09/2019

 

*Corresponding Author

Lynn Maori

E-mail: lynnmaori09@  gmail.com

 

Keywords: Malaria; Parasitemia; Trimester; Pregnant women; Multigravidae

 

 

 

 

 

INTRODUCTION

 

Malaria is a parasitic disease that affects the red blood cells. In West Africa, the species of protozoa (Plasmodium) known to cause malaria include- P. falciparum, P. vivax, P. malariae and P. ovale. The parasite is transmitted by the female mosquitoe of the Anopheles genus (Samak, 2004). Upto 2 billion people are affected by malaria worldwide. About 300-500 million cases are reported annually with 2-3 million deaths per year. Ninety percent of these cases occur in Africa most among pregnant women and children under 5 years of age (WHO, 2000). The exact burden of the disease in Nigeria is difficult to ascertain for many reasons including poor record keeping. Malaria in Pregnancy is a major public health problem in tropical and sub-tropical regions of the World.   The physiological changes that occur in pregnancy and the pathological effects of malaria have a synergistic effect on the course of the illness. Malaria in pregnancy tends to be more deadly. All these make the management of malaria in pregnancy more difficult. Even though direct maternal mortality from malaria is less common in areas of stable transmission, P. falciparum infection is estimated to cause upto 10,000 maternal deaths annually as well as 8-14% of all low birth weight babies and 3-8% of all infant deaths annually.

Malaria in pregnancy has serious consequences to the mother and her unborn baby. Pregnant women in endemic areas are vulnerable to malaria because pregnancy reduces a woman's immunity to malaria making her susceptible to infection than non-pregnant women and increasing the risk of anaemia. The evidence of malaria infection can be obtained from the detection of malaria parasites in the peripheral blood of pregnant women (Brabin,1991).

 

 

MATERIALS AND METHODS

 

Study area

 

This study was carried out in Bingham University Teaching Hospital (BUTH), Jos, Plateau State, Nigeria. Jos Plateau State where the Hospital is located got its name from its unique geographical features. The free encyclopedia (Wikipedia) states that Jos is a city in Nigeria's middle belt located at 90056N, 80053E, 9.9330N, 8.8830E high on the Jos Plateau, with an altitude of 4,062 feet (1.217m) above sea level. It enjoys a more temperate climate than most of the rest of Nigeria (average monthly temperature ranges from 700F – 770F or 210C – 250C and has a mean temperature of 18.70C maximum at 51.70C). 

 

Study population

 

The study was carried out on pregnant women attending ante-natal clinic at Bingham University Teaching Hospital (BUTH), Jos, between the period of November 2015 to January 2016.

 

Inclusion criteria

 

Pregnant women attending ante-natal clinic at Bingham University Teaching Hospital Jos, (BUTH) were eligible to be recruited for the study.

 

Exclusion criteria

 

Non pregnant women attending Bingham University Teaching Hospital (BUTH), Jos.

 

Ethical considerations

 

The ethical approval was sought and obtained from the ethical committee of Bingham University Teaching Hospital, (BUTH) prior to the commencement of the study.

 

Patient informed consent

 

Patient's consent and approval were sought prior to sample collection. Participation was

voluntary and those who gave their consent were enrolled in the study.

 

Determination of sample size

 

The sample size for this study was determined using the formula described by Thrusfield (1997) as shown below: -

 

            n =       (1.97)2 Pexp (1 – Pexp)

    d2 

 

Where: -           n = Minimum sample size

                        p = Expected prevalence of malaria parasitemia in Nigerian pregnant women (12% Singh et al., 2012).

 

                        d = Desired absolute precision of 5%

 

                     n = (1.96)2 × 0.11 (1 – 0.11)            

 0.052

 

= 3.8416 x 0.11 x 0.89 =    150.437056

0.0025

 

A Maximum number of 165 sample size was determined.

 

Specimen collection

 

Capillary blood was collected for this study. The patients were made to sit comfortably, the thumb was cleaned with cotton wool soaked in 70% Alcohol and allowed to air dry, a quick prick was made with a disposable sterile blood lancet. The first ooze of blood was wiped off with a dry cotton wool, a little pressure was applied to the thumb to ensure free flow of the blood, the subsequent drops of blood were placed on a clean grease free slide for thin and thick films and labelled appropriately.

 

Specimen processing

 

Thin and thick blood films were made for the study and were stained with Giemsa staining method. The thin and thick blood films were microscopically examined using oil immersion (X100 objective lens) and results recorded appropriately. Controls (positive and negative blood films) were also examined ensuring accuracy of the procedures.

 

Data analysis

 

Data were analysed using statistical software (Version 21 SPSS). The analysis was considered to be statistically insignificant where the P-value obtained was >0.05.

 

 

RESULTS

 

Plasmodium falciparum was identified as the causative agent of malaria parasitemia. One hundred and sixty-five blood samples were collected from the pregnant women attending ante-natal clinic at Bingham University Teaching Hospital (BUTH) Jos and analyzed for malaria parasitemia. The result of the study is presented in tables as follows: -

 

Table 1 shows the prevalence of malaria parasitemia in relation to gravidae. From a total of 54 primigravidae, 17 tested positive with a prevalence of 10.3% while the remaining 111 multigravidae recorded a prevalence of 18.8%.

 

Table 2 shows the prevalence of malaria parasitemia in relation to the ages of the pregnant women. The highest prevalence of malaria was 11.5% among the 26 to 30 years while the lowest prevalence (0.6%) was seen in the age range of 41 to 45 years.

 

Table 3 shows the prevalence of malaria parasitemia in relation to trimesters. Malaria parasitemia was most prevalent in the third trimester (14.9),  followed by the second trimester (12.1%) and lastly first trimester (2.4%).

 

Table 4 shows the prevalence of malaria parasitemia in relation to the use of long-lasting insecticide-treated nets (LLIN). 99 pregnant women who use the long-lasting insecticide-treated nets had a prevalence of (17.0%) and 66 pregnant women who do not use the long-lasting insecticide-treated nets recorded a prevalence of (12.1%).

The overall distribution of Plasmodium species of pregnant women in Bingham University Teaching Hospital (BUTH) of Jos North Local Government Area by gravidae, age, trimesters and the use of long-lasting insecticide-treated nets were calculated by Chi-Square test and concluded that there was no  significant difference in the malaria parasite infection by gravidae, age, trimesters and the use of long-lasting insecticide-treated nets since 165 pregnant women were examined with 48 positive samples having a prevalence of 29.1%.

   


 

Table 1: Prevalence of malaria parasitemia in pregnant women attending ante-natal clinic in BUTH in relation to gravidae

 

Gravidae

No. examine

No. positive (%)

P-value

Primigravidae

54

17(10.3)

0.637

Multigravidae

111

31(18.8)

 

Total

165

48(29.1)

 

 

 

Table 2: Prevalence of malaria parasitemia in pregnant women attending ante-natal clinic at BUTH in relation to age

Age

No. examine

No. positive (%)

P-value

21-25

21

7(4.2)

0.956

26-30

62

19(11.5)

 

31-35

55

14(8.5)

 

36-40

23

7(4.2)

 

41-45

4

1(0.6)

 

Total

165

48(29.1)

 

 

 

Table 3: Prevalence of malaria parasitemia in pregnant women attending ante-natal clinic at BUTH in relation to trimesters

Trimester

No. Examined

No. Positive

P-value

1st Trimester

23

4(2.4)

0.840

2nd Trimester

71

20(12.1)

 

3rd Trimester

71

24(14.9)

 

Total

165

48(29.1)

 

 

 

 

Table 4: Prevalence of malaria parasitemia in pregnant women attending ante-natal clinic at BUTH in relation to sleeping under long-lasting insecticide treated nets

 

LLIN

No. Examined

No. Positive

P-value

Use of LLIN

99

28(17.0)

0.840

Not use LLIN

66

20(12.1)

 

Total

165

48(29.1)

 

 

 

DISCUSSION

 

In this study, a prevalence of 29.1% malaria parasitemia among pregnant women attending Bingham University Teaching Hospital (BUTH) was recorded. This finding is lower compared to the previous report of (Jambo et al.,2011) and (Aribodor et al., 2009) who recorded a prevalence of 42.4% in Makurdi, and 64.4% in Nigeria. The disparity of this study may be due to the fact that the study was conducted during the dry season between the months of November 2015 to January 2016 where mosquitoes are less abundant according to (Ayanda, 2009) in Nasarawa State, Nigeria, prevalence of Plasmodium falciparum infection is higher in the wet season than in the dry season. It might also be due to the fact that the subjects were constantly attending their ante-natal clinics where they are given regular health education, long-lasting insecticide-treated nets and intermittent prophylaxis therapy (IPT). However, this report was higher compared with previous findings of (Neeru et al.,2001) in India and (Isah et al.,2012) in Nigeria who reported the prevalence of 1.3% and 3.1% respectively.

The study also showed that multigravidae had the highest prevalence of malaria parasitemia 18.8%, followed by primigravidae who had the lowest prevalence of 10.3%. This result is statistically insignificant P>0.05. (Taura et al.,2009) who recorded the highest prevalence of 45.2% among multigravidae pregnant women attending ante-natal clinic in Sir Mohammed Sanusi Specialist Hospital Kano Nigeria and (Ikeh et al.,2005) who recorded the lowest prevalence of 7.2% among multigravidae pregnant women in Jos University Teaching Hospital Nigeria. This could be as a result that primigravidae are less susceptible to malaria parasite than multigravidae because they have certain level of immunity to malaria parasite before they were pregnant.  

The age group of 26 to 30 years had the highest prevalence of 11.5% followed by the age group of 31 to 35 years (8.5%) while the least 0.6% was in the age group of 41 to 45 years. No significant age related but the result was in agreement with the previous findings of (Adefioye et al., 2007) in Ladoke Akintola University of Technology Osogbo, Nigeria who recorded the highest prevalence of 66.3% malaria parasitemia among pregnant women in the age group of 28 to 31 years. (Uko et al., 2010) who recorded a low prevalence rate of 6.8%. The prevalence of malaria  decrease with increase in age of the women, reasons might be that younger women are careless in covering themselves compared to the older women and also younger women have low immunity when it comes to pregnancy than the older women who have had multiple birth and exposure to malaria  which confirm an increase immunity in young women.

Women in their first trimester had 2.4% prevalence followed by women in their second trimester who had the prevalence of 12.1% and those in their third trimester had the prevalence rate of 14.9%. The result is not statistically significant P>0.05. The result agreed with the previous findings of (Singh et al.,2012) who recorded highest prevalence among women in their third trimester 39.2% reason being that the women in their third trimester have low resistance and immunity to malaria parasite. In contrary is the findings of (Coulibaly et al.,2004) who recorded the lowest prevalence of 4.4% among pregnant women in their third trimester in Burkina Faso. This may be due to the fact that at the onset of pregnancy, natural immunity is active though it gradually reduce as the pregnancy progresses.

The study also shows the result of pregnant women who use long-lasting insecticide treated nets had the highest prevalence of 17.0% while those who do not use the long-lasting insecticide treated nets had the lowest prevalence of 12.1%. The results are statistically insignificant P>0.05. Even though some who uses the long-lasting insecticide treated nets were still positive, reason being that they could be bitten by mosquitoes out door. This result is in agreement with the previous findings of (Nyamngee et al.,2014) who recorded the highest prevalence of 86.2% among pregnant women who use long-lasting insecticide treated nets in Ekiti Nigeria. This is associated with the lack of formal education about the consequences of malaria parasitemia in pregnancy (Augustine et al.,2012) who recorded the lowest prevalence of 7.5% among pregnant women who do not use long-lasting insecticide treated nets in Abuja Nigeria. Reasons may be that these women were on prophylaxis and having high immunity to malaria.  

 

 

CONCLUSION

 

At the end of the study the result showed the prevalence rate of 29.1% of malaria parasitemia. Pregnancy is among other factors affecting the prevalence of malaria in pregnant women which is due to low immunity during pregnancy. It is evidence that asymptomatic malaria parasitemia is common among the ante-natal pregnant women. It was properly stated from the study that the third trimester, multigravidae, and the young age are at greater risk of malaria parasitemia.

 

 

RECOMMENDATION

 

Malaria in pregnancy is preventable if the following can be strictly adhered to:

 

Insecticide treated nets should be given to the pregnant women free of charge on their first visit.

 

Ante natal care unit should educate the pregnant women on the dangers and effects of malaria and how to prevent being bitten by mosquitoes and also to keep their environments clean.

 

Anti-malarial drugs should be given to the pregnant women on their first ante natal visit whether they show symptoms or not.

 

Government should incorporate more special health education directed at pregnant women into their malaria enlightenment campaigns and provide free chemo prophylactic drugs to pregnant women.                                         

 

 

ACKOWLEDGEMENT

 

Authors are grateful to the staff of Gombe State Specialist Hospital most especially the department of Medical Microbiology and Bingham University Teaching Hospital Plateau State for their support to carry out the work

 

 

REFERENCES

 

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Cite this Article: Silas S; Maori L; Haruna M; Audu G; Irmiya SL; Jimoh A; David S; Adamu A; Mohammed N (2019). Prevalence of Malaria Parasitemia among Pregnant Women Attending Ante-Natal Clinic at Bingham University Teaching Hospital Plateau State. Greener Journal of Epidemiology and Public Health, 7(2): 18-22, https://doi.org/10.15580/GJEPH.2019.2.072219140.