Effects Of Malaria In Pregnancy

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RESEARCH PROJECT TOPIC ON EFFECTS OF MALARIA IN PREGNANCY

ABSTRACT

This study investigates the effects of malaria in pregnancy at the University of Maiduguri Teaching Hospital (U.M.T.H) in Maiduguri. The research involves 480 pregnant women aged 18-38 years, with a mean age of 28.2, who were examined for malaria parasitemia during the study period. The majority of participants were within the age group 25-31, married. The medical history revealed a low percentage with clinical malaria, intestinal parasitic infections (IPIs), and HIV seropositivity. Anemia was also assessed, with 16.3% prevalence among pregnant women, showing a correlation with factors such as IPIs, HIV seropositivity, and the number of pregnancies. The findings highlight the complex nature of malaria parasitemia and its association with demographic and medical factors among pregnant women in Maiduguri. Additionally, anemia, a common complication of malaria, underscores the multifaceted challenges faced by this vulnerable population. The study recommends comprehensive antenatal care programs that integrate screening for infectious diseases, nutritional interventions, and targeted management strategies to reduce the prevalence of malaria parasitemia and associated complications among pregnant women. These insights contribute to the broader understanding of maternal health in malaria-endemic regions, emphasizing the need for tailored interventions to enhance the well-being of pregnant women and their unborn children.

CHAPTER ONE

1.0INTRODUCTION

1.1      Background to the Study

Malaria is a life-threatening disease caused by the Plasmodium parasite and transmitted to humans through the bite of infected female Anopheles mosquitoes (Millicent and Gabriel, 2015). It remains a significant public health problem, particularly in sub-Saharan Africa, where the majority of malaria cases and deaths occur. According to the World Health Organization (WHO), an estimated 229 million cases of malaria occurred globally in 2019, leading to approximately 409,000 deaths, with pregnant women and young children being the most vulnerable populations.  Pregnant women are particularly susceptible to malaria infection due to the physiological changes that occur during pregnancy. These changes include alterations in the immune system, increased body temperature, and elevated levels of certain hormones, which make pregnant women more attractive to mosquitoes and more susceptible to the malaria parasite. Additionally, pregnant women often experience a decrease in immunity, making them less able to fight off malaria infection.

Malaria continues to pose a significant public health challenge in certain global regions, notably in Africa where Nigeria shoulders a substantial burden. Despite concerted efforts by international organizations to mitigate the incidence and mortality rates, Nigeria maintains a prominent position in the malaria landscape on the continent. Various intervention programs, including Roll Back Malaria (RBM), Millennium Development Goals (MDGs), Global Malaria Action Plan (GMAP), Sustainable Development Goals (SDGs), and Global Technical Strategy for Malaria 2016-2030, have been implemented to address this issue (Edogun et al., 2017; Aregbeshola and Khan, 2017). Progress has been achieved in combating malaria, attributed in part to the adoption of artemisinin combination therapy (ACT) as the primary treatment in malaria-endemic areas. Additionally, initiatives such as the distribution of long-lasting insecticide nets (LLIN), intermittent prevention treatment (IPT) for pregnant women, and vector control measures, along with increased funding, have contributed to these gains (Aregbeshola and Khan, 2017).

Despite these advancements, malaria remains a significant health concern in Nigeria, characterized by high morbidity and mortality rates. The persistent status of malaria as a public health problem in Nigeria can be attributed to systemic challenges, including a fragile health system, widespread poverty, inadequate investment in healthcare by governments at all levels, and uneven access to quality healthcare services (White et al., 2011). The prevalence of malaria is further influenced by the knowledge, attitudes, and practices of households. Vulnerable groups, such as children under 5 years of age, women, and pregnant women, often do not use insecticide-treated nets (ITNs) due to factors like family size, education level, gender of household head, place of residence, geopolitical zone, awareness of ITN benefits, and socio-economic status (Ezeama et al., 2014). Moreover, a significant number of households seek malaria treatment from pharmacy stores and alternative locations instead of public or private health facilities, often driven by better accessibility and shorter waiting times. Additionally, caregivers and parents frequently do not subject their children to diagnostic testing.

The impact of malaria on healthcare indicators in Nigeria is substantial, with the disease contributing to around 60% of outpatient hospital visits, 30% of hospitalizations, 30% of under-five mortalities, 25% of infant mortalities, and 11% of maternal mortalities (Ali et al., 2017). Nigeria’s malaria transmission remains holo-endemic, characterized by a consistent transmission rate throughout the year, including distinctive rainy and dry seasons (Millicent and Gabriel, 2015). Approximately 51% of malaria cases and deaths in Nigeria occur in rural villages, distant from effective diagnostic or treatment facilities (WHO, 2010). Early diagnosis and prompt, effective treatment of malaria have been fundamental in malaria control. The reduction of morbidity and interruption of parasite transmission through community-based anti-malarial treatment require accurate, rapid, and practical diagnostic methods. Advances in rapid field diagnostic techniques, based on the demonstration of parasite antigens, offer new possibilities for improved rural malaria diagnosis, independent of centralized diagnostic services. Despite significant strides in malaria control, misconceptions about malaria persist, and control practices have been unsatisfactory. However, the epidemiological patterns of malaria vary widely between different locations (White et al., 2011). Collecting specific data from a particular place is crucial for designing improved programs for strategic malaria control in that location. While effective low-cost strategies for malaria treatment are available, any attempt to control malaria in an area should start with a comprehensive evaluation of the prevailing situation, considering not only prevalence but also the community’s perspective on its health problems and its use of existing health services.

To enhance the chances of success in malaria intervention, planning and implementation should be based on proper epidemiological analysis and interventions tailored to address the specific needs of localities and countries (Dawaki et al., 2016). It is imperative to complement the existing research agenda, primarily focused on reducing morbidity and mortality, with one that identifies key knowledge gaps and defines strategies and tools for further reducing the burden of malaria. Operational research plays a crucial role in identifying gaps and areas for enhancing malaria control, evaluating intervention effectiveness for potential scale-up (Ajayi et al., 2017). The application of malaria operational research (MOR) findings in the planning of national malaria control programs is gaining increased attention. MOR can provide essential insights into what changes are needed, where, why, when, and how these changes should be implemented for a smooth transition from control to elimination (Maduka, 2018). However, malaria operational research has received little attention, and the relevance of conducted research to progress from malaria control to elimination remains uncertain. There is a need to prioritize research topics by researchers and malaria control implementers in Nigeria (Ajayi et al., 2017). This study’s findings will be valuable in planning a sustainable malaria operational research agenda toward eliminating malaria in the nation.

1.2     Statement of the Research Problem

The Federal Ministry of Health in Nigeria has a targeted goal of reducing all malaria-related morbidity and mortality to zero level by the year 2020, but has so far been unable to achieve this as the target year is here with us and as such, malaria is still a serious issue of concern in public health.

 

Despite the fact that malaria is a preventable and curable disease and that treatment is currently cheap, it is still one of the leading causes of death in Nigeria. Several cases of maternal mortality, infant mortality, abortive pregnancy, and low birth weight have been traced to malaria. Moreso, most of the rural communities and even some of the urban areas still lack the proper knowledge of the vectors responsible for transmitting the disease. They still keep stagnant water and bushes which serve as breeding areas for the vector around their residence

Malaria infection during pregnancy poses significant risks to both the mother and the unborn child, including maternal malaria parasitemia, low birth weight, preterm delivery, and increased infant mortality.  Firstly, it increases the risk to maternal and fetal health. Pregnant women with malaria are more susceptible to complications such as maternal malaria parasitemia, which can lead to hemorrhage during childbirth. Additionally, malaria during pregnancy is associated with adverse outcomes for the fetus, including low birth weight, preterm delivery, and stillbirth. These complications contribute to the high maternal and infant mortality rates in areas where malaria is endemic. Secondly, there is a lack of comprehensive data on the prevalence and burden of malaria among pregnant women in specific regions, including Maiduguri. Without accurate information, it becomes challenging for policymakers and healthcare providers to develop effective strategies and allocate resources for preventing and managing malaria in this vulnerable population. Furthermore, inadequate access to appropriate antenatal care and interventions, such as insecticide-treated bed nets and intermittent preventive treatment, further exacerbates the problem. Addressing these problems is crucial for improving the health outcomes of pregnant women and reducing the overall burden of malaria in affected areas. Despite efforts to control and prevent malaria, pregnant women in Maiduguri continue to be at risk of malaria infection, leading to adverse outcomes. Limited information is available on the prevalence of malaria parasitemia among pregnant women at the U.M.T.H, Maiduguri. Therefore, this study aims to address this gap in knowledge and provide valuable insights into the extent of malaria infection among pregnant women attending the U.M.T.H.

1.3 Research Questions

The research questions to be address in this work include:

  1. What is the prevalence of malaria parasitemia among pregnant women at U.M.T.H, Maiduguri?
  2. How does age influence the occurrence of malaria parasitemia among pregnant women in the study population?
  3. What is the association between marital status and the prevalence of malaria parasitemia in pregnant women?
  4. Are there significant differences in the prevalence of malaria parasitemia among pregnant women residing in Enugu compared to those in other areas?
  5. What is the impact of employment status on the occurrence of malaria parasitemia in pregnant women at U.M.T.H?
  6. Is there a correlation between the history of clinical malaria in the past year and the current prevalence of malaria parasitemia among pregnant women?
  7. How does the number of pregnancies affect the prevalence of malaria parasitemia in pregnant women, particularly for primigravidae and multigravidae?
  8. What role does the trimester of pregnancy play in influencing the prevalence of malaria parasitemia among pregnant women at U.M.T.H?
  9. How do lifestyle factors such as smoking and alcohol consumption contribute to the occurrence of malaria parasitemia among pregnant women?
  10. What is the relationship between inter-pregnancy gap duration and the prevalence of malaria parasitemia in pregnant women?

1.4     Aim and Objectives of the Study

The aim of this study was to determine the prevalence of malaria parasitaemia among pregnant women at the U.M.T.H, Maiduguri. The specific objectives include:

 

  1. To determine the prevalence of malaria parasitemia among pregnant women attending U.M.T.H, Maiduguri.
  2. To assess the impact of age on the occurrence of malaria parasitemia and related variables in the study population.
  3. To investigate the association between marital status and the prevalence of malaria parasitemia among pregnant women.
  4. To compare the prevalence of malaria parasitemia among pregnant women residing in Enugu and those in other areas.
  5. To analyze the influence of employment status on the occurrence of malaria parasitemia among pregnant women.
  6. To explore the relationship between the history of clinical malaria in the past year and the current prevalence of malaria parasitemia.
  7. To examine the effect of the number of pregnancies on the prevalence of malaria parasitemia, focusing on primigravidae and multigravidae.
  8. To assess the role of trimester of pregnancy in influencing the prevalence of malaria parasitemia among pregnant women.
  9. To investigate the impact of lifestyle factors, including smoking and alcohol consumption, on the occurrence of malaria parasitemia.
  10. To explore the relationship between the duration of inter-pregnancy gaps and the prevalence of malaria parasitemia among pregnant women.

 

1.5 Significance of the Study

The significance of the study extends to various stakeholders, including pregnant women, healthcare workers, the Ministry of Health, policymakers, and researchers. Here is an expansion on the significance of the study for each of these groups:

  1. Pregnant Women: The study holds significant importance for pregnant women as it aims to improve their health outcomes. By determining the prevalence of malaria parasitemia among pregnant women attending the U.M.T.H, the study will contribute to identifying the extent of the problem and raising awareness about the risks of malaria during pregnancy. The findings will help pregnant women understand the importance of preventive measures, such as sleeping under insecticide-treated bed nets and accessing appropriate antenatal care. Ultimately, the study’s results will empower pregnant women to make informed decisions regarding their health and the health of their unborn children.
  2. Healthcare Workers: The study’s findings will directly benefit healthcare workers who provide care to pregnant women. By determining the incidence of malaria infection and assessing the sensitivity of the rapid diagnostic test cassette, healthcare workers will have up-to-date information on the burden of malaria and the effectiveness of diagnostic tools. This knowledge will guide them in improving the accuracy of malaria diagnosis and ensuring appropriate treatment for infected pregnant women. Additionally, the study may identify gaps in healthcare worker knowledge and practices, leading to targeted training programs to enhance their understanding of malaria prevention and management during pregnancy.
  3. Ministry of Health: The Ministry of Health plays a crucial role in formulating policies and implementing programs to address public health concerns. The study’s significance lies in providing valuable data on the prevalence of malaria among pregnant women, specifically in the context of Maiduguri. This information will assist the Ministry of Health in developing evidence-based strategies and interventions to prevent and control malaria during pregnancy. The study’s findings may influence policy decisions related to the provision of malaria prevention measures, antenatal care services, and the allocation of resources to combat malaria in affected areas.
  4. Policymakers: Policymakers at various levels will benefit from the study’s findings. The prevalence data and insights into the effectiveness of diagnostic tools will inform policymakers about the specific challenges faced by pregnant women in relation to malaria. This understanding will enable the development of targeted policies and interventions that address the unique needs of pregnant women, such as improving access to preventive measures, ensuring availability of effective antimalarial drugs, and enhancing antenatal care services. The study will provide policymakers with evidence to advocate for increased funding and resources to combat malaria among pregnant women and improve overall maternal and child health outcomes.
  5. Researchers: The study’s significance to researchers lies in contributing to the existing body of knowledge on malaria in pregnancy, particularly in the context of Maiduguri. The findings will provide valuable insights into the local epidemiology of malaria and identify specific risk factors associated with malaria infection among pregnant women. This information will guide further research and investigations into innovative strategies for malaria prevention, diagnosis, and treatment in pregnancy. The study may also inspire collaboration between researchers, fostering a multidisciplinary approach to addressing the complex challenges of malaria in pregnancy.

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