Authors : James Ssekitooleko, Tinuola Femi Rufus, Denis Mubiru, Catherine Nyakakye, David Kuteesa Mansen
Abstract:
Malaria
during pregnancy has negative consequences to both the mother and fetus. In 2019,
there were an estimated 33million pregnancies globally, of which 35% were exposed
to malaria in Africa. To avert the consequences, the Uganda Ministry of Health is
implementing approaches for effective prevention with intermittent preventive treatment, use Insecticide-Treated Nets (ITN), prompt diagnosis, and treatment through
antenatal care (ANC). This study was
conducted to determine the prevalence of malaria and associated factors among pregnant women attending their
first ANC visit in Kole and Kyenjojo Districts in Uganda.
A cross-sectional study design was conducted among 760 randomly selected pregnant women. Quantitative data was collected using a
structured questionnaire to gather participants’ demographic, obstetric, coverage,
and use of malaria preventive methods and laboratory results on malaria, anaemia,
and HIV. Data was analyzed using STATA 15. Chi-square, odds
ratio, and logistic regression were used to test for associations. The overall prevalence
of malaria was 11.1%, varying from 6.8%
in Kyenjojo to 15.3% in Kole District.
Most cases were caused by P. falciparum. Factors
associated with malaria were age of mother (aOR: 0.44, 95% CI: 0.21-0.88), residence
in Kyenjojo (aOR: 0.48, 95% CI: 0.26-0.88), multiparity (aOR: 0.38, 95% CI: 0.16-0.91),
anaemia (aOR: 2.12, 95% CI: 1.12-4.00) and ITN non-use (aOR: 6.17, 95% CI: 2.76-13.86). Malaria prevalence
was low and varied between districts. Age, gravidity, gestational age, and ITN use
had a significant association with malaria. Therefore, early screening and identification
of mothers at most risk of complications during pregnancy is needed, plus improving
ANC.
Keywords:
Antenatal Care, Malaria in Pregnancy, Pregnant Women, Risk
Factors, Uganda.
References:
[1] WHO. World malaria report 2020
Geneva: World Health Organization. Available from: https://www.who.int/malaria/publications/world-malaria-report-2020/en/.
[2] Uganda Malaria Reduction and
Elimination Strategic Plan 2021-2025. Ministry of Health. https://www.health.go.ug/cause/the-uganda-malaria-reduction-strategic-plan-2014-2020/.
[3] Pell C, et al., 2011. Social
and cultural factors affecting uptake of interventions for malaria in pregnancy
in Africa: a systematic review of the qualitative research. Public Library of
Science One. 6: e22452. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140529/pdf/pone.0022452.pdf.
[4] Mubyazi G, et al., 2005. Intermittent
preventive treatment of malaria during pregnancy: a qualitative study of knowledge,
attitudes and practices of district health managers, antenatal care staff and pregnant
women in Korogwe District, North-Eastern Tanzania. Malaria Journal; 4:31.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1187919/pdf/1475-2875-4-31.pdf.
[5] Muhumuza E, et al., 2016. Factors
associated with the use of malaria control interventions by pregnant women in Buwunga
sub-county, Bugiri District. Malaria Journal; 15:342. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932743/pdf/12936_2016_Article_1407.pdf.
[6] Hill J, et al., 2013. Factors
affecting the delivery, access, and use of interventions to prevent malaria in pregnancy
in sub-Saharan Africa: a systematic review and meta-analysis. Public Library
of Science Medicine Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720261/pdf/pmed.1001488.pdf.
[7] Sangare L.R., et al., 2010.
Determinants of use of intermittent preventive treatment of malaria in pregnancy:
Jinja, Uganda. Public Library of Science One. 5: e15066. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993958/pdf/pone.0015066.pdf.
[8] Ndibazza, J, et al., 2013.
Associations between maternal helminth and malaria infections in pregnancy and clinical
malaria in the offspring: a birth cohort in entebbe, Uganda. The Journal of infectious
diseases, 208(12), doi: 10.1093/infdis/jit397. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836463/pdf/jit397.pdf.
[9] Geleta G, et al., 2017. Prevalence
of malaria and frequency of severe symptoms among pregnant women in Pawe hospital,
Northwestern Ethiopia. Annals of Clinical Pathology. 5:1109. Available from:
https://www.jscimedcentral.com/Pathology/pathology-5-1109.pdf.
[10] Adam I, Khamis AH, Elbashir
MI, 2005. Prevalence and risk factors for Plasmodium falciparum malaria in pregnant
women of eastern Sudan. Malaria Journal. ;4(1):18. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05289-9.
[11] Tegegne Y, et al., 2019. The
prevalence of malaria among pregnant women in Ethiopia: a systematic review and
meta-analysis. Journal of Parasitology Research. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521389/pdf/JPR2019-8396091.pdf.
[12] Linda A.F, et al., 2020. A
multicenter study of the prevalence and risk factors of malaria and anemia among
pregnant women at first antenatal care visit in Ghana. Public Library of Science
One. 15(8): e0238077. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444479/pdf/pone.0238077.pdf.
[13] Asmamaw T, et al., 2013. Prevalence
of malaria and HIV among pregnant women attending antenatal clinics at felege hiwot
referral hospital and Addis zemen health center. International Journal Life Science
Biotechnology Pharmaceutical Research. 3;2(1–13). Available from: http://www.ijlbpr.com/index.php?m=content&c=index&a=show&catid=120&id=86.
[14] Ahenkorah B, et al., 2020.
Parasitic infections among pregnant women at first antenatal care visit in northern
Ghana: A study of prevalence and associated factors. Public Library of Science
One. 15(7): e0236514. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380595/pdf/pone.0236514.pdf.
[15] Agomo C.O, et al., 2009. Prevalence
of Malaria in Pregnant Women in Lagos, South-West Nigeria. Korean Journal Parasitology.
179–183. P doi: 10.3347/kjp.2009.47.2.179. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688802/pdf/kjp-47-179.pdf.
[16] Briand V, et al., 2016. Prevalence
of malaria in pregnancy in southern Laos: a cross-sectional survey. Malaria Journal.
;15(1):436. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002160/.
[17] Sohail M, et al., 2015. Prevalence
of malaria infection and risk factors associated with Anaemia among pregnant women
in Semiurban Community of Hazaribag, Jharkhand, India. Biomed Research International.:740512.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691455/.
[18] Namusoke, F, et al., 2010.
Malaria burden in pregnancy at Mulago national referral hospital in Kampala, Uganda.
Malaria Research and Treatment. doi: 10.4061/2010/913857. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277833/.
[19] Kyabayinze, D. J, et al., 2011.
Placental Plasmodium falciparum malaria infection: operational accuracy of HRP2
rapid diagnostic tests in a malaria-endemic setting. Malaria Journal, 10(1),
306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206496/.
[20] Arinaitwe, E, et al., 2013.
Intermittent preventive therapy with sulfadoxine-pyrimethamine for malaria in pregnancy:
a cross-sectional study from Tororo, Uganda. Public Library of Science One,
8(9), e73073. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762885/.
[21]
Gontie G.B, Wolde H.F, Baraki A.G., 2020. Prevalence and associated
factors of malaria among pregnant women in Sherkole district, Benishangul Gumuz
regional state, West Ethiopia. BioMed Central Infectious Diseases. 20:573.
Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05289.
[22] Ouedraogo M, et al., 2019.
Utilization of key preventive measures for pregnancy complications and malaria among
women in Jimma Zone, Ethiopia. BioMed Central Public Health. 19: [22] 1443.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827171/.
[23] De Beaudrap P, et al., 2013.
Impact of malaria during pregnancy-on-pregnancy outcomes in an Uganda prospective
cohort with intensive malaria screening and prompt treatment. Malaria Journal.
12: 139. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754923/.
[24] Nega D, et al., 2015. Anemia
associated with asymptomatic malaria among pregnant women in the rural surroundings
of Arba Minch Town, South Ethiopia. BioMed Central Research Notes. doi:10.1186/s13104-015-1081-4.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392875/.
[25] Yimam Y, et al., 2021. A systematic
review and meta-analysis of asymptomatic malaria infection in pregnant women in
Sub-Saharan Africa: A challenge for malaria elimination efforts. Public Library
of Science One. 216(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016273/.
[26] Ofori M, et al., 2009. Pregnancy-associated
malaria in a rural community of Ghana. Ghana Medical Journal. 43(1):13–8.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709171/.
[27] Okiring, J, et al., 2019. Household
and maternal risk factors for malaria in pregnancy in a highly endemic area of Uganda:
a prospective cohort study. Malaria Journal, 18(1), 144. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6480498/.
[28] Van Eijk, A.M, et al., 2015.
Prevalence of malaria infection in pregnant women compared with
children for tracking malaria transmission in sub-Saharan Africa: a systematic review
and meta-analysis. The Lancet Global Health, 3(10). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673091/.
[29] Kwame D.D, et al., 2020. Epidemiology
of malaria among pregnant women during their first antenatal clinic visit in the
middle belt of Ghana: a cross sectional study. Malaria Journal. 19: 381. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585211/.