Abstract:

Introduction: Malaria is the commonest endemic disease, and the most vulnerable group of persons affected by malaria is the pregnant women. This has posed serious public health challenge in Nigeria; it is with these considerations that the Nigerian Government in the past few years has renewed efforts towards controlling malaria. Several interventions have been introduced amongst which were the introductions of Artemisinin-based combination therapies (ACTs) and massive distribution of long lasting insecticidal nets. Statistic has shown that 8 million women are pregnant every year in Nigeria and about 545 women out of every 100,000 die as a result of pregnancy-related complications.

Objectives: This study was done to ascertain the Diagnosis and treatment characteristics of malaria in pregnant women and assessed the training, work experience, knowledge, and perception of health workers regarding malaria in pregnancy, in North Western Nigeria.

Method: Arandom sampling method was carried out across 10 local governments and 15 health facilities in North Western Nigeria. Two participants from each facility gave a total of 300 health care workers recruited into this study.

Results: 91% of the participant believe that RDT /microscopy is the appropriate test for malaria; 38% of them agree that the test miss malaria cases while 14% believe that treatment should be given to a client that test Negative to either of the test. 37% of the participant prescribed Quinine, while 48% of the participant will prefer ACT and the least 2% will still go for Chloroquine.

Conclusion: This study exposed the under-diagnosis as well as miss treatment of malaria in pregnancy and the need for training and retraining of health care workers as well as establishing the malaria diagnosis quality assurance program to ensure the accuracy of malaria microscopy and RDT results at all levels.

References:

[1]. Bouyou-Akotet M. K., Adegnika A. A., Agnandji S. T., Ngou-Milama E., Kombila M., Kremsner P. G. (2005). Cortisol and susceptibility to malaria during pregnancy. Microbes and Infection. 1217-23.

[2]. Chukwuma Muanya. (2013). National Malaria Elimination Programme, FCA, Total renew commitment towards disease eradication.

[3]. Desai M., Kuile F., Nosten F., McGready R., Asamoa K., Brabin B., Newman R. (2007). Epidemeology and burden of malaria in pregnancy. Lancet of infectious diseases.93-104 Okpere E. E. Malaria in pregnancy. In Okpere E (Ed): Clinical Obstetrics. Uniben Press. 2004:56-63.

[4]. Federal Ministry of Health (FMOH). National Antimalarial Treatment Policy. FMOH, National malaria and Vector Control Division, Abuja, Nigeria 2005.

[5]. Federal Ministry of Health Nigeria (2015). National Malaria Elimination Programme,

[6]. Federal Ministry of health, (2015). National guidelines and strategies for malaria prevention and control during pregnancy, second edition

[7]. James F. Entwistle. (2016). Ending Malaria in Nigeria for good.

[8]. Jelinek T, Grobusch MP, Harms G, 2001. Evaluation of a dip-stick test for the rapid diagnosis of imported malaria among patients presenting within the network TropNetEurop. Scand J Infect Dis 33: 752–754.

[9]. Kalilani-Phiri LV, Lungu D, Coghlan R (2011) Knowledge and malaria treatment practices using artemisinin combination therapy (ACT) in Malawi: survey of health professionals. Malar J 10: 279. doi: 10.1186/1475-2875-10-279

[10]. Kalilani-Phiri, L.V. Lungu, D. Coghlan R. (2011) Knowledge and malaria treatment practices using artemisinin combination therapy (ACT) in Malawi: survey of health professionals. Malaria Journal, 10 p. 279

[11]. Kwansa-Bentum B, Ayi I, Suzuki T, Otchere J, Kumagai T, et al. (2011) Administrative practices of health professionals and use of artesunate-amodiaquine by community members for treating uncomplicated malaria in southern Ghana: implications for artemisinin-based combination therapy deployment. Trop Med Int Health 16: 1215–1224.

[12]. Leke, R.F.G., R.R. Djokam, R. Mbu, R.J. Leke and J. Fogako et al., 1999. Detection of the Plasmodium falciparum antigen histidine-rich protein 2 in blood of pregnant women: Implications for diagnosing placental malaria. J. Clin. Microbiol., 37: 2992-2996.

[13]. Luz, T.C.B., Suárez-Mutis, M.C., Miranda, E.S., Moritz, A.F., Freitas, L.F., Brasil, J.C., Osorio-de-Castro, C.G. (2013). Uncomplicated malaria among pregnant women in the Brazilian Amazon: Local barriers to prompt and effective case management. Acta Tropica, Volume 125, Issue 2, February 2013, Pages 137-142

[14]. Malaria situation analysis document. Abuja, Nigeria: Federal Ministry of Health; 2000. Federal Ministry of Health; pp. 14–26.

[15]. Manirakiza A, Soula G, Laganier R, Klement E, Djalle D, et al. (2011) Pattern of the antimalarials prescription during pregnancy in Bangui, Central African Republic. Malar Res Treat 2011: 414510

[16]. Marx A, Pewsner D, Egger M, Nuesch R, Bucher HC, Genton B, Hatz C, Juni P, 2005. Meta-analysis: accuracy of rapid tests for malaria in travelers returning from endemic areas. Ann Intern Med 142: 836–846.

[17]. Murray, C.K., R.A. Gasser Jr., A.J. Magill and R.S. Miller, 2008. Update on rapid diagnostic testing for malaria. Clin. Microbiol. Rev., 21: 97-110.

[18]. Okonta PI (2011) How many physicians prescribe quinine for the treatment of malaria in the first trimester of pregnancy? Ebonyi Med J 10: 105–111.

[19]. Okoro RN, Nwambu JO (2012) Evaluation of physicians' prescribing patterns of antimalarial drugs during pregnancy at the obstetrics and gynaecology department of a teaching hospital in Maduguri, Borno State, Nigeria. Int J Pharm Biomed Sci 3: 39–46.

[20]. Okpere, E.E., Enabudoso, E.J. Osemwenkha, A.P. (2010). Malaria in Pregnancy. Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria Med J 51:109-13.

[21]. Onwujekwe OC, Soremekun RO, Uzochukwu B, Shu E, Onwujekwe O (2012) Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria. BMC Res Notes 5: 211. doi: 10.1186/1756-0500-5-211

[22]. Population Services International Research and Metrics (2007) Cambodia 2007: TRaC study exploring the determinants of malaria health care provision among private providers in malaria endemic areas—first round. Washington (District of Columbia): Population Services International.

[23]. Rogerson S. J., Hviid L., Duffy P., Leke R. (2007). Taylor D. Malaria in pregnancy: pathogenesis and immunity. Lancet infectious diseases. 105- 17.

[24]. Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria endemic areas. Am J Trop Med Hyg. 2001;64:28–35.

[25]. Strategic Plan for Rolling Back Malaria in Nigeria 2001-2005. Abuja, Nigeria: Federal Ministry of Health; 2001. Federal Ministry of Health; pp. 9–11.

[26]. Uzochukwu, B.S.C. Ezeoke, O.P Ukaegbu, U.E., Onwujekwe O.E., Sibeudu, F.T. (2010). Malaria treatment services in Nigeria: a review. Nigerian Medical Journal. 51(3) : 114-119

[27]. Wongsrichanalai, C., Barcus, Muth, S., Sutamihardja, A and Wernsdorfer W.H. (2007). A Review of Malaria Diagnostic Tools: Microscopy and Rapid Diagnostic Test (RDT). Am J Trop Med Hyg. 77 (6): 119-127

[28]. World Health Organisation. Roll Back Malaria Factsheet No.94. Geneva. [Last cited on 2011 June 06]. Available from: http://www.who.int/mediacentre/factsheets/fs094en.

[29]. World Health Organization (2015). Malaria In pregnancy Guidelines for the treatment of malaria, third edition.

[30]. World Health Organization, 2000. Malaria Diagnosis New Perspectives. Report of a Joint WHO/USAID Informal Consultation, October 25–27, 2000. Geneva: WHO.

[31]. World Health Organization, 2004. The use of malaria diagnostic tests. Manila: WHO Regional Office for the Western Pacific (WPRO). WHO.