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Iddrisu H, Tagoe EA, Bonful HA. Adherence to sulfadoxine-pyrimethamine five-dose policy among pregnant women in an urban slum in Ghana: a mixed-methods study. Malar J 2024; 23:310. [PMID: 39420331 DOI: 10.1186/s12936-024-05127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Malaria in pregnancy (MiP) is a public health concern especially for pregnant women living in slums. The World Health Organization recommends at least three doses of Sulfadoxine-Pyrimethamine (SP) to prevent MiP. In Ghana, it is recommended that pregnant women receive a minimum of five doses of the medication. This study sought to determine the level of adherence to IPT5 policy and factors associated with adherence among pregnant women in a slum community in Ghana. METHODS This was a cross-sectional study involving 232 nursing mothers and four healthcare workers at the St. Martin's Memorial Hospital, Sukura, Ghana. Sociodemographic characteristics of nursing mothers were obtained using an interview-administered questionnaire. Data on the number of SP doses and other obstetrics characteristics were collected by reviewing the antenatal record books. To obtain information about healthcare and health system factors associated with adherence to the five-dose policy, four healthcare providers were interviewed. A data extraction form was used to obtain information about the availability of SP at the facility. RESULTS The level of adherence to IPT5 was 8.6% (20/232) (95% CI 5.0-12.3) among the participants. Only 8.4% of the participants received their first dose at 16 weeks. Respondents who began ANC in the second trimester were 81% less likely to adhere to IPT5 than those who began in the first trimester (aOR = 0.19, 95% CI 90.01-0.65, p < 0.008). Healthcare provider and health system factors that influence IPT5 uptake include healthcare providers' knowledge of IPTp-SP guidelines, the practice of Directly Observed Therapy, education of pregnant women, training of healthcare providers, and availability of water. SP was available at the facility during the period of review. CONCLUSION Adherence to the IPTp-SP five-dose policy was suboptimal. Pregnant women who started ANC early were more likely to adhere to the policy. Provider knowledge, DOT practice, training, education of pregnant women and water availability were also found to influence adherence. Encouraging early ANC visits and providing healthcare workers with necessary training can substantially improve adherence in slum areas.
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Affiliation(s)
- Hainau Iddrisu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Emmanuel Ayitey Tagoe
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Korle bu, Accra, Ghana
| | - Harriet Affran Bonful
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana.
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Bardoe D, Bio RB, Yar DD, Hayford D. Assessing the prevalence, risk factors, and socio-demographic predictors of malaria among pregnant women in the Bono East Region of Ghana: a multicentre hospital-based mixed-method cross-sectional study. Malar J 2024; 23:302. [PMID: 39385188 PMCID: PMC11466029 DOI: 10.1186/s12936-024-05120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 09/28/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Malaria is one of the world's most lethal vector-borne diseases, causing significant health burdens in endemic countries. Several studies on the prevalence of malaria among pregnant women in Ghana have been conducted in various parts of the country, yielding evidence pointing to intra- and inter-regional variations. The current study assessed the prevalence, risk factors, and sociodemographic predictors of malaria among pregnant women in the Bono East Region of Ghana. METHODS This multicentre hospital-based study employed a mixed-method cross-sectional design. A multistage sampling technique was used to select seven health facilities and recruited 1452 pregnant women who attended ANC at seven selected health facilities. Haematological examination, a structured closed-ended questionnaire, in-depth interviews (IDIs), and focus group discussions (FGDs) were used to obtain relevant data. Quantitative data were analysed with STATA 14 (StataCorp, College Station, USA). Likewise, the four-step thematic analysis was used to analyse qualitative data. A significant level was set at (p < 0.05) at a 95% confidence interval (CI). RESULTS The ages of the pregnant women at enrolment ranged between 17 and 40 years, with a mean (SD) of 28.8 ± 3.73 (95% C.I: 28.63-29.02). The overall prevalence of malaria infection among pregnant women was 10.8% (95% CI: 9.32-12.56). Presence of farm or domestic animals, living close to drainage tunnels, living near overgrown vegetation, not married, not having formal education, living in extended-type households, living in compound-type households, mud and thatch households, mud and iron sheet households, primigravidae, multiparity, first-time pregnant women, second-time, third-time, fourth-time, and fifth-time ANC visits, blood groups A, B, and AB were independent factors or predictors significantly associated with increased risk of malaria. CONCLUSION The current study revealed an approximately 10.8% prevalence of malaria among pregnant women. The prevalence revealed, was, however, higher than the national prevalence of 8.6%. The high prevalence of malaria, associated risk factors, and sociodemographic and maternal predictors highlight the need to strengthen screening for malaria, administer treatments, monitor maternal and foetal health, and provide education and counselling.
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Affiliation(s)
- Dennis Bardoe
- Department of Public Health Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ghana.
| | - Robert Bagngmen Bio
- Department of Public Health Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ghana
| | - Denis Dekugmen Yar
- Department of Public Health Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ghana
| | - Daniel Hayford
- Department of Integrated Science Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Mampong, Ghana
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Ajonina MU, Ajonina-Ekoti IU, Ngulefac J, Ade N, Awambeng DN, Nfor CK, Ayim M, Apinjoh TO. Long-lasting insecticidal nets use and the prevalence of Plasmodium falciparum infection among pregnant women attending antenatal care at the Bonassama District Hospital, Littoral Region of Cameroon: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:560. [PMID: 39198797 PMCID: PMC11351648 DOI: 10.1186/s12884-024-06769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Malaria during pregnancy continues to be a significant cause of morbidity and mortality for both infants and mothers, particularly in sub-Saharan African (SSA) countries, despite increased efforts to control it. The utilization of long-lasting insecticide-treated nets (LLINs) during pregnancy is a well-established strategy to reduce the prevalence of malaria. Nonetheless, inadequate adherence remains a persistent challenge in certain regions with high malaria endemicity. This research aimed to assess the effectiveness of long-lasting insecticidal nets in preventing asymptomatic malaria infections among pregnant women attending antenatal care at the Bonassama District Hospital in the Littoral Region of Cameroon. METHODS A hospital-based cross-sectional study was conducted from March to June 2022. Data on sociodemographic characteristics and LLIN usage were collected through a structured questionnaire, while asymptomatic malaria infections were identified using a PfHRP2/pLDH malaria qualitative rapid diagnostic kit. The relationship between categorical variables was analyzed using the chi-square test and logistic regression at a significance level of 5%. RESULTS Out of the 411 pregnant women included in the study, 35.4% were diagnosed with malaria. The LLIN utilization rate was 65.1%. The risk of malaria infection was 2.7 times higher (AOR = 2.75, 95% CI = 1.83-4.14, p < 0.001) among women who did not consistently use LLINs compared to those who did. Pregnant women in their first trimester (AOR = 3.40, 95% CI = 1.24-4.64, p = 0.010) and second trimester (AOR = 1.90, 95%CI = 0.99-3.62, p = 0.055) were more likely to sleep under net when compared to those in the third trimester. Younger women 20-29 years (71.4%), those in the first trimester (69.6%) and those who had the nets before pregnancy (68.9%) were amongst those who frequently used use the nets. Among the reasons reported for not frequently using LLINs were heat (55.2%), suffocation (13.6%) and the smell of nets (8.4%). CONCLUSION The use of LLIN was moderately high among the participants in this study, though still below national target. Age group, religion and gestation period were the major factors determining the use of LLINs. Considering the proven effectiveness of LLINs in reducing malaria morbidity and mortality, it is imperative for the National Malaria Control Programme (NMCP) to remain focused in promoting both LLIN ownership and utilization to achieve the national target of 100% and 80%, respectively.
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Affiliation(s)
- Marcelus U Ajonina
- Graduate School of Health Sciences, St Louis University Institute, Douala, Cameroon.
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.
- Department of Public Health, The University of Bamenda, Bambili, Bamenda, Cameroon.
- School of Health Sciences, Charisma University, 1321 Discovery Drive, Billings, MT, USA.
| | - Irene U Ajonina-Ekoti
- Department of Microbiology and Parasitology, The University of Bamenda, Bambili, Bamenda, Cameroon
| | - John Ngulefac
- United States Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, USA
| | - Nicholas Ade
- Graduate School of Health Sciences, St Louis University Institute, Douala, Cameroon
- Department of Physics, The University of Bamenda, Bambili, Cameroon
| | - Derick N Awambeng
- Graduate School of Health Sciences, St Louis University Institute, Douala, Cameroon
| | - Carine K Nfor
- McGadi Education and Research Initiative, Buea, Cameroon
| | - Martin Ayim
- School of Health Sciences, Charisma University, 1321 Discovery Drive, Billings, MT, USA
| | - Tobias O Apinjoh
- Department of Biochemistry and Molecular Biology, University of Buea, Buea, Cameroon
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Mwebesa E, Awor S, Natuhamya C, Dricile R, Legason ID, Okimait D, Mangwi Ayiasi R, Tumwesigye NM. Impact of mass media campaigns on knowledge of malaria prevention measures among pregnant mothers in Uganda: a propensity score-matched analysis. Malar J 2024; 23:256. [PMID: 39182108 PMCID: PMC11344330 DOI: 10.1186/s12936-024-05083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Uganda grapples with a considerable malaria burden, reporting prevalence rates of over 33% in some regions. To address this, the Uganda Ministry of Health employs audiovisual platforms for disseminating malaria prevention messages. However, the impact of these messages on pregnant women's knowledge of malaria prevention remains insufficiently explored. This paper therefore emphasizes the influence of audiovisual messages on the knowledge of malaria prevention measures among pregnant women in Uganda. METHODS Secondary data obtained from the Uganda Malaria Indicator Survey (MIS) 2018-2019 was used for this analysis. Women aged 15-49 were included in the study. A total of 8868 women were selected using a two-stage sample design. The two stages of selection included clusters and households. Women who were currently pregnant were included in the study, resulting in a weighted sample of 721 women. Propensity score-matched analysis was used to evaluate the impact of access to malaria messages on knowledge of prevention measures. RESULTS The study revealed that 39% [95% CI 34.0-44.2] of pregnant women were exposed to malaria messages before the survey. Those exposed had a 17.2% higher knowledge [ATT = 0.172; 95% CI 0.035-0.310] of using mosquito nets for prevention compared to those unexposed. Among women exposed, radios accounted for most form of access to mass media campaigns [64.8, 95% CI 57.0-71.8] followed by interpersonal communication [45.0, 95% CI 37.6-52.6], community health workers [38.8, 95% CI 29.6-48.8], community events [21.4, 95% CI 15.8-28.3], and social mobilization [18.3, 95% CI 12.7-25.8]. CONCLUSION Results highlight the importance of radios in spreading important malaria prevention messages to pregnant women. Being exposed to these messages is linked to increased awareness and knowledge about the proper use of insecticide-treated bed nets (ITNs) for preventing malaria. This finding underscores the importance of evaluating different channels for mass media campaigns to ensure the effective delivery of information about malaria prevention to the intended audiences.
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Affiliation(s)
- Edson Mwebesa
- Faculty of Science, Muni University, Arua, Uganda.
- School of Science and Aerospace Studies, Moi University, Eldoret, Kenya.
| | - Susan Awor
- School of Public Health, University of California Berkeley, Berkeley, USA
| | | | - Ratib Dricile
- Faculty of Health Sciences, Muni University, Arua, Uganda
| | - Ismail D Legason
- Faculty of Health Sciences, Muni University, Arua, Uganda
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - David Okimait
- Faculty of Arts & Social Sciences, Africa Renewal University, Buloba, Uganda
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Djuidje Chatue IA, Nyegue MA, Kamdem SD, Maloba F, Taliy Junaid I, Malhotra P, Masumbe Netongo P. Association between Epstein-Barr virus reactivation and severe malaria in pregnant women living in a malaria-endemic region of Cameroon. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003556. [PMID: 39133703 PMCID: PMC11318859 DOI: 10.1371/journal.pgph.0003556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 07/10/2024] [Indexed: 08/15/2024]
Abstract
Malaria kills nearly 619,000 people each year. Despite the natural immunity acquired to malaria, pregnant women and children under five die from severe forms of the disease in sub-Saharan Africa. Co-infection with acute Epstein-Barr Virus (EBV) infection has been shown to suppress the anti-malarial humoral responses, but little is known about the impact of EBV reactivation on malaria-associated morbidity. This study investigated the association between EBV reactivation and malaria severity in pregnant women living in a malaria-endemic region in Cameroon. A cross-sectional study was conducted on 220 pregnant women attending antenatal consultations in three health facilities in the West region of Cameroon. Malaria was diagnosed by microscopy, and Plasmodium species were identified by Nested PCR. Plasma samples were analyzed by ELISA for the presence of EBV nuclear antigen, EBV viral capsid antigen, and EBV early antigen to determine EBV reactivation. All statistics were performed using GraphPad Prism and SPSS software. The prevalence of malaria among pregnant women was 23.2%, of which 18.6% were P. falciparum mono-infections and 4.5% mixed infections (3.6% P. falciparum and P. malariae; 0.9% P. falciparum and P. ovale). 99.5% of the women were EBV seropositive, and 13.2% had EBV reactivation. Pregnant women with reactivated EBV were more likely to develop severe malaria than pregnant women with latent EBV (OR 4.33, 95% CI 1.08-17.25, p = 0.03). The median parasitemia in pregnant women with latent EBV was lower than in those with EBV reactivation (2816 vs. 19002 parasites/μL, p = 0.02). Our study revealed that lytic reactivation of EBV may be associated with the severity of malaria in pregnant women. Suggesting that, like acute infection, EBV reactivation should be considered a risk factor for severe malaria in pregnant women in malaria-endemic regions or could serve as a hallmark of malaria severity during pregnancy. Further detailed studies are needed.
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Affiliation(s)
- Ide Armelle Djuidje Chatue
- Department of Microbiology, University of Yaounde I, Yaounde, Centre, Cameroon
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaounde I (BTC-UYI), Yaounde, Centre, Cameroon
- Malaria Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, Delhi, India
| | | | - Severin Donald Kamdem
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaounde I (BTC-UYI), Yaounde, Centre, Cameroon
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Franklin Maloba
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaounde I (BTC-UYI), Yaounde, Centre, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Buea, Southwest Cameroon
- Biology Program, School of Science, Navajo Technical University, Crownpoint, New Mexico, United States of America
| | - Iqbal Taliy Junaid
- Malaria Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, Delhi, India
| | - Pawan Malhotra
- Malaria Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, Delhi, India
| | - Palmer Masumbe Netongo
- Molecular Diagnostics Research Group, Biotechnology Centre-University of Yaounde I (BTC-UYI), Yaounde, Centre, Cameroon
- Biology Program, School of Science, Navajo Technical University, Crownpoint, New Mexico, United States of America
- Department of Biochemistry, University of Yaounde I, Yaounde, Centre, Cameroon
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Lokole PB, Byamungu GG, Mutwale PK, Ngombe NK, Mudogo CN, Krause RWM, Nkanga CI. Plant-based nanoparticles targeting malaria management. Front Pharmacol 2024; 15:1440116. [PMID: 39185312 PMCID: PMC11341498 DOI: 10.3389/fphar.2024.1440116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024] Open
Abstract
Malaria is one of the most devastating diseases across the globe, particularly in low-income countries in Sub-Saharan Africa. The increasing incidence of malaria morbidity is mainly due to the shortcomings of preventative measures such as the lack of vaccines and inappropriate control over the parasite vector. Additionally, high mortality rates arise from therapeutic failures due to poor patient adherence and drug resistance development. Although the causative pathogen (Plasmodium spp.) is an intracellular parasite, the recommended antimalarial drugs show large volumes of distribution and low-to no-specificity towards the host cell. This leads to severe side effects that hamper patient compliance and promote the emergence of drug-resistant strains. Recent research efforts are promising to enable the discovery of new antimalarial agents; however, the lack of efficient means to achieve targeted delivery remains a concern, given the risk of further resistance development. New strategies based on green nanotechnologies are a promising avenue for malaria management due to their potential to eliminate malaria vectors (Anopheles sp.) and to encapsulate existing and emerging antimalarial agents and deliver them to different target sites. In this review we summarized studies on the use of plant-derived nanoparticles as cost-effective preventative measures against malaria parasites, starting from the vector stage. We also reviewed plant-based nanoengineering strategies to target malaria parasites, and further discussed the site-specific delivery of natural products using ligand-decorated nanoparticles that act through receptors on the host cells or malaria parasites. The exploration of traditionally established plant medicines, surface-engineered nanoparticles and the molecular targets of parasite/host cells may provide valuable insights for future discovery of antimalarial drugs and open new avenues for advancing science toward the goal of malaria eradication.
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Affiliation(s)
- Pathy B. Lokole
- Centre de Recherche en Nanotechnologies Appliquées aux Produits Naturels (CReNAPN), Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Centre d’Etudes des Substances Naturelles d’Origine Végétale (CESNOV), Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Center for Chemico- and Bio-Medicinal Research (CCBR), Department of Chemistry, Faculty of Sciences, Rhodes University, Grahamstown, Eastern Cape, South Africa
| | - Galilée G. Byamungu
- Centre de Recherche en Nanotechnologies Appliquées aux Produits Naturels (CReNAPN), Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Center for Chemico- and Bio-Medicinal Research (CCBR), Department of Chemistry, Faculty of Sciences, Rhodes University, Grahamstown, Eastern Cape, South Africa
- Department of Chemistry, Faculty of Sciences and Technology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Paulin K. Mutwale
- Centre de Recherche en Nanotechnologies Appliquées aux Produits Naturels (CReNAPN), Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Centre d’Etudes des Substances Naturelles d’Origine Végétale (CESNOV), Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nadège K. Ngombe
- Centre de Recherche en Nanotechnologies Appliquées aux Produits Naturels (CReNAPN), Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Centre d’Etudes des Substances Naturelles d’Origine Végétale (CESNOV), Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Celestin N. Mudogo
- Unit of Molecular Biology, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Rui W. M. Krause
- Center for Chemico- and Bio-Medicinal Research (CCBR), Department of Chemistry, Faculty of Sciences, Rhodes University, Grahamstown, Eastern Cape, South Africa
| | - Christian I. Nkanga
- Centre de Recherche en Nanotechnologies Appliquées aux Produits Naturels (CReNAPN), Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Kumah NE, Agbeno EK, Derkyi-Kwarteng L, Aniakwaa-Bonsu E, Djonor SK, Acquah S. Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital. BMC Pregnancy Childbirth 2024; 24:356. [PMID: 38745311 PMCID: PMC11092027 DOI: 10.1186/s12884-024-06568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Malaria in pregnancy can have adverse outcomes if untreated. Both malaria and pregnancy are associated with insulin resistance and diabetes. Although malaria is treated prophylactically with gestational diabetes mellitus (GDM) screened for in pregnancy as part a routine antenatal care, their impacts have not been examined in terms of other forms of dysglycaemia. This cross-sectional study examined insulin resistance and its relationship with dysglycaemia and malaria among pregnant women in the Cape Coast Teaching Hospital (CCTH). METHODS Using a structured questionnaire, demographic and clinical information were obtained from 252 pregnant women aged 18-42 years. Weight and height were measured for computation of body mass index (BMI). Measurement of insulin, lipid profile and glucose were taken under fasting conditions followed by oral glucose tolerant test. Insulin resistance and beta-cell function were assessed by the homeostatic model as malaria was diagnosed by microscopy. RESULTS The respective prevalence of GDM, gestational glucose intolerance (GGI) and insulin resistance were 0.8% (2/252), 19.44% (49/252) and 56.75% (143/252). No malaria parasite or dyslipidaemia was detected in any of the participants. Apart from BMI that increased across trimesters, no other measured parameter differed among the participants. Junior High School (JHS) education compared with no formal education increased the odds (AOR: 2.53; CI: 1.12-5.71; P = 0.03) but 2nd trimester of pregnancy compared to the 1st decreased the odds (AOR: 0.32; CI: 0.12-0.81; P = 0.02) of having insulin resistance in the entire sample. In a sub-group analysis across trimesters, pregnant women with JHS education in their 3rd trimester had increased odds (AOR: 4.41; CI: 1.25-15.62; P = 0.02) of having insulin resistance. CONCLUSION Prevalence of GDM and GGI were 0.8% and 19.44% respectively. The odds of insulin resistance increased in pregnant women with JHS education in the 3rd trimester. Appropriate measures are needed to assuage the diabetogenic risk posed by GGI in our setting.
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Affiliation(s)
- Nelson Ekow Kumah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Pathology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Aniakwaa-Bonsu
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Sampson Kafui Djonor
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Samuel Acquah
- Department of Medical Biochemistry, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
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Das JK, Lakhani S, Rahman AR, Siddiqui F, Ali Padhani Z, Rashid Z, Mahmud O, Naqvi SK, Amir Naseem H, Jehanzeb H, Kumar S, Beg MA. Malaria in pregnancy: Meta-analyses of prevalence and associated complications. Epidemiol Infect 2024; 152:e39. [PMID: 38347721 PMCID: PMC10945947 DOI: 10.1017/s0950268824000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 03/13/2024] Open
Abstract
This review aims to assess the prevalence of malaria in pregnancy during antenatal visits and delivery, species-specific burden together with regional variation in the burden of disease. It also aims to estimate the proportions of adverse pregnancy outcomes in malaria-positive women. Based on the PRISMA guidelines, a thorough and systematic search was conducted in July 2023 across two electronic databases (including PubMed and CENTRAL). Forest plots were constructed for each outcome of interest highlighting the effect measure, confidence interval, sample size, and its associated weightage. All the statistical meta-analysis were conducted using R-Studio version 2022.07. Sensitivity analyses, publication bias assessment, and meta-regression analyses were also performed to ensure robustness of the review. According to the pooled estimates of 253 studies, the overall prevalence of malaria was 18.95% (95% CI: 16.95-21.11), during antenatal visits was 20.09% (95% CI: 17.43-23.06), and at delivery was 17.32% (95% CI: 14.47-20.61). The highest proportion of malarial infection was observed in Africa approximating 21.50% (95% CI: 18.52-24.81) during ANC and 20.41% (95% CI: 17.04-24.24) at the time of delivery. Our analysis also revealed that the odds of having anaemia were 2.40 times (95% CI: 1.87-3.06), having low birthweight were 1.99 times (95% CI: 1.60-2.48), having preterm birth were 1.65 times (95% CI: 1.29-2.10), and having stillbirths were 1.40 times (95% CI: 1.15-1.71) in pregnant women with malaria.
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Affiliation(s)
- Jai K. Das
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Sohail Lakhani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Abdu R. Rahman
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Faareha Siddiqui
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Zahra Ali Padhani
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Zainab Rashid
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Omar Mahmud
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Syeda Kanza Naqvi
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Hamna Amir Naseem
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | | | - Suresh Kumar
- Department of Pathology, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mohammad Asim Beg
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Diouf MP, Kande S, Oboh MA, Manga IA, Tairou F, Seck A, Diallo A, Lo AC, Sow D, Sylla K, Ndiaye M, Tine RC, Faye B, Merle C, Amambua-Ngwa A, Miligan P, Ndiaye JLA. Prevalence of Malaria Infection in Pregnant Women Attending Antenatal Clinics in Southern Senegal. Am J Trop Med Hyg 2024; 110:214-219. [PMID: 38167431 PMCID: PMC10859798 DOI: 10.4269/ajtmh.23-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/13/2023] [Indexed: 01/05/2024] Open
Abstract
Despite marked progress in Senegal, three regions in the southeast part continue to have a high burden of malaria, but there have been no recent studies assessing the prevalence of malaria associated with pregnancy. This study aimed to determine the prevalence of malaria infection in pregnant women attending antenatal clinics in Senegal. During the malaria transmission season of 2019, pregnant women attending 11 health care facilities for a scheduled visit and those presenting unwell with signs of malaria were invited to participate in a malaria screening study. A finger prick blood sample was taken for malaria diagnosis by rapid diagnosis test (RDT) and polymerase chain reaction (PCR). A total of 877 pregnant women were enrolled, 787 for a scheduled antenatal consultation and 90 for an unscheduled consultation with signs of malaria. The prevalence of Plasmodium falciparum among the first group was 48% by PCR and 20% by RDT, and that among the second group was 86% by PCR and 83% by RDT. RDT sensitivity in capturing asymptomatic, PCR-positive infections was 9.2% but ranged from 83% to 94% among febrile women. The prevalence of infection by PCR in women who reported having received at least three doses of sulfadoxine pyrimethamine (SP) was 41.9% compared with 58.9% in women who reported they had not received any SP doses (prevalence ratio adjusted for gravidity and gestational age, 0.54; 95% CI, 0.41-0.73). The burden of P. falciparum infections remains high among pregnant women, the majority of which are not captured by RDT. More effective measures to prevent malaria infection in pregnancy are needed.
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Affiliation(s)
- Marie Pierre Diouf
- Service Parasitologie Mycologie, UFR Santé Thiès, Senegal
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Safietou Kande
- Service Parasitologie Mycologie, UFR Santé Thiès, Senegal
| | | | | | - Fassiatou Tairou
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Amadou Seck
- Service Parasitologie Mycologie, UFR Santé Thiès, Senegal
| | | | - Aminata Colle Lo
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Doudou Sow
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
- Gaston Berger University, Saint Louis, Senegal
| | - Khadime Sylla
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Magatte Ndiaye
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Roger Clément Tine
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Babacar Faye
- Service Parasitologie Mycologie, Cheikh Anta Diop University, Dakar, Senegal
| | - Corinne Merle
- World Health Organization Tropical Disease Research, Geneva, Switzerland
| | - Alfred Amambua-Ngwa
- Medical Research Council Unit, London School of Hygiene & Tropical Medicine, Serekunda, The Gambia
| | - Paul Miligan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Jugha VT, Anchang JA, Taiwe GS, Kimbi HK, Anchang-Kimbi JK. Association between malaria and undernutrition among pregnant women at presentation for antenatal care in health facilities in the Mount Cameroon region. PLoS One 2023; 18:e0292550. [PMID: 37824491 PMCID: PMC10569528 DOI: 10.1371/journal.pone.0292550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
In resource limited settings, malaria and undernutrition are major public health problems in pregnancy. Therefore, this study assessed the association between malaria infection and undernutrition among pregnant women in the Mount Cameroon area. This cross-sectional study enrolled 1,014 pregnant women consecutively over a year. A structured questionnaire was used to collect socio-demographic information and clinical data. Maternal nutrition was assessed using dietary diversity (DD). Peripheral blood samples collected were used for the diagnosis of malaria parasitaemia by microscopy whereas haemoglobin (Hb) levels were determined using an Hb meter. Logistic regression was used to determine factors associated with malaria and dietary diversity. The prevalence of malaria infection and undernutrition was 17.8% and 89.6% respectively. In addition, of those infected with malaria, geometric mean parasite density was 301/μL of blood (range: 40-9280) while mean DD score was 3.57±0.82 (range: 1-7). The odds of being infected with malaria parasitaemia was highest among women enrolled in the rainy season (OR = 1.58, P = 0.043), who were farmers (OR = 2.3, P = 0.030), had a household size of < 4 individuals (OR = 1.48, P = 0.026) and who were febrile (OR = 1.87, P < 0.001). Also, attending clinic visits in Mutengene Medical Centre (OR = 2.0, P = 0.012) or Buea Integrated Health Centre (OR = 2.9, P = < 0.001), being < 25 years (OR = 2.4, P = 0.002) and a farmer (OR = 10.6, P = 0.024) as well as < 4 clinic visits (OR = 1.62, P = 0.039) were identified as predictors of undernutrition. Furthermore, the association between malaria and DD was statistically significant (P = 0.015). In this study, undernutrition was highly frequent than malaria infection. Thus, there is an urgent need to improve maternal awareness through nutritional counselling and health campaigns on the benefits of consuming at least five food groups. Besides, improved maternal dietary nutrient intake is likely to have impact on the burden of malaria parasite infection.
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Affiliation(s)
- Vanessa Tita Jugha
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
| | - Juliana Adjem Anchang
- International Centre for Agricultural Research in the Dry Areas, ICARDA, Cairo, Eygpt
| | | | - Helen Kuokuo Kimbi
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
- Department of Biomedical Sciences, University of Bamenda, Bamenda, Cameroon
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
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Frempong NA, Ahiabor C, Anyan WK, Mama A, Kusi KA, Ofori MF, Adu B, Debrah AY, Anang AK, Ndam NT, Courtin D. Malaria, Urogenital Schistosomiasis, and Anaemia in Pregnant Ghanaian Women. J Parasitol Res 2023; 2023:7500676. [PMID: 37808169 PMCID: PMC10558271 DOI: 10.1155/2023/7500676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Background Anaemia is common in sub-Saharan Africa, and parasitic infections could worsen its burden during pregnancy. Moreover, women become susceptible to malaria during pregnancy. We investigated Plasmodium falciparum (P. falciparum) and Schistosoma haematobium (S. haematobium) infections and determined their association with anaemia during pregnancy. Methods A cross-sectional study involving 707 pregnant women attending antenatal care visits (ANC) and 446 at delivery was conducted in Battor and Adidome hospitals. Pregnant women were screened by microscopy and qPCR for P. falciparum and S. haematobium infections. Haemoglobin (Hb) levels were determined, and most participants received intermittent preventive treatment during pregnancy (IPTp) during ANC till delivery. Regression analyses were performed for associations between parasite infection and anaemia. Results P. falciparum microscopy prevalence at ANC and delivery was 8% and 2%, respectively, and by PCR 24% at ANC and 12% at delivery. Anaemia prevalence at ANC was 52% and 49% at delivery. There was an increased risk of anaemia with P. falciparum infection (aOR = 1.92; p = 0.04). IPTp (p = 0.003) and age (p = 0.004) were associated with increased Hb levels at delivery. S. haematobium prevalence by microscopy was 4% at ANC and 2% at delivery. No significant correlation between S. haematobium and Hb levels was observed (coef. = -0.62 g/dl; p = 0.07). Conclusion High anaemia prevalence was observed during pregnancy, and P. falciparum infection was associated with anaemia at ANC. Low S. haematobium prevalence could be attributed to previous praziquantel treatment during mass drug administration. Routine diagnosis and treatment of S. haematobium infections in endemic areas could be initiated to reduce schistosomiasis during pregnancy.
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Affiliation(s)
- Naa Adjeley Frempong
- Clinical Microbiology Department, Kwame Nkrumah University of Science and Technology, Ghana
- Parasitology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Charity Ahiabor
- Science Laboratory Technology, Accra Technical University, Ghana
| | - William K. Anyan
- Parasitology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Atikatou Mama
- Inserm U 1016, Institut Cochin, Université de Paris, 75014, France
| | - Kwadwo Asamoah Kusi
- Immunology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Michael F. Ofori
- Immunology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bright Adu
- Immunology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Alex Yaw Debrah
- Faculty of Health Sciences, Kwame Nkrumah University of Science and Technology, Ghana
| | - Abraham K. Anang
- Institute of Environment and Sanitation Studies(IESS), University of Ghana, Legon, Ghana
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Jaén-Sánchez N, González-Azpeitia G, Carranza-Rodriguez C, Manwere N, Garay-Sánchez P, Vallejo-Torres L, Pérez-Arellano JL. Increased peripartum mortality associated with maternal subclinical malaria in Mozambique. Malar J 2023; 22:182. [PMID: 37309000 DOI: 10.1186/s12936-023-04613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Plasmodium falciparum infection in pregnant women in sub-Saharan Africa is often asymptomatic. As these forms of malaria are often submicroscopic and difficult to diagnose by conventional methods (microscopy and/or rapid diagnostic test), diagnosis requires the use of molecular techniques such as polymerase chain reaction (PCR). This study analyses the prevalence of subclinical malaria and its association with adverse maternal and neonatal outcomes, a topic that has been scarcely evaluated in the literature. METHODS A cross-sectional study was conducted using semi-nested multiplex PCR to assess the presence of P. falciparum in placental and peripheral blood of 232 parturient pregnant women at the Hospital Provincial de Tete, Mozambique between March 2017 and May 2019. Multivariate regressions were performed to assess the associations of maternal subclinical malaria with several maternal and neonatal outcomes after controlling for the presence of preeclampsia/eclampsia (PE/E) and HIV infection, as well as for other maternal and pregnancy characteristics. RESULTS In total, 17.2% (n = 40) of the women studied had positive PCR for P. falciparum (7 in placental blood only, 3 in peripheral blood only). We found a significant association between subclinical malaria and a higher peripartum mortality risk, which persisted after controlling for maternal comorbidity and maternal and pregnancy characteristics (adjusted odds ratio: 3.50 [1.11-10.97]). In addition, PE/E and HIV infections were also significantly associated with several adverse maternal and neonatal outcomes. CONCLUSION This study demonstrated the association of subclinical malaria, as well as of PE/E and HIV, in pregnant women with adverse maternal and neonatal outcomes. Therefore, molecular methods may be sensitive tools to identify asymptomatic infections that can reduce the impact on peripartum mortality and their contribution to sustained transmission of the parasite in endemic countries.
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Affiliation(s)
- Nieves Jaén-Sánchez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria González-Azpeitia
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Pediatric Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Cristina Carranza-Rodriguez
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Nicholas Manwere
- Department of Health Sciences, University of Zambeze, Beira, Mozambique
| | | | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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13
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Oyerogba OP, Adedapo A, Awokson T, Odukogbe A, Aderinto N. Prevalence of malaria parasitaemia among pregnant women at booking in Nigeria. Health Sci Rep 2023; 6:e1337. [PMID: 37305154 PMCID: PMC10256616 DOI: 10.1002/hsr2.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/23/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Background Malaria is a major public health concern among pregnant women in sub-Saharan Africa. Within the region, Nigeria has the highest malaria cases. This study aimed to determine the prevalence and factors associated with malaria parasitaemia among pregnant women at a booking clinic in Ibadan, Nigeria. Methods A cross-sectional study was conducted between January and April 2021 at the University College Hospital in Ibadan, Nigeria. A sample of 300 pregnant women participated, and anaemia and malaria were diagnosed using packed cell volume and Giemsa-stained blood smears, respectively. Data analysis was done using SPSS 25.0. Results The study found that 26 (8.70%) pregnant women tested positive for malaria parasitaemia. Factors such as age, religion, level of education, and occupation were significantly related to the prevalence of malaria parasitaemia among pregnant women with p < 0.05. Conclusion Our study identified a high prevalence of malaria parasitaemia among pregnant women with demographic factors such as age, religion, level of education, and occupation significantly associated. Targeted malaria control interventions for pregnant women with low levels of education and low-income occupations are necessary, with more research needed to evaluate their effectiveness.
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Affiliation(s)
- Olufiade P. Oyerogba
- Department of Obstetrics and GynaecologyUniversity College HospitalIbadanNigeria
| | - Aduragbenro Adedapo
- Department of Obstetrics and GynaecologyUniversity College HospitalIbadanNigeria
| | - Titilayo Awokson
- Department of Obstetrics and GynaecologyUniversity College HospitalIbadanNigeria
| | - Akin‐Tunde Odukogbe
- Department of Obstetrics and GynaecologyUniversity College HospitalIbadanNigeria
| | - Nicholas Aderinto
- Department of Medicine and SurgeryLadoke Akintola University of TechnologyOgbomosoNigeria
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Asante KP, Wylie BJ, Oppong FB, Quinn A, Gyaase S, Lee AG, Ae-Ngibise KA, Burkart K, Boamah-Kaali EA, Kaali S, Chillrud S, Kinney PL, Owusu-Agyei S, Jack D. Association between malaria and household air pollution interventions in a predominantly rural area of Ghana. Malar J 2023; 22:106. [PMID: 36959655 PMCID: PMC10037900 DOI: 10.1186/s12936-022-04431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/24/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Though anecdotal evidence suggests that smoke from HAP has a repellent effect on mosquitoes, very little work has been done to assess the effect of biomass smoke on malaria infection. The study, therefore, sought to investigate the hypothesis that interventions to reduce household biomass smoke may have an unintended consequence of increasing placental malaria or increase malaria infection in the first year of life. METHODS This provides evidence from a randomized controlled trial among 1414 maternal-infant pairs in the Kintampo North and Kintampo South administrative areas of Ghana. Logistic regression was used to assess the association between study intervention assignment (LPG, Biolite or control) and placental malaria. Finally, an extended Cox model was used to assess the association between study interventions and all episodes of malaria parasitaemia in the first year of infant's life. RESULTS The prevalence of placental malaria was 24.6%. Out of this, 20.8% were acute infections, 18.7% chronic infections and 60.5% past infections. The study found no statistical significant association between the study interventions and all types of placental malaria (OR = 0.88; 95% CI 0.59-1.30). Of the 1165 infants, 44.6% experienced at least one episode of malaria parasitaemia in the first year of life. The incidence of first and/or only episode of malaria parasitaemia was however found to be similar among the study arms. CONCLUSION The findings suggest that cookstove interventions for pregnant women and infants, when combined with additional malaria prevention strategies, do not lead to an increased risk of malaria among pregnant women and infants.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana.
| | - Blair J Wylie
- Department of Obstetrics and Gynecology PH Building, Columbia University Medical Center, 16th Floor 622 West 168th Street, New York, NY, 10032, USA
| | - Felix B Oppong
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Ashlinn Quinn
- Berkeley Air Monitoring Group, 1935 Addison St., Suite A, Berkeley, CA, 94704, USA
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Alison G Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Ayuurebobi Ae-Ngibise
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Katrin Burkart
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Seattle, WA, 98121, USA
| | - Ellen Abrafi Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Seyram Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory at Columbia University, Palisades, NY, USA
| | - Patrick L Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, 722 W 168th Street, New York, NY, 10032, USA
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Orish VN, Puplampu PN, Lokpo SY, Kwadzokpui PK, De-Gaulle VF, Marinkovic A, Prakash S, Annan R, Okorie C, Sanyaolu A. Assessing nursing mothers' knowledge, perceptions and uptake of Sulphadoxine Pyrimethamine (IPTp-SP) during pregnancy in the Ho Teaching Hospital of the Volta Region of Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000904. [PMID: 36962812 PMCID: PMC10021858 DOI: 10.1371/journal.pgph.0000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
Intermittent preventive therapy during pregnancy with Sulphadoxine Pyrimethamine (IPTp-SP) is one of the potent strategies for preventing malaria in pregnancy (MiP). Factors such as the pregnant woman's knowledge and very importantly perception or belief about IPTp-SP remains key determinant of IPTp-SP uptake. This study assessed the knowledge and perception of nursing mothers and their uptake of IPTp-SP during pregnancy in the Ho Teaching Hospital. We administered a close-ended questionnaire to 303 nursing mothers and obtained their sociodemographic details as well as information on their knowledge and perception of IPTp-SP utilization. We also reviewed the nursing mothers' antenatal care (ANC) booklets to ascertain the number of times IPTp-SP was taken during pregnancy. Pearson chi-square was used to determine the association between the sociodemographic variable and the categories of knowledge, perception, and uptake of IPTp-SP. Analysis, was done using SPSS, and the p-value of less than 5% was considered statistically significant. Of the 303 nursing mothers sampled in this study, 265(87.5%) had heard about IPTp-SP of which 138(52.1%) had average knowledge of IPTp-SP. A total of 168(63.4%) had poor perception, and 168(64.6%) had adequate uptake (3-4 doses) of IPTp. Education was significantly associated with perception and uptake, with the majority of women who demonstrated excellent perception were those who had tertiary education (7, 6.35%, p = 0.05), and the majority who demonstrated excellent uptake (5 completed doses) were women who had tertiary education (47, 37.9%, p = 0.01). While knowledge was average, perception of IPTp-SP was poor for the majority of the nursing mothers which might have hampered their uptake of IPTp-SP during pregnancy. It is important that continuous assessment of the individual factors affecting the uptake of IPTp-SP be done regularly to curb the negative influences on the uptake of IPTp-SP.
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Affiliation(s)
- Verner N. Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | - Sylvester Y. Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Precious K. Kwadzokpui
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Laboratory Department, Ho Teaching Hospital, Ho, Volta Region, Ghana
| | | | | | | | - Rochelle Annan
- School of Medicine, University of Health Sciences Antigua, Antigua
| | - Chuku Okorie
- Union County College, Plainfield Campus, Plainfield, New Jersey, United States of America
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Andrade CBV, Lopes LVA, Ortiga-Carvalho TM, Matthews SG, Bloise E. Infection and disruption of placental multidrug resistance (MDR) transporters: Implications for fetal drug exposure. Toxicol Appl Pharmacol 2023; 459:116344. [PMID: 36526072 DOI: 10.1016/j.taap.2022.116344] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
P-glycoprotein (P-gp, encoded by the ABCB1 gene) and breast cancer resistance protein (BCRP/ABCG2) are efflux multidrug resistance (MDR) transporters localized at the syncytiotrophoblast barrier of the placenta and protect the conceptus from drug and toxin exposure throughout pregnancy. Infection is an important modulator of MDR expression and function. This review comprehensively examines the effect of infection on the MDR transporters, P-gp and BCRP in the placenta. Infection PAMPs such as bacterial lipopolysaccharide (LPS) and viral polyinosinic-polycytidylic acid (poly I:C) and single-stranded (ss)RNA, as well as infection with Zika virus (ZIKV), Plasmodium berghei ANKA (modeling malaria in pregnancy - MiP) and polymicrobial infection of intrauterine tissues (chorioamnionitis) all modulate placental P-gp and BCRP at the levels of mRNA, protein and or function; with specific responses varying according to gestational age, trophoblast type and species (human vs. mice). Furthermore, we describe the expression and localization profile of Toll-like receptor (TLR) proteins of the innate immune system at the maternal-fetal interface, aiming to better understand how infective agents modulate placental MDR. We also highlight important gaps in the field and propose future research directions. We conclude that alterations in placental MDR expression and function induced by infective agents may not only alter the intrauterine biodistribution of important MDR substrates such as drugs, toxins, hormones, cytokines, chemokines and waste metabolites, but also impact normal placentation and adversely affect pregnancy outcome and maternal/neonatal health.
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Affiliation(s)
- C B V Andrade
- Instituto de Biofisica Carlos Chagas Filho, Laboratorio de Endocrinologia Translacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Departamento de Histologia e Embriologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - L V A Lopes
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - T M Ortiga-Carvalho
- Instituto de Biofisica Carlos Chagas Filho, Laboratorio de Endocrinologia Translacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S G Matthews
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Obstetrics & Gynecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - E Bloise
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Mkubwa B, Kagura J, Chirwa T, Ibisomi L, Kinyanjui S. Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020. Malar J 2022; 21:398. [PMID: 36581863 PMCID: PMC9798621 DOI: 10.1186/s12936-022-04425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria is a significant cause of morbidity and mortality. Malaria infection in pregnancy can have severe consequences for the fetus and the mother. To fight against malaria infection in pregnancy, Kenya integrated the issuance of an insecticide-treated net (ITN) and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTpSP) with antenatal care (ANC) for pregnant women. However, the uptake of the ITN and IPTpSP is still low. Individual, social, or structural factors may influence the low uptake. It is, therefore, important to identify the determinants associated with the uptake of ITN and IPTpSP during pregnancy in Kenya. METHODS Data were from the 2020 Kenya Malaria Indicator Survey (MIS). A total of 1779 women between the ages of 15 to 49 years who had a history of either being pregnant or having given birth within 5 years before the MIS survey were included. Survey-adjusted multinomial logistic regression was used in the analysis. RESULTS During pregnancy, ITN use was more than half (54.9%). The use of at least one dose of IPTpSP was 43.5%, three or more doses of IPTpSP was 27.2%, and only 28.2% of the participants used both ITN and IPTpSP during pregnancy. The significant determinants of combined use of ITN and IPTpSP during pregnancy were maternal age (RR 3.57, CI 1.80-7.08; p=<0.001), maternal education (RRR 2.84, CI 1.33-6.06; p=0.007), wealth index (RR 2.14, CI 1.19-3.84; p=0.011) and living in the different malaria epidemiological zones: lake endemic (RRR 10.57 CI 5.65-19.76; p=<0.001), coastal endemic area (RRR 4.86 CI 1.86-12.67; p=0.001), seasonal (RRR 0.21 CI 0.10-0.39; p=<0.001) and low risk (RRR 0.07, CI 0.03-0.17; p=<0.001). CONCLUSION The uptake of malaria preventive measures is still below 80% for both ITN and IPTpSP during pregnancy in Kenya. The significant results on determinants of the use of ITN and IPTpSP could be considered in implementing malaria prevention programmes during pregnancy. For example, sensitizing the community on the importance of antenatal care visits will provide a platform to teach the importance of malaria prevention in pregnancy. Moreover, the pregnant mothers receive an ITN and IPTpSP during the ANC visit.
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Affiliation(s)
- Beatrice Mkubwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa
| | - Latifat Ibisomi
- grid.11951.3d0000 0004 1937 1135Department of Epidemiology and Biostatistics, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa ,grid.416197.c0000 0001 0247 1197Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Samson Kinyanjui
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research (Coast), KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
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The prevalence of molecular markers of resistance to sulfadoxine-pyrimethamine among pregnant women at first antenatal clinic attendance and delivery in the forest-savannah area of Ghana. PLoS One 2022; 17:e0271489. [PMID: 35939419 PMCID: PMC9359546 DOI: 10.1371/journal.pone.0271489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is used to prevent malaria and associated unfavorable maternal and foetal outcomes in pregnancy in moderate to high malaria transmission areas. Effectiveness of IPTp-SP is, however, threatened by mutations in the Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes which confer resistance to pyrimethamine and sulfadoxine, respectively. This study determined the prevalence of molecular markers of SP resistance among pregnant women in a high malaria transmission area in the forest-savannah area of Ghana. Genomic DNA was extracted from 286 P. falciparum-positive dried blood spots obtained from pregnant women aged ≥18 years (255 at first Antenatal Care (ANC) clinic visit and 31 at delivery from 2017 to 2019) using Chelex 100. Mutations in Pfdhfr and Pfdhps genes were detected using molecular inversion probes and next generation sequencing. In the Pfdhfr gene, single nucleotide polymorphisms (SNPs) were detected in 83.1% (157/189), 92.0% (173/188) and 91.0% (171/188) at codons 51, 59, and 108 respectively in samples collected at first ANC visit, while SNPs were detected in 96.6 (28/29), 96.6% (28/29) and 96.8% (30/31) in isolates collected at delivery. The Pfdhfr triple mutant N51I, C59R and S108N (IRN) was carried by 80.5% (128/159) and 96.5% (28/29) of the typed isolates collected at ANC visit and at delivery respectively. In the Pfdhps gene, SNPs were detected in 0.6% (1/174), 76.2% (138/181), 33.2% (60/181), 1.2% (2/174), 0% (0/183), and 16.6% (27/173) at codons 431, 436, 437, 540, 581 and 613 respectively in samples collected at ANC, and 0% (0/25), 72% (18/25), 40% (10/25), 3.6% (1/25), 0% (0/29) and 7.4% (2/27) in samples collected at delivery. Quadruple mutant Pfdhfr N51I, C59R, and S108N + Pfdhps A437G (IRN-GK) was present in 25.8% (33/128) and 34.8% (8/23) of isolates at ANC and at delivery respectively. Quintuple mutant alleles Pfdhfr N51I, C59R, and S108N + Pfdhps A437G and K540E (IRN-GE) were detected in 0.8% (1/128) and 4.4% (1/23) of samples collected at ANC and at delivery respectively. No mutations were identified at Pfdhfr codons 16 or 164 or Pfdhps 581. There is a high prevalence of Pfdhfr triple mutant P. falciparum infections among pregnant women in the study area. However, prevalence of the combined Pfdhfr/Pfdhps quadruple and quintuple mutants IRN-GK and IRN-GE respectively prior to commencement of IPTp-SP were low, and no Pfdhps A581G mutant was detected, indicating that SP is still likely to be efficacious for IPTp-SP in the forest-savannah area in the middle belt of Ghana.
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Ahadzie-Soglie A, Addai-Mensah O, Abaka-Yawson A, Setroame AM, Kwadzokpui PK. Prevalence and risk factors of malaria and anaemia and the impact of preventive methods among pregnant women: A case study at the Akatsi South District in Ghana. PLoS One 2022; 17:e0271211. [PMID: 35877761 PMCID: PMC9312417 DOI: 10.1371/journal.pone.0271211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Aim This study aimed to ascertain the prevalence and risk factors of malaria and anaemia as well as the impact of preventive methods among pregnant women at the Akatsi South District Hospital of Ghana. Subjects and methods A hospital based cross-sectional study using simple random sampling technique was conducted among 200 pregnant women receiving antenatal care and laboratory services at the Akatsi District Hospital from May 2016 to July 2016. A semi-structured questionnaire was administered to obtain participants’ malaria preventive methods in addition to demographic and gestational details. Participants’ hemoglobin and malaria status were assessed using one milliliter (1 ml) whole blood collected from each participant following standard procedures. Factors that produced a p-value of ≤0.2 from the univariate model were included in the final model. Association between potential covariates and the outcomes was assessed using multivariate logistic regression. The Clopper-Pearson test statistic was used to determine the 95% confidence intervals of the outcome variables of interest. We also estimated the population attributable fraction (PAF) of anaemia due to malaria by substituting the adjusted relative risk estimates (RRi) (using the adjrr command in STATA) of anaemia due to malaria into the category-specific attributable formula. P-values of <0.05 were considered statistically significant. Results Prevalence of anaemia in pregnancy (AiP), malaria in pregnancy (MiP) and AiP/MiP comorbidity was 63.5% (95% CI:56.4–70.2), 11.0% (96% CI:7.0–16.2) and 10.5% (95% CI:6.6–15.6) respectively. Prevalence rates of AiP (66.7%) and MiP (18.5%) predominated among pregnant women aged < 20 years. PAF of AiP due to MiP was 34.5% (95% CI:23.8–43.6). High use of IPTp-SP, 64.0% (95% CI:56.9–70.6) and LLIN, 90.0% (95% CI:85.0–93.8) was observed in this study. Only 42.0% (95% CI:35.1–49.2) used repellent. Not being on the IPTp-SP program posed a 11.70 times risk of MiP (95% CI:2.32–58.96; p = 0.003) compared to pregnant women on the IPTp-SP program. Similarly, not sleeping under LLIN posed an 8.07 times risk of MiP (95% CI:1.98–32.2; p = 0.004) compared to pregnant women who slept under LLIN. Meanwhile, being positive for MiP posed a 12.10 times risk (95% CI:1.35–85.06; p = 0.025) of AiP compared to those negative for malaria whereas failure to attend ANC as scheduled posed 6.34 times risk (95% CI:1.81–22.19; p = 0.004) of AiP among the pregnant women studied. Conclusion The prevalence of MiP and AiP among pregnant women in the Akatsi South District remains a great concern. High utilization of IPTp-SP and LLIN was observed with a resultant positive effect on malaria prevalence among pregnant women. Improved access to IPTp-SP and LLIN is hence encouraged to help further diminish the risk of malaria infection amongst pregnant women in the District.
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Affiliation(s)
- Asiwome Ahadzie-Soglie
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Laboratory Department of the Ho Teaching Hospital, Ho, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Abaka-Yawson
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Anita Mawuse Setroame
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Precious Kwablah Kwadzokpui
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- * E-mail:
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Lingani M, Zango SH, Valéa I, Sanou M, Ouoba S, Samadoulougou S, Robert A, Tinto H, Dramaix M, Donnen P. Prevalence and risk factors of malaria among first antenatal care attendees in rural Burkina Faso. Trop Med Health 2022; 50:49. [PMID: 35879789 PMCID: PMC9317114 DOI: 10.1186/s41182-022-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO recommends continuous surveillance of malaria in endemic countries to identify areas and populations most in need for targeted interventions. The aim of this study was to assess the prevalence of malaria and its associated factors among first antenatal care (ANC) attendees in rural Burkina Faso. METHODS A cross-sectional survey was conducted between August 2019 and September 2020 at the Yako health district and included 1067 first ANC attendees. Sociodemographic, gyneco-obstetric, and medical characteristics were collected. Malaria was diagnosed by standard microscopy and hemoglobin level was measured by spectrophotometry. A multivariate logistic regression analysis was used to identify factors associated with malaria infection. RESULTS Overall malaria infection prevalence was 16.1% (167/1039). Among malaria-positive women, the geometric mean parasite density was 1204 [95% confidence interval (CI) 934-1552] parasites/µL and the proportion of very low (1-199 parasites/µL), low (200-999 parasites/µL), medium (1000-9999 parasites/µL) and high (≥ 10,000 parasites/µL) parasite densities were 15.0%, 35.3%, 38.3% and 11.4%, respectively. Age < 20 years (adjusted odds ratio (aOR): 2.2; 95% CI 1.4-3.5), anemia (hemoglobin < 11 g/deciliter) (aOR: 3.4; 95% CI 2.2-5.5), the non-use of bed net (aOR: 1.8; 95% CI 1.1-2.8), and the absence of intermittent preventive treatment with sulfadoxine-pyrimethamine (aOR: 5.8; 95% CI 2.1-24.5) were positively associated with malaria infection. CONCLUSIONS The study showed that one out of six pregnant women had a microscopy-detected P. falciparum malaria infection at their first ANC visit. Strengthening malaria prevention strategies during the first ANC visit is needed to prevent unfavorable birth outcomes.
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Affiliation(s)
- Moussa Lingani
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique.
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso.
| | - Serge H Zango
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
- Epidemiology and Biostatistics Research Division, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgique
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Maïmouna Sanou
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Serge Ouoba
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec, Canada
| | - Annie Robert
- Epidemiology and Biostatistics Research Division, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgique
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Michèle Dramaix
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Philippe Donnen
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
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21
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Doe MTT, Bajinka O, Barrow A. Antenatal care positive responses to pregnant women in preventing and controlling malaria in pregnancy: the sub-Saharan African perspective. World J Pediatr 2022; 18:453-462. [PMID: 35616810 DOI: 10.1007/s12519-022-00549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The response to antenatal care (ANC) for maternal and offspring outcomes, especially in pregnant women has been thoroughly studied. However, despite the number of interventional studies on the treatment of sulfadoxine-pyrimethamine combination (IPTp-SP) uptake, the point in point cases of the positive responses of ANC in improving health conditions of pregnant women are not found in the literature. DATA SOURCES This review collected ANC responses to the positive health outcomes for pregnant women with malaria, the challenges faced regarding IPTp-SP uptake during ANC visits and the role of ANC in preventing and controlling malaria in sub-Saharan Africa. It elucidated ANC and uptake of optimal intermittent preventive IPTp-SP and further described ANC as a tool for heterogeneity for malaria prevention. RESULTS ANC is seen as a microscope to malaria in pregnacy, maternal iron deficiency and anemia checkpoints, ANC and malaria treatment strategies, and ANC and the use of insecticide treated nets (ITN). The review further discussed ANC attendance influencing factors, limitations to ANC implications and the prospects in ANC visits on preventing malaria in pregnancy. CONCLUSIONS A declining trend of malaria transmission in Africa has been observed in recent years. However, the burden of malaria in pregnancy remains a health concern. The rate of SP resistance, low uptake of IPTp-SP, low LLINs distribution, late gestational ANC visits and low turnaround for optimal ANC visits for first time mothers' aggrevated the malaria-endemic settings among pregnant women in sub-Saharan Africa.
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Affiliation(s)
- Margaret Tete Telay Doe
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, People's Republic of China.
| | - Ousman Bajinka
- Department of Microbiology, Central South University, Changsha, Hunan Provinces, China.,China-Africa Research Centre of Infectious Diseases, School of Basic Medical Sciences, Central South University, Changsha, 410078, Hunan, China.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Amadou Barrow
- Heidelberg, Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
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Orish VN, Ansong-Boateng J, Puplampu PN, Ibine B, Azanu W, Amoh MY, Lokpo SY, Afeke I, Alalbila TM, Agordoh PD, Marinkovic A, Sanyaolu A. HIV and malaria prevalence among pregnant women with and without pre-eclampsia at the Atua Government Hospital in Ghana's eastern region. Int J Gynaecol Obstet 2022; 159:912-917. [PMID: 35514313 DOI: 10.1002/ijgo.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the association of malaria and HIV with pre-eclampsia by evaluating their prevalence among pregnant women. METHODS Using a case-control study design, we randomly sampled the antenatal records of 125 pregnant women with clinician-diagnosed pre-eclampsia (cases) and 125 others without pre-eclampsia (controls) who visited Atua Government Hospital in the eastern region of Ghana between June 2014 and January 2017. All selected records had available routine HIV and malaria test results and were analyzed statistically. RESULTS In all 250 records, 122 (48.8%) were HIV positive and 35 (14.0%) had malaria. Of the 122 HIV-positive pregnant women, 29 (23.8%) were cases and 93 (76.2%) were controls; of the 35 women with malaria, one was in the case group (1/35, 2.9%) and the other 34 (97.1%) were in the control. Group. Pregnant women with pre-eclampsia had lower odds of HIV infection (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.19: adjusted AOR 0.07, 95% CI 0.04-0.13, P < 0.001). Similarly, pregnant women with pre-eclampsia had lower odds of having malaria infection (OR 0.02, 95% CI 0.00-0.17, P = 0.025; adjusted OR 0.00, 95% CI 0.00-0.01, P < 0.001). CONCLUSIONS Women with pre-eclampsia had lower odds of HIV and malaria infection in pregnancy.
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Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Jude Ansong-Boateng
- Department of Physician Assistant, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Prince N Puplampu
- Department of Physician Assistant, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Bolade Ibine
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Wisdom Azanu
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Michael Y Amoh
- Department of Obstetrics and Gynecology, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Sylvester Y Lokpo
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Innocent Afeke
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Thelma Mpoku Alalbila
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Percival D Agordoh
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
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Taremwa IM, Ashaba S, Kyarisiima R, Ayebazibwe C, Ninsiima R, Mattison C. Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study. BMC Public Health 2022; 22:373. [PMID: 35189865 PMCID: PMC8860364 DOI: 10.1186/s12889-022-12771-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda. Methods This was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach. Results Seventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention. Conclusions Although pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12771-3.
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Affiliation(s)
| | - Scholastic Ashaba
- Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Rose Kyarisiima
- Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | | | - Ruth Ninsiima
- Rwamanja Refugee Settlement, Kamwenge District, Uganda
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Osarfo J, Ampofo GD, Tagbor H. Trends of malaria infection in pregnancy in Ghana over the past two decades: a review. Malar J 2022; 21:3. [PMID: 34983534 PMCID: PMC8725495 DOI: 10.1186/s12936-021-04031-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background There has been a global decline in malaria transmission over the past decade. However, not much is known of the impact of this observation on the burden of malaria infection in pregnancy in endemic regions including Ghana. A narrative review was undertaken to help describe trends in malaria infection in pregnancy in Ghana. Among others, such information is important in showing any progress made in malaria in pregnancy control. Methods To describe trends in pregnancy-associated malaria infection in Ghana, a search and review of literature reporting data on the prevalence of asymptomatic Plasmodium falciparum infection in pregnancy was conducted. Results Thirty-six (36) studies, conducted over 1994–2019, were included in the review. In the northern savannah zone with largely seasonal malaria transmission, prevalence appeared to reduce from about 50–60% in 1994–2010 to 13–26% by 2019. In the middle transitional/forest zone, where transmission is perennial with peaks in the rainy season, prevalence apparently reduced from 60% in the late 1990 s to about 5–20% by 2018. In the coastal savannah area, there was apparent reduction from 28 to 35% in 2003–2010 to 5–11% by 2018–2019. The burden of malaria infection in pregnancy continues to be highest among teenagers and younger-aged pregnant women and paucigravidae. Conclusions There appears to be a decline in asymptomatic parasite prevalence in pregnancy in Ghana though this has not been uniform across the different transmission zones. The greatest declines were noticeably in urban settings. Submicroscopic parasitaemia remains a challenge for control efforts. Further studies are needed to evaluate the impact of the reduced parasite prevalence on maternal anaemia and low birthweight and to assess the local burden of submicroscopic parasitaemia in relation to pregnancy outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-04031-3.
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Affiliation(s)
- Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
| | - Gifty Dufie Ampofo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Dun-Dery F, Kuunibe N, Meissner P, Winkler V, Jahn A, Müller O. OUP accepted manuscript. Int Health 2022; 14:619-631. [PMID: 35064966 PMCID: PMC9623492 DOI: 10.1093/inthealth/ihab087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/02/2021] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background Malaria in pregnancy remains a significant cause of morbidity and mortality, affecting the highly endemic countries of sub-Saharan Africa (SSA). Insecticide-treated nets (ITNs) are effective for malaria prevention. However, poor adherence in SSA remains a challenge. Methods We conducted a standard questionnaire survey among 710 pregnant women from 37 primary care clinics in the Upper West Region of Ghana from January through May 2019. Using a sequential explanatory design, we integrated the survey data from six focus group discussions with pregnant women. Results While 67% of women had some general knowledge about malaria prevention, only 19% knew the specific risks in pregnancy. Determinants of ITN use included ITN ownership (odds ratio [OR] 2.4 [95% confidence interval {CI} 1.3 to 4.4]), good maternal knowledge of the risks of malaria in pregnancy (OR 2.4 [95% CI 1.3 to 4.3]) and more antenatal care (ANC) contacts (OR 1.3 [95% CI 1.0 to 1.5)]. Focus group discussions showed that non-use of ITNs resulted from inappropriate hanging infrastructure, a preference for other malaria prevention alternatives, allergy and heat. Conclusions Specific maternal knowledge of malaria risks in pregnancy was low and influenced the regular use of ITNs. Community and ANC-based malaria interventions should prioritize increasing knowledge of the specific risks of malaria.
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Affiliation(s)
- F Dun-Dery
- Corresponding author: Tel: +233248710709/+4915213599531; E-mail: ;
| | - N Kuunibe
- Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - P Meissner
- Pediatric Clinic, Klinikum Konstanz, Mainaustraße 35, 78464 Konstanz, Germany
| | - V Winkler
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 130.3 Heidelberg, Germany
| | - A Jahn
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 130.3 Heidelberg, Germany
| | - O Müller
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 130.3 Heidelberg, Germany
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Hepatitis B and Asymptomatic Malaria Infection among Pregnant Women in a Semiurban Community of North-Central Nigeria. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:9996885. [PMID: 34876911 PMCID: PMC8645382 DOI: 10.1155/2021/9996885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022]
Abstract
Background The overlap of malaria and Hepatitis B Virus (HBV) infections present a major threat to public health throughout endemic countries of tropical and sub-Saharan Africa. There is a paucity of data on the prevalence and associated factors of malaria and HBV infections among pregnant women in Ejule, a semiurban area of Nigeria. Therefore, the current study was designed to assess the seroprevalence of malaria and HBV among pregnant women attending antenatal clinics in Ejule Metropolis. Materials and Methods In a hospital-based cross-sectional study, blood samples collected from 200 apparently healthy pregnant women at the Ilemona Clinic were screened for Plasmodium falciparum (P. falciparum) and HBsAg using histidine-rich protein 2 (HRP2) and hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs), respectively. Relevant sociodemographic and putative risk factor information was obtained with structured questionnaires. Results The prevalence of the infections was 44 (22%), 5 (2.5%), and 1 (0.5%) for P. falciparum monoinfection and HBV monoinfection and coinfection, respectively. Single and concurrent infections peaked at ages 31-40 years but decreased with older ages. High P. falciparum, 31 (59.62%), and HBV 2 (3.85%) infection were observed among those without formal education. Contrary to ages, occupation, and knowledge of infection, malaria parasitemia differed significantly with lower educational qualification (p ≤ 0.001), being single (p=0.001), and inconsistent use of insecticide-treated bed nets (ITNs) (p=0.04, OR = 5, CI: 0.10-0.47). History of blood donation (OR = 5, p=0.04, CI: 1.10-32.80) and multiple sex partners (OR = 11.9, p=0.01, CI: 0.01-0.93) were found to be significantly associated with hepatitis B surface antigenemia rate during pregnancy. No evidence of HBV infection was observed in women with a history of HBV vaccination. Conclusions Malaria is still highly prevalent among pregnant women due to high illiteracy and noncompliance to using ITNs. Therefore, routine screening and educating pregnant mothers are crucial in eliminating malaria in endemic settings. The low rate of hepatitis B and coinfection with malaria shows that further improvement in HBV vaccination could considerably reduce the disease burden among pregnant women.
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Alhassan AR. Pregnant Women and Malaria Preventive Measures: A Case of Tamale Teaching Hospital, Ghana. J Trop Med 2021; 2021:6150172. [PMID: 34917153 PMCID: PMC8670969 DOI: 10.1155/2021/6150172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Saharan Africa, an estimated 25 million pregnancies are all at risk of malaria every year, with substantial morbidity and death effects for both the mother and the fetus. AIM To investigate the use of malaria preventive measures among pregnant women patronizing antenatal services of Tamale Teaching Hospital. Methodology. This study was conducted using a descriptive cross-sectional survey of 250 participants. Data analysis was done with SPSS version 20. Graphs and tables were used to present the study data. Bivariate analysis was done using Chi-square use to determine the relationships and binary logistics regression used for identification of predictor variables. RESULTS The mean age of the study participants was 30.0 ± 4.5 years and most of them (73.0%) were within the age group of 25-35 years. Respondents' favorable knowledge, a favorable attitude, and favorable practice were 78.0%, 62.0%, and 57.6%, respectively. And the following variables were associated with malaria preventive practice: age of the respondent (X 2 = 6.276, P=0.043), religion (X 2 = 6.904, P=0.032), level of education (X 2 = 41.482, P < 0.001), employment status (X 2 = 20.533, P < 0.001), monthly income (X 2 = 21.838, P < 0.001), and attitude level towards malaria prevention (X 2 = 35.885, P < 0.001). Further analysis revealed educational level and attitude level as predictors of malaria preventive practice. CONCLUSION This study recorded favorable knowledge, attitude, and practice with regards to malaria prevention among more than half of the study participants.
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Affiliation(s)
- Abdul Rauf Alhassan
- Department of Surgery, Tamale Teaching Hospital, P.O. Box TL 16, Tamale, Ghana
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Aberese-Ako M, Magnussen P, Ampofo GD, Gyapong M, Ansah E, Tagbor H. An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLoS One 2021; 16:e0257666. [PMID: 34618812 PMCID: PMC8496863 DOI: 10.1371/journal.pone.0257666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. Methods The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Results Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women’s trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Conclusion Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.
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Affiliation(s)
- Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail: ,
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Gifty D. Ampofo
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Kumar R, Farzeen M, Ahmed J, Lal M, Somrongthong R. Predictors of knowledge and use of long-lasting insecticidal nets for the prevention of malaria among the pregnant women in Pakistan. Malar J 2021; 20:347. [PMID: 34425857 PMCID: PMC8381575 DOI: 10.1186/s12936-021-03878-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Malaria is endemic to Pakistan with high prevalence among pregnant women and linked with maternal anaemia, intrauterine growth retardation, preterm birth, and low birth weight. The use of long-lasting insecticidal nets (LLINs) is a proven and cost-effective intervention preventing malaria among pregnant women. The present study aimed to explore predictors of knowledge and use of LLINs among pregnant women in Pakistan. Methods This was part of a quasi-experimental study of 200 pregnant women conducted in a rural district of Sindh province in Pakistan. Data were collected using Malaria Indicator Survey questionnaires developed by Roll Back Malaria Partnership to end Malaria Monitoring and Evaluation Reference Group. Pregnant women and mothers with newborns of six months of age were interviewed in their homes. Results The age of the women was from 18 to 45, two thirds of the respondents (72.5%) were uneducated and married (77%). Majority (92%) of the women had received antenatal care during pregnancy, and 29.5% women had received counseling on malaria during their antenatal care visits. Multiple linear regression showed that the type of latrine was the most significant (β = 0.285, p < 0.001) determinant of knowledge about malaria among pregnant women followed by the death of a newborn (β = 0.271, p < 0.001). The use of mobile phone was the most significant (β = 0.247, p < 0.001) predictor of usage of LLINs among pregnant women followed by the death of a newborn (β = 0.232, p < 0.05). Conclusions Maternal education, type of latrine, use of mobile phone, malaria during previous pregnancy and newborn death were strong predictors of knowledge and use of LLINs in pregnant women in Pakistan. There is a need to scale-up programmes that aim to create awareness regarding malaria among pregnant women. Mobile phone technology can be used to implement awareness programmes focusing on malaria prevention among women.
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Affiliation(s)
- Ramesh Kumar
- Health Services Academy, Ministry of National Health Services Regulation and Coordination, Government of Pakistan, Islamabad, Pakistan. .,College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Midhat Farzeen
- Health Services Academy, Ministry of National Health Services Regulation and Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Jamil Ahmed
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Manohar Lal
- Health Services Academy, Ministry of National Health Services Regulation and Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Dosoo DK, Malm K, Oppong FB, Gyasi R, Oduro A, Williams J, Atibilla D, Peprah NY, Twumasi M, Owusu-Agyei S, Greenwood B, Chandramohan D, Asante KP. Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana. BMJ Glob Health 2021; 6:bmjgh-2021-005877. [PMID: 34417272 PMCID: PMC8381314 DOI: 10.1136/bmjgh-2021-005877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ghana adopted the revised WHO recommendation on intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in 2012. This study has assessed the effectiveness and safety of this policy in Ghana. METHODS A total of 1926 pregnant women enrolled at antenatal care (ANC) clinics were assessed for birth outcomes at delivery, and placental histology results for malaria infection were obtained from 1642 participants. Association of reduced placental or peripheral malaria, anaemia and low birth weight (LBW) in women who received ≥4 IPTp-SP doses compared with 3 or ≤2 doses was determined by logistic regression analysis. RESULTS Among the 1926 participants, 5.3% (103), 19.2% (369), 33.2% (640) and 42.3% (817) of women had received ≤1, 2, 3 or ≥4 doses, respectively. There was no difference in risk of active placental malaria (PM) infection in women who received 3 doses compared with ≥4 doses (adjusted OR (aOR) 1.00, 95% CI 0.47 to 2.14). The risk of overall PM infection was 1.63 (95% CI 1.07 to 2.48) in 2 dose group and 1.06 (95% CI 0.72 to 1.57) in 3 dose group compared with ≥4 dose group. The risk of LBW was 1.55 (95% CI 0.97 to 2.47) and 1.06 (95% CI 0.68 to 1.65) for 2 and 3 dose groups, respectively, compared with the ≥4 dose group. Jaundice in babies was present in 0.16%, and 0% for women who received ≥4 doses of SP. CONCLUSION There was no difference in the risk of PM, LBW or maternal anaemia among women receiving 3 doses compared with ≥4 doses. Receiving ≥3 IPTp-SP doses during pregnancy was associated with a lower risk of overall PM infection compared with 2 doses. As there are no safety concerns, monthly administration of IPTp-SP offers a more practical opportunity for pregnant women to receive ≥3 doses during pregnancy.
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Affiliation(s)
- David Kwame Dosoo
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK .,Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Kezia Malm
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Felix Boakye Oppong
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Richard Gyasi
- Department of Pathology, University of Ghana College of Health Sciences, Accra, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Ghana.,Ghana Health Service Research and Development Division, Accra, Ghana
| | - John Williams
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
| | - Dorcas Atibilla
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Nana Yaw Peprah
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Mieks Twumasi
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Seth Owusu-Agyei
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK.,Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana.,Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK
| | - Kwaku Poku Asante
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UK.,Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
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