Maternal malaria, birth size and blood pressure in Nigerian newborns: insights into the developmental origins of hypertension from the Ibadan growth cohort

The Rate of Asymptomatic Plasmodium Parasitemia and Placental Parasitization in Urban and Rural Areas of Cross River State, Nigeria

Background: Malaria in pregnancy contributes to feto-maternal morbidity and mortality even in asymptomatic forms of the disease especially in malaria endemic regions such as Nigeria. Objective: To determine the rate of asymptomatic malaria parasitemia and placental parasitization among the rural and urban pregnant women and its feto-maternal effects in Cross River State, Nigeria. Methodology: This was a prospective study of 440 pregnant women in rural and urban settings. Participants completed structured questionnaire and also have their blood samples and placentas examined for presence of malaria parasites by microscopy and histology respectively. Maternal hemoglobin concentration, birth weight, neonatal length, Apgar score and other anthropometric measurements were obtained to assess feto-maternal effect of asymptomatic malaria parasitemia and placental parasitisation in pregnancy. Data were analyzed using SPSS version 21.0 and level of significance was set as 0.05. ResultsThe prevalence of asymptomatic malaria parasitemia was 40.2% while malaria placental parasitization was 70.2%. Based on residential status, 49.5% of rural residents had malaria parasitemia which is significantly higher than their urban resident counterparts 30.9% (p=0.000). The prevalence of placental parasitization was significantly higher among rural residents 80.9% than their urban resident counterparts 59.5% (p=0.000). Concerning obstetric outcome of patients with positive malaria placental parasitisation, preterm delivery, low 5th minutes Apgar score (<7), low birth weight (<2.5kg) and low neonatal length were significantly higher in pregnancy with positive placental parasitisation than in women with negative placental malaria parasitisation. Also, preterm delivery, anemia, low 5th minutes Apgar score (<7) and low birth weight (<2.5kg) were significantly higher in pregnancy with positive malaria parasitemia than women with negative malaria parasitemia. ConclusionAsymptomatic malaria parasitemia (40.2%) and malaria placental parasitization (70.2%) in this study is high and contributes to poor obstetric outcomes mostly in the rural areas. Rural pregnant women have the highest burden than the urban women. Promotion of the use of ITNs, IPT during pregnancy and other malaria preventive measures are necessary especially in rural areas where malaria burden is highest.

Perceptions of Nigerian healthcare workers towards hand hygiene: a qualitative study

Introduction

hand hygiene (HH) is an effective measure to reduce healthcare-associated infections and the growing burden of antimicrobial resistance. There is a need to understand the perceptions of healthcare workers towards its practice and the use of alcohol-based hand rubs (ABHR) to make recommendations to promote HH. Our study aimed to explore the perceptions of Nigerian healthcare workers towards HH and the use and availability of ABHR to suggest potential interventions to improve its practice as qualitative evidence in this field is limited in Nigeria.

Methods

a qualitative study design was utilized to understand the perceptions of healthcare workers towards HH and the use of ABHR at Adeoyo Maternity Hospital, Ibadan, Nigeria. Purposive sampling was used to recruit nineteen healthcare workers who were interviewed. Thematic content analysis was used to analyze the data generated.

Results

five themes emerged including discrepancies in what constitutes HH practice as participants, motivation for HH practice, a good knowledge of timing as regards practice, barriers to good practice and evidence of poor practice.

Conclusion

while many healthcare workers know about HH and self-reported compliance towards it seems to be high, knowledge gaps, lack of resources, absence of regulations and poor working conditions were impediments to the successful implementation of HH practices. We recommend that hospitals institute well-articulated HH regulations, continuous education and training of healthcare workers. Hospitals should also ensure adequate provision of resources for hand hygiene and institute a continuous monitoring and feedback program to evaluate compliance with regulations.

Child Electronic Growth Monitoring System: An innovative and sustainable approach for establishing the Kaduna Infant Development (KID) Study in Nigeria

BACKGROUND

Developing countries bear the burden of childhood stunting but lack resources for cohort studies to develop preventive strategies. To enable future prospective studies, we designed and tested the Child Electronic Growth Monitoring System (CEGROMS) using a readily available electronic data capture platform, the Research Electronic Data Capture (REDCap).

OBJECTIVES

To demonstrate the feasibility of using CEGROMS for data collection for a pilot study for the Kaduna Infant Development (KID) Birth Cohort Study in Nigeria.

METHODS

CEGROMS consists of the data capture form for growth monitoring, a central cloud server, electronic tablets, and desktop computer. We implemented the pilot study in 2017-2019 at the Barau Dikko Teaching Hospital, Kaduna, Nigeria. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for completeness of baseline data (relative to individuals with incomplete data) and completion of follow-up at different time points (relative to individuals with no follow-up visit) by the participant characteristics. Complete data were defined as date of birth, sex, and birthweight recorded at recruitment.

RESULTS

Among 3152 infant records in CEGROMS, 2789 (88.5%) had complete data. Of these, 1905 (68.3%) had at least one follow-up visit. The main determinants of data completeness were health facility delivery (OR 19.17, 95% CI 13.65, 26.92) and tertiary education (OR 3.54, 95% CI 2.69, 4.67). Follow-up was greater for women with tertiary education (OR 1.33, 95% CI 1.06, 1.51 for at least one visit). Maternal education is associated with completeness and follow-up (following adjustments for parity and employment).

CONCLUSIONS

The CEGROMS electronic data collection system enables complete and consistent data collection. The data will enable design of strategies to improve follow-up in the future implementation of the birth cohort study.

Knowledge of malaria prevention among pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, South West Nigeria

Background

Adequate knowledge of malaria prevention and control can help in reducing the growing burden of malaria among vulnerable groups, particularly pregnant women and children aged under 5 years living in malaria endemic settings. Similar studies have been conducted but with less focus on these vulnerable groups. This study assessed knowledge of malaria prevention and control among the pregnant women and non-pregnant mothers of children aged under 5 years in Ibadan, Oyo State, South West Nigeria.

Methods

In this cross sectional study, data on socio-demographic, clinical and knowledge on malaria prevention was collected using interviewer administered questionnaires from consenting study participants attending Adeoyo maternity hospital between May and November 2016. Data was described using percentages and compared across the two maternal groups in the study population. Knowledge scoring from collected data was computed using the variables on causes, symptoms and prevention of malaria and thereafter dichotomised. Multivariate analyses were used to assess the interactive effect of socio demographic and clinical characteristics with malaria knowledge. Level of statistical significance was set at p < 0.05.

Results

Of the 1373 women in the study, 59.6% (818) were pregnant women while 40.4% (555) were mothers of children aged under 5 years. The respondents mean age was 29 years ± 5.2. A considerable proportion of both the pregnant women (n = 494, 60.4%) and the non-pregnant mothers of children aged under 5 years (n = 254, 45.8%) did not have correct knowledge on malaria prevention measures based on our assessment threshold (p < 0.001). Having a tertiary level education was associated with better knowledge on malaria (4.20 ± 1.18, F = 16.80, p < 0.001). Multivariate analyses showed that marital status, educational attainment, gravidity, and HIV status were significantly associated with knowledge of malaria prevention and control.

Conclusion

The findings indicate that socio-demographic factors such as marital and educational status greatly influence knowledge on malaria prevention and control measures. Key health stakeholders and authorities need to implement strategies and direct resources to improve the knowledge of mothers on malaria prevention and control. This would stem the tides of malaria related deaths among pregnant women and children aged under 5 years.

Is birth weight associated with blood pressure among African children and adolescents? A systematic review

There is substantial evidence of an inverse association between birth weight and later blood pressure (BP) in populations from high-income countries, but whether this applies in low-income countries, where causes of low birth weight are different, is not certain.

OBJECTIVE

We conducted a review of the evidence on the relationship between birth weight and BP among African children and adolescents. Medline, EMBASE, Global Health and Web of Science databases were searched for publications to October 2016. Papers reporting the relationship between birth weight and BP among African children and adolescents were assessed. Bibliographies were searched for further relevant publications. Selected papers were summarized following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. In total, 16 papers from 13 studies conducted in nine African countries (Nigeria, Republic of Seychelles, Gambia, Democratic Republic of Congo, Cameroon, South Africa, Algeria, Zimbabwe and Angola) were reviewed. Eight studies were cohorts, while five were cross-sectional. The relationship between birth weight and later BP varied with age of the participants. Studies in neonates showed a consistently positive association, while predominantly inverse associations were seen among children, and studies in adolescents were inconsistent. Based on the limited number of studies identified, the relationship between birth weight and later BP may vary with age in African children and adolescents. Not all studies adequately controlled for confounding, notably gender or age. Whether the inverse relationship between birth weight and BP in later life observed in Western settings is also seen in Africa remains unclear.

Skinfold Thickness Measurement in Term Nigerian Neonates: Establishing Reference Values

Skin fold thickness (SFT) measurement is a reliable, cheap, simple, noninvasive method of body fat estimation at all ages including the neonatal period. Objective. To determine reference values of biceps, triceps, subscapular, and suprailiac skinfold thickness measurements in term Nigerian newborns. Method. A prospective cross-sectional study over a six-month period (Dec 2010-May 2011) was carried out on term and healthy neonates delivered between 37 and 41 weeks. The anthropometric measurements were taken within the first 48 hours of life including the skinfold thickness. The skinfold thickness measurements were taken at four sites, namely, triceps, biceps, subscapular, and suprailiac, using Harpenden skinfold calipers. The mean of two readings was recorded. Result. A total of one thousand one hundred and sixty-eight neonates were studied. The birth weight ranged between 2000 g and 5000 g with a mean birth weight of the neonates at 3259 ± 470 g. The mean birth weight of the males (3339 ± 0.45) was significantly higher than that of females (3200 ± 0.44) (p < 0.0001). Female neonates had higher mean values of triceps, subscapular, and suprailiac skinfold thickness (p < 0.001, resp.) while male neonates had higher mean value of biceps skinfold thickness (p = 0.008). Females also had higher mean values of the sum of skinfold thicknesses at all four sites and the sum at the two truncal sites at every stratified gestational age. Conclusions. The sex specific percentile chart developed for skinfold thickness measurements can be used to detect deviation from the reference population such that infants who are at risk of nutritional or health problems are identified early, and intervention is instituted promptly.

Prevalence of impaired glucose tolerance and other types of dysglycaemia among young twins and singletons in Guinea-Bissau

BACKGROUND

Twins may be at increased risk of dysglycaemic disorders due to adverse fetal conditions. Data from Africa regarding this association is limited. We studied impaired glucose tolerance (IGT) and other types of dysglycemia among twins and singletons in Guinea-Bissau.

METHODS

The study was conducted from February 2011 until March 2012 at the Bandim Health Project, a health and demographic surveillance system site in the capital Bissau. Twins (n = 209) and singletons (n = 182) were recruited from a previously established cohort. Oral glucose tolerance tests (OGTT) were performed, along with anthropometrics and collection of clinical and dietary data.

RESULTS

Median age was 16.6 and 14.2 years between twins and singletons, respectively (P = 0.08). Mean birth weight was 2410 vs. 3090 g, respectively (P < 0.001). Twins had higher median fasting- and two hour capillary plasma glucose, 5.4(3.2-8.2) vs. 5.0(3.2-11.5) mmol/L (P < 0.001) and 6.8(3.4-11.3) vs. 6.2(3.2-12.1) mmol/L (P < 0.001), respectively, compared to singletons. The prevalence of IGT was 2.5 % (5/209) vs. 3.5 % (6/182) (RR = 0.73, 95 % CI: 0.20-2.64). 12 % (25/209) of twins had impaired fasting glucose (IFG), compared to 3.5 % (6/182) of singletons (3.63, 1.53-8.62). Dysglycemia (IGT and/or IFG or overt diabetes) was found in 17 % (35/209) vs. 9 % (16/182) (1.90, 1.08-3.37), respectively.

CONCLUSIONS

Twins had higher glucose levels in both the fasting and postprandial state. This may indicate a detrimental effect of the twin fetal environment on glucose metabolism later in life, a result contrary to Scandinavian register studies. The IGT burden was low in this young age group and the risk was similar in twins and singletons.

The impact of malaria in pregnancy on changes in blood pressure in children during their first year of life

We established a maternal birth cohort in Ibadan, Nigeria, where malaria is hyperendemic, to assess how intrauterine exposure to malaria affected infant blood pressure (BP) development. In a local maternity hospital, healthy pregnant women had regular blood films for malaria parasites from booking to delivery. Growth and BP were measured on 318 babies, all followed from birth to 3 and 12 months. Main outcomes were standardized measures of anthropometry and change in BP to 1 year. Babies exposed to maternal malaria were globally smaller at birth, and boys remained smaller at 3 months and 1 year. Change in systolic BP (SBP) during the year was greater in boys than in girls (20.9 versus 15.7 mm Hg; P=0.002) but greater in girls exposed to maternal malaria (18.7 versus 12.7 mm Hg; 95% confidence interval, 1-11 mm Hg; P=0.02). Eleven percent of boys (greater than twice than expected) had a SBP ≥95th percentile (hypertensive, US criteria), of whom 68% had maternal malaria exposure. On regression analysis (β coefficients, mm Hg), sex (boys>girls; β=4.4; 95% confidence interval, 1.1-7.7; P=0.01), maternal malaria exposure (3.64; 0.3-6.9; P=0.03), and weight change (2.4; 0.98-3.8/1 standard deviation score; P=0.001) all independently increased SBP change to 1 year, whereas increase in length decreased SBP (-1.98; -3.6 to -0.40). In conclusion, malaria-exposed boys had excess hypertension, whereas malaria-exposed girls a greater increase in SBP. Intrauterine exposure to malaria had sex-dependent effects on BP, independent of infant growth. Because infant-child-adult BP tracking is powerful, a malarial effect may contribute to the African burden of hypertension.

Perceptions of intermittent preventive treatment of malaria in pregnancy (IPTp) and barriers to adherence in Nasarawa and Cross River States in Nigeria

Background

Malaria during pregnancy is dangerous to both mother and foetus. Intermittent preventive treatment of malaria in pregnancy (IPTp) is a strategy where pregnant women in malaria-endemic countries receive full doses of sulphadoxine-pyrimethamine (SP), whether or not they have malaria. The Nigerian government adopted IPTp as a national strategy in 2005; however, major gaps affecting perception, uptake, adherence, and scale-up remain.

Methods

A cross-sectional study was conducted in peri-urban and rural communities in Nasarawa and Cross River States in Nigeria. Study instruments were based on the socio-ecological model and its multiple levels of influences, taking into account individual, community, societal, and environmental contexts of behaviour and social change. Women of reproductive age, their front-line care providers, and (in Nasarawa only) their spouses participated in focus group discussions and in-depth individual interviews. Facility sampling was purposive to include tertiary, secondary and primary health facilities.

Results

The study found that systems-based challenges (stockouts; lack of provider knowledge of IPTp protocols) coupled with individual women’s beliefs and lack of understanding of IPT contribute to low uptake and adherence. Many pregnant women are reluctant to seek care for an illness they do not have. Those with malaria often prefer to self-medicate through drug shops or herbs, though those who seek clinic-based treatment trust their providers and willingly accept medicine prescribed.

Conclusions

Failing to deliver complete IPTp to women attending antenatal care is a missed opportunity. While many obstacles are structural, programmes can target women, their communities and the health environment with specific interventions to increase IPTp uptake and adherence.

Maternal malaria status and metabolic profiles in pregnancy and in cord blood: relationships with birth size in Nigerian infants

BACKGROUND

Malaria is more common in pregnant than in non-pregnant Nigerian women, and is associated with small birth size and the attendant short- and long-term health risks. The influence of malaria on maternal metabolic status in pregnancy and in cord blood and how this relates to birth size has not been studied. The study objective was to define relationships between maternal and cord serum metabolic markers, maternal malaria status and birth size.

METHODS

During pregnancy, anthropometric measurements, blood film for malaria parasites and assays for lipids, glucose, insulin and TNF were obtained from 467 mothers and these analytes and insulin-like growth factor-I (IGF-I) were obtained from cord blood of 187 babies.

RESULTS

Overall prevalence of maternal malaria was 52%, associated with younger age, anaemia and smaller infant birth size. Mothers with malaria had significantly lower cholesterol (total, HDL and LDL) and higher TNF, but no difference in triglyceride. In contrast, there was no effect of maternal malaria on cord blood lipids, but the median (range) cord IGF-I was significantly lower in babies whose mothers had malaria: 60.4 (24, 145) μg/L, versus no malaria: 76.5 (24, 150) μg/L, p = 0.03. On regression analysis, the key determinants of birth weight included maternal total cholesterol, malarial status and cord insulin and IGF-I.

CONCLUSIONS

Malaria in pregnancy was common and associated with reduced birth size, lower maternal lipids and higher TNF. In the setting of endemic malaria, maternal total cholesterol during pregnancy and cord blood insulin and IGF-I levels are potential biomarkers of foetal growth and birth size.