Each year between 75,000 and 200,000 infant deaths are attribute to malaria infection in pregnancy globally according to Steketee and Brabin with 3 to 8% of infant deaths caused by pregnancy associated malaria.
In studies by Mccormick and Matteelli malaria contributes to adverse pregnancy out comes like low birth weight which is known to be the single most important risk factor for neonatal and infant mortality.
In this study the prevalence of malaria parasite in cord blood was 58.0% this is comparable to 64.6% obtained by Uneke and 54.2% obtained in Ile Ife as well as 56.9% in a study in Onitsha by Okafor it was higher than 7.8% found by Akum in Cameroon.
This study also found that 89.8% of term babies had cord blood parasitaemia compared to 10.0% of preterm babies. This shows that cord blood malaria is not a risk factor for low birth weight similarly 58.0% of the neonates with normal birth weight had
cord blood malaria parasites compared with 30.0% of low birth weight neonates. This concurs with a study by Nnaji that majority of the infants with normal weight had cord blood malaria.
RELATED INFORMATION
There was a higher number of cord blood malaria in babies of primigravide (58.0%) and second time pregnant women (30.0%) compared to a low value (10%) in multigravidae. This agrees with that of Nnaji et al who noted that primigravidae and secondigravidae have increases risk of malaria parasitaemia. In mothers that received preventive malaria treatment as advocated by the world health organization the incidence of cord blood malaria parasites in their neonates was very low (30.0%) compared to 70.0% in mothers who did not. This finding has a resemblance to 58.0% of cord blood parasitaemia seen in mothers that had clinical malaria in the index pregnancy. Villamor et al (2005) observed too that maternal blood parasitaemia was the strongest risk factor for umbilical cord prarasitaemia .
This study indicates that there is an association between malaria hence they need to imbibe the WHO recommended package of interventions for the prevention and control of malaria during pregnancy.
The South East geopolitical zone of Nigeria where this study was done is a highly endemic area for malaria infestation due to its semi tropical rainforest vegetation which fevours the proliferation of the female anopheles mosquitoes. The vector for plasmodium parasites. Infant mortality in Nigeria is unacceptable at 75 per 1000 live births malaria contributes significantly to this figure and placental malaria parasitization as demonstrable by cord blood parasitaemia is caused by untreated malaria in pregnancy . Appropriate preventive measures should be adopted during antenatal care and prompt diagnosis and treatment of pregnant mothers effected to protect the lives of future generations.
Awareness of the dangers posed by malaria in pregnancy should be made to all and sunding.
Pregnant women should register early and receive optimal care in health facilities with skilled health attendants. Malaria should be combated using the WHO recommended package which includes.
1. Use of insecticide treated nets (TMS) to prevent infection
2. Use of intermittent preventive treatment (IPT) to prevent asymptomatic infection among pregnant
3. Effective case management of malaria illness for all women of reproductive age in malarious areas must be ensured
4. Antenatal care should be free or subsidized and anti malaria drugs available and given to pregnant women to reduce placental and cord blood parasitaemia which endangers the lives of infants after birth.
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Akum ATE, Kuoh AJ, Minang JT, Achimbom BM, Ahmadou MJ,
Troye Blomberg M.( 2005) The effect of maternal, umbilical
cord and placental malaria parasitaemia on the birth weight of newborns from south-western Cameroon. Acta paediatr 94(7): 917-23.
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Human Cerebral Malaria. Am J Trop Med. Hyg, 43:30-37
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SA et al. (1999) malaria infection during pregnancy. Intrauterine growth retardation and preterm delvery in Malawi. Journal of infections Diseases;179:1580-1583
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technical report series Geneva: WHO;;892.PT-V
APPENDIX
MATERIAL USE INCLUDE
§ EDTA container
§ Glass slides
§ Pipette
EQUIPMENTS
§ Microscope
§ Staining rack
REAGENTS
§ Giemsen’s stain
§ Oil immersion
§ Buffer
APPENDIX 2
CHI-SQUARE ANALYSIS
Chi-square was calculated from the formula
X2 = (O–E)2
E
Where O = observed data
E= expected data
Table 2A
Distribution at parasitaemia based on age
|
Age |
Parasitaemia |
No Parasitaemia |
Total |
|
20-29 |
11 |
13 |
24 |
|
30-39 |
18 |
5 |
23 |
|
≥40 |
1 |
2 |
3 |
|
TOTAL |
30 |
20 |
50 |
Table 2b
Chi square analysis of the distribution of parasitaemia based on age range
|
Age 20-29 |
0 |
E |
0-E |
(0-E)2 |
(0-E)2/E |
|
P |
11 |
13.92 |
-2.92 |
8.3264 |
0.8459 |
|
Np 30 – 39 |
13 |
10.08 |
2.92 |
8.5264 |
0.8459 |
|
P |
18 |
13.8 |
4.20 |
17.640 |
1.2783 |
|
Np |
5 |
9.2 |
4.20 |
17.6400 |
1.9174 |
|
≥ 40 |
|||||
|
P |
1 |
1.74 |
-0.74 |
0.5476 |
0.3147 |
|
NP |
2 |
1.26 |
0.74 |
0.5476 |
0.4346 |
|
Total |
50 |
5.4034 |
Table 3a: Distribution of parasitaemia in the subject in relation to trimester.
|
Trimester |
Parasitaemia |
No parasitaemia |
Total |
|
1st |
10 |
6 |
16 |
|
2nd |
12 |
9 |
21 |
|
3rd |
8 |
5 |
13 |
|
Total |
30 |
20 |
50 |
3b
|
Trimester |
0 |
E |
O-E |
(O-E)2 |
(O-E)2 E |
|
1st |
|||||
|
P |
10 |
9.6 |
0.4 |
0.16 |
0.0167 |
|
NP |
6 |
6.4 |
-0.4 |
0.16 |
0.0250 |
|
2nd |
|||||
|
P |
12 |
12.6 |
-0.6 |
0.36 |
0.0286 |
|
NP |
9 |
8.4 |
0.6 |
0.36 |
0.0429 |
|
3rd |
|||||
|
P |
8 |
7.8 |
0.2 |
0.04 |
0.0051 |
|
NP |
5 |
5.2 |
-0.2 |
0.04 |
0.0077 |
|
TOTAL |
50 |
0.1260 |
X2 cal =0.126
RESULT DATA
|
S/N |
AGE |
TRIMESTER |
MALARIA PARASITEAEMIA |
PARASITAENMIA COUNT |
|
1 |
40 |
1st |
+VE |
++ |
|
2 |
32 |
2nd |
+VE |
+ |
|
3 |
20 |
1st |
-VE |
NIL |
|
4 |
25 |
2nd |
-VE |
NIL |
|
5 |
34 |
3rd |
-VE |
NIL |
|
6 |
38 |
1st |
+VE |
+++ |
|
7 |
21 |
2nd |
+VE |
+ |
|
8 |
26 |
2nd |
+VE |
++ |
|
9 |
28 |
2nd |
-VE |
NIL |
|
10 |
33 |
3rd |
+VE |
++ |
|
11 |
31 |
3rd |
+VE |
+++ |
|
12 |
37 |
3rd |
+VE |
++ |
|
13 |
27 |
2nd |
-VE |
NIL |
|
14 |
39 |
2nd |
+VE |
++ |
|
15 |
29 |
1st |
+VE |
+ |
|
16 |
22 |
2nd |
-VE |
NIL |
|
17 |
23 |
1st |
+VE |
+ |
|
18 |
24 |
2nd |
-VE |
NIL |
|
19 |
30 |
1st |
+VE |
++ |
|
20 |
41 |
3rd |
-VE |
NIL |
|
21 |
36 |
2nd |
+VE |
+ |
|
22 |
35 |
3rd |
-VE |
NIL |
|
23 |
21 |
1st |
+VE |
+ |
|
24 |
25 |
2nd |
+VE |
++ |
|
25 |
33 |
3rd |
-VE |
NIL |
|
26 |
38 |
3rd |
+VE |
+ |
|
27 |
26 |
2nd |
-VE |
NIL |
|
28 |
31 |
2nd |
+VE |
++ |
|
29 |
20 |
1st |
-VE |
NIL |
|
30 |
28 |
2nd |
+VE |
+ |
|
31 |
21 |
1st |
+VE |
++ |
|
32 |
30 |
1st |
-VE |
NIL |
|
33 |
20 |
1st |
-VE |
NIL |
|
34 |
30 |
3rd |
+VE |
++ |
|
35 |
36 |
3rd |
-VE |
NIL |
|
36 |
25 |
2nd |
-VE |
NIL |
|
37 |
28 |
2nd |
-VE |
NIL |
|
38 |
22 |
2nd |
+VE |
+ |
|
39 |
30 |
1st |
+VE |
++ |
|
40 |
33 |
2nd |
+VE |
+ |
|
41 |
20 |
1st |
-VE |
NIL |
|
42 |
34 |
3rd |
+VE |
++ |
|
43 |
21 |
1st |
-VE |
NIL |
|
44 |
35 |
3rd |
+VE |
+ |
|
45 |
36 |
3rd |
+VE |
+ |
|
46 |
40 |
2nd |
-VE |
NIL |
|
47 |
28 |
2nd |
+VE |
++ |
|
48 |
25 |
1st |
+VE |
NIL |
|
49 |
30 |
1st |
+VE |
++ |
|
50 |
32 |
2nd |
+VE |
+ |
Table 4.1
The malaria age and frequency of cord blood parasitaemia.
|
Maternal Age |
Frequency |
Percentage (%) |
|
< 20 years |
5 |
10.0 |
|
20-30 years |
10 |
20.0 |
|
30-40 |
20 |
40.0 |
|
> 40 years |
15 |
30.0 |
|
Total |
50 |
100 |
Table 4.2
The gestational age (maturity) of neonates and cord blood parasitaemia
|
Gestational Age |
Frequency |
Percentage (%) |
|
< 37 weeks |
15 |
30.0 |
|
>37 weeks |
35 |
70.0 |
|
Total |
50 |
100 |
Table 4.3
The parity of mothers and cord blood parasites frequency
|
Parity of mothers |
Frequency |
Percentage (%) |
|
Primigravidae |
30 |
60.0 |
|
Second pregnancy |
15 |
30.0 |
|
Third pregnancy |
5 |
10.0 |
|
Total |
50 |
100 |
Table 4.4
Comparism of birth weight of neonates and cord blood parasitaemia
|
Birth weight of neonates |
Frequency |
Percentage (%) |
|
< 2.5 kg |
15 |
30.0 |
|
2.5-3.9 kg |
30 |
60.0 |
|
> 4 kg |
5 |
10.0 |
|
Total |
50 |
100 |
Table 4.5
The effect of preventive material treatment in pregnancy (IPT) on the cord blood malaria parasite load
|
Frequency |
Percentage (%) |
|
|
mothers that received IPT in the index pregnancy. |
15 |
30.0 |
|
Mothers that did not receive IPT in the index pregnancy |
35 |
70.0 |
|
Total |
50 |
100 |
Table 4.6
Clinical malaria in pregnancy and cord blood malaria parasitaemia
|
|
Frequency |
Percentage (%) |
|
Mothers that had malaria in the index pregnancy. |
30 |
60.0 |
|
Mothers without clinical malaria in the index pregnancy. |
20 |
40.0 |
|
Total |
50 |
100 |
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