RESUMO
OBJECTIVES: Pregnant women in malaria-endemic communities are susceptible to Plasmodium falciparum infections, with adverse consequences including maternal anaemia, placental malaria parasitaemia and infant low birth weight (LBW). We sought to assess the prevalence, incidence, and clinical markers of pregnancy-associated malaria (PAM) in a rural district of Ghana. METHODS: A total of 294 pregnant women were enrolled and followed passively and actively, monthly and weekly until delivery. Haemoglobin levels, malaria parasitaemia and Hb electrophoresis were done from peripheral blood samples. At delivery, placental smears were examined for malaria parasites. RESULTS: Prevalence of peripheral blood P. falciparum parasitaemia at enrolment was 19.7% and related to parity. Incidence rate of parasitaemia was 0.06 infections/ person/month [95% confidence interval (CI): 0.04 to 0.08]. Symptomatic infections rose sharply from the first trimester to the last. Prevalence of malaria parasites in the placenta was 35.9% (61/170) and highest among primigravidae (P(chi(2))=0.006). Incidence of LBW infants was 17.7% (30/170), most common among those with placental P. falciparum infection (P(chi(2))=0.005) corresponding to a relative risk of 2.8 [1.4 to 5.2]. Median infant birth weight in those with placental infection was significantly lower than in those without infections (P(chi(2))=0.001). Maternal haemoglobin levels were lower (9.7 [9.3-10.1] g/dL) at enrolment, among women who subsequently had placental P. falciparum infection than among those who did not have placental infection at delivery (10.5 [10.2-10.8] g/dL) (P (t)=0.003). CONCLUSION: Primigravidae and secundigravidae are significantly at risk of developing PAM, and low haemoglobin during pregnancy is a clinical indicator of placental P. falciparum infection.
RESUMO
SummaryAnaemia associated with pregnancy is a serious health problem and its control requires the initial identification of the major factors responsible. Haemoglobin (Hb) levels of 205 women, aged 15 to 49 years, in the last trimester of pregnancy and residing within 4 of 6 sub-districts in Sekyere West district of the Ashanti region of Ghana, were determined. Demographic characteristics, dietary habits and other information were obtained and analysed. Blood and stool samples were tested for the presence of malaria parasites and intestinal worms respectively. The data showed that, 57.1% of pregnant women had Hb<10g/dl, the Ministry of Health cut off point for anaemia. Anaemia was more prevalent in rural compared to urban parts of the district (p=0.01). Low parity and young age were significantly associated with low Hb and high prevalence of maternal anaemia. Presence of malaria parasites in peripheral blood constituted a significant risk for low Hb (Hb = 9.2g/dL vs 9.5g/dL p=0.03). Independent of this, hookworm was even more strongly associated with low Hb (Hb = 8.3g/dL vs Hb=9.5g/dL, p=0.01). Contribution of dietary intake to the prevalence of anaemia cannot be inferred from the data generated under the current study.
