Malaria Infection in pregnancy: relation between placental malaria infection, maternal anaemia and new born birth weight at Mulago National Referral Hospital.

Abstract

Malaria Infection in pregnancy: relation between placental malaria infection, maternal anaemia and new born birth weight at Mulago National Referral Hospital. BACKGROUND: Malaria is an enormous global health problem affecting 300-500 million people annually. In Uganda there is stable malaria in 95% of the country. The disease burden affects mostly the young children and pregnant women. There is sequestration of malaria parasites in the placenta leading to complications in the mother and the baby. The risk of malaria decreases with increasing gravidity. In Uganda the policy of the Ministry of Health is to give intermittent presumptive treatment during pregnancy for control of malaria in pregnancy twice between 16 and 36 weeks of amenorrhoea at least one month apart. Of the babies delivered in Mulago Hospital 12.3% were low birth weight however the association with malaria and maternal anemia has not been assessed. In Uganda, there is stable P. falciparum transmission in 95% of the country. Mulago Hospital is in a malaria endemic area however the exact burden of malaria in pregnancy is not known. OBJECTIVE OF THE STUDY: To determine the prevalence of malaria infection, maternal anaemia, and their association with birth weight in mothers delivered in Mulago Hospital. METHODS: A total of 399 pregnant women above 28 weeks of amenorrhoea delivering in Mulago hospital were enrolled in an analytical cross sectional study after informed consent. Data was collected using a questionnaire on demographic characteristics, obstetric and history of taking ant-malarial prophylaxis during pregnancy. A peripheral blood sample was taken off and made thick and thin smears and hemoglobin level estimation. After delivery the birth weight of the babies were measured, placental tissue cut to make thick smears and a piece of placenta tissue was fixed in 10% formal saline and then taken for histology to look for evidence of malaria. The slides were stained and examined for malaria parasites. The prevalence of placental malaria infestation was then computed. Using the chi square test and Odds Ratios the relation between malaria infestations, maternal anaemia with birth weight was described. RESULTS: The study found that 13.9% percent of the participants had malarial infection by histological diagnosis and 21.8 % had maternal anaemia. There was a statistically significant association between maternal anaemia and malaria infection with anaemic mothers at higher risk of having malaria. Mothers with malaria infection had higher tendency of delivering LBW babies however this was not statistically significant. When adjusted for malaria and maternal anaemia, LBW was significantly associated with maternal age. CONCLUSION: The prevalence of placental malaria and maternal aneamia in Mulago National Referral Hospital was 13.9 % and 21.8% respectively. In addition it was concluded from the study that an increase in malaria infection was associated with decrease in haemoglobin level and birth weight.