Prevalence and factors associated with congenital malaria in newborns aged 1-7 days attending Tororo District Hospital- Uganda.

Abstract

Introduction: Malaria is the most prevalent infection in Sub-Saharan Africa, accounting for a great degree of morbidity and mortality especially in the paediatric population. There is evidence to show that babies born to mothers in malaria endemic areas have a degree of acquired immunity against malaria and this has probably led to the thought that congenital malaria is uncommon. Studies in Africa have however shown that newborns may have malaria parasites in their placental blood and that transmission occurs intrauterine resulting in uterine growth restriction, preterm birth, anemia in infancy and an increased risk of congenital malaria. There are few studies done in Uganda to document the burden of congenital malaria. The aim of this study was to describe the prevalence, clinical presentation and factors associated with congenital malaria in newborns, delivered in Tororo District Hospital. Method: This was a cross sectional study conducted in Tororo District Hospital from 14th February 2014 to 4th April 2014. A total of 261 newborns aged up to 7 days and their mothers were recruited from the labor suit, immunization unit of the postnatal ward and the pediatric ward. Socio-demographic and obstetric information of the mothers was collected. Physical examination was done for newborns. Thick blood smear and RDT were done for blood samples from the mothers and newborns. For newborns and their mothers recruited from the labor suit, thick blood smear and RDT were also run for blood samples gotten from the placenta and the cord. Blood films were stained using Giemsa stain and examined for malaria parasites. Results: Congenital malaria was documented in 6.1 % (16/ 261, 95% CI: 3.2-9 %) newborns. No clinical feature (birth weight, Apgar score, fetal length, fever, hepatomegaly, splenomegaly, anemia and jaundice) was found to be associated with congenital malaria. Maternal malaria

parasitaemia was significantly associated with congenital malaria (OR = 8.936, 95% CI = 2.811-28.411 parasitaemia was significantly associated with congenital malaria (OR = 8.936, 95% CI = 2.811-28.411, P-value < 0.001). Conclusion/ Recommendations: The prevalence of congenital malaria in newborns aged up to 7 days attending Tororo District Hospital was 6.1% (16/ 261). No specific clinical feature was associated with congenital malaria. Maternal malaria parasitaemia was significantly associated with congenital malaria. Newborns in high malaria transmission area, especially those born to mothers with malaria parasitaemia at delivery should be evaluated for congenital malaria. Strengthening malaria prevention during pregnancy should be encouraged in order to reduce the occurrence of congenital malaria in newborns. Additional research using more sensitive malaria diagnosis methods like PCR is encouraged to show the real burden of congenital malaria in newborns in Tororo District., P-value < 0.001).