Pregnancy-Associated Malaria in a Rural Community of Ghana
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Date
2009-03
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Journal ISSN
Volume Title
Publisher
Ghana Medical Journal
Abstract
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(2)=0.006). Incidence of
LBW infants was 17.7% (30/170), most common
among those with placental P. falciparum infection
(P(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(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.
Description
Journal Article
Keywords
Placenta, pregnancy, malaria, haemoglobin