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Relationship between Plasmodium density during pregnancy and fetal birth weight in a university teaching hospital

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  • Save Public Health Research 2012, 2(4): 110-113 DOI: 10.5923/j.phr.20120204.08 Association Between Malaria Parasite Density in Pregnancy and Fetal Birth Weight in a University Teaching Hospital Nwangwa E. K*, Ekhoye E. I. Department ofPhysiology, Faculty of Basic M edicalScience, College of HealthScience, Delta State University, P.M .B 001, Abraka, Delta State, Nigeria Abstract Malaria in pregnancy is an obstetric, social and med ical problem requiring mult idisciplinary and mu ltid imensional solution. In Africa, perinatal mortality due to malaria is at about 1500/day. In areas where malaria is endemic, 20-40% o f all babies born may have co mp lications of malaria.In this Prospective study, two hundred (200) consenting pregnant women who were attending antenatal clinic in a Un iversity Teaching hospital who met the inclusion criteria were recru ited for the study. Malaria parasitaemia were examined using Giemsa staining of the thick and thin b lood films and WBC by coulter automated cell count and QBC centrifugal haematology system. Other parameters (fetal birth weight, gestational age, parity, maternal age) were also documented. The result showed a strongly positive correlation(r =0.7258) and statistically significant (p<0.05) decrease in birth weight for mild (3.29±0.07kg), moderate (2.86±1.33kg) and severe (2.17±0.213kg)parasitamia in primigravida and mild (3.43±0.05kg), moderate (3.12±0.05kg ) and severe (2.92±0.21kg) in mult igravida.Also found is that the average birth weight in primigravida (2.85±0.158kg) is lower than that of mult igravida (3.07±0.039kg). It is therefore, reco mmended that malaria screening should form part of routine antenatal investigations in malaria endemic reg ions to prevent the problems associated with low birth weight. Keywords Malaria Parasite Density, Birth Weight, Pregnancy 1. Introduction Malaria causes about 400 – 900 million cases of fever and approximately one to three million deaths annually[1]. The vast majority of cases occur in children under the age of 5 years, pregnant women are also vulnerable[2]. Hundreds of millions are infected each year and it is responsible for one million deaths per year world wide, 90% in Africa[3].It is estimated that each year over 30 million wo men beco me pregnant in malaria in fected areas of Africa with most living in area of stable malaria trans mission[4]. Despite the effort to reduce transmission and increase treat ment, there has been litt le change in these areas at risk of this disease[5]. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next t wenty years[1]. M alaria an d p reg n an cy are mu t u ally ag g rav at in g conditions. The physiological changes due to ma laria have a synergistic effect on the course of each other, thus making the life difficult fo r the mother, the child and the treating physician. Most ep idemio log ic studies conducted in the * Corresponding author: (Nwangwa, E.K) Published online at Copyright © 2012 Scientific & Academic Publishing. All Rights Reserved malaria endemic countries have found the primigravidae are more susceptible in hu man malaria than mult igravidae[6]. In areas of intense transmission, Plas modiu m falciparu m infection during pregnancy is usually asymptomatic and therefore remains undetected and untreated, despite the presence of parasites in the placenta. The main adverse man ifestations of malaria in pregnancy are maternal anaemia and pre-term delivery[7,8.9]. Malaria parasitaemia has been associated with risk factor for low birth weight babies caused by intra-uterine growth retardation (IUGR) and pre-term deliveries (PTD)[10]. A healthy birth weight is ext remely important for newborn as low birth weight babies are more susceptible to health problems, slower development, delayed milestones and low immun ity[11]. It is also established as an important risk factor for neonatal morb idity[12]. Therefo re, pregnant wo men must acquire a form of pregnancy-associated immun ity during their first pregnancies that helps protect them during subsequent pregnancies[7]. The aim o f this study is to find the association between malaria parasite density and birth weight in relation to Primigravida and mult igravida. 2. MaterialsAnd Methods 111 Public Health Research 2012, 2(4): 110-113 2.1.Study Area This study was carried out in University of Benin Teaching hospital,Benin City. Edo State Nigeria. It is located at the south- south geographical oil rich region with rain forest Vegetation. Malaria transmission is stable and all-round the year. 2.2.Study Popul ati on, Data Collection, Data Analysis The studypopulation was drawn fro m both primigravid and mu ltigravid wo men and their newborn babies, and were recruited fro m March 2009 to October, 2010 as part of prospective study investigating the effect of malaria parasitaemia on fetal birth weight. Wo men with pregnancy induced hypertension, diabetes mellitus, parity greater than four, renal d isease, smokers and other chronic ailments e.g. sickle cell, and asthma were excluded fro m th is study. Maternal age, weight and birth weight of the babies’ data were co llected for this study. 2.3. StudyPopul ati on During this course of study, pregnant females with ages ranging fro m 20 to 44 years attending antenatal clinic at the Obstetrics and Gynecology department of Un iversity of Benin Teaching Hospital were considered.All pregnant wo men who presented on different occasions with signs and symptoms of malaria (fever, headache, easy fatigability and weakness) in different trimesters and during labour were tested for malaria. Those who were positive and met inclusion criteria were recruited fo r the study. The total number of subjects used for the study was 200 pregnant fe males . 2.4. Sample Collection and Analysis Maternal blood samples were collected during labor by pricking the finger with a sterile lancet and collecting 1 or 2 drops of blood directly on two clean glass slides and immed iately thick and thin blood film were made using Giemsa staining technique. The air dried s mears were field stained, flushed in clean water and slanted on a draining rack to air dry. The dried stained smear was microscopically examined at x100 object ive (o il immersion). The diagnosis of malaria was based on the identification of asexual plasmodiu m on the thick blood film wh ile the th in blood film was used to identify species of plasmodiu m. About 3 ml in tube were transported on ice within 1 hours to a laboratory and within 2 hours of init ial samp le co llection, WBC were counted by a Coulter auto mated cell count (Beckman-Coult er) and a QBC centrifugal haematology system(Becton-Dic kinson Diagnostic system). The density of the parasite attack was determined by counting the number of asexual parasites against 100 leucocytes on the thick blood film and converted to parasite/µl assuming the total white blood cell count to be 8000 leucocytes/µl. Parasite Density = Nu mber of parasites present X 8000 Average WBC count per µl of blood1 – 10 parasites/ 100 hpf was regarded as(+) or mild infection11-100 parasites/ 100hpfwas regarded as (++)or moderate infect ion1-10 parasites/1hpf of blood as (+++) or severe infection. 2.5. Ethical Considerati on Institutional approval was obtained from University of Benin Teaching Hospital to conduct the research in the antenatal clinic o f Obstetrics and Gynaecology department. 2.6.Statistical Analysis Statistical analysis of measures of central tendency and dispersion of variables (gestational age, maternal age, parity and fetal birth weight) was performed. Evaluation of the relationship between parasite density and fetal birth weight was analysed by Pearson;s correlation coefficient and statistical significance by students t-test. All analysis was performed using SPSS version 17.0. The level of signifi cance was considered at P<0.05. 3. Results More number of wo men in this study group were in the young and prime reproductive period age category. i.e. < 25 years of age (36%) fo llo wed by 25 - 30 years (33%) and >30 years (31%). Table 1. Demographic and Reproductive Characteristics of Pregnant Women Infected with Malaria (n = 200), Benin, Nigeria, 2009-2010 Ch aract erist ics Age group <25 years 25 – 30 years >30 years Gestational age <37 weeks 37 – 40 weeks >40 weeks Gravida (Birth weight (kg) Primigravidae (2.85±0.158) Multigravidae (3.07±0.039) Su bject s No. % 72 36 66 33 62 31 60 30 112 56 28 14 112 56 88 44 Among the subjects, 56% had a term delivery with gestational age at delivery (37-40) weeks, 30% of the subjects having a preterm delivery (Table I). The primigravid wo men (56%) had the parasitaemia and the mean birth weight of babies (2.85 ± 0.158)kg while the mu ltigrav ida wo men (44%) had babies of mean weight (3.07 ± 0.039)kg. Th is shows that as parity increases, the intensity of the infection decreases and the incidence of low birth weight also decrease (p < 0.05). As shown in the table below (Table II), 48% of the wo men had mild (+) malaria parasitaemia in fection with the mean birth weight (3.29 ± 0.065), 32% had moderate (++) infection with the mean b irth weight (2.86 ± 0.133)kg and 20% of the wo men had a severe (+++) infection with the mean birth weight of their babies (2.17 ± 0.213)kg which is a low birth weight compared to the normal birth weight (≥ 2.5kg). There was a significant decline in fetal birth weight as the density of parasitaemia increased. The babies born by Nwangwa E. K et al.: Association Between M alaria Parasite Density in Pregnancy and 112 Fetal Birth Weight in a University Teaching Hospital mothers with severe (+++) parasitaemia infection were seriously affected as they had very lo w b irth weight (< 2.50kg) as against normal b irth weight. pregnancyis therefore highly encouraged especially in malaria endemic area. Table 2. Association between Malaria parasite density and birth weight Fe talbi rth wei ght (k g) Nu mb er Pe rce ntage s Mil d (+) Primig 11 ravida 2 56 3.29±0.07 (48%) Mul tig ra vi da 88 44 3.43± 0.05(58%) Mode rate (++) 2.86±0.13( 32%)* 3.12±0.67( 30%)* Se vere (+++) 2.17±0.21 (20%)** 2.92±0.21 (12%)** *P<0.05 compared with the Mild Parasitaemia, ** p< 0.05 compared with the Moderate parasitaemia. r=0.7258. 4. Discussions 6. Recommendations It is recommended therefore, that mala ria control practices should form part of safe motherhood and should be sponsored fro m the national health scheme fund and made available and accessible at all levels of health care system. ACKNOWLEDGEMENTS The researchers wish to thank the staff of Obstetrics and Gynaecology department of University of Benin Teaching Hospital for their support and assistance Pregnancy and the physiological changes associated with it has been shown to be a predisposing factor to malaria, its associated maternal anaemiaand the resultant reduction in birth weight. Atypical man ifestation of malaria is co mmon in pregnancy, particularly in the second half of pregnancy. Malaria during pregnancy has been reported to be an important determinant of fetaloutcome[13, 8]. Findings fro m this study indicates that malaria parasitaemia significa ntly (P< 0.05) decreases fetal birth weight; this reduction in fetal b irth weight is highly dependent on the degree of parasitaemia. With increasing nu mber of pregnan cies, the incidence of low birth weight is reduced[14], with primigravida having an average birth weight of 2.85± 0.158kgand multig ravida 3.07±0.039 kg.The increased risk of ma laria a mong primigravidae has been well described[7], and is again seen in this study population. According to Brab in,[13] the reduction in birth weight is usually mo re marked in primigravidae but can extend to second and third gravidae in areas of low malaria transmission [15]. Also in this study most of the subject (56%) had term delivery (37-40 weeks) showing that malaria does not have any significant effect on the gestational age at delivery this was similar to other findings where the two main Plas modiu m species, P. falciparu m and P. vivax, were associated with lowbirth weight, but they do not reduce gestational age [15,16,17,18]. 5. Conclusions It is obvious from this study that malaria parasitaemia in pregnancy has a negative effect on fetal birth weight. Therefore, there is an urgent need for an intensified effort against malaria in pregnancy by the adoption, practice and the sustainability of the measures targeted at preventing malaria transmission in order to guide against the risk of maternal anaemia in pregnant wo men and also to reduce fetal morb idity, still b irth, and in fant mortality that results fro m low b irth weight attributable to malaria during pregnancy. The use of intermittent prophylactic therapy (IPT) in REFERENCES [1] Breman J (2001); The ears of the hippopotamus; M anifestation, determinants and estimates of malaria burden; AM J Trop M ed publisher, New-Jersey [2] Greenwood B M , Greenwood AM , Bradley AK, Byass P, Jammeh K, M arsh K et al. 1987M ortality and morbidity from malaria among children in a rural area of the Gambia, West Africa. Transactions of the Royal Soceity of Tropical M edicine Hygeine; 81: 478-486 [3] WHO (2010). Roll Back M alaria WHO partnership. "Economic costs of malaria" [4] World Health Organization/UNICEF. 2003. Africa malaria report 2003. WHO/CDS/MAL/2003.1093. World Health Organization, Geneva, Switzerland. [5] Hay S, Guerra C, Tatem A, Noor A, Snow R (2004). "The global distribution and population at risk of malaria: past, present, and future". Lancet Infect Dis 4 (6): 327–36.PM ID 15172341. [6] Bray R.S, Anderson M .J., (1979) Falciparum M alaria and Pregnancy. 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