Description
Introduction
Malaria in pregnancy results in adverse pregnancy outcomes including low birth weight and maternal anemia. In Ghana, there has been minimal reduction in these outcomes over the past decade despite improving implementation of recommended control interventions including intermittent preventive treatment using sulphadoxine-pyrimethamine and insecticide treated bed net use. A health facility-based non-interventional study was conducted to identify risk factors contributing to persistent low birth weight and maternal anemia in two regions of Ghana. This study reports on the baseline malaria parasitemia and anemia prevalence and associated factors.
Methodology
A total of 5196 pregnant women of all parities, ages and gestational age were enrolled consecutively at booking antenatal care visit between 2018 and 2020 in Ashanti and Volta regions of Ghana after obtaining their written informed consent. Data were collected electronically on socio-economic and demographic characteristics, obstetric history, ITN ownership and use and presenting complaints. Full blood count and malaria parasitemia determination by microscopy were done while HIV, sickling, syphilis, G6PD and Hepatatis B surface antigen test results were obtained from their maternal and child health record books. Urine and stool samples were also collected for parasite determination. Descriptive and inferential statistics were conducted using STATA version 16 to determine risk factors of malaria parasitemia and anemia at booking antenatal care visit.
Results and discussion
The mean (SD) age and gestational age were 27.3 (6.5) years and 15.5 (8.37) weeks respectively and 54.9% were multigravidae. Bed net use was lower than ownership; 59.8% versus 80.8%. Overall malaria prevalence was 5.7%, comparable to current reports in the country and globally; but higher in Ashanti region compared to Volta region (10.24% [95% CI: 8.92 – 11.68] versus 2.63% [CI: 2.07 – 3.29]). Conversely, parasite density was lower in Ashanti (982/µl) than Volta region (18226/µl) possibly due to reduced induced antimalarial antibodies in the lower prevalence area. Overall, 55.2% had anemia; higher in Volta region (65.6% [95% CI: 63.78 – 67.31]) than in Ashanti (42.6% [95% CI: 40.53 – 44.60]). Lower socio-economic status, younger age and submicroscopic parasitemia, reported to be higher in lower transmission areas, may contribute to higher maternal anemia prevalence in Volta region.
The study region, gestational age at booking, wealth status, gravidity and reporting a clinical symptom were risk factors for malaria infection while study region, gestational age at booking, wealth status, maternal age and malaria infection were associated with maternal anemia at multivariate analyses stage.
Conclusions
There is low malaria prevalence supporting Ghana’s move towards malaria elimination. Maternal anemia however is of serious public health magnitude among pregnant women. Targeted interventions focusing on regional and local contextual factors are essential for malaria elimination and anemia in pregnancy control. Sub-microscopic malaria infection and gametocyte carriage in pregnancy’s contribution to malaria transmission need investigation to inform malaria elimination strategies.
Acknowledgements
1. Sponsors: Wellcome Trust [WT: 1077741/A/15/Z], UK Foreign, Commonwealth & Development Office, with support from DELTAS Africa program.
2. Regional and district health directorates, heads of health facilities and antenatal clinics and pregnant women in Ashanti and Volta Region.
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