Abstract

Background: Malaria in pregnancy (MIP) is a major public health problem in endemic areas of sub Saharan Africa and has important consequences on birth outcome resulting to high morbidity and mortality. Because malaria is a complex phenomenon and malaria epidemiology is rapidly changing additional evidence is still required to understand how best to control malaria. This study followed a cross section of pregnant women who had access to the LRH, ANC unit

Method: From the month of April to June 2019, pregnant women were enrolled in a cross sectional study. During routine ANC activity, they were test for malaria. At delivery, the babies were placed on a balance to determine their birth weights.

Result: Overall 200 pregnant women, 24(12%) were positive for malaria, and 54 participants among the 200 gave birth in the maternity unit in the LRH, 4 of which were positives and 1 of the babies was delivered with low birth weight. The prevalence was significantly low in women who used a combination of insecticides, treated mosquito nets and indoor residual spray. Malaria was significantly more prevalent in the second trimester. Also the prevalence was low in women who came for routine ANC visit and in women who have taken fansida. The prevalence of low birth rate occurs more in women affected with malaria in the third trimester.

Conclusion: The low prevalence doesn’t signify malaria eradication. The ministry of public health should organize a campaign which will be used to sensitize women on early booking for ANC, hence prompt malaria detection and treatment should be offered to pregnant women regardless of symptoms or other preventive measures used during pregnancy and with increased focus on mothers living in the remote areas.

CHAPTER ONE

INTRODUCTION

1.1 Background Of The Study

Despite increase malaria control efforts, recent reports indicate that over 1.2 million deaths due to malaria in 2010. Pregnant women represent a particularly vulnerable risk group as malaria infection can lead to life threatening diseases for both the mother and the fetus with 125 million women at risk of malaria in pregnancy (MIP) year; better diagnostic tools are needed for timely identification and treatment malaria infection. About 1700 cases of malaria are diagnosed each year in the US, with the most of the cases from migrants and travelers from countries with high rate of transmission. [1] Malaria infection during pregnancy is a significant public health problem with substantial risk for pregnant woman, her fetus and the new born child. Malaria associated maternal illness and low Birth weight is mostly the result of plasmodium falciparum infection and occurs predominant in Africa. [2] In Cameroon, malaria has prevalence rate of 29%. It is the major cause of morbidity and mortality among children under five (18%), pregnant women (5%), people living with HIV/AIDS (5.5%) and lastly poor (40%) which constitutes about two third of the total population estimated to about 19million. Approximately one million cases of malaria occur each year in Cameroon, accounting for than 59% morbidity among children below five years of age about 40 to 45% of medical consultations, 30 to 47%. [3] it is also responsible for 49% of parental consultation and 59% of hospitalization during pregnancy. [4]

MiP is thought to affect birth outcomes through two mechanisms, intrauterine growth restriction (IUGR) and preterm delivery, which might – at least partially – explain these discordant findings. It has been estimated that MiP in settings with stable malaria transmission in Africa is potentially responsible for up to 70% of IUGR and36% of preterm delivery [5]. The former has been consistently associated with placental infection [6,7,8,9,10,11,12,13], while the latter appears to correlate with systemic manifestations of malaria infection in the mother [14,15,16]. However, accurate determination of gestational age is required to distinguish IUGR from preterm delivery—a determination that is difficult to make in resource-constrained settings, where tools such as ultrasound are rarely available. As a result, evidence of the relative importance of IUGR versus preterm delivery due to MiP remains limited [17].

In recent years control of MiP has relied partly on intermittent preventive treatment (IPT), with WHO currently recommending at least two doses with sulphadoxine-pyrimethamine (SP) [18]. However, growing resistance of malaria parasites to SP in many regions [19,20], combined with the changing epidemiology of malaria, indicate that other prevention approaches must be strengthened. To help fill the evidence gap regarding the impact of MiP on delivery outcomes in accurately dated pregnancies, this study reports on the findings from a prospective cohort of pregnant women with access to weekly antenatal malaria screening and prompt treatment.

1.2 Problem Statement

Malaria in pregnancy is a life threatening disease or saheataron that can lead to a serious pregnancy complication on both the mother and the fetus not living out the new born baby or neonate. Such as dystosia, low birth weight baby, maternal anemia which are consequences of malaria in pregnancy the prevalence of malaria and the impact on the fetus and pregnancy outcome has been well demented in many African Countries, few studies have evaluated the prevalence of malaria in pregnant women in Cameroon. This research proposal is air at determining the prevalence of malaria in pregnant women and the effect of weight on the pregnancy outcome in women attending the Regional Hospital Limbe.

1.3 Rational

MiP is a major public health problem in Cameroon. The Epidemeological profile of malaria in Cameroon ranges from the geographical and climatic regions which includes an endemic and perennial transmission zone occupying the Southern Equatorial forest, the Coastal and Western Plateau with 7-12 months of rainfall, an endemic and seasonal transmission zone in Adamawa Plateau, and Savana forest with 4-6 months of rainfall and lastly an epidemic and strong seasonal occupying Sadano-suda-sahelian region with 1-3 months of rainfall. The goal of this study is to evaluate malaria associated in pregnant women as well as the effect of low birth weight of the newborn in women at risk. Without research such as this one, we are unlikely to improve our understanding on how to prevent or predict effects and outcome of malaria in pregnancy and deliver proper management, increase survival and improve quality of care so as to reduce the burden of the

disease.

1.4 Objective of The Study

1.4.1 General Objectives

To determine the prevalence of malaria in pregnant women and the effect on the weight of the pregnancy outcome in the Limbe Regional Hospital.

1.4.2 Specific Objectives

1. To determine the prevalence of malaria in pregnant women attending the Limbe Regional Hospital.
2. To determine the effect of weight on the pregnancy outcome.
3. To determine the effect on the pregnancy outcome as neonate.
4. To determine the prevalence of malaria with demographic obstetric and gynecologic factors.

1.5 Research Question

1. What is the prevalence of malaria in pregnant women attending ANC in the Limbe Regional Hospital?
2. How will malaria in pregnancy turn to affect the birth weight of the pregnancy out come?

1.6 Hypothesis

1.6.1    Null Hypothesis

The prevalence of malaria in pregnancy and the effect of low birth weight of the pregnancy outcome are low

1.6.2 Alternative Hypothesis

The prevalence of malaria in pregnancy and low birth weight of the pregnancy outcome are high.