Placental Plasmodium Parasitemia and Pregnancy Outcome In Asymptomatic Parturients at Term In A Tertiary Institution South East Nigeria

Background: Malaria in pregnancy is a major public health problem in sub-Saharan Africa and can result in placental malaria with its associated adverse pregnancy outcomes.Method: This was a case control study involving 190 consenting, asymptomatic, booked parturients, recruited consecutively at 36 week. The aim was to determine the effect of placental malaria on pregnancy outcome in asymptomatic women delivering at term. The participants were screened for malaria parasites using peripheral blood film. Based on their results, the participants were grouped into parasitemia positive cases (Group 1) and parasitemia negative controls (Group 2). Both groups were then followed up in the clinic till they presented in labour at term. In labour, participants’ peripheral venous blood sample were collected and used to determine intrapartum haematocrit and peripheral parasitemia. After delivery, cord blood and a section of the placenta were collected for investigation. Data analysis: Collected data were analysed using Statistical Product and service solutions (SPSS) software (version 20). Numerical variables were presented as mean and standard deviation (Mean SD), while categorical variables were presented as numbers and percentages. Chi-square test(X2) was used to compare qualitative variables. Odds ratio (OR) and Confidence interval(CI) were used to observe the odds of outcomes. A p-value 0.05 was considered statistically significant.Results: The prevalence of placental malaria and congenital malaria were 41.05% and 29.47% respectively. Birth weight, APGAR score, NICU admission or congenital malaria were not statistically significant between the two groups. The mean birth weight was 3.16 ± 0.5 kg while 17.89% had low birth weight. There was also no significant difference between the two groups in terms of the association of placental parasitaemia and maternal anaemia or dose of IPT taken. There was no significant association between placental parasitaemia and low parity. Multivariate logistic regression analysis of maternal anaemia and low birth weight showed significant placental parasitaemia in both cases (p = 0.004). Conclusion: Placental parasitaemia is a major complication of malaria in pregnancy and is associated with adverse feto-maternal effects. Early booking and uptake of intermittent preventive therapy with sulphadoxine-pyrimethamine may help reduce the adverse effects.

1344Interbirth interval and maternal anaemia in 21 sub-Saharan African countries: a multinational cross-sectional study

Background Anaemia is a global public health problem, which disproportionately affects women in sub-Saharan Africa (SSA). The causes of anaemia are multifactorial, and a short interbirth interval has been identified as a potentially modifiable risk factor. However, the current evidence for the association between interbirth interval and maternal anaemia remains inconclusive. Hence, this study aimed at examining the association between the interbirth interval and maternal anaemia in SSA. Methods We conducted a multinational cross-sectional study of interbirth interval (time between two singleton live births) and maternal anaemia for 21 SSA countries using the most recent nationally representative Demographic and Health Surveys, 2010-2017. Modified Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (CIs) after adjusting for confounding variables. Results There were 81,693 women included in the study (89.2% nonpregnant, 10.8% pregnant and 32.2% postpartum). Overall, 36.9% of women had anaemia (36.0% of non-pregnant, 44.3% pregnant, and 38.7% of postpartum women). Compared to a 24-35 months interbirth interval, maternal anaemia was not associated with short (<24 months) interbirth intervals (aRR 1.01, 95% CI; 0. 98, 1.04) or long (≥60 months) interbirth interval (aRR 1.00, 95% CI 0.96, 1. 04). Conclusions Our finding revealed insufficient evidence that both short and long birth intervals were associated with the risk of maternal anaemia in SSA. Key messages It is unlikely that the high prevalence of maternal anaemia in SSA can be reduced by avoiding short nor long interbirth intervals.

Obstetric factors associated with anaemia in pregnancy in a primary health center in south-south Nigeria

Anaemia has been reported as one of the commonest medical complications associated with pregnancy in the developing countries. It increases maternal, fetal and neonatal morbidity and mortality significantly. In Nigeria, maternal anaemia usually predates the period of pregnancy in the life of most of the mothers. These women succumb to early unprepared marriage, give birth to many children with poor child spacing and due to poverty and ignorance they book late for antenatal. This study determines the obstetric factors associated with anaemia in pregnancy in a primary health centre in Port Harcourt in order to create awareness on maternal anaemia and the need to institute preventive and therapeutic measures. Methods: This is a cross-sectional; hospital- based study. A total of two hundred and twenty-seven pregnant women attending the antenatal clinic were enrolled into the study at booking in a primary health centre. Data was collected by administrating questionnaires. Blood sample was collected for haemoglobin estimation. Means were compared using z-test and statistical significance was set at P<0.05. Results: Out of the 227, 111(48.9%) were primigravida, most of whom were anaemic (65.8%). Majority of the women booked in the second trimester 135 (59.3%) and those that booked at the third trimester were more anaemic (70.9%). Pregnant women with birth interval of <1(66.7) and > 4years (78.6%) were mostly anaemic Conclusion: Anaemia in pregnancy especially for those living in developing countries can be reduced if women are educated on the need for proper nutrition before pregnancy and on early ante-natal booking.

Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border: Results from a retrospective cohort

Background Soil-transmitted helminth (STH) infections are widespread in tropical and subtropical regions. While many STH infections are asymptomatic, vulnerable populations such as pregnant women face repercussions such as aggravation of maternal anaemia. However, data on prevalence and the effect of STH infections in pregnancy are limited. The aim of this analysis was to describe the burden of STH infections within and between populations of pregnant women from a local refugee camp to a mobile migrant population, and to explore possible associations between STH infection and pregnancy outcomes. Methodology This is a retrospective review of records from pregnant refugee and migrant women who attended Shoklo Malaria Research Unit antenatal care (ANC) clinics along the Thailand-Myanmar border between July 2013 and December 2017. Inclusion was based on provision of a stool sample during routine antenatal screening. A semi-quantitative formalin concentration method was employed for examination of faecal samples. The associations between STH mono-infections and maternal anaemia and pregnancy outcomes (i.e., miscarriage, stillbirth, preterm birth, and small for gestational age) were estimated using regression analysis. Principal findings Overall, 12,742 pregnant women were included, of whom 2,702 (21.2%) had a confirmed infection with either Ascaris lumbricoides, hookworm, Trichuris trichiura, or a combination of these. The occurrence of STH infections in the refugee population (30.8%; 1,246/4,041) was higher than in the migrant population (16.7%; 1,456/8,701). A. lumbricoides was the predominant STH species in refugees and hookworm in migrants. A. lumbricoides and hookworm infection were associated with maternal anaemia at the first ANC consultation with adjusted odds ratios of 1.37 (95% confidence interval (CI) 1.08–1.72) and 1.65 (95% CI 1.19–2.24), respectively. Pregnant women with A. lumbricoides infection were less likely to miscarry when compared to women with negative stool samples (adjusted hazard ratio 0.63, 95% CI 0.48–0.84). STH infections were not significantly associated with stillbirth, preterm birth or being born too small for gestational age. One in five pregnant women in this cohort had STH infection. Association of STH infection with maternal anaemia, in particular in the event of late ANC enrolment, underlines the importance of early detection and treatment of STH infection. A potential protective effect of A. lumbricoides infection on miscarriage needs confirmation in prospective studies.

Anaemia prevalence and determinants in under 5 years children: findings of a cross-sectional population-based study in Sudan

Background Early childhood is an age at risk of anaemia and its deleterious consequences. In Sudan, there is limited evidence on the prevalence and determinant of anaemia in under-five children. This study was conducted in Sudan to assess the prevalence of anaemia in children and to identify its determinants. Methods We conducted a household survey involving children aged 6 months to 5 years in November 2016. A representative population was sampled across rural, urban and camps settlements across 18 states in Sudan. We used a pre-designed questionnaire data collection. Haemoglobin (Hb) level and malaria infection were checked. In this cross-sectional study, we dichotomized the outcome variable and performed logistic regression analyses. Results A total of 3094 children under 5 years enrolled in the study, 1566 (50.6%) of them were female and 690 (22.3%) of them were under 2 years old. Anaemia prevalence in the whole cohort (6 months - < 5 years) was 49.4% and the mean haemoglobin concentration was 108.1 (standard deviation (SD): 15.4) g/L. The prevalence in younger (6 months - < 2 years) children (61.9%) was higher than in older (2 - < 5 years) children (45.6%) (p < 0.001). Severe anaemia (Hb < 70 g/L) prevalence in the whole population was 1.6%. Age (Odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.75–2.90, p < 0.001), type of place of residence (OR 0.37, 95%CI 0.18–0.74, p = 0.005), maternal anaemia (OR 1.74, 95%CI 1.39–2.17, p < 0.001), and malaria infection (OR 2.82, 95%CI 1.56–5.11, p < 0.001) were the identified predictors of anaemia in the whole cohort. In younger children, only the economic class was an anaemia predictor, with a lower anaemia risk among the rich wealth class (OR 2.70, 95%CI 1.29–5.62, p = 0.008). However, in older children, three anaemia predictors were identified. These are maternal anaemia (OR 1.79, 95%CI 1.40–2.28, < 0.001), malaria infection (OR 2.77, 95%CI 1.48–5.21, p = 0.002), and type of residency (where camps’ residents were less likely affected with anaemia than rural children (OR 0.38, 95%CI 0.17–0.87, p = 0.022)). Conclusions About half of the under-5 children in Sudan are anaemic, with worse prevalence in younger children. Efforts targeted at improving socio-economic status, decreasing maternal anaemia and childhood malaria infection may mitigate this alarming trend.

Mapping of anaemia prevalence among pregnant women in Kenya (2016–2019)

Background Reducing the burden of anaemia is a critical global health priority that could improve maternal outcomes amongst pregnant women and their neonates. As more counties in Kenya commit to universal health coverage, there is a growing need for optimal allocation of the limited resources to sustain the gains achieved with the devolution of healthcare services. This study aimed to describe the spatio-temporal patterns of maternal anaemia prevalence in Kenya from 2016 to 2019. Methods Quarterly reported sub-county level maternal anaemia cases from January 2016 – December 2019 were obtained from the Kenyan District Health Information System. A Bayesian hierarchical negative binomial spatio-temporal conditional autoregressive (CAR) model was used to estimate maternal anaemia prevalence by sub-county and quarter. Spatial and temporal correlations were considered by assuming a conditional autoregressive and a first-order autoregressive process on sub-county and seasonal specific random effects, respectively. Results The overall estimated number of pregnant women with anaemia increased by 90.1% (95% uncertainty interval [95% UI], 89.9–90.2) from 155,539 cases in 2016 to 295,642 cases 2019. Based on the WHO classification criteria, the proportion of sub-counties with normal prevalence decreased from 28.0% (95% UI, 25.4–30.7) in 2016 to 5.4% (95% UI, 4.1–6.7) in 2019, whereas moderate anaemia prevalence increased from 16.8% (95% UI, 14.7–19.1) in 2016 to 30.1% (95% UI, 27.5–32.8) in 2019 and severe anaemia prevalence increased from 7.0% (95% UI, 5.6–8.6) in 2016 to 16.6% (95% UI, 14.5–18.9) in 2019. Overall, 45.1% (95% UI: 45.0–45.2) of the estimated cases were in malaria-endemic sub-counties, with the coastal endemic zone having the highest proportion 72.8% (95% UI: 68.3–77.4) of sub-counties with severe prevalence. Conclusion As the number of women of reproductive age continues to grow in Kenya, the use of routinely collected data for accurate mapping of poor maternal outcomes remains an integral component of a functional maternal health strategy. By unmasking the sub-county disparities often concealed by national and county estimates, our study findings reiterate the importance of maternal anaemia prevalence as a metric for estimating malaria burden and offers compelling policy implications for achieving national nutritional targets.