ABSTRACT

Asymptomatic malaria parasitaemia in pregnancy is a major public health challenge responsible

for significant morbidity and mortality in endemic areas. In areas with stable malaria

transmission like Nigeria, the vast majority of infections with Plasmodium falciparum in

pregnancy remain asymptomatic, undetected and untreated with the attendant major impacts on

the mother and the unborn fetus. The aim of this study was to determine the prevalence of

asymptomatic malaria parasitaemia and its associated factors among women attending antenatal

clinics (ANC) in a secondary health facility.

The study was conducted at the General Hospital, Nassarawa-Eggon, Nasarawa State, from June

to August, 2014. Two hundred and forty-two pregnant women were recruited after obtaining an

informed consent and a structured questionnaire was administered to each participant.

CareStartTM Rapid Diagnostic Test (RDT) kits and two thin and thick blood films were used to

identify malaria parasites and estimate density. Haemoglobin levels were estimated using the

packed cell volume (PCV) technique.

A total of 242 pregnant women participated in this study. About half of the women, (48.8%)

were in the reproductive age group of 25 – 34 years,(65. 3%)were civil servants,(34. 3%) had a

primary level of education and (63.2%) were multigravidae. The malaria specie that was

identified in the area was Plasmodium falciparum. The percentage prevalence for malaria

parasitaemia was 22. 7% by microscopy and 25.6% by RDT screening. Age below 25years and

nonusage of LLIN were significantly associated with malaria parasitaemia while primigravidae

and anaemia were not.

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The level of asymptomatic malaria parasitaemia revealed in this study was high. Younger age of

less than 25 years had highest risk of malaria parasitaemia. Failure to use LLIN is associated

with an increased risk of malaria infection. Malaria parasitaemia can be responsible for anaemia

in pregnancy and mother to child transmission of malaria. The performance of RDT for malaria

screening in this study is comparable with Microscopy as the Gold Standard for use in our health

facility.    The administration of IPT should be intensified and routine diagnosis of malaria

infection should be introduced as part of antenatal care strategy in our health facilities.

Keywords: Asymptomatic malaria parasitaemia, pregnant women, LLIN, Nassarawa-Eggon, Nigeria

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CHAPTER ONE

INTRODUCTION

1. 1 Background

Malaria is a common parasitic disease, transmitted mainly by female Anopheles mosquitoes.

Globally, 125 million women and approximately half of the world’s population are at risk of

malaria every year.1 Most malaria cases and deaths occur in sub-Saharan Africa.2 However,

Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected.

In 2014, 97 countries and territories had ongoing malaria transmission.3 Seventy percent of

pregnant women in Nigeria suffer from malaria with maternal and foetal complications.4 Among

the different species of Plasmodium parasites, Plasmodium falciparum is the most prevalent

endemic species within the Nigeria sub-region and the most deadly.5

An increased risk of malaria during pregnancy was observed over 60 years ago,6 and besides

young children, pregnant women remain the main high risk group for malaria in endemic areas.7

Frequency and severity of malaria are greater in pregnant women, than in non-pregnant women,8

and causes serious adverse effects including abortion, low birth weight and maternal anaemia.9

Incidentally malaria infection is more rampant among the primigravidae and secundigravidae

than the Multigravidae.10

In areas of high or moderate transmission, most malaria infections in pregnant women are

asymptomatic and infected women therefore do not present for treatment.11The clinical