The Prevalence of Malaria Among Pregnant Women on Admission in Imo State Specialist Hospital, Owerri
Chapter One
OBJECTIVES OF THE STUDY
The broad objective of this study is to examine the prevalence of malaria among pregnant women on admission to Imo State Specialist Hospital Owerri. Specifically, the study seeks:
- To examine the rate at which malaria is prevalent among residents of Imo State.
- To find out the rate at which malaria affects pregnant women and their unborn children admitted to Specialist Hospitals.
- To ascertain the symptoms of malaria present in pregnant women admitted to specialist hospitals.
- To ascertain the intensity of malaria effect on pregnant women and their unborn children admitted to Specialist Hospitals.
- To determine the complications associated with malaria in Pregnant Women.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.
CONCEPTUAL FRAMEWORK
OVERVIEW OF MALARIA IN PREGNANCY
According to Oxford Medical Dictionary, pregnancy is a period during which a woman harbors a developing foetus normally in the uterus. This last for approximately 266 days from the time of conception till the time of delivery the baby 280 days from the first day of a woman’s menstrual period. It has been observed that malaria in pregnancy has continued to be a scourge in tropical and subtropical region of the world. However, p. Falciparum has been noted to be the most serious form of the disease in pregnancy. (WHO, 1993).
An infectious disease caused by a parasitic protozoan a blood borne parasite the natural ecology of malaria involves malaria parasites infecting successively two types of hosts: humans and female Anopheles mosquitoes. Parasitic infection of red blood cells is caused by Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale.
Malaria remains a great human scourge. Pregnant women and children below 5 are among the most vulnerable groups. Considering the closeness between mother and child, effective measures put in place to protect the mother from malaria could also protect the child and hence reduce the morbidity and mortality related to malaria. The World Health Organization during its Global ministerial conference on malaria in 1992 in Amsterdam, approved a number of control measures which included early diagnosis and prompt effective treatment, chemoprophylax is in susceptible groups, reduction of man vector contact, Information Education and Communication, surveillance and research.
CHAPTER THREE
MATERIALS AND METHODS
Study Area,
This study was carried out in Imo State, Nigeria. Imo state situates in south eastern Nigeria. It enjoys a teaming population of young men and women engaged in all walks of life. It comprises of 3 political zones: Owerri, Orlu and Okigwe.
Test Samples
The samples used for this study are blood samples collected from pregnant women registered for ante natal care (ANC) at the Federal Medical Centre Owerri, Imo State University Teaching Hospital Orlu and Okigwe General Hospital.
Population of the study
A total of 3000 pregnant women aged 18 to 45 years registered for ante – natal care at the selected health institutions in the three zones of Imo State (Owerri, Orlu and Okigwe) were randomly selected for the study. The objectives of the study were carefully explained to the participants and their willingness to participate in the study was sought for and those who voluntarily accepted to be included in the study were selected.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
INTRODUCTION
Out of 3000 pregnant women targeted for this study, 2,871 (95.7%) gave full consent and consequently participated in the study. One hundred and twenty nine (4.3%) others did not complete their questionnaires properly or did not donate blood samples for laboratory investigation after completing their questionnaires or declined after giving initial consent to participate in the study.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
SUMMARY
The broad objective of this study is to examine the prevalence of malaria among pregnant women on admission in Imo State specialist hospital Owerri. The study will also ascertain the symptoms of malaria present in pregnant women admitted to specialist hospitals. It will ascertain the intensity of malaria effect on pregnant women and their unborn children admitted to Specialist Hospitals.It will determine the complication associated with malaria in Pregnant Women.
A study in a comparative approach between July to August 2012. Blood samples were collected from the patients and a thick blood film made. The films were stained using parasitological standard procedures. Twenty-five (25) pregnant women in their 1st trimesters had the highest severe parasitaemia with 54.5%. And also primigravidae were also observed to have the highest infection rate with 87.5%. Similarly, the direct stained smear technique showed that 2,301 (80.1%) persons had malaria parasites while the Plasmodium falciparium (pf) antigen test showed that 1,801 (62.7%) persons were positive for malaria due to Plasmodium falciparium.Comparatively, the QBC and slide smear techniques were more effective for parasite detection than the pf antigen test. The age related prevalence showed that pregnant women within the age bracket 18 – 25 years had the highest prevalence (86.1%) of malaria infection, followed by those in the 36 – 40 (82.8%). The least prevalent age group was the 40 years and above group (74.7%) The overall mean infection according to zones showed that Owerri had the highest prevalence (83.9%), followed by Okigwe (72.1%) and Orlu (66.9%). Statistical analysis of the data showed a significant difference (p < 0.05) in the prevalence of plasmodiasis between the three zones of Imo State. Many pregnant women lost their jobs, some could not attend fully their businesses, some missed their religious activities due to malaria in pregnancy. Some women had low birth weight babies, some pre – term delivery etc due to malaria in pregnancy. This study has shown that malaria is a major public health challenge among pregnant women in Imo State Nigeria, leading to inestimable economic and social losses.
CONCLUSIONS
This study showed that malaria is endemic amongst pregnant women in the State and amongst the Imo populace in general. The data available from the State Ministry of Health showed increase in the prevalence of malaria amongst Imo populace and pregnant women in particular. From 2012 to 2013, the prevalence of malaria increased by 65% and dropped in 2014 but rose again from 2014 to 2015 by 104% with a slight drop in 2016 but rose again from 2015 to 2017 by 2.1%. One obvious fact from the available data is that malaria has remained endemic and increases at a very high rate in Imo State over the years. This finding corroborates the report of previous workers (Nwokeocha, 2004) who reported increasing prevalence of malaria amongst children in Imo State. The increasing prevalence of malaria in Imo over the years may be related to deteriorating environment and poor sanitary condition prevalent in Imo State for over a decade now.
RECOMMENDATIONS
From our present day study, we recommend that further research tools be carried out on other antimalarial drug such as sulfadoxine- pyrimethamine, proguanil, within the study area to provide a good surveillance data on antimalarial drug resistance that/which provide stakeholders, involve in malaria control programme arrive at valuable strategies and policies in curtailing drug resistance menace. Also update in surveillance data will help to improve effective control strategies that will prevent a new gene pool of the vector (Anopheles gambiae) thereby resulting in inefficacy of the anti malarial drugs and insecticides.
This study also recommends that patients tested negative for malaria parasitaemia by standard microcopy, who still suffer re-surgencies of malaria fever be retested using both standard microscopy and Rapid Diagnostic Test. This is to prevent misdiagnosis and unnecessary treatment for malaria in many malaria suspected subjects.
Generally, presumptive rule diagnosis should be avoided to enable malaria suspected patient to undergo laboratory test before onset of treatment for malaria. This will help prevent emergence of antimalarial drug resistance resulting due to much exposure of the parasite to the drug leading to a selection under pressure whereby the parasite mutate to circumvent therapeutic effect of the drug.
REFERENCES
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