Thesis
Background: Malaria infection in pregnancy is an enormous public health problem in Sub-Saharan Africa. In areas of high malaria transmission, P. falciparum infection during pregnancy is usually characterized by malaria related anemia in the mother and placental malaria. This situation has been associated with poor pregnancy outcomes across many populations. The aim of this study was to determine the extent of asymptomatic P. falciparum infection and its relation with anemia in healthy pregnant women living in Kinshasa, Democratic Republic of the Congo, an endemic area for malaria transmission.
Methods: A cross-sectional study was conducted in healthy pregnant women attending prenatal care consultations. Information on socio-demographic characteristics was collected using a questionnaire. P. falciparum infection was diagnosed using Rapid diagnostic test (RDT), microscopy and Polymerase Chain Reaction. Hemoglobin concentration was determined at the same time. Bivariate and multivariate logistic regression models were used to determine the association between variables.
Results: From 332 pregnant women enrolled, complete RDT and microscopy data was available for 332 blood samples and of these 166 samples were analyzed by PCR. The prevalence of asymptomatic P. falciparum infection using microscopy TBS, RDTs and PCR, were respectively 21.6% (95% CI 17.4-26.6%), 27.4% (95% CI 22.7-32.6%) and 29.5% (95% CI 22.7-37.1%). The medium parasite density was 126 (IQR =105-162). Women who spent last night under a mosquito net were less likely to have asymptomatic P. falciparum infection compared to women who did not use a mosquito net (OR 0.1; 95%CI:0.03-0.5, p<0.01); being less than 20 years was strongly associated with asymptomatic P. falciparum infection (AOR 2.6; 95% CI 1.1-6.1, P=0.04) and married women were less likely to have asymptomatic P. falciparum infection than single women (AOR 0.3; 95% CI 0.1-0.9, p = 0.02).Prevalence of anemia was 61.1%. The likelihood of having anaemia for pregnant women with asymptomatic malaria was about 3.8 times more AOR 3.8 (95% CI 1.0-14.8; p=0.04).
Conclusion: These alarming results emphasize the need to actively diagnose and treat asymptomatic malaria infection during prenatal care visits, regardless of Intermittent Preventive Treatment with Suldoxine-Pyrimethamine, and to increase efforts in promoting the use of Insecticide Treated Nets in DRC.
Sokoine University of Agriculture