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10.06.2023 | Research

High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana

verfasst von: Nsoh Godwin Anabire, Belinda Aculley, Abigail Pobee, Eric Kyei-Baafour, Gordon A. Awandare, Maria del Pilar Quintana, Lars Hviid, Michael F. Ofori

Erschienen in: Infection | Ausgabe 6/2023

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Abstract

Purpose

Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P. falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana.

Methods

The study was conducted during two seasons; October–November 2020 (dry season, n = 124) and May–June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%).

Results

Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia.

Conclusions

Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings.

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World Health Organization. World malaria report 2021. Geneva: World Health Organization; 2021. p. 42–3. Licence: CC BY-NC-SA 3.0 IGO.

Laishram DD, Sutton PL, Nanda N, Sharma VL, Sobti RC, Carlton JM, Joshi H. The complexities of malaria disease manifestations with a focus on asymptomatic malaria. Malar J. 2012;11:1–15.CrossRef

Rogerson SJ, Hviid L, Duffy PE, Leke RF, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007;7:105–17.CrossRefPubMed

Yimam Y, Nateghpour M, Mohebali M, Abbaszadeh Afshar MJ. A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: a challenge for malaria elimination efforts. PLoS One. 2021;16: e0248245.CrossRefPubMedPubMedCentral

Menendez C, Ordi J, Ismail M, Ventura P, Aponte J, Kahigwa E, Font F, Alonso P. The impact of placental malaria on gestational age and birth weight. J Infect Dis. 2000;181:1740–5.CrossRefPubMed

Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001;64:28–35.CrossRefPubMed

Van Geertruyden J-P, Thomas F, Erhart A, D’Alessandro U. The contribution of malaria in pregnancy to perinatal mortality. Am J Trop Med Hyg. 2004;71:35–40.CrossRefPubMed

McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr. 2009;12:444–54.CrossRefPubMed

Grum T, Brhane E, Hintsa S, Kahsay G. Magnitude and factors associated with anemia among pregnant women attending antenatal care in public health centers in central zone of Tigray region, northern Ethiopia: a cross sectional study. BMC Pregnancy Childbirth. 2018;18:1–7.CrossRef

10.

Adam I, ALhabardi NA, Al-Wutayd O, Khamis A. Prevalence of schistosomiasis and its association with anemia among pregnant women: a systematic review and meta-analysis. Parasites Vectors. 2021;14:1–10.CrossRef

11.

Correa-Agudelo E, Kim H-Y, Musuka GN, Mukandavire Z, Miller FD, Tanser F, Cuadros DF. The epidemiological landscape of anemia in women of reproductive age in sub-Saharan Africa. Sci Rep. 2021;11:1–10.CrossRef

12.

Matangila JR, Lufuluabo J, Ibalanky AL, Inocêncio da Luz RA, Lutumba P, Van Geertruyden J-P. Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo. Malar J. 2014;13:1–10.CrossRef

13.

Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr. 2006;83:993–1016.CrossRefPubMed

14.

Stephen G, Mgongo M, Hussein Hashim T, Katanga J, Stray-Pedersen B, Msuya SE. Anaemia in pregnancy: prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania. Anemia. 2018;2018: 1846280.CrossRefPubMedPubMedCentral

15.

Debella A, Eyeberu A, Getachew T, Atnafe G, Geda B, Dheresa M. Perinatal outcomes in anemic pregnant women in public hospitals of eastern Ethiopia. Int Health. 2022;15:274–80.CrossRefPubMedCentral

16.

Kidanto HL, Mogren I, Lindmark G, Massawe S, Nystrom L. Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia. S Afr Med J. 2009;99:98–102.PubMed

17.

Mehrotra M, Yadav S, Deshpande A, Mehrotra H. A study of the prevalence of anemia and associated sociodemographic factors in pregnant women in Port Blair, Andaman and Nicobar Islands. J Fam Med Prim Care. 2018;7:1288.CrossRef

18.

Nyamtema AS, Jong AB-D, Urassa DP, Hagen JP, van Roosmalen J. The quality of antenatal care in rural Tanzania: what is behind the number of visits? BMC Pregnancy Childbirth. 2012;12:1–5.CrossRef

19.

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: summary: highlights and key messages from the World Health Organization’s 2016 global recommendations for routine antenatal care. Geneva: World Health Organization; 2018.

20.

Mosha D, Chilongola J, Ndeserua R, Mwingira F, Genton B. Effectiveness of intermittent preventive treatment with sulfadoxine–pyrimethamine during pregnancy on placental malaria, maternal anaemia and birthweight in areas with high and low malaria transmission intensity in T anzania. Trop Med Int Health. 2014;19:1048–56.CrossRefPubMed

21.

Mikomangwa WP, Oms M, Aklillu E, Kamuhabwa AA. Adverse birth outcomes among mothers who received intermittent preventive treatment with Sulphadoxine-Pyrimethamine in the low malaria transmission region. BMC Pregnancy Childbirth. 2019;19:1–11.CrossRef

22.

Agyeman YN, Newton S, Annor RB, Owusu-Dabo E. Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: a cross-sectional study. PLoS One. 2021;16: e0250350.CrossRefPubMedPubMedCentral

23.

COSMIC Consortium. Community-based malaria screening and treatment for pregnant women receiving standard intermittent preventive treatment with sulfadoxine-pyrimethamine: a multicenter (The Gambia, Burkina Faso, and Benin) cluster-randomized controlled trial. Clin Infect Dis. 2019;68:586–96.CrossRef

24.

Kayentao K, Garner P, van Eijk AM, Naidoo I, Roper C, Mulokozi A, MacArthur JR, Luntamo M, Ashorn P, Doumbo OK. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis. JAMA. 2013;309:594–604.CrossRefPubMedPubMedCentral

25.

Berry I, Walker P, Tagbor H, Bojang K, Coulibaly SO, Kayentao K, Williams J, Oduro A, Milligan P, Chandramohan D. Seasonal dynamics of malaria in pregnancy in West Africa: evidence for carriage of infections acquired before pregnancy until first contact with antenatal care. Am J Trop Med Hyg. 2018;98:534.CrossRefPubMed

26.

Ofori MF, Lamptey H, Dickson EK, Kyei-Baafour E, Hviid L. Etiology of placental Plasmodium falciparum malaria in African women. J Infect Dis. 2018;218:277–81.CrossRefPubMedPubMedCentral

27.

Desai M, Gutman J, Taylor SM, Wiegand RE, Khairallah C, Kayentao K, Ouma P, Coulibaly SO, Kalilani L, Mace KE. Impact of sulfadoxine-pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis. 2016;62:323–33.CrossRefPubMed

28.

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011.

29.

Anabire NG, Aryee PA, Abdul-Karim A, Abdulai IB, Quaye O, Awandare GA, Helegbe GK. Prevalence of malaria and hepatitis B among pregnant women in Northern Ghana: comparing RDTs with PCR. PLoS One. 2019;14: e0210365.CrossRefPubMedPubMedCentral

30.

Ampofo GD, Tagbor H, Bates I. Effectiveness of pregnant women’s active participation in their antenatal care for the control of malaria and anaemia in pregnancy in Ghana: a cluster randomized controlled trial. Malar J. 2018;17:1–15.CrossRef

31.

Severe Malaria Observatory. Knowledge sharing for severe malaria, Ghana; Malaria prevention; 2020. https://www.severemalaria.org/countries/ghana#&gid=4&pid=1%0A. Cited 31 Oct 2022.

32.

Dun-Dery F, Kuunibe N, Meissner P, Winkler V, Jahn A, Müller O. Determinants of the use of insecticide-treated mosquito nets in pregnant women: a mixed-methods study in Ghana. Int Health. 2022;14:619–31.CrossRefPubMedPubMedCentral

33.

Awine T, Malm K, Bart-Plange C, Silal SP. Towards malaria control and elimination in Ghana: challenges and decision making tools to guide planning. Glob Health Action. 2017;10: 1381471.CrossRefPubMedPubMedCentral

34.

Nwaefuna EK, Afoakwah R, Orish VN, Egyir-Yawson A, Boampong J. Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine against submicroscopic falciparum malaria in central region, Ghana. J Parasitol Res. 2015;2015: 959427.CrossRefPubMedPubMedCentral

35.

Rouamba T, Samadoulougou S, Ouédraogo M, Hien H, Tinto H, Kirakoya-Samadoulougou F. Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013 and 2017. Malar J. 2021;20:1–13.CrossRef

36.

Thompson JM, Eick SM, Dailey C, Dale AP, Mehta M, Nair A, Cordero JF, Welton M. Relationship between pregnancy-associated malaria and adverse pregnancy outcomes: a systematic review and meta-analysis. J Trop Pediatr. 2020;66:327–38.CrossRefPubMed

37.

Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther. 2013;11:623–39.CrossRefPubMed

38.

Galatas B, Bassat Q, Mayor A. Malaria parasites in the asymptomatic: looking for the hay in the haystack. Trends Parasitol. 2016;32:296–308.CrossRefPubMed

39.

Orish VN, Onyeabor OS, Boampong JN, Afoakwah R, Nwaefuna E, Acquah S, Sanyaolu AO, Iriemenam NC. Prevalence of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) use during pregnancy and other associated factors in Sekondi-Takoradi, Ghana. Afr Health Sci. 2015;15:1087–96.CrossRefPubMedPubMedCentral

40.

Desai M, Ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, Newman RD. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7:93–104.CrossRefPubMed

41.

Homann MV, Emami SN, Yman V, Stenström C, Sondén K, Ramström H, Karlsson M, Asghar M, Färnert A. Detection of malaria parasites after treatment in travelers: a 12-months longitudinal study and statistical modelling analysis. EBioMedicine. 2017;25:66–72.CrossRef

Titel: High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana
verfasst von: Nsoh Godwin Anabire
Belinda Aculley
Abigail Pobee
Eric Kyei-Baafour
Gordon A. Awandare
Maria del Pilar Quintana
Lars Hviid
Michael F. Ofori
Publikationsdatum: 10.06.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Infection / Ausgabe 6/2023
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-023-02058-z

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High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana