Background
Methods
Results
Parameter | All | Primiparae | Parae II & III | Multiparae (>III) |
P
|
---|---|---|---|---|---|
No. (%) | 839 (100) | 304/832 (36.5) | 305/832 (36.7) | 223/832 (26.8) | |
Age (years; median, range; n = 827) | 25 (15–47) | 21 (15–36) | 25 (18–40)* | 33 (22–47)* | < 0.0001 |
Residence in Agogo (%, No.) | 48.9 (410) | 48.7 (148/304) | 54.8 (167/305) | 41.3 (92/223) | 0.009 |
Proportion without school degree (%, No.) | 15.4 (128/829) | 8.6 (26/302) | 14.6 (44/302)* | 26.0 (57/219)* | < 0.0001 |
Axillary temperature (°C; mean ± SD; n = 826) | 36.4 ± 0.5 | 36.5 ± 0.6 | 36.4 ± 0.5 | 36.4 ± 0.5 | 0.32 |
Fever (%, No.) | 2.8 (23/826) | 4.0 (12/300) | 1.7 (5/302) | 2.7 (6/129) | 0.22 |
Haemoglobin (g/dL; median; range) | 11.5 (4.6–16.8) | 11.4 (4.6–16.4) | 11.6 (5.8–16.8) | 11.5 (4.7–15.6) | 0.28 |
Anaemia (haemoglobin <11 g/dL) | 35.2 (295) | 38.5 (117/304) | 32.5 (99/305) | 35.0 (78/223) | 0.30 |
No. of previous ANC visits (median, range, n = 821) | 4 (0–12) | 3 (0–11) | 4 (0–12)* | 4 (0–10) | 0.01 |
Proportion with ≤3 ANC visits (%, No.) | 47.7 (392/821) | 52.5 (156/297) | 43.1 (129/299)* | 47.9 (105/219) | 0.07 |
Caesarean section (%, No.) | 22.1 (185) | 21.7 (66/304) | 19.0 (58/305) | 26.5 (59/223) | 0.12 |
Birth weight (g; median, range; n = 838) | 2950 (1280–4500) | 2785 (1280–4000) | 3000 (1600–4250)* | 3100 (1500–4500)* | <0.0001 |
Gestational age (weeks; median, range; n = 831) | 38.4 (20.0–43.1) | 38.4 (20.0–43.1) | 39.0 (32.0–43.1)* | 39.4 (27.0–42.1)* | 0.0001 |
Low birth weight (LBW) | 16.0 (134/837) | 26.0 (79/304) | 10.9 (33/304)* | 9.4 (21/223)* | < 0.0001 |
Preterm delivery | 18.8 (156/831) | 26.3 (80/304) | 16.0 (48/300)* | 12.2 (27/221)* | < 0.0001 |
Proportion with chloroquine in plasma (%, No.) | 22.4 (182/821) | 27.9 (83/298) | 19.1 (57/299)* | 19.4 (42/217)* | 0.02 |
Proportion with pyrimethamine in plasma (%, No.) | 35.0 (287/821) | 35.6 (106/298) | 33.8 (101/299) | 35.9 (78/217) | 0.85 |
Detection and prevalence of Plasmodium falciparum
Parameter | Prevalence of Plasmodium falciparum (%) |
P
| ||
---|---|---|---|---|
Primiparae | Parae II & III | Multiparae | ||
No. | 304 | 305 | 223 | |
Peripheral blood
| ||||
Diagnosic mean | ||||
Microscopy | 27.0 | 16.4* | 11.7* | < 0.0001 |
HRP2 test | 45.4 | 30.5* | 23.8* | < 0.0001 |
PCR | 59.2 | 52.1 | 46.2* | 0.01 |
GMPD (μL, 95%CI) | 740 (481–1137) | 343 (189–623)* | 593 (263–1336) | 0.12 |
Placental blood
| ||||
Diagnostic mean | ||||
Microscopy | 46.1 | 33.1* | 22.0* | < 0.0001 |
Haemozoin | 42.4 | 29.8* | 16.6* | < 0.0001 |
HRP2 test | 50.7 | 37.4* | 32.3* | < 0.0001 |
PCR | 65.1 | 59.7 | 52.0* | 0.01 |
GMPD (/HPF; 95%CI) | 1.2 (0.8–1.8) | 0.6 (0.4–1.1) | 0.4 (0.2–0.7)* | 0.01 |
Stage of infection | ||||
None | 47.4 | 57.7* | 70.9* | |
Resolved | 6.6 | 9.2 | 7.2 | |
Late | 35.9 | 20.7* | 9.4* | |
Early | 10.2 | 12.5 | 12.6 | < 0.0001 |
Factors influencing the presence of placental malaria
Factor | Haemozoin detected (%, fraction) | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|---|
OR (95%CI) |
P
| OR (95%CI) |
P
| ||
Parity | |||||
>1 | 24.2 (128/528) | 1 | 1 | ||
1 | 42.4 (129/304) | 2.3 (1.7–3.2) | < 0.0001 | 1.5 (1.0–2.2) | 0.04 |
Age-group (years) | |||||
>30 | 17.4 (33/190) | 1 | 1 | ||
26–30 | 27.0 (57/211) | 1.8 (1.1–2.9) | 0.02 | 1.7 (1.0–2.8) | 0.04 |
21–25 | 33.9 (82/242) | 2.4 (1.5–4.0) | 0.0001 | 2.1 (1.3–3.5) | 0.003 |
≤20 | 45.7 (84/184) | 4.0 (2.4–6.6) | <0.0001 | 3.0 (1.7–5.2) | 0.0002 |
Season | |||||
Dry | 27.1 (109/402) | 1 | 1 | ||
Rainy* | 34.3 (150/437) | 1.4 (1.0–1.9) | 0.02 | 1.4 (1.1–2.0) | 0.02 |
Association between diagnosis of malaria and its clinical manifestation
Diagnostic tool | No. | Low birth weight | Preterm delivery | Anaemia | ||||||
---|---|---|---|---|---|---|---|---|---|---|
% | OR (95%CI) |
P
| % | OR (95%CI) |
P
| % | OR (95%CI) |
P
| ||
Peripheral blood
| ||||||||||
Microscopy | ||||||||||
Negative | 680 | 15.8 | 18.4 | 32.9 | ||||||
Positive | 159 | 17.0 | 1.1 (0.7–1.8) |
ns
| 20.3 | 1.1 (0.7–1.8) |
ns
| 44.7 | 1.6 (1.1–2.4) | 0.005 |
HRP2 test | ||||||||||
Negative | 553 | 14.3 | 16.5 | 29.5 | ||||||
Positive | 286 | 19.4 | 1.4 (1.0–2.1) | 0.06 | 23.1 | 1.5 (1.1–2.2) | 0.02 | 46.2 | 2.1 (1.5–2.8) | <0.0001 |
PCR | ||||||||||
Negative | 395 | 14.2 | 17.9 | 25.6 | ||||||
Positive | 444 | 17.6 | 1.3 (0.9–1.9) |
ns
| 19.6 | 1.1 (0.8–1.6) |
ns
| 43.7 | 2.3 (1.7–3.1) | <0.0001 |
HRP2 test if microscopy negative | ||||||||||
Negative | 542 | 14.2 | 16.5 | 29.3 | ||||||
Positive | 138 | 21.9 | 1.7 (1.0–2.8) | 0.03 | 26.1 | 1.8 (1.1–2.9) | 0.01 | 47.1 | 2.1 (1.4–3.2) | <0.0001 |
PCR if microscopy negative | ||||||||||
Negative | 394 | 14.2 | 17.9 | 25.6 | ||||||
Positive | 286 | 17.9 | 1.3 (0.9–2.0) |
ns
| 19.1 | 1.1 (0.7–1.6) |
ns
| 43.0 | 2.2 (1.6–3.1) | <0.0001 |
Placental blood
| ||||||||||
Microscopy | ||||||||||
Negative | 546 | 14.3 | 17.7 | 28.8 | ||||||
Positive | 293 | 19.2 | 1.4 (1.0–2.1) | 0.07 | 20.8 | 1.2 (0.8–1.8) |
ns
| 47.1 | 2.2 (1.6–3.0) | <0.0001 |
Haemozoin | ||||||||||
Negative | 580 | 13.6 | 16.5 | 27.8 | ||||||
Positive | 259 | 21.3 | 1.7 (1.2–2.6) | 0.005 | 23.9 | 1.6 (1.1–2.3) | 0.01 | 51.7 | 2.8 (2.0–3.8) | <0.0001 |
HRP2 test | ||||||||||
Negative | 497 | 12.9 | 16.0 | 27.0 | ||||||
Positive | 342 | 20.5 | 1.8 (1.2–2.6) | 0.003 | 22.8 | 1.6 (1.1–2.2) | 0.01 | 47.1 | 2.4 (1.8–3.3) | <0.0001 |
PCR | ||||||||||
Negative | 341 | 13.5 | 17.5 | 23.8 | ||||||
Positive | 498 | 17.7 | 1.4 (0.9–2.1) |
ns
| 19.7 | 1.2 (0.8–1.7) |
ns
| 43.0 | 2.4 (1.8–3.3) | <0.0001 |
Stage of infection | ||||||||||
None | 482 | 13.5 | 16.7 | 27.0 | ||||||
Resolved | 64 | 20.3 | 1.6 (0.8–3.3) |
ns
| 25.0 | 1.7 (0.9–3.2) |
ns
| 42.2 | 2.0 (1.1–3.5) | 0.01 |
Late | 195 | 21.6 | 1.8 (1.1–2.8) | 0.009 | 23.6 | 1.5 (1.0–2.4) | 0.04 | 54.9 | 3.3 (2.3–4.7) | <0.0001 |
Early | 98 | 14.3 | 1.1 (0.6–2.1) |
ns
| 15.5 | 0.9 (0.5–1.7) |
ns
| 31.6 | 1.3 (0.8–2.1) |
ns
|
Positive diagnosis | Low birth weight | Preterm delivery | Anaemia | |||
---|---|---|---|---|---|---|
aOR (95%CI) |
P
| aOR (95%CI) |
P
| aOR (95%CI) |
P
| |
Peripheral blood
| ||||||
Microscopy | 0.9 (0.6–1.5) |
ns
| 1.1 (0.7–1.7) |
ns
| 1.6 (1.1–2.3) | 0.01 |
HRP2 test | 1.2 (0.8–1.8) |
ns
| 1.4 (0.9–2.0) |
ns
| 2.0 (1.5–2.7) | <0.0001 |
PCR | 1.1 (0.8–1.7) |
ns
| 1.1 (0.7–1.5) |
ns
| 2.1 (1.6–2.9) | <0.0001 |
HRP2 test if microscopy negative | 1.5 (0.9–2.5) |
ns
| 1.7 (1.0–2.7) | 0.03 | 2.1 (1.4–3.2) | 0.0002 |
PCR if microscopy negative | 1.2 (0.8–1.9) |
ns
| 1.0 (0.7–1.6) |
ns
| 2.0 (1.4–2.8) | <0.0001 |
Placental blood
| ||||||
Microscopy | 1.1 (0.7–1.7) |
ns
| 1.1 (0.7–1.6) |
ns
| 2.2 (1.6–2.9) | <0.0001 |
Haemozoin | 1.3 (0.8–1.9) |
ns
| 1.3 (0.9–1.9) |
ns
| 2.8 (2.0–3.9) | <0.0001 |
HRP2 test | 1.5 (1.0–2.2) | 0.04 | 1.4 (1.0–2.1) | 0.055 | 2.3 (1.7–3.2) | <0.0001 |
PCR | 1.2 (0.8–1.9) |
ns
| 1.1 (0.8–1.6) |
ns
| 2.4 (1.7–3.3) | <0.0001 |
Stage of infection | ||||||
Resolved | 1.5 (0.8–3.0) |
ns
| 1.5 (0.8–2.9) |
ns
| 2.0 (1.1–3.4) | 0.02 |
Late | 1.2 (0.8–1.9) |
ns
| 1.2 (0.8–1.9) |
ns
| 3.4 (2.3–4.9) | <0.0001 |
Early | 1.1 (0.6–2.1) |
ns
| 1.0 (0.5–1.8) |
ns
| 1.2 (0.8–2.0) |
ns
|