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PrevalenceofMalariaandAnemiaamongPregnantWomenAttendingaTraditionalBirthHomeinBeninCity,Nigeria

OmanMedJ.2012May27(3):232236.

PMCID:PMC3394357

doi:10.5001/omj.2012.52

PrevalenceofMalariaandAnemiaamongPregnantWomenAttendingaTraditional
BirthHomeinBeninCity,Nigeria
BankoleHenryOladeinde, 1,*RichardOmoregie, 2IkponmwosaOdia, 3andOladapoBabatundeOladeinde4
1
DepartmentofMedicalMicrobiology,CollegeofHealthSciences,IgbinedionUniversity,Okada,EdoState,Nigeria.
2
SchoolofMedicalLaboratorySciences,UniversityofBeninTeachingHospital,P.M.B1111,BeninCity,EdoState,Nigeria.
3
InstituteofLaserFeverResearchandControl,IrruaSpecialistHospital,Irrua,EdoState,Nigeria.
4
NationalFistulaCenter,Abakiliki,EbonyiState.Nigeria.
*
Addresscorrespondenceandreprintsrequestto:BankoleHenryOladeinde,DepartmentofMedicalMicrobiology,CollegeofHealthSciences,Igbinedion
University,Okada,EdoState,Nigeria.Email:bamenzy@yahoo.com
Received2012Feb24Accepted2012Apr18.
Copyrightnotice

ThisarticlehasbeencitedbyotherarticlesinPMC.

Abstract

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Objectives

Todeterminetheprevalenceofmalariaandanemiaamongpregnantwomenattendingatraditionalbirthcenteras
wellastheeffectofherbalremedies,gravidity,age,educationalbackgroundandmalariapreventionmethodson
theirprevalence.
Methods

Bloodspecimenswerecollectedfrom119pregnantwomenattendingaTraditionalBirthHomeinBeninCity,
Nigeria.Malariaparasitemiawasdiagnosedbymicroscopywhileanemiawasdefinedashemoglobinconcentration
<11g/dL.
Results

Theprevalenceofmalariainfectionwas(OR=4.3595%CI=1.213,15.600p=0.016)higheramongprimigravidae
(92.1%).Pregnantwomen(38.5%)withtertiarylevelofeducationhadsignificantlylowerprevalenceofmalaria
infection(p=0.002).Malariasignificantlyaffectedtheprevalenceofanemia(p<0.05).Anemiawasassociatedwith
consumptionofherbalremedies(OR=2.97395%CI=1.206,7.330p=0.017).Theprevalenceofmalaria
parasitemiaandanemiawerenotaffectedbymalariapreventionmethodsusedbytheparticipants.
Conclusion

Theoverallprevalenceofmalariainfectionandanemiaobservedinthisstudywere78.9%and46.2%,respectively.
Higherprevalenceofmalariainfectionwasassociatedwithprimigravidaeandlowerprevalencewithtertiary
educationofsubjects.Anemiawasassociatedwithconsumptionofherbalremedies.Thereisurgentneedtocontrol
theprevalenceofmalariaandanemiaamongpregnantwomenattendingtraditionalbirthhomes.
Keywords:Pregnancy,MalariaPrevention,Herbaltreatment,Anemia,Traditionalbirthattendants
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394357/

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Introduction

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Atraditionalbirthattendant(TBA)hasbeendefinedasapersonwhoassistsmothersduringchildbirthandwho
initiallyacquiresherskillsbydeliveringbabiesherselforthroughapprenticeshiptootherTBAs.1Theyareknown
toformanintegralpartofmostcommunities,andprovideawindowtolocalcustoms,traditionsandperceptions
regardingchildbirthandnewborncare.2TBAs,predominantlyuneducated,3presentlydeliverthemajorityof
womeninNigeria,asinotherdevelopingcountries.1Itisestimatedthatbetween6080%ofalldeliveriesin
developingcountriesoccuroutsidemodernhealthfacilities,withasignificantproportionoftheseattendedtoby
TBAs.1ThescopeofservicesrenderedbyTBAsarechangingbytheday,asreportsshowingthattheyalso
providecaretopeopleatpuberty,duringpregnancy,labor,andalsogiveadviceaboutchildcare.4
Malariaduringpregnancyisamajorhealthconcernandranksamongthecommonestcomplicationsofpregnancy
inNigeria.5Complicationsofmalariainpregnancyincludehypoglycemia,acutepulmonaryedema,premature
labor,spontaneousabortion,stillbirths,lowbirthweightsandanemia.6Inthelightofthenumerousattendantrisks
ofmalariainpregnancy,WHOrecommendedathreeprongedapproachtothestrategicframeworkformalaria
preventionandcontrolduringpregnancyinareasofstabletransmissioninAfrica.Thisincludestheuseof
insecticidetreatedbednets(ITN),intermittentpreventivetreatment(IPTP)andeffectivecasemanagementof
malariaillnessandanemia.7ReportsshowthatcompliancewiththisrecommendationinNigeriaispoor.8TBAs
arelargelyuneducated,3andmaynotappreciatetheimportanceoftheserecommendations.
Anemiainpregnancyisanimportantpublichealthproblemworldwide,9andparticularlyindevelopingcountries
wherenutritionaldeficiency,worminfestationandmalariaarecommon.10Anemiainpregnancyisawellknown
riskfactorformaternaldeath,stillbirths,lowbirthweights,andfetalimpairment.11Managementandcontrolof
anemiainpregnancyisenhancedbytheavailabilityoflocalprevalencestatistics,whichisnotadequatelyprovided
inNigeria.9Thus,accurateandearlydiagnosisofmalariaillnessiskeytoeffectivemanagementofthedisease.12
MostTBAsdonotfocusondiagnosisinmanagementofdisease,astheyoftenlacktheskillsandfacilitiestodoso.
StudieshavealsoshownthatTBAsarelargelyunabletoprevent,ortreatmostlifethreateningobstetric
complications.13
Againstthisbackgroundandthepaucityofreportsontheprevalenceofanemia,malaria,typeandefficacyof
malariapreventionmethodsemployedbypregnantwomenattendingTraditionalBirthCentersinEdoState,
Nigeria,thisstudywasundertaken.
Methods

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ThestudywascarriedoutfromMaytoAugust2010,aperiodthatcoincideswiththerainyseasoninEdoState,
Nigeria.TargetInstitutionwasaleadingTraditionalBirthCenterlocatedinasuburbanareaofEvbotubuQuarters,
BeninCity,Nigeria.OnehundredandNineteen(119)pregnantwomenwithagerangingfrom1643yearswere
selectedforthisstudy.Selectioncriteriaincludedbeingregisteredinthecenterforatleastonemonth,andnon
attendanceofanyotherconventionalhealthfacility.Adetailedquestionnairewasformedtoassesseducational
statusofthestudypopulation,levelofawarenessanduseofinsecticidetreatedbednets(ITN),aswellasother
preventivemeasurestheytakeagainstmalaria.Thequestionnairealsosoughttofindoutthetypeofantimalaria
drug(Herbalorconventional)usedbythemduringthecourseofpregnancy.
TheherbalmixturegiventothematTBAcenterisAgboIbawhichisknownforitsantimalariapropertiesin
Nigeria.14Dosagewasasprescribedbyresidenttraditionalbirthattendant.Verbalinformedconsentwasobtained
fromallparticipatingpregnantwomenandtheirspouse.EthicalclearanceforthisworkwasgivenbyEdoState
MinistryofHealth,BeninCity.Forspecimencollectionandprocessing5mlofvenousbloodwascollectedfrom
eachpatient,dispensedintoethylenediaminetetraaceticacid(EDTA)container,andmixed.Malariawas
diagnosedbyexaminationofstainedthickbloodfilmsaspreviouslydescribed.15Hemoglobinestimationwas
determinedusingtheSysmexKX21Hematologyanalyzer(SysmexCooperation,KobeJapan).Anemiain
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pregnantwomenwasdefinedasahemoglobinconcentration<11.0g/dl.16
ThedataobtainedwereanalyzedwithChisquare(X2)orFischersexacttestasappropriateandoddratioanalysis
wasdoneusingthestatisticalsoftwareINSTAT.Statisticalsignificancewassetatp<0.05.
Results

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Atotalof94(78.9%)ofthe119pregnantwomenwereinfectedwiththemalariaparasite.Theprevalenceof
malariaparasitemiadidnotdiffersignificantlybetweensubjectsthatconsumedAgboIbasolelyandthosethat
consumedAgboIbaalongsideotherconventionalmedications.Graviditywassignificantlyassociatedwithmalaria
parasitemia(OR=4.35095%CI=1.213,15.600p=0.016)withhigherprevalenceamongprimigravidaesubjects.
Theprevalenceofmalariaparasitemiawassignificantlyloweramongpregnantsubjectswithtertiarylevelof
educationcomparedwithsubjectswithotherlevelsofeducation(p=0.002).Theageofthestudiedsubjectsdidnot
affecttheprevalenceofmalariaparasitemia(p=0.114).(Table1)
Table1
Effectofage,gravidity,educationalstatusandmalariamanagement
methodonprevalenceofmalariaparasiticinfectioninpregnant
women.
Theprevalenceofanemiainpregnantwomenwas46.2%,andwassignificantlyaffectedbymalaria.Theuseof
AgboIbaalonewasassociatedwithanemia(OR=2.97395%C.I=1.206,7.330p=0.017),[Table2].Gravidity,
ageandeducationalstatusofpregnantwomendidnotsignificantlyaffecttheprevalenceofanemia,(Table2).In
addition,theuseofsomemalariapreventionmethodsdidnotsignificantlyaffecttheprevalenceofmalaria
parasitemiaandanemia.(Tables3and4)
Table2
Effectofage,gravidity,educationalstatus,malariaparasitemiaand
malariamanagementmethodontheprevalenceofanemiainpregnant
women.
Table3
Effectofmalariaparasiteprotectionmethodsontheprevalenceof
malariaamongpregnantwomen.
Table4
Effectofmalariaparasiteprotectionmethodsontheprevalenceof
anemiaamongpregnantwomen.
Discussion

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Malariaandanemiaareassociatedwithseriousmortalityandmorbidityamongpregnantwomen.Despitethefact
thatmostTBAsareuneducated,theyareresponsiblefor6080%ofdeliveriesinthedevelopingworld.1Thisstudy
focusedondeterminingtheefficacyoflocalherbalmixturesusedbyTBAsinthepreventionandtreatmentof
malariainfection.Theprevalenceofmalariaparasitemiaobservedinthisstudy(78.9%),ishigherthanthat
previouslyreported62.4%.17Thedifferencecouldbeduetogeographicallocation,asthestudywascarriedoutin
BeninCitySouthSouthgeopoliticalzone,whilethatofIdowuetal.wasinAbeokutawhichisintheSouthWest
geopoliticalzoneofNigeria.
AgboIbahasbeenreportedtohaveprophylacticactionagainstmalariaparasite.18Howeverinthisstudytheuse
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ofAgboIbaeithersolelyorincombinationwithconventionalantimalarialdrugsdidnotshowanysignificant
differenceintheprevalenceofmalaria.Itispossiblethatthestrainofplasmodiumfalciparum(theonlyspeciesof
plasmodiaobservedinthisstudy)isresistanttoAgboIba,as85.2%ofpregnantwomenwhotookAgboIbaalone
hadmalariaparasitemia.Thiswouldrequirefurtherinvestigationtoverify.Thehighprevalenceofmalaria
parasitemiaamongpregnantsubjectsthattookAgboIbaandconventionalantimalariaagentsmayalsoindicate
resistancetoeitheragentsorpossibleantagonisticeffectofbothcombinations.Againthiswillrequirefurther
studiestoverify.Inasimilarvein,theprevalenceofmalariaamongpregnantwomendidnotdiffersignificantly
withintheagerangeofthestudypopulation.
Thefindingthathigherprevalenceofmalariaparasitemiawasassociatedwithprimigravidaestatushadearlierbeen
noted.19,20IthasbeenreportedthatPlasmodiumfalcipariumstrainsmaygetsequesteredintheplacenta.21With
successivepregnancies,womenareexposedtovarietyofstrainsofmalariaparasite,andmaydevelopefficient
mechanismtocontrolinfectionandpreventdisease.22,23Primigravidaewomenhavelowerimmunityagainstthe
strainsofmalariaparasite,hencepresentmorefrequentlywithmalaria.Thereasonsforpeoplewithtertiarylevelof
educationhavingalowerincidenceofmalariaaremultifactorial.Personswithtertiarylevelofeducationaremost
likelytoliveinareasofgoodsanitaryconditionandhygiene.Thatis,areasthatmaynotsupportthebreedingof
mosquitoes.Indeed,fewerpregnantwomenwithtertiaryeducationattendedtheTraditionalBirthHomeinthis
study,andhadtheleastprevalenceofmalaria.Itwasobservedthatthemalariatherapyisnecessarytoimproveor
correctthisanemiccondition.Generallyamongpregnantwomenstudied,malariawasfoundtosignificantlyaffect
theprevalenceofmalaria.Thishasbeenpreviouslydocumented.24Therewasnodifferenceintheprevalenceof
anaemiabetweenprimigravidaeandmultigravidae.Thisisinagreementwithapreviousreport.10
TheprevalenceofanemiaamongpregnantwomenattendingtraditionalBirthHomeinthisstudy(46.2%)islower
thanthatpreviouslyreportedinAbeokuta(81.2%).10Animportantfactortoconsideristhattheetiologyofanemia
ismultifactorial,andthusseveralunderlyingmorbidandcomorbidconditionscouldcausewidevariationsinthe
prevalenceofanemia.Locationmayalsoaccountforthisdisparity.TheuseofAgboIbasolelywassignificantly
associatedwithanemiaamongpregnantwomenattendingtheTraditionalBirthHome.Someantimalarialdrugsare
knowntodestroyredbloodcellsandthenexerttheiractivityagainsttheexposedmalariaparasite.25,26Thismay
bethesamemechanismbywhichAgboIbafunctionshowever,theAgboIbamixturewasnoteffectiveashigh
prevalenceofmalariawasobservedinthisstudy.Toourknowledge,thisisthefirstreportassociatingAgboIba
withanemia.Theconventionaladditionofbloodbuildingsupplementspreventionmethodsusedbythepregnant
womendidnotsignificantlyaffecttheprevalenceofmalariaparasitemiaandanemia.Informationfrom
questionnairerevealedthat10(8.4%)ofthe119pregnantwomenhadknowledgeofinsecticidetreatedbednets,as
amethodofpreventingmalariaparasiteinfection,thoughnoneofthesubjectshadusedany.Thefindingsthatnone
ofthepregnantwomenhadusedInsecticidetreatednetshadpreviouslybeenobserved.17Thereisthereforeneed
fortheGovernmentandotherinterventionagenciestoextendmalariacontrolinterventionprogramstopregnant
womenattendingTraditionalBirthHomeswithfreedistributionofinsecticidetreatedbednets.Thespecific
durationofuseofAgboIbawithorwithoutconventionalantimalariaremedieswasnotnoted.Themalariaand
anemiastatusofpregnantwomenpriortoconsumptionofAgboIbaandthetypeofconventionalantimalariaused
werenotascertained.Thesewerelimitationsobservedtothestudy.
Conclusion

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Inbrief,anoverallprevalenceofmalariaparasitemiaandanemiaof78.9%and46.2%,respectivelywasobserved
inthisstudy.TheuseofAgboIbadidnotsignificantlyaffecttheprevalenceofmalariaparasitemia,butitwas
associatedwithanemia.Prevalenceofmalariaparasitemiawashigheramongprimigravidaeandleastamong
pregnantwomenwithtertiarylevelofeducation.Measurestocontrolmalariainfectionandanemiaamongpregnant
womenattendingTraditionalBirthHomesarenecessary.
Acknowledgements
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394357/

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Theauthorsreportednoconflictofinterestandnofundingwasreceivedforthiswork.
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