The Rate of Asymptomatic Plasmodium Parasitemia and Placental Parasitization in Urban and Rural Areas of Cross River State, Nigeria

Abstract

BACKGROUND: Malaria in pregnancy contributes to feto-maternal morbidity and mortality even in asymptomatic forms of the disease especially in malaria endemic regions such as Nigeria. AIM: The study aims to determine the rate of asymptomatic malaria parasitemia and placental parasitization among the rural and urban pregnant women and its feto-maternal effects in Cross River State, Nigeria. METHODOLOGY: This was a prospective study of 440 pregnant women in rural and urban settings. Participants completed structured questionnaire and also have their blood samples and placentas examined for presence of malaria parasites by microscopy and histology, respectively. Maternal hemoglobin concentration, birth weight, neonatal length, Apgar score, and other anthropometric measurements were obtained to assess feto-maternal effects of asymptomatic malaria parasitemia and placental parasitization in pregnancy. Data were analyzed using SPSS version 21.0, and level of significance was set as 0.05. RESULTS: The prevalence of asymptomatic malaria parasitemia was 40.2% while malaria placental parasitization was 70.2%. Based on residential status, 49.5% of rural residents had malaria parasitemia which is significantly higher than their urban resident counterparts 30.9% (p = 0.000). The prevalence of placental parasitization was significantly higher among rural residents 80.9% than their urban resident counterparts 59.5% (p = 0.000). Concerning obstetric outcome of patients with positive malaria placental parasitization, preterm delivery, low 5th min Apgar score (<7), low birth weight (<2.5 kg), and low neonatal length were significantly higher in pregnancy with positive placental parasitization than in women with negative placental malaria parasitization. Furthermore, preterm delivery, anemia, low 5th min Apgar score (<7), and low birth weight (<2.5 kg) were significantly higher in pregnancy with positive malaria parasitemia than women with negative malaria parasitemia. CONCLUSION: Asymptomatic malaria parasitemia (40.2%) and malaria placental parasitization (70.2%) in this study were high and contributes to poor obstetric outcomes mostly in the rural areas. Rural pregnant women have the highest burden than the urban women. Promotion of the use of insecticide treated nets, intermittent preventive treatment during pregnancy and other malaria preventive measures are necessary especially in rural areas where malaria burden is highest.