THE PREVALENCE OF MALARIA AMONG PREGNANT WOMEN ON ADDMISSION IN IMO STATE SPECIALIST HOSPITAL OWERRI

THE PREVALENCE OF MALARIA AMONG PREGNANT WOMEN ON ADDMISSION IN IMO STATE SPECIALIST HOSPITAL OWERRI

ABSTRACT

A study was conducted during July and August 2012 to investigate the prevalence of malaria infection among pregnant women admitted to Imo State Specialist Hospital Owerri. Blood samples were taken from the patients, and a thick blood film was created. The films were stained according to parasitological best practices. The most severe parasitaemia was seen in twenty-five (25) pregnant women in their first trimesters (54.5%). Furthermore, primigravidae were found to have the highest infection incidence of 87.5%.

TABLE OF MATERIALS

The first chapter

Introduction – – – –

Epidemiology and clinical characteristics – – –

Malaria-causing agents

Period of incubation – – – – –

Symptoms and signs

Life cycle – – – – – – – –

Pathogenesis – – –

Malaria – – – –

Malaria treatment and management during pregnancy – – – – –

Obstetric care for malaria-infected pregnant women – – – – –

Antepartum care for malaria-infected pregnant women – – – – – –

Malaria treatment during pregnancy intrapartum

Malaria postpartum management in pregnancy

Malaria prevention and control during pregnancy

Review of the literature

The investigation’s goal

The second chapter

Materials and procedures

Population under investigation

Taking samples

Examination in a laboratory

Thick blood film reported

The third chapter

Malaria infection prevalence and rate by trimester – – – –

3.1 Prevalence and rate of malaria infection by trimester – – – – – –

4th Chapter

Discussion

Conclusion

Recommendation

References

Appendix

CHAPITRE ONE

INTRODUCTION

Malaria is an infection caused by plasmodium, a parasite that infects red blood cells. Malaria has been infecting humans since the dawn of time, according to historical sources. The term “mal aria” (Italian for “bad air”) was first used in English in 1740 by H. When discussing the sickness, Walpole. In the twentieth century, the term malaria was abbreviated. Laveran was the first to find parasites in human blood in 1880. Ross discovered that mosquitos transmit malaria in 1889.

Malaria is still a major cause of misery in tropical and subtropical locations around the world (Brabin, 1989). It is currently endemic in approximately 100 countries, impacting 4% of the world’s population. Malaria was eradicated or effectively suppressed in several parts of the world over the last decade, but it is again making a comeback (Gilles, 1987). It is returning to previously eliminated places and spreading into new ones, such as Central Asia and Eastern Europe. Malaria kills more people today than it did 30 years ago, despite worldwide economic improvement.

CLINICAL AND EPIDEMIOLOGICAL FEATURES

Malaria in pregnancy continues to be a significant cause of maternal and prenatal morbidity and mortality, frequently related with maternal sickness, anemia, low birth weight, premature delivery, and prenatal loss, particularly in primigravidae. Malaria infection may be asymptomatic in semi-immune pregnant women; however, pregnant women are more likely to develop clinical disease than non-pregnant women at all levels of endemicity (Harrison, 1995). There are unparasitized blood cells, resulting in more anemia than can be explained solely by RBCS parasitization (who,1991).

Primgravidity is a documented pregnancy risk factor. It only grows more common, but also more intense, in primigravide (Jimoh, 2003). Prior antimalarial injection will change the peak prevalence of parasitemia. In a study conducted in Madan, Papua New Guinea, the highest prevalence in primigravidae investigated was 55%, compared to 86% in another study conducted in Kenya (flemming, 1986). According to studies, the maximum incidence of infection occurs in the second trimester, with inflection rates at birth and in the postnatal period approaching non-pregnant women values, probably due to immunity strengthening throughout pregnancy (Akindele et al 1993).

MALARIA CAUSER’S AGENT

Malaria is caused by five (5) plasmodium species. These are their names:

plasmodium vivax (p. vivax) – This species is less severe and rarely fatal. However, infected persons still require therapy because unchecked progression can lead to a variety of health issues. (Rogreson and colleagues, 2007)

Plasmodium Malariae (P. Malaria) is likewise less severe and does not cause death. To avoid further health complications, the diseased person should be carefully treated. This species has been shown to remain in the blood of victims for several years (WHO, 2008).

Plasmodium Ovale (P. Ovale) – It is also modest and requires appropriate treatment to avoid significant health problems. It can remain in the infected person’s liver for years without causing symptoms. (Neeru, 2005)

Plasmodium Falciparum (P. Falciparum) is the most severe form of malaria. It is mainly prevalent in Africa, particularly Sub-Saharan Africa. The sick person required thorough and adequate treatment (Okwa, 2003).

Plasmodium knowlesi (P. Knowlesi) is a parasite. Malaria is caused by this parasite in macaques, but it can also infect people.

PLASMODIUM INCUBATION TIME

This refers to the time it takes from infection to the onset of symptoms. This is generally determined by the parasite’s species.

P. falicparum – from 9 to 14 days

P. Vivax is effective for 12 to 18 days.

P. vivax takes 12 to 18 days to mature.

P. malaria – 18 to 40 days

Incubation times for P. vivax and P. ovale, on the other hand, might range from 7 days to several months.

SYMPTOMS AND SIGNIFICANCE

Malaria symptoms often appear 8 to 25 days after an infection. Those who have taken antimalaria medicine as a preventative measure, on the other hand, may experience symptoms later. The following are examples of indications and symptoms.

Fever

Shivering

Arthralgia (joint pain)

Vomiting

Anemia due to hemolysis

Jaundice

Convulsion

Acute cold followed by rigidity

Extensive headache

Spleen enlargement, for example.

THE LIFE CYCLE

Malaria has a complex life cycle that includes asexual reproduction in the mammalian host and sexual reproduction in the anophelene vector. The female anopheles mosquito, which carries malaria-causing parasites, feeds on a human and injects the parasite into the bloodstream as sporozoites. Sporozoites enter the liver and infiltrate it. The sporozites proliferate, divide, and create tens of thousands of merozoites within a few days (5-6). Some malaria parasite species can survive in the liver for long periods of time. Merozoites escape the liver cells and re-enter the bloodstream to invade red blood cells, where they undergo asexual replication and release newly produced merozoites. Instead of replicating asexually, certain merozoites infected blood cells grow into sexual forms of the parasite known as male and female gametocytes that circulate in the blood stream.

When a mosquito consumes blood, it consumes gametocytes. The infected human blood cell bursts in the intestines, releasing gametocytes, which develop into mature sex cells known as gametes. Male and female gametes combine to produce ookinetes, which burrow into the mosquito midgut and give rise to misfits. Each oocyst’s growth and division produces thousands of active haploid forms known as sporozoites, which travel to the mosquito’s salivary gland to await another round of blood meal (Ter kulie et al 2003).

PATHOGENESIS

Mosquito infects a person by taking a blood meal during the life cycle of malaria parasites in the human body. The sporozoite first enters the bloodstream and migrates to the liver. They infect liver cells (hepatocytes), multiply into merozoites, rupture the liver cells, and re-enter the bloodstream. The merozoites then infect red blood cells, where they evolve into ring forms, trophozoites, and schizonts, all of which create more merozoites. Sexual forms (gametocytes) are also generated, and if ingested by a mosquito, they will infect the host and continue the life cycle. Malaria has two cycles/phases: exoerythrocytic and erythrocytic. Exoerythrocytic infection involves hepatic or liver cells, whereas erythrocytic infection involves erythrocytes or red blood cells. The sporozite migrates to the liver and infects hepatocytes. Within 8-30 days, it can continue to multiply without causing any symptoms (Cogsnell, 1992).

MALARIA INFECTION’S EFFECT ON PREGNANCY

Malaria has numerous negative impacts on pregnant women. Pregnant women are known to be more susceptible to malaria than non-pregnant women. During pregnancy, a woman’s immune system is compromised. He becomes significantly more susceptible to malaria, which can sometimes result in the infant dying before or shortly after birth (Steketee et al, 2001). Malaria during pregnancy can have the following negative effects:

Anemia (both maternal and fetal anemia)

Fever

Blood sugar fluctuations

Infection of the genital organs

The possibility of cerebral malaria or other neurological issues

Miscarriages

a stillbirth

MALARIA TREATMENT AND MANAGEMENT DURING PREGNANCY

Malaria treatment during pregnancy differs from malaria treatment outside of pregnancy in various ways. In pregnancy, the frequency and severity of infections increase, particularly among primigravidae (Mutabingwa, 2004). Pregnant women with malaria must be treated medically as well as obstetrically, with consideration for both mother and fetal concerns. It is fair to expect malaria infection to be confirmed throughout pregnancy. Many factors influence the selection of an appropriate medicine, including the fetus’ gestational age, the severity of the condition, the resistance of the infecting malaria parasites to anti malaria drugs, and the drug’s safety profile in both mother and fetus. Effective care should, ideally, eliminate both peripheral and placental parasites (Lars Hived, 1998).

MALARIA INFECTION IN PREGNANT WOMEN: OBSTETRIC MANAGEMENT

Obstetric management is an essential component of the overall management of malarious pregnant women. It includes prenatal, intrapartum, and postpartum care.

MALARIA ANTEPARTUM CARE FOR PREGNANT WOMEN

Essentially, the antenatal clinic serves as a blueprint for institutional therapy during the antepartum or pregnant period. A history of malaria is collected as part of regular antenatal care, and blood tests, including a full blood count and malaria parasites, are frequently asked. Regular prenatal care is critical, since one missed monthly clinic visit can result in a twofold rise in malaria incidence. Garnier (1994).

MALARIA IN PREGNANCY: INTRAPARTUM MANAGEMENT

Treatment of acute malaria with an appropriate drug should be included in the intrapartum therapy of parturient malarious women. Routine intrapartum haemoglobin checks are required because continuing hemolytic or pre-existing maternal anemia can have a significant impact on maternal and fetal outcome (Shulman et al, 1999).

MALARIA POSTPARTUM MANAGEMENT IN PREGNANCY

After giving birth, the mother should finish her antimalarials and supportive care. The foetus should be thoroughly checked, and congenital malaria should be ruled out. The foetus should be thoroughly checked, and congenital malaria should be ruled out. Malaria parasites should be tested in the newborn’s peripheral venous blood. Many authors’ experiences have demonstrated that high maternal parasitaemia considerably increases placental parasitization and fetal parasitaemia, resulting in fetal anemia and perhaps fetal death (Parise etal, 1998). The use of malaria vaccination in both the mother and the fetus postpartum remains equivocal and contentious, with numerous trials underway to determine its safety profile and effectiveness.

MALARIA PREVENTION/MANAGEMENT DURING PREGNANCY

There are two primary methods for avoiding malaria during pregnancy:

Avoiding mosquito bites can be accomplished in a variety of ways.

A) VECTOR CONTROL: This entails attempting to reduce interaction with the disease’s vector. Mosquito control can greatly lower the incidence of malaria and other mosquito-borne infections. Installation of screened windows and air conditioning, along with initiatives to limit vector populations, have resulted in the absolute elimination of malaria without completely eliminating the mosquito (Neeru, 2005).

B) USE OF INSECTICIDE TREATED BED NETS (ITNS): ITNS have been shown to minimize the incidence of malaria infection during pregnancy as well as the death rate in endemic areas. If ITNS are widely utilized in endemic areas, the mosquito population and life lengths may decline drastically.

2) Disease prevention using antimalarial medications: Drugs that are effective while not affecting the developing foetus should be taken beginning in early pregnancy. This sort of protection is also known as suppression; it does not prevent the parasite from entering the bloodstream, but it does prevent it from growing in the blood (mc cormick,1985).

REVIEW OF LITERATURE

Pregnancy, according to the Oxford Medical Dictionary, is a period in which a woman has a developing foetus in her uterus. This lasts roughly 266 days from conception to delivery of the baby, or 280 days from the first day of a woman’s menstrual cycle.

Malaria in pregnancy has been observed to be a scourge in tropical and subtropical regions of the world. Nonetheless, p. Falciparum malaria has been identified as the most dangerous form of the disease during pregnancy. (WHO, 1993).

Malaria is the leading cause of stillbirths, infant mortality, maternal mortality, and even low birth weight in pregnant women (Menendez, 1994). People in malaria-endemic areas may have immunity or semi-immunity, resulting in either no or minimal symptoms.

The severity of malaria is determined by three factors:

The parasite’s species

Individuals’ immunity

The ability of one’s spleen to function (Schultiz, 1994).

When a female anopheles mosquito bites a human, it transmits the parasite. Malaria can be spread from person to person by organ donation, sharing of used needles/syringes, and blood transfusion since the parasite lives in human red blood cells. Furthermore, an infected woman can pass malaria to her infant during birth, which is known as congenital malaria (Bray et al, 1999).

THE STUDY’S OBJECTIVES

This study aims to determine the prevalence of malaria in pregnant women and their unborn offspring. It is also designed to educate mothers of childbearing age, as well as the broader public, on how to prevent malaria infection and improve the health of mother and child.