FACTORS ASSOCIATED WITH ASYMPTOMATIC MALARIA PARASITAEMIA AMONG WOMEN ATTENDING ANTENATAL CLINIC IN GENERAL HOSPITAL NASSARAWA-EGGON, NASARAWA STATE, NORTH CENTRAL NIGERIA


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TABLE OF CONTENTS

LIST OF ACRONYMS
ABSTRACT

CHAPTER ONE
INTRODUCTION
1.1       Background
1.2       Problem Statement
1.3       Justification
1.4       Research Questions
1.5       Objectives
1.5. 1 General Objective:
1.5. 2 Specific Objectives:
1.5.3 Scope of the Study:

CHAPTER TWO
LITERATURE REVIEW
2.1       Public Health Importance of Malaria
2.2       Epidemiology
2.3       Malaria Transmission
2.4       Malaria in Pregnancy
2.5       Susceptibility of Pregnant Women to Malaria
2.6       Anaemia in Pregnancy
2.7       Diagnosis of Malaria in Pregnancy
2.8       Prevention and Control of Malaria in Pregnancy

CHAPTER THREE
METHODOLOGY
3.1       Study Area:
3.2       Study Design:
3.3       Study Population:
3. 3.1 Inclusion:
3. 3.2 Exclusion Criteria:
3.4       Sample Size Determination:
3.5       Sampling Technique:
3.6       Study Instruments:
3. 6.1 Questionnaire:
3. 6.2 Laboratory Equipment’s and Reagents:
3. 6.2. 1 Sample Collection:
3. 6.2. 2 Sample Processing:
3. 6.2. 3 Malaria Parasites Detection and Estimation:
3. 6.2. 4 Haemoglobin Level Estimation:
3.6.2.5 Measurement of Variables:
3.7       Data Entry:
3.8       Data Management:
3. 8.1 Statistical Analysis:
3.9       Ethical Considerations:
3.10 Limitations:

CHAPTER FOUR
RESULTS

CHAPTER FIVE
DISCUSSION

CHAPTER SIX
CONCLUSION AND RECOMMENDATION
6. 1 Conclusion
6. 2 Recommendation
REFERENCES




ABSTRACT

Asymptomatic malaria parasitaemia in pregnancy is a major public health challenge responsible for significant morbidity and mortality in endemic areas. In areas with stable malaria transmission like Nigeria, the vast majority of infections with Plasmodium falciparum in pregnancy remain asymptomatic, undetected and untreated with the attendant major impacts on the mother and the unborn fetus. The aim of this study was to determine the prevalence of asymptomatic malaria parasitaemia and its associated factors among women attending antenatal clinics (ANC) in a secondary health facility.

The study was conducted at the General Hospital, Nassarawa-Eggon, Nasarawa State, from June to August, 2014. Two hundred and forty-two pregnant women were recruited after obtaining an informed consent and a structured questionnaire was administered to each participant. CareStartTM Rapid Diagnostic Test (RDT) kits and two thin and thick blood films were used to identify malaria parasites and estimate density. Haemoglobin levels were estimated using the packed cell volume (PCV) technique.

A total of 242 pregnant women participated in this study. About half of the women, (48.8%) were in the reproductive age group of 25 – 34 years,(65. 3%)were civil servants,(34. 3%) had a primary level of education and (63.2%) were multigravidae. The malaria specie that was identified in the area was Plasmodium falciparum. The percentage prevalence for malaria parasitaemia was 22. 7% by microscopy and 25.6% by RDT screening. Age below 25years and nonusage of LLIN were significantly associated with malaria parasitaemia while primigravidae and anaemia were not.
The level of asymptomatic malaria parasitaemia revealed in this study was high. Younger age of less than 25 years had highest risk of malaria parasitaemia. Failure to use LLIN is associated with an increased risk of malaria infection. Malaria parasitaemia can be responsible for anaemia in pregnancy and mother to child transmission of malaria. The performance of RDT for malaria screening in this study is comparable with Microscopy as the Gold Standard for use in our health facility. The administration of IPT should be intensified and routine diagnosis of malaria infection should be introduced as part of antenatal care strategy in our health facilities.
 



CHAPTER ONE

INTRODUCTION

1. 1 Background

Malaria is a common parasitic disease, transmitted mainly by female Anopheles mosquitoes.

Globally, 125 million women and approximately half of the world’s population are at risk of malaria every year.1 Most malaria cases and deaths occur in sub-Saharan Africa.2 However, Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2014, 97 countries and territories had ongoing malaria transmission.3 Seventy percent of pregnant women in Nigeria suffer from malaria with maternal and foetal complications.4 Among the different species of Plasmodium parasites, Plasmodium falciparum is the most prevalent endemic species within the Nigeria sub-region and the most deadly.5

An increased risk of malaria during pregnancy was observed over 60 years ago,6 and besides young children, pregnant women remain the main high risk group for malaria in endemic areas.7
Frequency and severity of malaria are greater in pregnant women, than in non-pregnant women,8 and causes serious adverse effects including abortion, low birth weight and maternal anaemia.9

Incidentally malaria infection is more rampant among the primigravidae and secundigravidae than the Multigravidae.10

In areas of high or moderate transmission, most malaria infections in pregnant women are asymptomatic and infected women therefore do not present for treatment.11The clinical consequences of asymptomatic malaria may vary across different epidemiological settings and are not fully understood.12 On the other hand, asymptomatic parasitaemia provides a reservoir for transmission and may be a precursor in the progression to symptomatic disease.12The presence of......


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