DISCUSSION, CONCLUSION, RECOMMENDATIONS & REFERENCES OF PREVALENCE OF MALARIA PARASITE IN CORD BLOOD

Each year between  75,000 and  200,000  infant  deaths are attribute to malaria infection  in pregnancy globally according to Steketee and Brabin  with  3  to  8%  of infant deaths  caused by pregnancy  associated malaria. 

In  studies by Mccormick and Matteelli malaria contributes to adverse pregnancy out comes  like low birth weight which is known  to be the single most important risk factor for  neonatal and infant mortality.

In this study the  prevalence of malaria  parasite in cord  blood  was 58.0%  this is comparable to  64.6% obtained by  Uneke and  54.2%  obtained in  Ile Ife as well as  56.9% in a study in Onitsha by Okafor  it was higher than  7.8% found by Akum  in Cameroon.

This study also  found that  89.8%  of  term babies  had  cord blood parasitaemia  compared to  10.0%  of  preterm babies. This  shows  that cord  blood malaria is not   a risk  factor for low birth weight  similarly  58.0%  of the  neonates  with normal  birth weight had 

cord blood malaria  parasites compared with  30.0%  of low birth weight  neonates. This  concurs with a study  by Nnaji that majority of the infants  with normal weight had cord blood malaria.

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There was  a higher number of cord  blood malaria  in babies of primigravide  (58.0%)  and second time pregnant  women (30.0%)  compared to a low value  (10%)  in multigravidae. This  agrees with that of Nnaji et al  who noted that primigravidae and  secondigravidae have increases  risk of malaria parasitaemia. In  mothers that   received  preventive malaria  treatment as  advocated by the world health organization the incidence of  cord   blood  malaria  parasites in their  neonates  was very low (30.0%)  compared  to  70.0% in mothers who did not. This   finding has a  resemblance to  58.0%  of cord blood parasitaemia seen in mothers   that had clinical  malaria in the   index pregnancy.  Villamor  et al (2005) observed too that maternal blood  parasitaemia was the strongest risk factor  for umbilical cord  prarasitaemia .

This study indicates that there is an association between malaria   hence they need to imbibe the WHO recommended   package of interventions for the prevention and control of malaria during pregnancy.

The South East geopolitical zone of  Nigeria  where this study was done is a highly  endemic area for malaria  infestation due  to its semi tropical  rainforest vegetation which fevours the proliferation  of the female anopheles mosquitoes.  The vector for plasmodium parasites. Infant mortality in  Nigeria is unacceptable at  75 per 1000 live births  malaria contributes significantly  to this  figure  and placental malaria  parasitization as demonstrable by cord blood parasitaemia is caused by untreated malaria  in pregnancy . Appropriate preventive measures should be adopted during antenatal care and prompt  diagnosis and treatment of    pregnant mothers effected to protect the  lives of future generations. 

Awareness of  the dangers posed  by  malaria in pregnancy  should be made to all  and  sunding.

Pregnant women should register early and receive optimal care in health facilities with skilled health attendants.  Malaria should be combated using the WHO recommended package which includes.

1.        Use of insecticide treated nets (TMS) to  prevent infection

2.       Use of intermittent preventive  treatment  (IPT) to prevent asymptomatic  infection among pregnant   

3.       Effective case management   of malaria  illness for all women of reproductive  age in malarious areas must  be ensured 

4.       Antenatal care should be free or subsidized and anti malaria drugs available and given to pregnant women to reduce  placental  and cord blood parasitaemia which  endangers the  lives of  infants after   birth.  

REFERENCES

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malaria parasite infection among pregnant women in Osogbo, Southwest. Nigeria: American-Eurrasian Sci Res. 2: 43-45.

African Summit on Roll Back Malaria (2000) Abuja, Nigeria 25 April

2000 general world health organization.

Akum ATE, Kuoh AJ, Minang JT, Achimbom BM, Ahmadou MJ,

Troye Blomberg M.( 2005) The effect of maternal, umbilical

cord and placental malaria parasitaemia on the birth weight of newborns from south-western Cameroon. Acta paediatr 94(7): 917-23.

Ali A. Haghdoost, Neal Alexander, Tom smith. (2007) Mortality rate:

critical literature review and a new analytical approach. J Vect Borne Dis June 44:98-104.

Alkawa, M.K., Iseki, J.M., Barnwell, J.W. (1990) The pathology of

Human Cerebral Malaria. Am J Trop Med. Hyg, 43:30-37

Alecrim, W.D., Espirnosa, E.E., Alecrim, M.E. (2000) Plasmodium

Falciparum infection in the pregnant patients. Infect Dis Clin North Am: 14:83-95.

Allen, S.J., O. Donnel A, Alexander, N.O. (1999) prevalence of malaria

parasitaemia in pregnancy J. Trop Med Hyg. 112:23-4.

Andrews K.J., Lanzer M.M. (2002) plasmodium falciparum

sequestration in the placenta parasitol res, 88:715-723.

Brook, J.M, Genese, C.A, Bloland P.B  (1994) Malaria Probably 

locally acquired in New Jersy, N. Engl J. Med 1994 331:23-23

Bernard J Brabin, Marian Wasame, Ulrika Udden Feldt-(2008)work,

Stephanie Devicour, Tenny Hil, Sabine Gies Monitoring and evaluation of malaria in pregnancy – developing a rational basis for control malaria Journal;7

Cheesbrough M,  (2005)  District Laboratory  Practice in

Tropical Counties Vol 1 Cambridge university press

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Kakkilaya, B.S  (2008)Treatment of Malaria

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Preterm delivery and low birth weight. Afr. Med. J 99(2): 98-102.

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Nnaji G.A, Okafor CL, Ikechebelu JI (2006) An evaluation of

the effect of parity and age on malaria parasitaemia in pregnancy. Journal of obstetrics and Gynecology; 26(8):755-758.

Nnaji, G.A, ikechebelu Ji, Okafor CI.( 2007) A Comarison of

the prevalence of malaria parasitaemia in pregnant and non pregnant women. Nigerian Journal of medicine 18(3):272-276.

Ochei, J, Kolnatkar, A (2007). Theory and partial  in medical laboratory

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technical report series Geneva: WHO;;892.PT-V

APPENDIX

MATERIAL USE INCLUDE

§  EDTA container

§  Glass  slides

§  Pipette

EQUIPMENTS

§  Microscope

§  Staining rack

REAGENTS

§  Giemsen’s stain

§  Oil immersion

§  Buffer

APPENDIX 2

CHI-SQUARE ANALYSIS

Chi-square was calculated from the formula

X² = (O–E)²

  E

Where O = observed data

E= expected data

Table 2A

Distribution at parasitaemia based on age

Age	Parasitaemia	No Parasitaemia	Total
20-29	11	13	24
30-39	18	5	23
≥40	1	2	3
TOTAL	30	20	50

Table 2b

Chi square analysis of the distribution of parasitaemia based on age range

Age 20-29	0	E	0-E	(0-E)2	(0-E)2/E
P	11	13.92	-2.92	8.3264	0.8459
Np 30 – 39	13	10.08	2.92	8.5264	0.8459
P	18	13.8	4.20	17.640	1.2783
Np	5	9.2	4.20	17.6400	1.9174
≥ 40
P	1	1.74	-0.74	0.5476	0.3147
NP	2	1.26	0.74	0.5476	0.4346
Total	50				5.4034

Table 3a:  Distribution of parasitaemia in the subject in relation to trimester.

Trimester	Parasitaemia	No parasitaemia	Total
1st	10	6	16
2nd	12	9	21
3rd	8	5	13
Total	30	20	50

3b

Trimester	0	E	O-E	(O-E)2	(O-E)2     E
1st
P	10	9.6	0.4	0.16	0.0167
NP	6	6.4	-0.4	0.16	0.0250
2nd
P	12	12.6	-0.6	0.36	0.0286
NP	9	8.4	0.6	0.36	0.0429
3rd
P	8	7.8	0.2	0.04	0.0051
NP	5	5.2	-0.2	0.04	0.0077
TOTAL	50				0.1260

X² cal =0.126

RESULT DATA

S/N	AGE	TRIMESTER	MALARIA PARASITEAEMIA	PARASITAENMIA COUNT
1	40	1st	+VE	++
2	32	2nd	+VE	+
3	20	1st	-VE	NIL
4	25	2nd	-VE	NIL
5	34	3rd	-VE	NIL
6	38	1st	+VE	+++
7	21	2nd	+VE	+
8	26	2nd	+VE	++
9	28	2nd	-VE	NIL
10	33	3rd	+VE	++
11	31	3rd	+VE	+++
12	37	3rd	+VE	++
13	27	2nd	-VE	NIL
14	39	2nd	+VE	++
15	29	1st	+VE	+
16	22	2nd	­-VE	NIL
17	23	1st	+VE	+
18	24	2nd	-VE	NIL
19	30	1st	+VE	++
20	41	3rd	-VE	NIL
21	36	2nd	+VE	+
22	35	3rd	-VE	NIL
23	21	1st	+VE	+
24	25	2nd	+VE	++
25	33	3rd	-VE	NIL
26	38	3rd	+VE	+
27	26	2nd	-VE	NIL
28	31	2nd	+VE	++
29	20	1st	-VE	NIL
30	28	2nd	+VE	+
31	21	1st	+VE	++
32	30	1st	-VE	NIL
33	20	1st	-VE	NIL
34	30	3rd	+VE	++
35	36	3rd	-VE	NIL
36	25	2nd	-VE	NIL
37	28	2nd	-VE	NIL
38	22	2nd	+VE	+
39	30	1st	+VE	++
40	33	2nd	+VE	+
41	20	1st	-VE	NIL
42	34	3rd	+VE	++
43	21	1st	-VE	NIL
44	35	3rd	+VE	+
45	36	3rd	+VE	+
46	40	2nd	-VE	NIL
47	28	2nd	+VE	++
48	25	1st	+VE	NIL
49	30	1st	+VE	++
50	32	2nd	+VE	+

Table 4.1

The malaria age and frequency of cord blood parasitaemia.

Maternal Age	Frequency	Percentage (%)
< 20 years	5	10.0
20-30 years	10	20.0
30-40	20	40.0
> 40 years	15	30.0
Total	50	100

Table 4.2

The gestational age (maturity)  of neonates and cord blood parasitaemia

Gestational Age	Frequency	Percentage (%)
< 37 weeks	15	30.0
>37 weeks	35	70.0
Total	50	100

Table 4.3

The parity of mothers and cord blood parasites frequency

Parity of mothers	Frequency	Percentage (%)
Primigravidae	30	60.0
Second pregnancy	15	30.0
Third pregnancy	5	10.0
Total	50	100

Table 4.4

Comparism of birth weight of neonates and cord blood parasitaemia

Birth weight of neonates	Frequency	Percentage (%)
< 2.5 kg	15	30.0
2.5-3.9 kg	30	60.0
> 4 kg	5	10.0
Total	50	100

Table 4.5

The effect of preventive material treatment in pregnancy (IPT) on the cord blood malaria parasite load

	Frequency	Percentage (%)
mothers that received IPT in the index pregnancy.	15	30.0
Mothers that did not receive IPT in the index pregnancy	35	70.0
Total	50	100

Table 4.6

Clinical malaria in pregnancy and cord blood malaria parasitaemia

	Frequency	Percentage (%)
Mothers that had malaria in the index pregnancy.	30	60.0
Mothers without clinical malaria in the index pregnancy.	20	40.0
Total	50	100

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