International Journal of Research and Reports in Hematology

Malaria Parasite Density and Anaemia in Pregnant Women Attending Antenatal Consultation in the Regional Hospital Bamenda, Cameroon

Calvin Bisong Ebai *

Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Cedric Yamssi

Department of Biomedical Sciences, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Flore Nguemaïm Ngoufo

Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon and Department of Biomedical Sciences, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Omarine Nfor Nlinwe

Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Felicite Natacha Etindele Ebongue

Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Odelia Kwende-Tanjong Lum

Department of Nursing and Midwifery, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon.

Helen Kuokuo Kimbi

Department of Biomedical Sciences, Faculty of Health Sciences, University of Bamenda, P.O. Box 39, Bambili, North West Region, Cameroon and Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, South West Region, Cameroon.

*Author to whom correspondence should be addressed.

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Abstract

Aims: The aims were to investigate the variation of malaria parasite density (GMPD) with sociodemographic and pregnancy related characteristics; the prevalence of anaemia and anamia levels; assess the variation of malaria parasite density (GMPD) with level of anaemia; and to assess the variation of anaemia levels with parity among malaria parasite infected pregnant women attending ANC.

Study Design: It was a cross-sectional hospital-based study.

Place and Duration of Study: This study was carried out at the ANC unit of the Bamenda Regional Hospital.

Methodology: Pregnant women with malaria parasitaemia from a preliminary study were involved in this study. A questionnaire was used to collect data on sociodemographic characteristics and pregnancy related parameters. Capillary blood samples were used for the preparation of thick and thin blood smears for malaria parasite microscopy; determination of haemoglobin concentration and WBC count. Data was analyzed using SPSS version 20. Kruskal-Wallis’ test was used to assess differences in GMPD. The student t-test was used to determine the variation of GMPD with trimester, parity and level of anaemia while the χ² and OR were used to compare the prevalence of anaemia. P-values < .05 were considered significant.

Results: GMPD was higher in second trimester (475±510) than first trimester (261±190) (P=.00), higher at third trimester (300±206) than first trimester (261±190) (t=12.7, P=.01) as well as in second trimester than in third (t=2.3, P=.03). Participants with malaria parasitaemia were at 7 times more odds to have anaemia (OR = 6.8; P=.001). The prevalence of mild anaemia was higher in women who were positive for malaria parasitaemia (17; 37.8%), (N=45) than those who were negative (19; 9.3%). Moderate anaemia was higher in women with positive malaria parasitaemia (2; 4.4%) than those who were negative (1; 0.5%) (χ2= 30.2; P=.01). GMPD was higher in mild anaemic (650±523/µL) than in non-anaemic (236±469/µL) participants (t= 2.5; P=.03).

Conclusion: GMPDs vary with trimester while mild and moderate anaemias were present. Higher GMPDs were observed in mild anaemia than others. Anaemia levels were most recorded among the primigravidae. Frequent checks on GMPD and haemoglobin level on primigravidae could reduce severe malaria anaemia in pregnancy.

Keywords: Malaria parasite density, anaemia, pregnant women, Regional Hospital Bamenda, Cameroon

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References

Antinori S, Galimberti L, Milazzo L, Corbellino M. Plasmodium knowlesi: the emerging zoonotic malaria parasite. Acta Trop. 2013;125:191–201.

Jamison DT, Feacham RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ et al. Disease and Mortality in Sub-Saharan Africa, Second Edition. © Washington, DC: World Bank; 2006. Available:http://hdl.handle.net/10986/7050 License: CC BY 3.0 IGO.”

Nicholas J. White. Anaemia and malaria. Malar J. 2018;17:371. Available:https://doi.org/10.1186/s12936-018-2509-9

Brabin BJ, Hakimi M. and Pelletier D. An analysis of anemia and pregnancy-related maternal mortality. J Nutr. 2001;131:604S–14S

Getahun W, Belachew T, and Wolide AD. Burden and associated factors of anaemia among pregnant women attending antenatal care in southern Ethiopia: A cross sectional study. BMC Res Notes. 2017;10:1–7

WHO. World Malaria report 2021. An in-depth update on global and regional malaria data and trends.

Available:https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2021.

Huynh BT, Fievet N, Gbaguidi G, Borgella S, Mévo BG, Massougbodji A. Malaria associated symptoms in pregnant women followed-up in Benin. Malar J. 2011;10(72). Available:https://doi.org/10.1186/1475-2875-10-72mmm

Garrison A, Boivin MJ, Fiévet N, Zoumenou R, Alao JM, Massougbodji A, Cot M, and Bodeau-Livinec F. The Effects of Malaria in Pregnancy on Neurocognitive Development in Children at 1 and 6 Years of Age in Benin: A Prospective Mother–Child Cohort Clin Infect Dis. 2022 ;74(5):766–775.

DOI: 10.1093/cid/ciab569

Bittaye SO, Jagne A, Jaiteh LE, Nadjm B, Amambua-Ngwa A, Sesay AK et al. Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia. Malar J. 2022;21(1):270.

DOI: 10.1186/s12936-022-04294-4 PMID: 36131306; PMCID: PMC9491657.

Monebenimp F, Bisong CE, Chiabi A, Chelo D, Moyo-Somo R. Clinical and Biological Factors Associated with Treatment Outcome of Cerebral Malaria in children under Five in Yaounde. Journal of Neuroparasitology. 2010;1:1-5

Bayisa G, Dufera M. Malaria Infection, Parasitemia, and Hemoglobin Levels in Febrile Patients Attending Sibu Sire Health Facilities, Western Ethiopia. Hindawi BioMed Research International; 2022. Article ID 6161410,

Available:https://doi.org/10.1155/2022/6161410

Achidi EA, Kuoh AJ, Minang JT, Ngum B, Achimbom BM, Motaze SC, Ahmadou MJ, Troye-Blomberg M. Malaria infection in pregnancy and its effects on haemoglobin levels in women from a malaria endemic area of Fako Division, South West Province, Cameroon. J ObstetGynaecol. 2005;25(3):235-40. DOI: 10.1080/01443610500060628 PMID: 16147724.

Chandrashekar VN, Punnath K, Dayanand KK, Achur RN, Kakkilaya SB, Jayadev P, Kumari SN ,Gowda DC. Malarial anemia among pregnant women in the south-western coastal city of Mangaluru in India. Informatics in Medicine Unlocked. 2019;100159. Journal Homepage: www.elsevier.com/locate/imu Contents lists available at ScienceDirect

Tako EA, Zhou A, Lohoue A, Leke R, Taylor DW, Leke RF. Risk factors for placental malaria and its effect on pregnancy outcome in Yaounde, Cameroon. The American Journal of Tropical Medicine and Hygiene. 2005;72(3):236-242. DOI: 10.4269/ajtmh.2005.72.23 PMID: 15772313.

Rouamba RT, Samadoulougou S, Ouédraogo M, Hien H, Tinto H, Kirakoya Samadoulougou F et al. Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013 and 2017 Malar J. (2021) 20:211 Available:https://doi.org/10.1186/s12936-021-03703-4

Ayres PM, Mandel CT, Pehrson C, Mao Y, Resende M, Daugaard M, et al. Placental Sequestration of Plasmodium falciparum Malaria Parasites Is Mediated by the Interaction Between VAR2CSA and Chondroitin Sulfate A on Syndecan-1. PLoSPathog. 2016 ;12(8):e1005831. DOI: 10.1371/journal.ppat.1005831

PMID: 27556547;PMCID: PMC4996535.

Chua CLL, Khoo SKM, Ong JLE, Ramireddi GK, Yeo TW, Teo A. Malaria in Pregnancy: From Placental Infection to Its Abnormal Development and Damage. Front Microbiol. 2021;12:777343. DOI: 10.3389/fmicb.2021.777343

PMID: 34867919; PMCID: PMC8636035.

Aregawi M, Abdullah SA, Abdul-wahiyd HA, Fabrizio M, Katikiti S, Warsame M. Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008. Malaria Journal. 2011:46 - 46. Available:https://doi.org/10.1186/1475-2875-10-46

Agyeman YN, Newton S, Annor RB, Owusu-Dabo E. Intermittent preventive treatment comparing two versus three doses of sulphadoxine pyrimethamine (IPTp-SP) in the prevention of anaemia in pregnancy in Ghana: A cross-sectional study. PLoS ONE. 2021;16(4):e0250350. Available:https://doi.org/10.1371/journal.pone.0250350

Ebai CB, Ebongue FNE, Lum OKT, Musoro JZ, Yamssi C and Kimbi HK. Plasmodium falciparum Parasitaemia during Pregnancy and the Use of Malaria Prevention Methods by Women Attending Antenatal Consultation at the Regional Hospital Bamenda, Northwest Cameroon. International Journal of Tropical Disease & Health, 2020;41(20):46–56. Available:https://doi.org/10.9734/ijtdh/2020/v41i2030393

Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin ObstetGynaecol. 2012;26(1):3-24. DOI: 10.1016/j.bpobgyn.2011.10.010 Epub 2011 Dec 3. PMID: 22138002.

22. Cheesbrough M. District Laboratory Practice in Tropical Countries Part 1. Cambridge University Press, Cambridge;1998

Nnaji GA, Okafor CI, Ikechebelu JI. An evaluation of the effect of parity and age on malaria parasitaemia in pregnancy. Journal of Obstetrics and Gynaecology. 2006;26(8):755 – 758

Steketee RW, Wirima JJ, Slutsker L, Breman JG, Heymann DL. Comparability of treatment groups and risk factors parasitaemia at the first antenatal clinic visit in a study of malaria treatment and prevention in pregnancy in rural Malawi. American Journal of Tropical Medicine and Hygiene. 1996;55:17 – 23

Dosoo DK, Chandramohan D, Atibilla D, Oppong FB, Ankrah L, Kayan K. Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross sectional study. Malar J. 2020;19(1):381. DOI: 10.1186/s12936-020-03457-5 PMID: 33097044; PMCID: PMC7585211.

Anchang-Kimbi JK, Nkweti VN, Ntonifor HN, Apinjoh TO, Tata RB, Chi HF et al. Plasmodium falciparum parasitaemia and malaria among pregnant women at first clinic visit in the mount Cameroon Area. BMC Infect Dis. 2015;15:439. DOI: 10.1186/s12879-015-1211-6

PMID: 26494140; PMCID: PMC4619095. Centers of Disease control. Malaria. Available: http: // www.cdc.gov/malaria.

Somerset DA, Zheng Y, Kilby MD, Sansom DM, Drayson MT. Normal human pregnancy is associated with an elevation in the immune suppressive CD25+ CD4+ regulatory T-cell subset. Immunology. 2004;112:38–43. Available:https://doi.org/10.1111/j.1365-2567.2004.01869.x27

Beeson JG, Duffy PE. The immunology and pathogenesis of malaria during pregnancy. Current Topics in Microbiology and Immunology. 2005;297:187–227.

Rogerson SJ, Hviid L, Duffy P, Leke R, Taylor D. Malaria in pregnancy: Pathogenesis and immunity. Lancet Infectious Diseases. 2007;7(2):105-117.

Mohan K, Dubey ML, Ganguly NK, Mahajan RC: Plasmodium falciparum: role of activated blood monocytes in erythrocyte membrane damage and red cell loss during malaria. Exp Parasitol. 1995;80:54-63.

DOI:10.1006/expr.1995.1007

Casals-Pascual C, Kai O, Cheung JO, Williams S, Lowe B, Nyanoti M, et al. Suppression of erythropoiesis in malarial anemia is associated with hemozoin in vitro and in vivo. Blood. 2006 Oct 15;108(8):2569-77.

DOI: 10.1182/blood-2006-05-018697. Epub 2006 Jun 27. PMID: 16804108.Fite MB, Assefa N and Mengiste B. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Arch Public Health. 2021;79:219. Available:https://doi.org/10.1186/s13690-021-00711-3

Anchang-Kimbi JK, Nkweti VN, Ntonifor HN, Apinjoh TO, Chi HF, Tata RB et al. Profile of red blood cell morphologies and causes of anaemia among pregnant women at first clinic visit in the mount Cameroon area: A prospective cross-sectional study. BMC Res Notes. 2017 Nov 29;10(1):645.

DOI: 10.1186/s13104-017-2961-6. PMID: 29187241; PMCID: PMC5707787.

World Health Organization. A Strategic Framework for Malaria Prevention and Control During Pregnancy in the African Region. Brazzaville: WHO Regional Office for Africa; 2004. AFR/MAL/04/01.