Prevalence of Hypoglycaemia Among Plasmodium Falciparum Infected Women Attending Antenatal Clinics in Nsukka Local Government Area of Enugu State, Nigeria
Chapters One
Objectives of the Study
The general objective of this study is to assess the prevalence of hypoglycaemia among pregnant women infected with P. falciparum in Nsukka Local Government Area.
The specific objectives of this study are to:
- determine the prevalence of hypoglycaemia among P. falciparum infected and non-infected pregnant women in the study area.
- determine the predisposing factors for both hypoglycaemia and P. falciparum prevalence among the study population.
- assess the ethno-management practices of hypoglycaemia and P. falciparum among community members in the study area.
- ascertain the knowledge and attitude of pregnant women towards antenatal services in the study area.
Chapter Two
Literature Review
Scanty data exist on the epidemiology of malaria in pregnancy outside tropical Africa. Singh et al. (1999) work on the epidemiology of malaria in pregnancy in Central India showed highest malaria prevalence among primigravidae, followed by secundigravidae and multigravidae. Anaemia was implicated as the major problem among pregnant women in this region as the mean haemoglobin level was lower in primigravidae infected with P. falciparum. Assabri and Muharram (2002) work on the malaria in pregnancy in Hodiedah, Republic of Yemen showed that malaria prevalence and anaemia were higher among pregnant women than non-pregnant women, and that primigravidae have 1.5 times greater risk of malaria infection than multigravidae. Both findings agree with the work done a decade later in India. Bangal and Giri (2012) study of pregnancy outcome in malaria among the rural population in India revealed that pregnant women infected with malaria developed severe haematological abnormalities such as anaemia, and that many women had either spontaneous abortion or preterm delivery. Also, these pregnancy-associated malaria outcomes are influenced by different factors in different epidemiological settings and depend on the time of infection during the pregnancy period.
In Africa, much works had been done on malaria in pregnancy with respect to its presenting outcomes in both areas of unstable and stable malaria transmissions. Here we would take a review of the recent works done within the past decades. For Gabonese pregnant women, Bouyou-Akotet et al. (2003) undertook an epidemiological study in Libreville on the prevalence of Plasmodium falciparum infected pregnant women in Gabon, and found that malaria prevalence was higher in primigravidae than secundigravidae, and in women under 20 years old. Anaemia prevalence was also higher, with a significant association between P. falciparum infection and anaemia. A contrasting result was observed in Adam et al. (2005) work on the prevalence and risk factors of Plasmodium falciparum malaria among pregnant women of eastern Sudan, where they demonstrated that no significant association exists between malaria and parity, and that age was not significantly associated with malaria. The work reported also that women who attended the antenatal clinic in the third trimester had about a 1.5-fold higher risk of malaria parasitaemia. Clerk et al. (2009) findings in Ghana confirmed the largely afebrile nature of malaria infection during pregnancy in areas of stable transmission. The study noted that parasitaemia among pregnant women in northern Ghana has a seasonal variation and that the prevalence of anaemia is high among pregnant women, and that younger women and paucigravidae are more likely to have anaemia and parasitaemia. In a rural Cameroonian village, Leke et al. (2010) showed in the longitudinal studies of Plasmodium falciparum malaria in pregnancy that haematological, parasitological, and clinical changes are presented in individual women who were repeatedly infected with P. falciparum during the course of pregnancy, and that the ability to control the level of parasitaemia below a threshold level, not the absence of parasites, appears to be a key element in determining maternal health. Another work in Sudan by Omer et al. (2011) which was not in consonance with the work of Adam et al. (2005), showed malaria risk factors to include maternal age, gravidity, trimester and living in rural areas as diagnosed by blood films. They indicated in their study that malaria risks could also be poverty related like illiteracy, low income and residence in rural areas, where health care facilities and malaria control programmes are meager and less effective; hence there is close correlation between malaria prevalence among pregnant women and the socio-economic status. Taylor et al. (2011) reported on the quantification of the burden and consequences of pregnancy-associated malaria in Democratic Republic of Congo, as well as the potential benefits of preventing it. The work estimated the infection risk, potential consequences, and potential benefits of the control of pregnancy associated malaria on a national scale using representative data. At the University Hospital, Kumasi, Ghana, Tay et al. (2013) study on malaria and anaemia in pregnant and non-pregnant women of child-bearing age at the University Hospital Kumasi Ghana reported that malaria parasitaemia and anaemia were common medical conditions association with pregnancy, and that pregnant women were more susceptible to malaria and anaemia than non-pregnant women of child-bearing age. Gabbad et al. (2014) study on malaria in pregnant women attending antenatal clinic at Ed-Duweim Hospital Sudan reported that the prevalence of malaria in pregnancy was high, and that many cases of malaria in the catchment area were remaining at homes without seeking diagnosis and treatment. They concluded that gravidity, rural residence, knowledge about malaria and presence of breeding sites in the house where factors associated with malaria in pregnant women.
In Nigeria, characterized with stable transmission, some existing literatures on malaria in pregnancy are noteworthy. Among the pregnant women in Osogbo, Adefioye et al. (2007) study on prevalence of malaria parasite infection among pregnant women in Osogbo, Southwest, Nigeria, observed that illiterate pregnant women had the highest prevalence rate of malaria parasite infection, and is probably because they are more exposed to malaria parasites due to bad environmental condition and their life styles. Wagbatsoma and Omoike (2008) study on prevalence and prevention of malaria in pregnancy in Edo State, Nigeria determined the effect of prevention on the prevalence of malaria during pregnancy in Edo State and reported a sure safeguard against material morbidity, mortality and fetal death, and that although, the discomfort associated with the use of insecticide treated net (ITN) during pregnancy and the cost of combined protection could affect compliance, it could be overcome by subsidy. Erhabor et al. (2010) study on effects of falciparum-malaria on the indices of anaemia among pregnant women in the Niger Delta of Nigeria, demonstrated that Plasmodium falciparum– parasitized primigravidae seemed to be at a significantly greater risk of anaemia and malaria compared to multigravidae women, and they also showed the effect of malaria on haematological parameters in pregnancy.
CHAPTER THREE
MATERIALS AND METHODS
Study Area
The study area is Nsukka Local Government Area of Enugu State, in South-East Nigeria. Nsukka town from where the Local Government Area got its name is the site of the University of Nsukka Local Government Area is an urban settlement made up of schools (nursery, primary, secondary, and tertiary schools), hospitals (government, mission, private, and university hospitals), churches (Roman Catholic, Protestants, and Pentecostals), government offices (L.G.A. headquarters, post office, etc.), banks (microfinance and commercial banks), as well as its suburbs that have rural features like markets (daily and Igbo weekly markets). Nsukka LGA is located approximately within latitudes 6º 51′ N and 7º 00′ N of the Equator and longitudes 7º 23′ E and 7º 45′ E of the Greenwich Meridian. It covers a total land area of approximately 407.50km² (Orji, 2010), with an elevation of 1,810ft (552m). It is made up of twenty-one autonomous communities, namely; Alor-Uno, Anuka, Eden, Edem-Ani, Ede-Oballa, Eha-Alumona, Ibagwa-Ani, Lejja, Ibagwa-Agu, Umabor, Eha-Ndiagu, Okpaligbo, Nsukka, Owerre-Obimo, Obukpa, Okpuje, Okutu, Ikwara-Ibimo, Akwari , Agu-Obete and Opi. (See Figure 1) The climate of Nsukka LGA falls under the Tropical Wet and Dry climate (AW) of Koppen’s climatic classification (Phil-Eze, 2004). The average daily minimum and maximum temperature of the area are about 23.3º C and 27º C, respectively, while its average monthly maximum temperature is about 31.5º C (Inyang, 1978). Like most parts of Nigeria, Nsukka Local Government Area has two main seasons: wet/ rainy season and dry season. The wet season usually occurs between April and October, while the dry season is from November to March with a short cool and dry spell in December and January known as harmattan. Rainfall in Nsukka is very high and intense. The average monthly rainfall ranges from 250mm in April to 380mm in October, with a mean annual total of 1500mm (Inyang, 1978). It is underlain mainly by two geologic formations- the false bedded sand stone (Ajalli sandstone) and Lower Coal Measure (Nsukka Formation). Generally, Nsukka LGA is on a plateau, with heights which vary between 365 – 420 metres above mean sea level with isolated and outstanding peaks reaching over 545 metres. It is characterized by sparse surface drainage, with marshy streams and springs lines issuing from fetched aquifers on the slopes of the hills. Nsukka LGA lies in a transitional zone of the savanna vegetation of the north and the rainforest belt of the south and this gives the area the look of “Derived Savanna”. The soils of Nsukka LGA are classified into two major groups, namely; ferrallitic soils (deep porous red soils derived from sandy deposits, and the red and brown soils derived from sandstones and shales), and hydromorphic soils. According to the national population census of 2006, Nsukka LGA has a total population of 309,633 persons, with 149, 241 males and 160, 392 females (National Population Commission, 2007). There are several socio-economic activities and occupations engaged by the inhabitants of Nsukka Local Government.
CHAPTER FOUR
RESULTS
Obstetric and Demographic Characteristics of the Study Population
The obstetric and demographic characteristics of the study population were captured for the different locations in the study area. The data collected showed that the women were mostly in their mid-ages (20-44 years) for pregnancy, with a greater preponderant 181 (48.3%) of the women at age within 30-34 (Table 1). Observations made on the obstetric characteristics of trimester and parity of the pregnant women as revealed from Table 1 shows that the study population has highest frequency of the women that are pregnant for the first time (primigravidae) and in their second trimester. The residential distribution of the pregnant women as observed was equitable since they were recruited following a cross-sectional design that enabled proportional representation of the urban, semi-urban and rural locations (Table 1). Other demographic characteristics of the pregnant women like educational level showed that highest number of the population had secondary education, and are mainly self-employed either in trade or in craft.
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