Malaria risk factors in women on intermittent preventive treatment at delivery and their effects on pregnancy outcome in Sanaga-Maritime, Cameroon.

Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP) used for intermittent preventive treatment (IPT) is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPTp-SP) at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively). Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001). Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007). Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPTp-SP (p<0.0001 and p = 0.018 respectively). Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome

IPT_p effect on malaria and other delivery parameters with respect to parity.

*<p>Statistically significant.</p>f<p>Fisher's exact test.</p>k<p>Kruskal-Wallis test.</p>g<p><i>p</i>-value: <i>p</i>-value for gravidity effect</p>SP<p><i>p</i>-value: <i>p</i>-value for SP effect.</p

Malaria parasite prevalence and density in mothers and neonates with respect to socio-economic, obstetrical characteristics and mosquito net use.

<p>OR: Odds Ratio.</p><p>CI: Confidence Interval.</p>*<p>Statistically significant.</p>f<p>Fischer's exact test.</p>—<p>Statistics that could not be computed.</p

Influence of malaria infection, mosquito nets and use of SP for IPT_p on some pregnancy outcomes.

<p>OR: Odds Ratio;</p>§<p>Prevalence;</p>*<p>Statistically significant;</p>f<p>Fischer's exact test;</p>u<p>Mann-Whitney test;</p>k<p>Kruskal-Wallis test.</p

Baseline characteristics of the study population.

*<p>Percentages in brackets.</p

Effect of parasite load in mother on the occurrence of neonatal infection.

*<p>Statistically significant.</p>f<p>Fisher's exact test</p>o<p><i>p</i>-value: <i>p</i>-value for overall difference.</p>c<p><i>p</i>-value: <i>p</i>-value for class difference.</p

Effect of mosquito net use on malaria infection and other delivery parameters with respect to parity.

*<p>Statistically significant.</p>f<p>Fisher's exact test.</p>u<p>Mann-Whitney test.</p>g<p><i>p</i>-value: <i>p</i>-value for gravidity effect.</p>MN<p><i>p</i>-value: <i>p</i>-value for mosquito net effect.</p

Malaria screening at the workplace in Cameroon.

Malaria remains a major health problem in Cameroon; It accounts for 38% of consultations, 24% of deaths and 36.8% of absenteeism in the country. The negative economic impact of malaria has encouraged a new control approach targeting companies. In this regard, a cross sectional study was conducted from February 2015 to June 2017 in 14 companies in the town of Douala. This study aimed at determining the prevalence, control practices of employees and identifying associated factors with malaria. A total of 2705 workers were interviewed and systematically screened for malaria using LED fluorescence microscopy (CyScope®). All positive cases were given a malaria treatment. The prevalence of malaria and asymptomatic malaria was 30.1% and 28.9% respectively; asymptomatic malaria accounted for 95.7% of all positive diagnostic test. Malaria infection was significantly higher in employees aged 36-60 years (30.5%) and having completed primary studies (36%). ITNs ownership and utilization were 86.36% and 77.23% respectively. The risk for malaria infection has significantly decreased with age and educational level while the employees' level of education and size of households were significantly associated with the regular utilization of ITNs. This is the first study assessing malaria prevalence and risk factors in workplace in Cameroon and using a novel diagnostic tool. This study outlines a high prevalence of malaria infection, especially asymptomatic carriage, high rates of ITNs ownership and utilization, as well as the influence of level of education, age and household size as associated factors. Active case detection of asymptomatic carriers through systematic screening of employees at workplace and their treatment is feasible with the Cyscope microscope and could be a good complement to ongoing control strategies