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

Baseline characteristics of the study population.

*<p>Percentages in brackets.</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

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

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