Preventive Aspects of Malaria in Pregnancy in Badagry Local Government Area of Lagos State, Nigeria

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Chukwurah, N.J
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The study focused on the Preventive aspects of malaria in pregnancy in Badagry Local Government Area, one of the 20 LGAs in Lagos State in Southwestern Nigeria. The objectives of the study were to determine the knowledge, attitude and practices of the community on malaria; determine the effectiveness of Intermittent Preventive Treatment in pregnancy (IPTp) using Sulfadoxine-pyremethamine (SP) [IPTp-SP] in the prevention of malaria; and ascertain the safety of SP during pregnancy by administering SP to pregnant laboratory bred albino mice. Data were obtained using semi-structured questionnaire and focus group discussion on beliefs, knowledge and practices of community members in Ikoga ward and in pregnant women attending antenatal clinics. Microscopic diagnosis using Giemsa stain was conducted to establish the baseline parasitological prevalence of malaria amongst 3,978 participants in the community. Entomological data on the vector population was collected by Pyrethrum Spray Collection (PSC). The mosquitoes were identified morphologically and the A. gambiae complex by Polymerase Chain Reaction (PCR). IPTp-SP intervention was evaluated in 426 pregnant women who received one or two doses of SP (1500mg sulfadoxine + 75 mg pyrimethamine), depending on when they registered. Fifty seven pregnant women did not take the SP, because of reaction to SP. The pregnant women comprised 183 of primigravidae, 135 of secundigravidae and 165 of multigravidae. Parameters used to evaluate the effectiveness of the SP included parasite rate determination, parasitaemia, anaemia, clinical malaria and determination of Low Birth Weight (LBW). The safety of SP was experimentally evaluated from the histopathological examination of foetuses of SP treated pregnant mice and by sperm test assay of male mice administered SP. Analysis of the questionnaire on malaria prevention revealed malaria to be a serious health problem; 48% of community members use Raid insecticide spray; 30% take herbs while 21% use mosquito coil. Malaria prevention by pregnant women included taking of herbs by 30%, use of chloroquine (30%) and daraprim (23%) while 48% and 21% use raid insecticide spray and mosquito coils respectively to control mosquito. Parasitological results revealed the predominant parasite to be P. falciparum with malaria prevalence of 23.3%. The Anopheles mosquitoes were predominantly A. gambiae sensu stricto and A. arabiensis in the ratio of 2:1. There was a reduction in malaria prevalence from 15.7% to 2.1% in pregnant women administered SP and showed statistical significance, (P<0.05); parasitaemia decreased from 44,650 per Ql of blood to 14,085 per Ql of blood, but showed no statistical significance among the different gravida. The percentage of pregnant women that had PCV of less than 33% decreased from 44.7% to 37.9% with SP administration and showed statistical significance, (P<0.05). Four percent of the pregnant women who received SP had LBW compared with 3.5% of those who did not receive SP, and was not statistically significant, (P>0.05). Morphological and histopathological examination of foetuses of mice treated with SP and control confirmed the absence of abnormality. Sperm head abnormalities were observed in both test (5.2%) and control (3.1%). Sperm head abnormality in test animals were not statistically significant over the negative control values, (P<0.05), was not dose dependent and did not increase with the duration of exposure. Therefore SP is not mutagenic at the recommended dose levels and can be considered effective. abnormalities observed included pin head, round head, bent and coiled tail.
A Thesis Submitted to the School of Postgraduate Studies, University of Lagos
Anopheles mosquitoes , Intermittent Preventive Treatment in pregnancy , Sulfadoxine-pyremethamine , Malaria , Research Subject Categories::MEDICINE::Microbiology, immunology, infectious diseases
Chukwurah, N.J (2011). Preventive Aspects of Malaria in Pregnancy in Badagry Local Government Area of Lagos State, Nigeria. A Thesis Submitted to University of Lagos School of Postgraduate Studies Phd Thesis and Dissertation, 288pp.