CHAPTER ONE

1.0 INTRODUTION

Malaria is a life threatening parasite disease transmitted by female Anopheles mosquitos. More

than 40% 0f the world population lives in malarious areas. It is estimated that the number of case

of malaria rose from 233 million in 2000 to 2005 but decreased to 225 million in 2009. The

number of deaths due to malaria is the estimated to have decreased from 985,000 in 2000 to 781

000 in 2009 (WHO, 2010). Malaria is the most highly prevalent tropical diseased with high

mortality, and with high economic and social impact. Over 90% of all deaths caused by malaria

occur in sub – Saharan Africa and about 85%of deaths globally were in children under 5 years of

age (WHO, 2010). In addition, pregnant women are at immense risk of malaria due to natural

immune depression in pregnancy (Fievet, Cot, Ringwald, Bickii, Dubois & Hesran, 2017). About

25% of all estimated malaria cases in World Health Organization Africa Region occur in Nigeria

(WHO, 2010). Malaria infection during pregnancy is a major public health problem in tropical

and subtropical region throughout the world. The burden of malaria infection during pregnancy

is caused mainly by plasmodium falciparum, the most common malaria species in Africa (WHO,

2010).

Each year at least 3 million pregnancies occur among women in malarious areas of Africa, most

of who reside in area of relatively stable malaria transmission (Brabin, 2000).The symptoms and

complications of malaria during pregnancy differ with the intensity of malaria transmission and

thus with the level of immunity the pregnant woman has acquired (Greenwood, Bojang, Whitty

& Targett, 2007). Beyond the impact of malaria on children and pregnant women, it affects the

general population. 100% of the total population of Nigeria is at risk of malaria and at least 50%

of the total population suffers from at least one episode of malaria each year (WHO,

1
2010).About 51% 0f malaria cases and deaths in Nigeria occur in rural villages away from

effective diagnostic or treatment facilities (WHO, 2010). Malaria case deaths have been

increasing in the country, mainly due to injudicious use of antimalarial drugs, delayed health

seeking, and reliance on the clinical judgment without laboratory confirmation in most of the

peripheral health facilities (Vander, Presmasiri & Wickremasinghe, 2005).

Despite evidence of cost effectiveness of improving treatment access and compliance (Goodman,

Coleman & Mills, 1999), Most victims of malaria still die because of a lack of health care close

to their homes or because their condition is not diagnosed by health workers. Early diagnosis and

prompt effective treatment of malaria illness has been a cornerstone of malaria control.

Diagnosis based on symptoms alone has inherent difficulties (Vander et al., 2005). Although

volunteer health workers in rural areas have practiced it with some success. The reduction of

morbidity and interruption of parasite transmission by means of community-based antimalarial

treatment require an accurate, rapid and practical method of diagnosis. The delivery of treatment

in rural area as in Nigeria is complicated by the centralized nature of microscopy services (Alaba

& Alaba, 2008).

1.2 Statement of the Problem

Malaria is one of the most important parasitic diseases in the world and remains a major

challenge to mankind. This is due to the high level of Morbidity and Mortality rate caused by

malaria, especially plasmodium falciparum which is the most hazardous in during pregnancy.

1.3 Aims of the Study

This is to assess the prevalence of malaria infection among pregnant women attending antenatal

care at Federal Medical Center Bida.

2
1.4 Objective of the Study

i. To determine the prevalence of malaria infection among pregnant women attending

antenatal care at Federal Medical Center Bida

ii. To determine the prevalence of malaria infection among pregnant women attending

antenatal care at Federal Medical Center Bida in respect to gestational age.

iii. To determine the prevalence of malaria infection among pregnant women attending

antenatal care at Federal Medical Center Bida in respect to age group.

1.5 Justification of the Study

This research will work on the incidence of malaria infection among pregnant women attending

antenatal care at Federal Medical Center Bida.is significant in the treatments of malaria in

pregnant women. The knowledge of this research will be used to estimate individual and general

public on increase routine malaria testing.

1.6 Scope and Limitations of the Study

The research work will be limited to Bida and its environs. The scope of the study covers the

pregnant women attending antenatal care at federal medical center Bida and effect of malaria on

them.

1.7 Definition of Terms

i. Malaria: A disease spread by mosquito, in which a protozoan, plasmodium, multiplies in

blood every few days

ii. Pregnancy: The state of being pregnant. Many women experience sickness during

pregnancy.

3
iii. Antenatal: Relating to the medical care give to pregnant women.

iv. Infection: An uncontrolled growth of harmful microorganisms in a host.

4
 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 History of malaria

Malaria is one of the oldest documented diseases of mankind whose name is derived from the

word “Malaria” in Italian. (“Mal” means bad and “aria” means air) and it was also known as

Roman fever, ague, marsh fever, and periodic fever. A French army surgeon Alphonse Laveran

(1880) was the first to discover the causative agent Plasmodium, in the red blood cell (RBC) of a

patient in Algeria. There were numerous bizarre theories on how malaria was transmitted until

1898 when Dr. Ronald Ross discovered that the female Anopheles mosquito was actually

responsible for transmitting malaria parasite. This discovery revolutionized malaria control,

which had hitherto often been haphazard or based purely on treating the patient by killing the

malaria parasites (Olowe et al., 2015).

In Nigeria, before independence, the colonialists established Government Reservation Areas

(GRA) in an attempt to build their homes far away from the natives as it was found that the

travelling/flying distance of these mosquitoes from the breeding grounds was a limiting factor in

spreading the parasites. Nigeria’s quest for effective control of malaria began well before the

World Health Organization (WHO) global malaria eradication period between 1955 and 1968s,

(Olowe et al. 2015).

2.2 Epidemiology

Malaria is a major cause of illness and death especially among children under the age of 5 years

and pregnant women. It is estimated that in Worldwide, malaria affects about 3.3 billion people,

or half of the world’s population, in 106 countries and territories. WHO estimates 216 million

5
cases of malaria occurred in 2020, 81% in the African region. WHO estimates there were

655,000 malaria deaths in 2020, 91% in the African Region, and 86% were children under 5

years of age. Malaria is the 3rd leading cause of death for children under five (5) years

worldwide, after pneumonia and diarrheal disease, (Nigeria Malaria Fact Sheet, 2021).

In Africa, Thirty countries in Sub-Saharan Africa account for 90% of global malaria deaths.

Nigeria, Democratic Republic of Congo (DRC), Ethiopia, and Uganda account for nearly 50% of

the global malaria deaths. Malaria is the 2nd leading cause of death from infectious diseases in

Africa, after HIV/AIDS. Almost 1 out of 5 deaths of children under 5years in Africa are due to

malaria (NMFS. 2021).

Malaria is a major public health problem in Nigeria where it accounts for more cases and deaths

than any other country in the world. Malaria is a risk for 97% of Nigeria’s population. The

remaining 3% of the population live in the malaria free highlands. There are an estimated 100

million malaria cases with over 300,000 deaths per year in Nigeria. This compares with 215,000

deaths per year in Nigeria from HIV/AIDS. Malaria contributes to an estimated 11% of maternal

mortality. Malaria accounts for 60% of outpatient visits and 30% of hospitalizations among

children under five years of age in Nigeria. Malaria has the greatest prevalence, close to 50%, in

children age 6-59 months in the South West, North Central, and North West regions. Malaria has

the least prevalence, 27.6% in children age 6 to 59 months in the South East region (NMFS

2021).

2.3 Causative agents of malaria

There are more than 125 species of Plasmodium exist infecting wide range of birds, reptiles and

mammals. However, human infection is mainly caused by five species such as:

6
  Plasmodium Vivax (or P. Vivax) is the second significant species that causes benign

tertian malaria. (Periodicity of fever is once in 48 hours, i.e. recurs every third day).

 Plasmodium falciparum (or P. Falciparum) is responsible for the majority of malaria

deaths globally and is the most prevalent species in sub-saharan Africa that causes

malignant tertian malaria. (Severe malaria, periodicity of fever is once in 48 hours, recurs

every third day).

 Plasmodium Malariae (or P. Malariae) causes benign quartan malaria. (Periodicity of

fever is once in 72 hours, i.e. recurs every fourth day).

 Plasmodium Ovale (or P. Ovale) causes ovale tertian malaria. (Periodicity of fever is

once in 48 hours, i.e. recurs every third day).

 Plasmodium Knowlesi (or P. Knowlesi) causes quotidian malaria. (Fever periodicity is

once in 24 hours i.e. recurs every day). It is a parasite of monkey but can also affect

humans and many cases affecting man were recently reported from Asia (Quinn &

Robert, 2021).

2.4 Incubation period of malaria parasites

The malaria incubation period is defined as the time elapsed between exposure of the infectious

agent (through the bite of the Anopheles mosquito) and the manifestation of the first clinical sign

or symptom. Usually, these periods vary depending on the species of Plasmodium causing

malaria,

 For Plasmodium falciparum, the average incubation period is between 9-14 days.

 For Plasmodium vivax, the incubation period is between 12-17 days.

 For Plasmodium malariae, the incubation period is between 30-40 days.

 For plasmodium ovale, the incubation period is between 16-18 days.

7
  For plasmodium knowlesi, the incubation period is between 14 days (Quinn & Robert,

2021).

2.5 Mode of transmission

Malaria is primarily transmitted through the bite of an infected female mosquito of the genus

Anopheles, which previously had stung a person infected with malaria. It can also be transmitted

through blood transfusion, transplantation of organs, infected needles, and from mother to fetus

during pregnancy (Brasil et al., 2011).

2.6 Morphology of parasite

Malarial parasites form four developmental stages in humans (hepatic schizonts, intra-

erythrocytic trophozoites, schizonts and gamonts) and three developmental stages in mosquitoes

(ookinetes, oocysts and sporozoites). Liver schizonts appear as clusters of small basophilic

bodies (merozoite nuclei) located within host hepatocytes, measuring 40-80µm in diameter when

mature. Intra-erythrocytic stages consist of small rounded trophozoites (ring forms) measuring 1-

2µm in diameter, amorphous multinucleate schizonts measuring up to 7-8µm in length, and

micro – (♂) and macro- (♀) gametocytes ranging in length from 7-14µm (Bongdap, 2020). The

morphological characteristics (size, shape and appearance) of the blood stages are characteristics

for each Plasmodium spp. Microgametocytes have a larger more diffuse nucleus (ready for

gamete production) while macrogametocytes have darker-staining cytoplasm (plentiful

ribosomes for protein synthesis). In the mosquito, long slender microgametes (15-25µm in

length) produced by exflagellation fertilize the rounded macrogametes to form motile ookinetes

(15-20 x 2-5µm) which migrate through the gut wall to form ovoid oocysts (up to 50µm in

8
diameter) on the exterior surface. The oocysts produce thousands of thin elongate sporozoites

(~15µm long) which ultimately infect the salivary gland, (Brasil et al., 2011).

2.7 Stages of malaria infection

The stages of malaria occur in two (2) stages. These are;

2.7.1. Sporogony stage:

Sporogony (sexual reproduction) is a complex event involving several morphologically distinct

of life-stages and begins when mosquitoes ingest blood containing male and female gametocytes.

Sporogony has three basic phases based on changes that occur in parasite abundance within the

mosquito vector. The first phase may be termed "early sporogony", a relatively brief period of

time where parasites numbers typically decrease within the mosquito. Early events include

gametogenesis and fertilization, zygote transformation into ookinetes, ookinete motility through

the bloodmeal and peritrophic matrix, penetration across midgut epithelia, and udergo

9
encystment beneath the midgut basal lamina to form oocysts. These events occur during the time

that the engorged mosquito is digesting its blood meal (2 days). Early sporogony is followed by a

period lasting up to a week or more. The "mid-sporogony" here parasites are in the oocyst stage.

Oocysts grow in size but their numbers remain static. The enlarging oocysts undergo multiple

rounds of mitosis to form a syncytium, followed by cellular differentiation to form several

thousand daughter cells (sporozoites). The final phase is "late sporogony" which involves release

of the sporozoites into the mosquito haemocoel and their subsequent invasion into the mosquito

salivary glands. Sporogony is considered complete after sporozoites successfully infect the

mosquito salivary glands (10 to 16 days after initiation) and mosquitoes are able to transmit the

parasite to a vertebrate host by infectious bite (Zollner et al., 2006).

2.7.2. Schizogony stage:

Schizogony is the asexual reproduction that takes place in man. It has the following stages.

These are as follows

 Pre-erythrocyte schizogony: this phase of malaria occurs after the introduction of

sporozoites, the infective form of the parasite, through the skin by the Anopheles mosquito.

In this phase the patient is asymptomatic and the patient is not infective. Sporozites that are

not removed by the body's defenses migrate to the liver and undergo development. After a

variable period the micro-merozoites are liberated. Sporozoites of P. vivax and P. ovale may

remain in the liver in the form of hypnozoites.

 Erythrocytic schizogony: In this phase the red blood cells become infected by the micro-

merozoites. While in the red blood cells the micro-merozoites pass through several stages of

develop until they finally develop into merozoites. This asexual parasitic form is present at a

10
 variable time from when the human was inoculated with the sporozoite. In P.vivax this

occurs at about 12 days, in P. falciparum about 9 days the red blood cells that are invaded is

dependent on which form of Plasmodium the patient has been inoculated with. P.

falciparum invades all red blood cells. P. vivax and P. ovale preferentially invade young red

blood cells and reticulocytes. P. malariae preferentially invades senescent red blood cells.

The merozoites then go through a cycle of where they pass through the various stages of

development to produce more merozoites. As each cycle terminates the red cells are

ruptured and the merozoite are released into the circulation the merozoites then may invade

more red blood cells and the cycle continues again. The cycle occurs approximately every

48 hours in P. falciparum infection, every 48-72 hours in P. vivax and P. ovale, and every

72 hours in P. malariae infection.

 Gametogony: This occurs when a few merozoites develop into the sexual form of the

parasite known as gametocytes. This may occur after the erythrocytic phase has been

occurring for a considerable length of time once gametocytes are formed then determine the

prevalence of malaria in respect to the patient is infective. Only the mature forms of the

gametocytes are found in the peripheral blood (Roberts et al., 2009).

11
2.8 Life cycle

Plasmodium parasites are spread by the bite of infected female Anopheles mosquitoes, which

feed on human blood in order to nourish their own eggs. While taking its meal (usually between

dusk and dawn), an infected mosquito injects immature forms of the parasite, called sporozoites,

into the person’s bloodstream. The sporozoites are carried by the blood to the liver, where they

mature into forms known as schizonts. Over the next one to two weeks each schizont multiplies

into thousands of other forms known as merozoites. The merozoites break out of the liver and re-

enter the bloodstream, where they invade red blood cells, grow and divide further, and destroy

the blood cells in the process. The interval between invasion of a blood cell and rupture of that

cell by the next generation of merozoites is about 48 hours for P. falciparum, P. vivax, and P.

ovale. In P. malariae the cycle is 72 hours long. P. knowlesi has the shortest life cycle 24 hours

of the known human Plasmodium pathogens, and thus parasites rupture daily from infected blood

cells. Most merozoites reproduce asexually that is, by making identical copies of themselves

12
rather than by mixing the genetic material of their parents. A few, however, develop into a sexual

stage known as a gametocyte. These will mate only when they enter the gut of another mosquito

that bites the infected person. Mating between gametocytes produces embryonic forms called

ookinetes; these embed themselves in the mosquito’s gut, where they mature after 9 to 14 days

into oocysts, which in turn break open and release thousands of sporozoites that migrate to the

insect’s salivary glands, ready to infect the next person in the cycle (Bongdap, 2020).

2.9 Pathogenesis

Clinical illness is caused by the erythrocytic stage of the parasite. No disease is associated with

sporozoites, the developing liver stage of the parasite, the merozoites released from the liver, or

gametocytes.

The first symptoms and signs of malaria are associated with the rupture of erythrocytes when

erythrocytic-stage schizonts mature. This release of parasite material presumably triggers a host

13
immune response. The cytokines, reactive oxygen intermediates, and other cellular products are

released during the immune response play a prominent role in pathogenesis, and are probably

responsible for the fever, chills, sweats, weakness, and other systemic symptoms associated with

malaria. In the case of falciparum malaria (the form that causes most deaths), infected

erythrocytes adhere to the endothelium of capillaries and postcapillary venules, leading to

obstruction of the microcirculation and local tissue anoxia. In the brain this causes cerebral

malaria, in the kidneys it may cause acute tubular necrosis and renal failure; and in the intestines

it can cause ischemia and ulceration, leading to gastrointestinal bleeding and to bacteremia

secondary to the entry of intestinal bacteria into the systemic circulation. The severity of malaria-

associated anemia tends to be related to the degree of parasitemia. The pathogenesis of this

anemia appears to be multifactorial. Haemolysis or phagocytosis of parasitized erythrocytes and

ineffective erythropoiesis are the most important factors, and phagocytosis of uninfected

erythrocytes and an autoimmune hemolytic anemia have also been implicated. Massive

intravascular haemolysis leading to haemoglobinuria and renal failure is referred to as

blackwater fever. It was described more frequently in the past than currently. Haemolysis may

also occur after the use of certain antimalarials (especially primaquine) in patients with glucose

6-phosphate dehydrogenase deficiency (Crutcher et al., 2014).

2.10 Signs and symptoms

Malaria signs and symptoms usually appears 10 days to 1 month after the person was infected.

Symptoms can be mild. Parasites can live in the body for several years without causing

symptoms.

Signs and symptoms of malaria are similar to flu signs and symptoms. They include:

14
  Fever and sweating.

 Chills that shake the whole body.

 Headache and muscle aches.

 Fatigue.

 Chest or abdominal pain.

 Cough and breathing problems.

 Diarrhea, nausea and vomiting.

 Loss of appetites.

 Jaundice (yellow of skin).

 High body temperature.

 Profound weakness (Quinn & Robert 2021).

2.11 Complications

Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Pregnant

women, babies, young children and the elderly are particularly at risk. The plasmodium

falciparum parasite causes the most severe malaria symptoms and most deaths. Complications of

severe malaria can happen within hours or days of the first symptoms. It's important to seek

urgent medical help as soon as possible. These includes

Anaemia: The destruction of red blood cells by the malaria parasite can cause severe anaemia.

Anaemia is where the red blood cells are unable to carry enough oxygen to the body's muscles

and organs. This leaves you feeling drowsy, weak and faint.

15
Cerebral malaria: In rare cases, malaria can affect the brain. This is called cerebral malaria,

which can cause your brain to swell. This can sometimes lead to permanent brain damage. It can

also cause fits (seizures) or coma.

Hypoglycemia: It is a common feature in patients with severe malaria. It may be overlooked

because all clinical features of hypoglycemia (anxiety, dyspnea, tachycardia, sweating, coma,

abnormal posturing, and generalized convulsions) are also typical of severe malaria itself.

Hypoglycaemia may be caused by quinine- or quinidine-induced hyperinsulinemia, but it may be

found also in patients with normal insulin levels.

Other complications that can arise as a result of severe malaria include:

 Liver failure and jaundice – yellowing of the skin and whites of the eyes.

 Shock – a sudden drop in blood pressure.

 Pulmonary oedema – a build-up of fluid in the lungs.

 Acute respiratory distress syndrome (ARDS).

 Kidney failure.

 Swelling and rupturing of the spleen.

 Dehydration. (Andrej et al., 2013).

2.12 Diagnosis

2.12.1 Malaria microscopy

Microscopic examination remains the gold standard for laboratory confirmation of malaria in the

malaria-endemic world, as well as in the United States.

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2.12.1.1. Technique

A blood specimen collected from the patient is spread as a thick or thin blood smear, stained with

a Romanovsky stain (most often Giemsa), and examined with a 100X oil immersion objective.

Visual criteria are used to detect malaria parasites and to differentiate (when possible) the

various species and life cycle stages.

2.12.1.2. Advantages: Microscopy is an established, relatively simple technique that is familiar

to most laboratorians in endemic countries. In such areas, microscopy is a standard technique

used for diagnosing other diseases (such as tuberculosis), often by the same laboratories using

the same facilities and equipment. Blood slide microscopy makes it possible to count the number

of parasites and is more useful than rapid diagnostic tests for monitoring the effectiveness of

malaria treatment (WHO, 2012).

2.12.1.3. Disadvantages: Microscopy requires a level of skill often not available in many health

facilities in several malaria-endemic countries, especially in remote rural areas, where most

malaria transmission occurs. In addition, lack of functional microscopes or electricity to run

them, lack of or sub-standard reagents such as stains, and high workloads may affect the quality

of results (WHO, 2012).

2.12.2 Rapid diagnostic test kits

A Rapid Diagnostic Test (RDT) is an alternate way of quickly establishing the diagnosis of

malaria infection by detecting specific malaria antigens in a person’s blood. RDTs have recently

become available in Nigeria (WHO, 2012).

17
Technique

A blood specimen collected from the patient is applied to the sample pad on the test card along

with certain reagents. After 15 minutes, the presence of specific bands in the test card window

indicate whether the patient is infected with Plasmodium falciparum or one of the other 3 species

of human malaria. It is recommended that the laboratory maintain a supply of blood containing

P. falciparum for use as a positive control (WHO, 2012).

Advantages

High-quality malaria microscopy is not always immediately available in every clinical setting

where patients might seek medical attention. Although this practice is discouraged, many

healthcare settings either save blood samples for malaria microscopy until a qualified person is

available to perform the test, or send the blood samples to commercial or reference laboratories.

These practices have resulted in long delays in diagnosis. The laboratories associated with these

health-care settings may now use an RDT to more rapidly determine if their patients are infected

with malaria (WHO, 2012).

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Disadvantages

The use of the RDT does not eliminate the need for malaria microscopy. The RDT may not be

able to detect some infections with lower numbers of malaria parasites circulating in the patient’s

bloodstream. Also, there is insufficient data available to determine the ability of this test to detect

the 2 less common species of malaria, P. ovale and P. malariae. Therefore all negative RDTs

must be followed by microscopy to confirm the result (WHO, 2012).

In addition, all positive RDTs also should be followed by microscopy. The currently approved

RDT detects 2 different malaria antigens; one is specific for P. falciparum and the other is found

in all 4 human species of malaria. Thus, microscopy is needed to determine the species of

malaria that was detected by the RDT. In addition, microscopy is needed to quantify the

proportion of red blood cells that are infected, which is an important prognostic indicator (WHO,

2012).

2.13 Preventions of malaria

If you are located or traveling to places where malaria is common, make sure to stay safe from

mosquito bites. Protection from mosquito bites/ mosquitoes is the only thing you can do to

prevent the onset of this disease. Also, the chances of severity vary from individual to individual

depending on their physical condition and health records. Here are some of the preventive

measures you can take to control malaria and stop it from spreading further. These include the

following:

 Wear full sleeve protective clothing.

19
 Spray insect repellants on your exposed skin. The recommended repellent contains 20-

35% N N, N-Diethyl-meta-toluamide (DEET).

 Use a mosquito net over the bed if your bedroom isn’t air-conditioned or screened. For

additional safety, you can treat the mosquito net with the insecticide permethrin.

 When you go out, in addition to spraying insect repellants on your exposed skin, you can

also spray on your clothing. Mosquitoes find it easy to bite through thin clothing.

 Keep your home and surroundings clean without any junks or wastes.

 When it comes to controlling the disease, keep an eye out for the symptoms like fever

with high temperature. As soon as you find any possible signs of malaria, consult your

doctor immediately.

 Make sure you don’t keep your windows and doors open at night as mosquitoes get

active during the night and pose a higher risk. You can either use a mosquito or any net to

seal your window and then open for the whole day.

 Depending on the condition and prescription, you can take anti-malarial tablets.

 If you are a regular user of sunscreen, make sure you apply sunscreen first and then use

an insect repellent. Also, go for a sunscreen with SPF of 30-50.

 Follow the prescriptions of the doctor. This means that if your doctor has requested you

to follow a 2-week course, follow the prescription and medications for two weeks.

 Currently, there is no over-the-counter medication available for malaria. So the only way

you can treat this disease is by taking all the necessary precautions and safety measures

(CDC 2020).

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 CHAPTER THREE

3.0 MATERIALS AND METHODS

3.1 Study Area

The study was carried out at Federal Medical Center Bida and was investigated at the department

of parasitology. Niger state has a population of 3,950,240millions of people (2006 census). The

state has land area of 76,363km2 and located between longitude 10.50 degree and north to 6.00

degree east and latitude 10.000 degree E. Niger state is bounded to the different states. It

comprises of 25 local Government (2008) Bida has a population of 318,300millions of people

(projection, 2022). And the latitude Bida is 9.08333 and longitude is 6.016667

3.2 Research Design

This study was a cross sectional analytical studies which will conducted among pregnant women

attending antenatal clinic at federal medical center Bida. Which involved the collection of their

blood sample and investigation using thick film for malaria infection.

3.3 Study Population

The population of the study targeted 200 sample which were used for the microscopy using thick

film.

3.4 Sample Technique

Random sampling technique was used to sample the patients. Each patient has an equal and

independent chance of selection when taking the samples.

21
3.5 Sample Size

The determined sample size of this research work was 100.

3.6 Inclusion Criteria

All patients coming for antenatal within the period of duration were included.

3.7 Sample Collection

A clean sterile EDTA container was used to collect samples of blood from paediatric patients

one after the other and essential data such as age and serial/sample number were noted on the

container.

3.8 Research Materials

i. Giemsa stain

ii. Slides and spreader

iii. Microscope

iv. Syringe and needles

v. Blood sample

vi. Cotton wool

vii. Immersion oil

viii. EDTA containers

ix. Hand glove

3.9 Method of Data Analysis

Data analysis was based on simple frequency distribution tables.

22
 CHAPTER FOUR

4.0. DATA ANALYSIS AND RESULTS .

Table 4.1: Prevalence of malaria infection among pregnant women attending antenatal

care at Federal Medical Center Bida

Total Number No. of Positive Malaria (%) No. of Negative malaria (%)

100 21 79

The table above shows the overall prevalence of malaria infection among pregnant women

attending antenatal care at Federal Medical Center Bida. Out of 100 data reviewed, 21% were

positive for malaria infection while 79% were negative.the rate of malaria infection among the

study population.

Table 4.2: Prevalence of malaria infection among pregnant women attending antenatal

care at Federal Medical Center Bida with respect to gestational age

Gestational age Frequency (n) Positive (%) Negative (%)

1ST trimester 28 06 (21.4) 22 (78.6)

2ND trimester 45 12 (26.7) 33 (73.3)

3RD trimester 27 03 (11.1) 24 (88.9)

23
 Total 100 21 79

The table above shows the overall prevalence of malaria infection among pregnant women

attending antenatal care at Federal Medical Center Bida with respect to trimester showed that

those in second trimester have more prevalence of 12 (26.7%), followed by first trimester of 06

(21.4%) while 03 (11.1%) prevalence was recorded among those pregnant women that were in

third trimester.

Table 4.3: Prevalence of malaria infection among pregnant women attending antenatal

care at Federal Medical Center Bida with respect to age.

Age group (years) Frequency (n) Positive (%) Negative (%)

18 – 22 10 05 (50.0) 5 (50.0)

23 – 27 30 08 (26.7) 22 (73.4)

28 – 32 22 03 (13.6) 19 (86.4)

24
 33 – 37 08 04 (50.0) 04 (50.0)

> 38 30 01 (3.3) 29 (96.7)

Total 100 21 79

The analysis of the results obtained by age group revealed that age group 18-22 had prevalence

of malaria with 5 (50%), age group 23-27 had prevalence of malaria with 8 (26.7%), age group

28-32 had prevalence of malaria with 3 (13.6%), followed by age group 33-37 had prevalence of

malaria with 4 (50%) and age group >38 had the prevalence of malaria with 1 (3.3%) among the

study population.

CHAPTER FIVE

5.0 DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 Discussion

This study was conducted for the purpose of investigating the prevalence of malaria infection

among pregnant women attending antenatal care at Federal Medical Center Bida, with specifics

regarding the age and gestational age of the participants. This was achieved using a cross-
25
sectional survey design. This study takes up the case of pregnant women attending antenatal care

at Federal Medical Center Bida, Niger state. Data was obtained from 100 participants.

Out of 100 data reviewed, 21% were positive for malaria infection while 79% were negative.

Notably, the table shows a significant prevalence rate of malaria infection among the study

population. This prevalence is lower than the 52.7% malaria prevalence reported Amadi &

Nwankwo, (2012) in Abia. According to our study, Plasmodium falciparum was the only

species of malaria parasite detected, and this was similar to that of a study done in Al Jabalian

Locality, White Nile state, Sudan, which has similar result (Suliman, Tamomh, Younis,

Magboul, Mohammed & Hassan, 2021). This also is in accordance with the World Health

Organization (WHO), where Plasmodium falciparum is the predominate species in Africa

(WHO, 2023).

In this current study, trimester showed that those in second trimester have more prevalence of 12

(26.7%), followed by first trimester of 06 (21.4%) while 03 (11.1%) prevalence was recorded

among those pregnant women that were in third trimester. This is in line with the previous

findings of Menendez, (2015) but in conflict with the work of Brabin, (2019) who reported that

pregnant women were at higher risk during the first trimester of pregnancy.

Age group revealed that ages 18-22 had prevalence of malaria with 5 (50%), age group 23-27

had prevalence of malaria with 8 (26.7%), age group 28-32 had prevalence of malaria with 3

(13.6%), followed by age group 33-37 had prevalence of malaria with 4 (50%) and age group

>38 had the prevalence of malaria with 1 (3.3%) among the study population. Younger pregnant

women were more affected by the malaria than the older ones in this study. This was in

conformity with the earlier findings (Rogerson & Boeuf, 2007). They showed that higher

26
prevalence of malaria at lower age group and lower prevalence at higher age groups might be

due to the existence of natural immunity to infectious diseases (malaria inclusive) which the

pregnant women acquired as their ages increased.

5.2 Conclusion

In conclusion, this study showed that the prevalence of malaria infection among pregnant women

attending antenatal care at Federal Medical Center Bida, with specifics regarding the age and

gestational age, the study further showed that the age group 23-27 had prevalence is highest

prevalence of malaria and second trimester had the highest prevalence of malaria.

5.3 Recommendation

Based on the study findings, the following recommendations were made:

i. Measures to control malaria infection among pregnant women attending Federal Medical

Center Bida, Niger state.

ii. Pregnant women who are less than 20 years old, are vulnerable age group and should be

cautious of their exposures to mosquitoes’ bites so as to reduce the pressure on the

already overstretched health facilities.

iii. Strategies for reducing malaria parasitaemia and anaemia in pregnancy should be

intensified in rural settings.

iv. Also, there is need for a critical appraisal of implementation of the ongoing programme

for maternal health in the rural settings of Minna and Nigeria as a whole.

v. The presence of symptomatic compliant of malaria during pregnancy does not suggest the

presence of malaria.

27
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