Malaria parasitemia during delivery

OBJECTIVE: The aim of this study is to investigate the impact of plasmodium falciparum infection in parturient women in Central Sudan where malaria transmission is mesoendemic. The purpose of this paper is to find out the prevalence of malaria parasitemia and the risk of anemia among parturient women and to suggest appropriate strategies to lower their prevalence rates.

METHODS: This prospective study was conducted at Medani Teaching Hospital, Sudan, a tertiary regional referral center, during the period January 1997 through to December 1997. All cases were admitted during labor to the delivery room and were clinically suspected to have malaria. History, examination and investigations were carried out on all patients.

RESULTS: The total number of patients enrolled in this study was 550, amounting to 14.9% of all women (N=3,687) who delivered during the study period. The prevalence of malaria parasitemia was 58.9% (N=550) while prevalence of anemia (defined as hemoglobulin <9.0 g/dl) was 24.1%. The mean hemoglobulin levels in patients with positive and negative malaria parasitemia was 9.72 ± 1.62 and 9.85 ± 1.60 g/dl. Statistically the difference in the mean hemoglobulin level was not significant, t=0.879, (P>0.05). A significant negative correlation between parasite count in maternal blood and hemoglobulin level of the mother, was observed, where r=-0.121 (P=0.032). Out of 17 (3.3%) patients who had used chloroquine tablets for prophylaxis, 11 patients still had positive parasitemia. Although there was a higher parasite count in those 11 patients, statistically the difference was not significance where P> 0.05.

CONCLUSION: The study documents a high prevalence of malaria parasitemia and anemia among the parturient women in Central Sudan. There were 533 pregnant women (97%) who did not use chloroquine tablets as chemoprophylaxis and 17 (3%) had prophylaxis. Eleven of the later (N=17) had positive parasitemia. In view of the high prevalence of parasitemia and anemia, and although the sample of patients who used chloroquine tablets for prophylaxis and had positive parasitemia is small (17 out of 550), a wide scale prophylaxis placebo-controlled trial is recommended to test the impact of prophylactic drugs in pregnancy and to measure the effect on the mother, and the neonate. The drug that proves to be effective as a prophylactic, should be an integral part of ante-natal care along with iron and folic acid as anti-anemic therapy. Moreover, prompt treatment of malaria infection with the appropriate anti-malarial drug, spray of insecticides and the use of insecticide-impregnated bed-nets and curtains for preventing malaria are recommended.