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Parasitic infections among pregnant women at first antenatal care visit in northern Ghana: A study of prevalence and associated factors.

ABSTRACT: BACKGROUND:Parasitic infections remain widespread in developing countries and constitute a major public health problem in many parts of sub-Saharan Africa. It is prevalent among children under 5 years and pregnant women; however, studies among the later high risk group is limited in the northern part of Ghana. Here, we evaluated the prevalence and associated factors of parasitic infections among pregnant women at first antenatal care visit in northern Ghana. METHODS:This was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, Bolgatanga Regional Hospital, Upper East Region-Ghana. A total of 334 consecutive consenting pregnant women were included. Questionnaires were administered to obtain socio-demographic data. Venous blood, stool and urine samples were collected for parasite identification using microscopy. Factors associated with parasitic infections were evaluated using regression models. Statistical analysis was performed using R. RESULTS:Parasitic infections identified were giardiasis (30.5%), P. falciparum malaria (21.6%) and schistosomiasis (0.6%). Polyparasitic infection was identified in 6.6% of the population. Increasing age [Age of 20-29 years: AOR = 0.16, 95% CI (0.06-0.38); Age of 30-39 years: AOR = 0.21, 95% CI (0.08-0.50); Age >39 years: AOR = 0.30, 95% CI (0.11-0.83)] was associated with lower odds whiles presence of domestic animals [AOR = 1.85, 95% CI (1.01-3.39)], being in the second trimester of pregnancy [AOR = 2.21, 95% CI (1.17-4.19)], having no formal education [AOR = 3.29, 95% CI (1.47-7.35)] and basic education as the highest educational level [AOR = 6.03, 95% CI (2.46-10.81)] were independent predictors of increased odds of giardiasis. Similarly, having no formal education [AOR = 2.88, 95% CI (1.21-8.79)] was independently associated with higher odds of P. falciparum malaria. The use of insecticide treated net (ITN) [AOR = 0.43, 95% CI (0.21-0.89)] and mosquito repellent [AOR = 0.09, 95% CI (0.04-0.21)] were independent predictors of lower odds of P. falciparum malaria. CONCLUSION:Giardiasis and P. falciparum malaria are common among pregnant women in northern Ghana. The major associated factors of giardiasis are lack of or low level of formal education, the presence of domestic animals and being in the second trimester of pregnancy. Increasing age confers protection against giardiasis. Likewise, lack of formal education is an associated factor for P. falciparum malaria among pregnant women in northern Ghana. The use of ITN and mosquito repellents reduce the risk of P. falciparum malaria. Given the possible role of parasitic infections in adverse pregnancy outcomes, our findings highlight the need for regular screening and treatment of infected women in the northern parts of Ghana. Public health education and improving socio-economic status could help reduce the risk of parasitic infections among pregnant women in the region.

SUBMITTER: Ahenkorah B

PROVIDER: S-EPMC7380595 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Parasitic infections among pregnant women at first antenatal care visit in northern Ghana: A study of prevalence and associated factors.

Ahenkorah Benjamin B Nsiah Kwabena K Baffoe Peter P Ofosu Winfred W Gyasi Charles C Owiredu Eddie-Williams EW

PloS one 20200724 7

<h4>Background</h4>Parasitic infections remain widespread in developing countries and constitute a major public health problem in many parts of sub-Saharan Africa. It is prevalent among children under 5 years and pregnant women; however, studies among the later high risk group is limited in the northern part of Ghana. Here, we evaluated the prevalence and associated factors of parasitic infections among pregnant women at first antenatal care visit in northern Ghana.<h4>Methods</h4>This was a cro ...[more]

PMID: 32706826

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Project description:BackgroundMalaria in pregnancy remains a major public health problem in Africa and Ghana and has been associated with a variety of pregnancy-related adverse complications. The development of effective and timely health policies for the prevention and control of malaria and anemia in pregnancy; requires current and consistent data on the prevalence and risk factors. We report the prevalence and risk factors of malaria and anemia from three major hospitals across three regions in Ghana.MethodsThis multicenter cross-sectional study comprising a total of 628 pregnant women was conducted at the antenatal care units of the Achimota Hospital in the Greater Accra Region (n = 199), St. Michael's Hospital in the Ashanti Region (n = 221), and Effia Nkwanta Regional Hospital in the Western Region (n = 211). Questionnaires were administered to obtain socio-demographic, obstetrics and clinical data. Venous blood, stool and urine samples were collected for hematological profile and parasite identification using microscopy. Risk factors were evaluated using logistic regression models.ResultsThe overall prevalence of P. falciparum malaria was 8.9%. Factors independently associated with malaria were self-reported mosquito exposure (moderate exposure: aOR = 3.11, 95% CI (1.12-8.61) and severe exposure: aOR = 10.46, 95% CI (3.86-28.34)) and non-use mosquito repellents (aOR = 3.29, 95% CI (1.70-6.39)). Multiparty (parity of 2: aOR = 0.19, 95% CI (0.05-0.70) and parity ≥3: aOR = 0.11, 95% CI (0.03-0.45)) and age (20-30 years old: aOR = 0.22, 95% CI (0.09-0.56)) reduced the odds of infection. The overall prevalence of anemia was 42.4%. The prevalence of mild, moderate and severe anemia were 35.7%, 6.1% and 0.6%, respectively. The use of water other than purified water (tap water: aOR = 3.05, 95% CI (2.06-4.51) and well water: aOR = 2.45, 95% CI (1.35-4.44)), increasing gestational age (second trimester: aOR = 2.05, 95% CI (1.41-2.97) and third trimester: aOR = 7.20, 95% CI (3.06-16.92)) and malaria (aOR = 2.40, 95% CI (1.27-4.53)) were independent risk factors for anemia.ConclusionsAlthough the prevalence of malaria is relatively low, that of anemia remains high. We recommend increasing efforts to make ITNs more available to strengthen malaria prevention. Public health education programs could help improve uptake and proper use of ITNs. To help reduce anemia in pregnancy, women should be empowered economically and interventions that reduce malnutrition should be encouraged. Women should be educated on early initiation of antenatal care to enhance surveillance, identification and treatment of anemia.

Project description:BACKGROUND:Anaemia during pregnancy is a major public health problem in developing countries. It is important to regularly monitor haemoglobin level in pregnancy and factors associated with it to inform clinical and preventive services. The aim of this study was to assess the prevalence and determinants of anaemia in pregnant women attending antenatal clinic (ANC) of a tertiary referral hospital in Northern Ghana. METHODS:An analytical cross-sectional study involving 400 pregnant women receiving antenatal care in Tamale Teaching Hospital was conducted. Using a semi-structured questionnaire and 24-h dietary recall, data were collected on socio-demographic characteristics, health practices, dietary diversity, anaemia knowledge and haemoglobin level of the women. Anaemia was defined as haemoglobin concentration less than 11?g/dl. Chi-square test and logistic regression analysis were used to identify the independent determinants of pregnancy anaemia. RESULTS:The mean age and haemoglobin of the women were 28.3 (±4.5) years and 10.81 (±1.41) g/dl respectively. About half of the women 50.8% [95% Confidence Interval (CI): 45.8-55.7] were anaemic and the prevalence of anaemia increased with pregnancy trimester. Among a host of socio-demographic, dietary, and preventive health service factors evaluated, the women's knowledge on anaemia and pregnancy trimester at interview were the independent determinants of anaemia in pregnancy. Compared to women of the highest anaemia knowledge tertile, women belonging to the lowest (AOR?=?2.63, 95% CI: 1.50-4.61) and middle (AOR?=?1.92, 95% CI: 1.12-3.27) anaemia knowledge tertiles were about 3 and 2 times more likely to be anaemic respectively. Similarly, women in third trimester of pregnancy were about 4 times more likely to be anaemic compared to those in first trimester at the time of interview (AOR?=?3.57, 95% CI: 1.91-6.67). CONCLUSIONS:There is a high prevalence of anaemia, which increases with pregnancy trimester, in pregnant women attending ANC in a tertiary referral hospital in Northern Ghana. The women's knowledge on anaemia and pregnancy trimester at the time of interview are associated with their anaemia status. The high prevalence of anaemia in pregnancy needs urgent intervention to prevent the occurrence of adverse maternal and neonatal outcomes. Education on anaemia should be intensified at ANCs.

Project description:BackgroundIntestinal parasitic infections (IPIs) affect millions of pregnant women worldwide and if left untreated can cause adverse effects for mothers, fetuses, and newborns. This study was aimed at determining the prevalence and associated risk factors of intestinal parasitic infections among pregnant women in Woreilu, Northeast Ethiopia.MethodsA cross-sectional study was conducted in Woreilu Health Center from October 2018 to February 2019. A convenient sampling technique was used to select the study subjects. The data related to the sociodemographic information and associated risk factors were collected by the interview technique, and fresh stool samples were collected from each pregnant woman. The microscopic examination of the stool samples was done by using direct wet mount preparations in normal saline and formol ether concentration techniques. Descriptive statistics and binary logistic regression were used. A p value < 0.05 was taken as statistically significant.ResultsA total of 331 pregnant women were included. The mean ± standard deviation of age of the participants was 26.3 ± 5.96 years ranging between 16 and 43 years. The overall prevalence of IPIs was 144 (43.5%) with the predominance of E. histolytica/dispar (44.4%) followed by A. lumbricoides (15.7%). Being a student (AOR = 3.35, 95% CI: 1.01-11.09, p = 0.047), second trimester (AOR = 3.94, 95% CI: 1.46-10.64, p = 0.007), third trimester (AOR = 3.32, 95% CI: 1.15-9.6, p = 0.027), and using spring water for drinking (AOR = 2.91, 95% CI: 1.62-5.22, p ≤ 0.001) were significantly associated with IPIs.ConclusionThe prevalence of IPIs was high in this study. Being a student, second and third trimester, and using spring water for drinking were associated factors with IPIs. Therefore, improving the sanitation of the students and providing clean drinking water for the women should be strengthened. Screening women and providing health education during their antenatal care (ANC) visits are also recommended.

Project description:BackgroundHigh prevalence of malaria and hepatitis B has been reported among pregnant women in Ghana. In endemic areas, the diagnoses of malaria and hepatitis B among pregnant women on antenatal visits are done using histidine-rich protein 2 (HRP2) and hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs), respectively, which are, however, reported to give some false positive results. Also, socio-economic determinants have been drawn from these RDTs results which may have questionable implications. Thus, this study was aimed at evaluating the prevalence of malaria and hepatitis B by comparing RDTs with polymerase chain reaction (PCR) outcomes, and relating the PCR prevalence with socio-economic status among pregnant women in Northern Ghana.MethodsWe screened 2071 pregnant women on their first antenatal visit for Plasmodium falciparum and hepatitis B virus (HBV) using HRP2 and HBsAg RDTs, and confirming the infections with PCR. Socio-economic and obstetric information were collected using a pre-tested questionnaire, and associations with the infections were determined using Pearson's chi-square and multinomial logistic regression analyses at a significance level of p<0.05.ResultsThe prevalence of the infections by RDTs/PCR was: 14.1%/13.4% for P. falciparum mono-infection, 7.9%/7.5% for HBV mono-infection, and 1.9%/1.7% for P. falciparum/HBV co-infection. No statistical difference in prevalence rates were observed between the RDTs and PCRs (χ2 = 0.119, p = 0.73 for malaria and χ2 = 0.139, p = 0.709 for hepatitis B). Compared with PCRs, the sensitivity/specificity of the RDTs was 97.5%/99.1% and 97.9%/99.4% for HRP2 and HBsAg respectively. Socio-economic status was observed not to influence HBV mono-infection among the pregnant women (educational status: AOR = 0.78, 95% CI = 0.52-1.16, p = 0.222; economic status: AOR = 1.07, 95% CI = 0.72-1.56, p = 0.739; financial status: AOR = 0.66, 95% CI = 0.44-1.00, p = 0.052). However, pregnant women with formal education were at a lower risk for P. falciparum mono-infection (AOR = 0.48, 95% CI = 0.32-0.71, p<0.001) and P. falciparum/HBV co-infection (AOR = 0.27, 95% CI = 0.11-0.67, p = 0.005). Also those with good financial status were also at a lower risk for P. falciparum mono-infection (AOR = 0.52, 95% CI = 0.36-0.74, p<0.001).ConclusionOur data has shown that, the RDTs are comparable to PCR and can give a representative picture of the prevalence of malaria and hepatitis B in endemic countries. Also, our results support the facts that improving socio-economic status is paramount in eliminating malaria in endemic settings. However, socio-economic status did not influence the prevalence of HBV mono-infection among pregnant women in Northern Ghana.

Project description:Intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is used to prevent malaria and associated unfavorable maternal and foetal outcomes in pregnancy in moderate to high malaria transmission areas. Effectiveness of IPTp-SP is, however, threatened by mutations in the Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes which confer resistance to pyrimethamine and sulfadoxine, respectively. This study determined the prevalence of molecular markers of SP resistance among pregnant women in a high malaria transmission area in the forest-savannah area of Ghana. Genomic DNA was extracted from 286 P. falciparum-positive dried blood spots obtained from pregnant women aged ≥18 years (255 at first Antenatal Care (ANC) clinic visit and 31 at delivery from 2017 to 2019) using Chelex 100. Mutations in Pfdhfr and Pfdhps genes were detected using molecular inversion probes and next generation sequencing. In the Pfdhfr gene, single nucleotide polymorphisms (SNPs) were detected in 83.1% (157/189), 92.0% (173/188) and 91.0% (171/188) at codons 51, 59, and 108 respectively in samples collected at first ANC visit, while SNPs were detected in 96.6 (28/29), 96.6% (28/29) and 96.8% (30/31) in isolates collected at delivery. The Pfdhfr triple mutant N51I, C59R and S108N (IRN) was carried by 80.5% (128/159) and 96.5% (28/29) of the typed isolates collected at ANC visit and at delivery respectively. In the Pfdhps gene, SNPs were detected in 0.6% (1/174), 76.2% (138/181), 33.2% (60/181), 1.2% (2/174), 0% (0/183), and 16.6% (27/173) at codons 431, 436, 437, 540, 581 and 613 respectively in samples collected at ANC, and 0% (0/25), 72% (18/25), 40% (10/25), 3.6% (1/25), 0% (0/29) and 7.4% (2/27) in samples collected at delivery. Quadruple mutant Pfdhfr N51I, C59R, and S108N + Pfdhps A437G (IRN-GK) was present in 25.8% (33/128) and 34.8% (8/23) of isolates at ANC and at delivery respectively. Quintuple mutant alleles Pfdhfr N51I, C59R, and S108N + Pfdhps A437G and K540E (IRN-GE) were detected in 0.8% (1/128) and 4.4% (1/23) of samples collected at ANC and at delivery respectively. No mutations were identified at Pfdhfr codons 16 or 164 or Pfdhps 581. There is a high prevalence of Pfdhfr triple mutant P. falciparum infections among pregnant women in the study area. However, prevalence of the combined Pfdhfr/Pfdhps quadruple and quintuple mutants IRN-GK and IRN-GE respectively prior to commencement of IPTp-SP were low, and no Pfdhps A581G mutant was detected, indicating that SP is still likely to be efficacious for IPTp-SP in the forest-savannah area in the middle belt of Ghana.

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Parasitic infections among pregnant women at first antenatal care visit in northern Ghana: A study of prevalence and associated factors.

Publications

Parasitic infections among pregnant women at first antenatal care visit in northern Ghana: A study of prevalence and associated factors.

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