Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana
Abstract Background Malaria infection during pregnancy can cause significant morbidity and mortality to a pregnant woman, her fetus and newborn. In areas of high endemic transmission, gravidity is an important risk factor for infection, but there is a complex relationship with other exposure-related...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-022-04252-0 |
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| author | Ayodele Akinnawo Kaali Seyram Ellen Boamah Kaali Samuel Harrison David Dosoo Matthew Cairns Kwaku Poku Asante |
| author_facet | Ayodele Akinnawo Kaali Seyram Ellen Boamah Kaali Samuel Harrison David Dosoo Matthew Cairns Kwaku Poku Asante |
| author_sort | Ayodele Akinnawo |
| collection | DOAJ |
| description | Abstract Background Malaria infection during pregnancy can cause significant morbidity and mortality to a pregnant woman, her fetus and newborn. In areas of high endemic transmission, gravidity is an important risk factor for infection, but there is a complex relationship with other exposure-related factors, and use of protective measures. This study investigated the association between gravidity and placental malaria (PM), among pregnant women aged 14–49 in Kintampo, a high transmission area of Ghana. Methods Between 2008 and 2011, as part of a study investigating the association between PM and malaria in infancy, pregnant women attending antenatal care (ANC) clinics in the study area were enrolled and followed up until delivery. The outcome of PM was assessed at delivery by placental histopathology. Multivariable logistic regression analyses were used to investigate the association between gravidity and PM, identify other key risk factors, and control for potential confounders. Pre-specified effect modifiers including area of residence, socio-economic score (SES), ITN use and IPTp-SP use were explored. Results The prevalence of PM was 65.9% in primigravidae, and 26.5% in multigravidae. After adjusting for age, SES and relationship status, primigravidae were shown to have over three times the odds of PM compared to multigravidae, defined as women with 2 or more previous pregnancies [adjusted OR = 3.36 (95% CI 2.39–4.71), N = 1808, P < 0.001]. The association appeared stronger in rural areas [OR for PG vs. MG was 3.79 (95% CI 3.61–5.51) in rural areas; 2.09 (95% CI 1.17–3.71) in urban areas; P for interaction = 0.07], and among women with lower socio-economic scores [OR for PG vs. MG was 4.73 (95% CI 3.08–7.25) amongst women with lower SES; OR = 2.14 (95% CI 1.38–3.35) among women with higher SES; P for interaction = 0.008]. There was also evidence of lower risk among primigravidae with better use of the current preventive measures IPTp and LLIN. Conclusions The burden of PM is most heavily focused on primigravidae of low SES living in rural areas of high transmission. Programmes should prioritize primigravidae and young women of child-bearing age for interventions such as LLIN distribution, educational initiatives and treatment to reduce the burden of malaria in first pregnancy. |
| first_indexed | 2024-12-10T18:53:12Z |
| format | Article |
| id | doaj.art-095f6b138e774f8aadd6a56410710be2 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-10T18:53:12Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-095f6b138e774f8aadd6a56410710be22022-12-22T01:37:14ZengBMCMalaria Journal1475-28752022-08-012111810.1186/s12936-022-04252-0Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in GhanaAyodele Akinnawo0Kaali Seyram1Ellen Boamah Kaali2Samuel Harrison3David Dosoo4Matthew Cairns5Kwaku Poku Asante6London School of Hygiene and Tropical MedicineResearch and Development Division, Kintampo Health Research Centre, Ghana Health ServiceResearch and Development Division, Kintampo Health Research Centre, Ghana Health ServiceResearch and Development Division, Kintampo Health Research Centre, Ghana Health ServiceResearch and Development Division, Kintampo Health Research Centre, Ghana Health ServiceLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical MedicineAbstract Background Malaria infection during pregnancy can cause significant morbidity and mortality to a pregnant woman, her fetus and newborn. In areas of high endemic transmission, gravidity is an important risk factor for infection, but there is a complex relationship with other exposure-related factors, and use of protective measures. This study investigated the association between gravidity and placental malaria (PM), among pregnant women aged 14–49 in Kintampo, a high transmission area of Ghana. Methods Between 2008 and 2011, as part of a study investigating the association between PM and malaria in infancy, pregnant women attending antenatal care (ANC) clinics in the study area were enrolled and followed up until delivery. The outcome of PM was assessed at delivery by placental histopathology. Multivariable logistic regression analyses were used to investigate the association between gravidity and PM, identify other key risk factors, and control for potential confounders. Pre-specified effect modifiers including area of residence, socio-economic score (SES), ITN use and IPTp-SP use were explored. Results The prevalence of PM was 65.9% in primigravidae, and 26.5% in multigravidae. After adjusting for age, SES and relationship status, primigravidae were shown to have over three times the odds of PM compared to multigravidae, defined as women with 2 or more previous pregnancies [adjusted OR = 3.36 (95% CI 2.39–4.71), N = 1808, P < 0.001]. The association appeared stronger in rural areas [OR for PG vs. MG was 3.79 (95% CI 3.61–5.51) in rural areas; 2.09 (95% CI 1.17–3.71) in urban areas; P for interaction = 0.07], and among women with lower socio-economic scores [OR for PG vs. MG was 4.73 (95% CI 3.08–7.25) amongst women with lower SES; OR = 2.14 (95% CI 1.38–3.35) among women with higher SES; P for interaction = 0.008]. There was also evidence of lower risk among primigravidae with better use of the current preventive measures IPTp and LLIN. Conclusions The burden of PM is most heavily focused on primigravidae of low SES living in rural areas of high transmission. Programmes should prioritize primigravidae and young women of child-bearing age for interventions such as LLIN distribution, educational initiatives and treatment to reduce the burden of malaria in first pregnancy.https://doi.org/10.1186/s12936-022-04252-0Placental malariaGravidityPrimigravidaeSecundigravidaeMultigravidaeTransmission |
| spellingShingle | Ayodele Akinnawo Kaali Seyram Ellen Boamah Kaali Samuel Harrison David Dosoo Matthew Cairns Kwaku Poku Asante Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana Malaria Journal Placental malaria Gravidity Primigravidae Secundigravidae Multigravidae Transmission |
| title | Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana |
| title_full | Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana |
| title_fullStr | Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana |
| title_full_unstemmed | Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana |
| title_short | Assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in Ghana |
| title_sort | assessing the relationship between gravidity and placental malaria among pregnant women in a high transmission area in ghana |
| topic | Placental malaria Gravidity Primigravidae Secundigravidae Multigravidae Transmission |
| url | https://doi.org/10.1186/s12936-022-04252-0 |
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