MALARIA PARASITAEMIA AND ASSOCIATED PREVENTIVE FACTORS AMONG PREGNANT WOMEN IN MISUNGWI AND NYAMAGANA DISTRICT, MWANZA REGION, 2012 Maria Mgella Zinga, MD M. Sc (Tropical Diseases Control) Dissertation Muhimbili University of Health and Allied Sciences October, 2012 i MALARIA PARASITAEMIA AND ASSOCIATED PREVENTIVE FACTORS AMONG PREGNANT WOMEN IN NYAMAGANA AND MISUNGWI DISTRICT, MWANZA REGION, 2012 By Maria Mgella Zinga, MD A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Tropical Diseases of the Muhimbili University of Health and Allied Sciences Muhimbili University of Health and Allied Sciences October 2012 ii CERTIFICATION The undersigned certifies that he has read and hereby recommend for examination of the dissertation entitled “Malaria parasitaemia and associated preventive factors among pregnant women in Nyamagana and Misungwi districts, Mwanza region, 2012” in fulfillment of the requirements for the degree of Master of Science in Parasitology and Medical Entomology of the Muhimbili University of Health and Allied Sciences. _____________________________________ Prof. Zul Premji (Supervisor) Date: _____________________________________ iii DECLARATION AND COPYRIGHT I, Maria Mgella Zinga declare that this dissertation is my own original work and that it has not been presented and will not be presented to any other university for a similar or any other degree award. Signature................................................ Date..................................... © This dissertation is copyright material protected under the Berne Convention, the Copyright Act of 1999 and other international and national enactments, in that behalf, on intellectual property. It may not be reproduced by any means, in full or in part, except for short extracts in fair dealings; for research or private study, critical scholarly review or discourse with an acknowledgement, with the written permission of the Directorate of Postgraduate Studies, on behalf of both the author and Muhimbili university of Health and Allied sciences. iv AKNOWLEDGEMENT Completion of this thesis would not have been possible without the invaluable assistance and support of different individuals. First, I thank the pregnant women for their willingness to participate in this study, the villages and district leadership for allowing this study to be carried out in their administrative areas. I am in debt to all the antenatal clinics nurses and laboratory technologist of health facilities and Bugando University. Special thanks to Dr. Benson Kidenya and Dr.Humphrey Mazigo for assisting in data analysis and laboratory staff from Bugando University. My supervisor, Prof Premji and Dr Elia Mbaga for their guidance and unflagging confidence in my abilities will remain an inspiration for years to come. Many thanks to academic staff of Muhimbili University for their support in teaching which inspired me to this research. My experience with this batch of TDC students at Muhimbili University has been made memorable through the support and friendship of many of my colleagues. Finally, I must acknowledge the generosity and love provided by my family and my sponsor Catholic University of Health and Allied Sciences. v ABSTRACT Background: Malaria is still a problem during pregnancy in Tanzania and is associated with maternal anemia, premature delivery, intrauterine growth retardation and low birth weight. Tanzania adopted The World Health Organization (WHO) recommendation that all pregnant women living in sub-Saharan Africa countries with stable malaria transmission to receive Intermittent Preventive Treatment during pregnancy (IPTp) using two doses of Sulphadoxine Pyrimethamine, use Insecticide treated bed nets (ITNs) and effective case management of malaria and anemia. There is increased SP resistance and low uptake of IPTp-SP and unequal distribution of prevention tools like ITNs between rural and urban settings in the country. This study aims at determining preventive factors that are associated with presence of malaria parasitaemia and anemia among pregnant women. Methods: A cross-sectional hospitalbased study was conducted between May and June 2012, where a pretested questionnaire was administered to 400 pregnant women at selected nine antenatal clinics in Misungwi and Nyamagana districts in Mwanza and blood samples were collected for determining malaria parasitaemia and anaemia. The antenatal booklets were inspected for timing and number of visits to the clinic, obstetric history and use and timing of IPTp-SP. Data were entered, cleaned and analyzed using STATA software version 10. Data were summarized using frequency distribution tables for categorical variables and by calculating means and standard deviations for continuous variables. For categorical variables proportions were compared using X2 test or Fisher’s exact test, logistic regression were used to identify independent predictors of malaria and SP use. Results: Of the 400 pregnant women studied, 5.5% (22/400) had P.falciparum malaria. The prevalence of anaemia was 48.6% (194/399). Coverage of SP for at least one dose was 40% and for second dose was 16%. About 98% of respondents reported to own and use ITNs. No significant association was observed between malaria parasitaemia and anaemia (OR=0.87, vi 95%CI, 0.36-2.02, P=0.7). Risk factors for malaria parasitaemia were primigravidae (AOR=2.53, 95%CI, 0.97-6.58, P=0.05) and non- use of SP (AOR=7.68, 95%CI, 1.74-33.75. P=0.007). Conclusion: 5.5% of pregnant women had malaria parasitaemia, About 50% had mild anaemia. However given the health impact of the diseases in pregnancy, antenatal interventions such as IPTp-SP are needed to be improved to reach the recommended coverage. vii TABLE OF CONTENTS CERTIFICATION ................................................................................................................... iiii DECLARATION AND COPYRIGHT…………………………………………………………..iv AKNOWLEGMENT……………………………………………………………………………...v ABSTACT………………………………………………………………………………………..vi TABLE OF CONTENTS ......................................................................................................... vii LIST OF TABLES ................................................................................................................... xii LIST OF FIGURES ................................................................................................................. xii LIST OF ABBREVIATIONS.................................................................................................. xiii DEFINITION OF TERMS ..................................................................................................... xivv CHAPTER ONE .........................................................................................................................1 Back ground ................................................................................................................................1 1.1. Malaria and anaemia ............................................................................................................1 1.2. Problem statement ................................................................................................................2 1.3 Justification ...........................................................................................................................3 1.4 Conceptual framework ..........................................................................................................4 1.5. Hypothesis ...........................................................................................................................6 1.6. Research question .................................................................................................................6 1.7. General objective..................................................................................................................6 1.8. Specific objectives ................................................................................................................6 CHAPTER TWO ........................................................................................................................7 Literature review .........................................................................................................................7 2.0 Introduction ...........................................................................................................................7 viii 2.1 Policies, strategies and targets of malaria prevention in pregnancy ........................................7 2.1.1 Global vision for Malaria Control ................................................................................7 2.1.2 Global targets for Malaria control ................................................................................7 2.1.3 National drug policy for malaria control ......................................................................8 2.2 Malaria burden among pregnant women ................................................................................9 2.3 Factors associated with presence or absence of malaria infection during pregnancy ............. 11 2.3.1 Socio-demographic factors of pregnant women ......................................................... 11 2.3.2 Gestational age at First ANC visit.............................................................................. 12 2.3.3Level of knowledge of pregnant women on IPTp ........................................................ 13 2.3.4 Practice