Authored by İlker Etikan
Abstract
Objectives: Malaria during antenatal period was a major health problem that lead to both mother and child death. The aim of this study is to assess the predictors of malaria during pregnancy among six states of Nigeria based on anti-malarial pill prescribed to pregnant women by the health facility.Methods: The analysis involves chi-square test for independent association between the predictors and risk of malaria diagnosis among the qualitative variables, Mann Whitney u test for quantitative variables and binary logistic regression for the multivariate analysis.
Results: The analysis shows that the risk of malaria during pregnancy was significantly associated with Age, IPTp-up take, ITN use, source of energy for lightening, main material use for room’s rooftop and livestock keeping. This shows that, appropriate use of insecticide treated bed nets, optimal IPTp uptake against malaria and other protective measures, teamed with some elements such as sources of energy for lightening and main material for room’s rooftop decreased the incidence of malaria infectious disease among antenatal women.
Conclusion: The research suggested that the illiterates and poor women are less probable of using these preventive measures in other to reduce the spread of malaria disease among pregnant women and entire population as whole.
Keywords:Malaria; Pregnancy; Chi square test; Mann whitney - U test; Logistic regression
Introduction
A life hostile parasitic infectious disease conveyed by female anopheles mosquitoes is called malaria [1]. In human body, malaria is caused by a protozoan of the Plasmodium type of the four subspecies, which include P.falciparum, P.vivax, P.malariae and P.ovale. The subspecie that causes greatest sickness and death in African countries was P. falciparum. This parasitic disease is transmitted by the bites of female anopheles mosquitoes of the genus Anopheles which is the most efficient and responsible for disease transmission in Africa [2]. Initially the parasite starts by infecting the liver where it begins to build up. After some days, the developing parasites are discharged into the blood stream to infect the red blood cells, where they continue to increase, ultimately bursting the red blood cells and infecting others in advance. If they reach high numbers, they may cause severe disease or even death as well [3].One of the major health problems that cause both maternal and neonatal mortality is malaria during pregnancy. Low birth weight is one of the major factors that cause child mortality, where malaria during pregnancy reduces the birth weight. In Africa, maternal and neonatal mortality were associated with up to 300,000 death estimate in each year as indicated by statistics [4]. Luxemburger [5] make an estimate among Koran population living in Thailand, malaria during antenatal period have an effect on child mortality during the first month of child’s life [6]. Examined the Status of Pregnant Women having in Lagos State, Nigeria [7]. Examined the Inferiority of Single-Dose Sulfadoxine-Pyrimethamine Intermittent Preventive Remedy for Malaria during the pregnancy of women with HIV-Positive Zambia [8].
Determined the Prevalence of Malaria Parasite Infection among Pregnant Women in Osogbo, Southwest of Nigeria [9]. Examined the prevalence of malaria parasite infection among pregnant women living in a suburb of Lagos, Nigeria [10]. studied the Effects of Malaria and Intermittent Preventive (IPTp) Treatment during Pregnancy on Fetal Anemia in Malawi with Unconditional linear and logistic regressions [11]. studied the Impact of malaria during pregnancy on pregnancy outcomes in Ugandan potential cohort with intensive malaria screening and prompt treatment using Multivariate analysis [12]. Made an assessment of the spatial pattern of malaria infection in Nigeria. The pattern of spatial variation in the rate of malaria infection was analyzed using principal component analysis (PCA) [13].
Measured the level and predictors of optimal IPTp-SP doses in six districts of Tanzania using Chi-Square to test the independent association between IPTp uptake and risk factors of malaria during antenatal period, and multinomial logistic regression for multivariate analysis [14]. Studied the Epidemiology of Malaria Infection in Pregnant Women in Some selected areas of Nassarawa State, Nigeria [15]. investigated the prevalence and risk factors of malaria based on the rapid diagnosis test (RDT) in Ethiopia.
Methods
Data and area
The information use in this research was a documented data obtained from National Bureau of Statistics Nigeria, it was health results based on financing Nigeria in the year 2013, and the survey was conducted by Federal ministry of Health in collaboration with National Bureau of statistics and World Bank. It was an exit interview for antenatal care visit in six states of Nigeria namely Adamawa, Benue, Nassarawa, Ogun, Ondo and Taraba State which represent the six geopolitical zones of Nigeria. The data was analyzed both descriptively and inferentially using standard methods of applied statistics in health sciences.Variables
The dependent or outcome of interest is prescription or given Quinine or Fansidar antimalarial pills by the health worker at ANC unit. Many drugs such as Arthimeter, chloroquine and pyrimethamine/sulfadoxine (Fansidar) are the most common drugs used for curing malaria in Nigeria and Africa as whole, such drugs assist in malaria treatment during pregnancy [16]. Thus, the dependent variable is binary, signifying whether or not a person was positive for malaria according to these antimalarial pills prescription, and it was derived from the question: “During this visit, has a health worker given or prescribed you any antimalarial pills?” The response was categorized in two categories such that:Given or prescribed antimalarial pills = Independent variables include Age, Highest level of Education, marital status, spouse education level, pregnancy weeks, IPTp uptake, primigravidae status, use of insecticide treated net, health insurance scheme, land asset, total family, main source of water, main source of energy for cooking and lightening, main material use for house wall, roof and floor, number of nets/person and livestock keeping.
Statistical Analysis
Statistical analysis play an important role in medical research area and the estimates and predicted values obtained provides change in the dynamic of epidemiology of malaria among antenatal women in a valuable vision. Therefore this study employs the application of logistic modeling to analyze factors associated with malaria during pregnancy, and the model obtained was purely based on statistical result. The analysis was done using univariate, bivariate and Multivariate statistical method. In the univariate analysis, frequency distribution and percentages for each qualitative variable while median and interquartile range (IQR) of the each quantitative variable were stated. Secondly, bivariate analysis was conducted, in which the outcome variable, presence or absent of malaria was cross tabulated against each and every independent variable. The statistical significant relationship between each pair of variables was tested using Pearson’s Chi-Square (χ2) test, for the categorical variables, while for the continuous variables, due to violation of normality assumption which is one of the main parametric assumptions, a non-parametric version of independent sample t- test was used, hence Mann Whitney U test was considered to test the difference between each predictor with the response variable. Where p-value less than 5% (p-value ≤ 0.05) of the outcome and each of the independent variables reject the hypothesis of no significant association between the variables, and hence concluded that they were significantly associated, else, no association was deduced.An interaction between the significant variables in the multivariate analysis was also done to see the significant association for interaction between variables. The category “present of malaria” of the outcome variable was made a baseline/ reference outcome hence assessing what predicts absence of malaria. For multivariate analysis, selection of predictor variables for building model depends on each one’s to become statistically significant in the overall model. Also the model was assessed using Hosmer and Lemeshow’s test from the measures of model fit.
Results and Discussions
A total of 1,676 antenatal women aged from 9 to 48 responded to malaria related questions fromsix states of Nigeria, of which 39.7% were from Adamawa state, 6.1% from Benue state, 16.6% from Nassarawa state, 5.0% from Ogun state, 22.3% from Ondo state and 10.3% were from Taraba state, all missing values were excluded. The majority of women (97%) were married, and about 32.2% have secondary education level. Occupationally, majority of the pregnant women were livestock keepers. From the descriptive statistics result, it was observed that 49.5% of the women were prescribed or given an antimalarial pill by the health facility, while 50.5% of the pregnant women were not prescribed. Furthermore, 60.1% of the women were multigravidae, 44.3% take partial intermitted preventive treatment against malaria, while 20.3% took optimal IPTp-doses. Also 51.7% were using insecticide treated net, while only 9.6% of the women were covered under health insurance scheme.Bivariate analysis
In the Bivariate analysis, chi-square test was employed for the categorical variables, educationlevel of the pregnant women was found to have a significant association with malaria diagnosis (p < 0.001), majority of preprimary educated women were malaria positive, while majority of women with secondary education level were malaria free. Marital status was insignificant, whereas husband education level have a significant relationship with malaria diagnosis (p < 0.001). From the chi square test result, it was observed that spouses with secondary education level, their wives were most likely malaria free. Primigravidae has a significant relationship with malaria diagnosis (p = 0.024). Such that malaria positive was highest among primigravidae compared to multigravidae. Furthermore, use of intermitted preventive treatment against malaria was found to have a significant association with malaria risk (p < 0.001), were majority of women with positive malaria did not received either partial or optimal IPTp- doses. While most of them with partial IPTp were malarial free. Use of ITN was found to have a statistical significant relationship with malarial diagnosis (p = 0.014). Health insurance scheme was found to have insignificant relationship with malaria risk, as well as material used for room’s wall and floor. But material used for room’s rooftop was found to have a significant relationship with malaria risk (p < 0.001), were majority of women with corrugated iron/metal were found to be malaria positive. Main sources of water for drinking during both dry and rainy season were found to be significant (p = 0.010 and p <0.001). Women drinking borehole water, were found have malaria risk diagnosis in both seasons (Table 1).To read more about this article...Open access Journal of Annals of Biostatistics & Biometric Applications
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