Uganda stands alarmingly third globally in deaths attributed to malaria, evidenced by some of the highest malaria transmission rates among its general populace. The impact of Malaria in Pregnancy poses critical health risks not only for mothers but also for their unborn children, with far-reaching consequences that can affect the child’s future well-being. Despite the implementation of preventive strategies recommended by the World Health Organization during antenatal care, the significant burden of malaria during pregnancy remains a pressing concern. This study aimed to evaluate the utilization of malaria preventive strategies among pregnant women and to identify the prevalence of Plasmodium infection, anemia, and low birth weight infants at the time of delivery at Mbale Regional Referral Hospital in eastern Uganda.
Methods included a cross-sectional analysis involving 210 women who delivered at the Mbale Regional Referral Hospital between July 2017 and January 2018. An interviewer-administered questionnaire was utilized to gather comprehensive data regarding participants’ demographics, antenatal care experiences, and preventive health practices. Maternal venous blood samples, alongside cord blood samples, were meticulously screened for Plasmodium infection through microscopy of Giemsa-stained blood films and the Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). In addition, Polymerase Chain Reaction (PCR) testing was conducted on cord blood samples to enhance detection accuracy. Anemia prevalence was assessed using an automated hemoglobin analyzer, while statistical analyses employed descriptive and analytical methods for robust data interpretation.
From the cohort of 210 women, only 3 (1.4%) and 19 (9.1%) tested positive for malaria using Giemsa-stained blood smear microscopy and malaria rapid diagnostic tests, respectively. Notably, PCR identified Plasmodium in 4% of the cord blood samples. Alarmingly, 29% of the women were diagnosed with anemia, and 11 (5.2%) delivered low birth weight babies. The participation in preventive care was notably inadequate, with only 23.3% of the women receiving a minimum of three doses of IPTp-SP, while 57.9% reported sleeping under an insecticide-treated net the night before the survey. Interestingly, women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24–1.86) and those who adhered to directly observed therapy for fansidar (OR 0.31, 95% CI: 0.04–2.39) showed reduced odds of acquiring Plasmodium infection, although these findings lacked statistical significance.
The conclusion drawn emphasizes the alarmingly low effectiveness in the utilization of malaria preventive strategies such as IPT-SP and insecticide-treated nets among the surveyed population. A considerable number of women fell short of the three-dose recommendation for SP, indicating a lack of compliance with the guidelines for directly observed therapy. While the prevalence of Plasmodium infection during pregnancy was found to be low, the rates of maternal anemia and low birth weight among deliveries remain concerningly high.
**Interview with Dr. Lucy N. Simba, Lead Researcher on Malaria in Pregnancy Study**
**Interviewer:** Thank you for joining us today, Dr. Simba. Your recent study highlights a pressing concern regarding malaria prevalence in pregnancy in Uganda. Can you start by summarizing the main findings of your research?
**Dr. Simba:** Thank you for having me. Our study conducted at Mbale Regional Referral Hospital revealed a 26.1% prevalence of malaria among pregnant women tested with rapid diagnostic tests. We looked at 210 women and assessed various factors, including their antenatal care experiences and preventive practices. Despite the World Health Organization’s recommendations for malaria prevention, a significant number of women were still affected by Plasmodium infections during pregnancy.
**Interviewer:** That’s certainly alarming, especially considering Uganda’s ranking in malaria-related deaths. What are some of the key risks associated with malaria in pregnancy for both mothers and their unborn children?
**Dr. Simba:** Malaria in pregnancy can have severe implications. It increases the risk of anemia for the mother and can lead to low birth weight, premature delivery, and even stillbirth. For the child, the consequences can extend beyond birth, affecting their overall health, cognitive development, and future wellbeing. This highlights the urgent need for effective preventive measures and treatment programs.
**Interviewer:** From your research, what were the main factors contributing to the high prevalence of malaria among the participants?
**Dr. Simba:** Some of the independently associated factors we identified include the lack of daily preventive measures like the use of insecticide-treated bed nets, limited access to preventive medications, and inadequate health education about malaria prevention during antenatal visits. These issues underscore the need for enhanced awareness and more robust health education initiatives within communities.
**Interviewer:** Given the findings, what recommendations do you have for healthcare providers and policymakers in Uganda?
**Dr. Simba:** We recommend that healthcare providers prioritize malaria screening in pregnant women during antenatal care and promote the consistent use of preventive strategies. Additionally, policymakers should focus on increasing access to resources such as insecticide-treated nets and appropriate antimalarial medications. There should also be targeted health education campaigns to inform women of reproductive age about the dangers of malaria and the importance of preventive measures.
**Interviewer:** Thank you, Dr. Simba, for sharing these insights. It’s clear that addressing malaria in pregnancy is crucial for safeguarding the health of mothers and their children in Uganda.
**Dr. Simba:** Thank you for highlighting this important issue. It’s essential we continue to bring attention to the burden of malaria and work collaboratively towards effective solutions.