Detection of Pregnancy Associated Malaria Among Pregnant Women as a Strategy to Improve Mother Child Health Outcomes in Bungoma County, Kenya

Abstract

Malaria is caused by a protozoa of genus Plasmodium and remains a major public health burden in the Sub-Saharan Africa. In Kenya the prevalence varies between 6.1 to 37% with harmful consequences to both the mother and her baby, including adverse pregnancy outcomes such low birth weight, high morbidity and mortality. However, effective antenatal strategies for improving maternal and child health outcomes through the prevention, early detection and treatment of malaria are still a challenge in resourceconstrained settings. The objective of this study was to detect malaria and to determine its influence on the maternal and the child health outcomes. The response rate was 97%. Malaria test was conducted either via microscopy or rapid test before enrollment, then the cohort splits into malaria positive and negative. The sample size calculation was based on the prevalence of malaria in the unexposed group versus the prevalence of malaria in the exposed group according to the previous studies. Simple random sampling technique was used to enroll participants aged between 18-49 years and having about 16 weeks of gestation. The follow up period ranged from the first antenatal visit (March 2022) and delivery (December 2022). Permission was sought from relevant institutions and informed consent from the participants. Prerequisites on training, pre-testing of tools and standard operating procedures were satisfied. Categorical and outcomes data were analyzed using SPSS 27 and R plotting. Qualitative data were performed via Nvivo computer programs categorized under major themes and sub-themes. Chi-square, Fischer’s exact and relative risk were used for bi-variate analysis at a p-value less or equal 0.05 (95%). The relative risk was 0.999, confidence level of 0.926-1.077. The prevalence of low birth weight was 4.6% with 6 cases of which 3 (4.5%) in the negative cohort and 3 (4.7%) in the positive cohort. Anaemic pregnant women were 41 (31.5%), HIV were 5 (3,8%), pre-eclampsia were 5 (3.8%), gestational diabetes were 2 (1.5%). Otherwise, majority of the participants were aged 18–25 years, were primigravida, were married, had secondary school level, earned between 20-30 thousand shillings, were resident in rural areas, and were in their second trimester. Marital status, gestational age and area of residence were associated with malaria but were not risk factors with a pvalue less than 0.001, 0.001 and 0.028. A panel of sixteen proteins in malaria positive cohort, and six others in malaria negative cohort was identified after computing metadata sample using analysis of variance, t-test and adjusted Bonferroni with a relative influence of biomarkers varying from a mean difference of 2.856690795 to 0.217887462 in malaria positive cohort against -1.185322211 to 0.1622524175 in malaria negative cohort. There was difference in both cohorts with regard to knowledge of side effects p-value <0.01, different doses p-value <0.012 and prior information p-value < 0.003. The results revealed that birth cohort with malaria did not result in significant low birth weight. Therefore, this study recommends to conduct further research for a cost-effective test from the discovered novel biomarkers, which can be useful for low resource settings as an alternative option.