{"paper_id":"932f4292-c318-450b-95a9-f47fefcfe8da","body_text":"Asymptomatic placental cord blood malaria in pregnant women attending the Bamenda Regional Hospital: A cross sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Asymptomatic placental cord blood malaria in pregnant women attending the Bamenda Regional Hospital: A cross sectional study Mungwi Synthia Njiwale, Ebanga Echi Joan Eyong, Calvin Bisson Ebai, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3946733/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Malaria in pregnancy has been a major health problem of humans through history and is a leading cause of preterm births, miscarriages, stillbirths and death. The aim of this study was to determine the prevalence of malaria in placental cord blood and the risk factors associated with it at the Regional Hospital Bamenda, Cameroon. Two hundred and fifty-eight samples were collected from the placental cord using a sterile syringe. Slides were prepared, stained using Giemsa (10%) and observed under the microscope. Risks factors were assessed via questionnaires. Data obtained was analysed using SPSS version 21. Chi square test was used to test for differences in proportions in different categories and regression analysis was also used to get the relationship between prevalence and risk factors in this study. The overall prevalence of placental cord blood malaria was 3.9% ( 10 ) and the disease was more prevalent among parturients in the age group 21–30 years 2.71% ( 7 ) than those of the age group 41–50 years who recorded zero prevalence. Parturients with secondary and tertiary level of education had the highest prevalence 5(1.94%) and those with less than 3 children recorded the highest prevalence 2.71% ( 7 ) compared to those with more than 3 children 1.16% ( 3 ). The Plasmodium species identified were Plasmodium falciparum (3.5%) and Plasmodium malariae (0.4%). The risk factors that predisposed the parturients in this study included; not sleeping under mosquito nets, living by streams, those with bushes around the house and those who did not take their anti-malaria drugs effectively. Malaria parasites were prevalent in the placental cord blood which means pregnant women are not free from this infection and it merits extra preventive and treatment measures. Placental malaria Prevalence Risk Factors Regional Hospital Bamenda Cameroon Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Malaria still remains a major public health concern of most endemic areas of the world (WHO, 2022). In 2020, it was responsible for about 241 million clinical cases of sickness and 627,000 deaths worldwide. About 95% of cases and 96% deaths were reported in the sub-Saharan Africa (WHO, 2022). Five species of the malaria parasite infect humans, namely Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi (Mbanefo et al ., 2020; WHO, 2022). Plasmodium falciparum , the deadliest species, accounts for 99.7% of infections in Sub-Saharan Africa (Mbanefo et al ., 2020). The parasites are transmitted to humans through the bite of infected female Anopheles mosquitoes. In malaria high-transmission areas, some population groups are at considerably higher risk of infection with Plasmodium falciparum and development of malaria morbidity or mortality than others. These include children less than five years of age and pregnant women. Malaria contributes significantly to perinatal disease burden in terms of pregnancy loss, prematurity due to preterm labour, and intrauterine growth retardation (Bakken et al ., 2021; Pons-Duran et al ., 2022). Malaria is highly endemic in Cameroon. Plasmodium falciparum is the predominant malaria parasite species with Anopheles gambiae being the primary vector responsible for the transmission (WHO, 2021). The Government of Cameroon has made the fight against malaria a priority with a highlight in the country’s health sector strategy and the adoption of strategies to curb the spread of the disease. Cameroon is among the 15 highest burden malaria countries, with 2.9% of global malaria cases and 2.4% of malaria deaths in 2020 (WHO, 2021). Placental malaria, defined as the accumulation of Plasmodium -infected erythrocytes in the intervillous space in the placenta. The placental infection does not reflect the existence of peripheral infection over a short period preceding the delivery or whether it is related to infection during pregnancy. Susceptibility to this may be correlated to high exposure to malaria and repeated episodes of parasitaemia during the pregnancy (Uneke, 2007). Mother-to-child transmission of malaria constitutes one of the major problems compromising foetal development. It represents a risk factor for preterm birth, foetal growth restriction, and low birth weight (Uneke, 2007; Al-Obaidi and Taylor-Robinson, 2017). Mother malaria-related low birth weight is estimated to be up to 20% in an endemic area, with a relatively high risk of preterm delivery (Al-Obaidi and Taylor-Robinson, 2017; Owa et al ., 2017). The transplacental transmission of Plasmodium falciparum from mother to foetus has been well-described (Uneke et al ., 2007; Zakama et al ., 2020; Chua et al ., 2021; Omer et al ., 2021). The direct burden of neonatal malaria infection in terms of prevalence is not well-described in malaria endemic areas (Al-Obaidi and Taylor-Robinson, 2017; Owa et al ., 2017). The course and outcome of pregnancy can be adversely influenced by placental malaria. The risk of primary postpartum hemorrhage is high in women who are already anaemic from placental malaria before labour (Amanuel et al ., 2021; Mitta et al ., 2023). Malaria is a known cause of puerperal pyrexia (Ngunyi et al ., 2020) and should be borne in mind while treating this condition. The need for adequate protection of pregnant women in malaria endemic area from the harmful effects of P. falciparum is, therefore, absolutely essential (Fehintola et al ., 2016). Various studies on placental malaria parasitaemia and its effects on pregnancy and its outcomes have been conducted in different parts of the world and in Cameroon (Anchang-Kimbi et al ., 2015; Mahamat et al ., 2020; Okoro et al ., 2023; Unger et al ., 2023). Alhough a similar study has been done in the same hospital, they focused on the pediatrics department and the effect of high Plasmodium falciparum prevalence of cord malaria on complement activation, oxidative stress (Mahamat et al ., 2020). However, this study was conducted to establish the prevalence as well as the risk factors of placental malaria parasitemia in this environment. It will surely go a long way to providing data for an evidence-based policy-making process in malaria control program and better appraisal of the baseline characteristic of placental malaria. MATERIALS AND METHODS Study design and population Two hundred and fifty-eight persons were enrolled in this hospital-based cross-sectional study. It was carried out in the regional hospital of Bamenda from March, 2023 to May, 2023. A pretested close-ended questionnaire was administered to participants to facilitate the research. The study participants were pregnant women who voluntarily consented to the collection of blood from their cord during childbirth at the regional hospital in Bamenda, after they had been informed about the purpose of the study, its risks and benefits. ETHICAL CONSIDERATIONS This study was approved by the research ethics committee of the Faculty of Health Sciences, of The University of Bamenda. The purpose of the study was explained to women who attend ante-natal clinic and all pregnant women were given consent forms and questionnaires prior to delivery before collecting blood from the placental cord. The questionnaire included the parturients’ socio-demographic information such as: age, marital status, occupation, level of education, monthly salary and religion. The parturients medical and clinical history was also included in the questionnaire. Inclusion criteria Pregnant women who gave their informed consent prior to delivery were included in the study. Women who gave birth normally and those who gave through a caesarian section (CS) were included the study as well as those on prophylaxis were included in the study. Exclusion criteria Non- pregnant women, pregnant women that did not give their consent prior to delivery were not included in the study. Or pregnant women with complications such as diabetes were excluded from the study. Estimation of sample size The population sample size was determined using Lorenze’s formula: (Flavio., et al. , 2021). Where n = sample size, z = confidence interval at 95% (standard value = 1.96) p = prevalence from previous study = 21.33% it will be 0.2133 (Mahamat et al ., 2020) q = (1-p) expected non-prevalent d = margin of error at 5% (0.05). Sample size (n) = 1.96 2 (0.2133) (0.7867) / (0.05) 2 N = 258 participants. Thus, a minimum sample size of 258 pregnant women were recruited for the study. Data collection After obtaining a signed informed consent from the eligible participant, a semi-structured interviewer-administered questionnaire was filled. The questionnaire contained information that includes maternal age, marital status, educational status, occupation, gravidity, antenatal care, malaria preventive measures, placental blood microscopy for malaria parasite detection as well as parasite density. The questionnaire was given out to those who could read and write to fill it while for those who could not read or write, the questions were read out to them in Pidgin English, the lingua franca in the area. Placental blood collection Two millilitres of blood was collected from the placental cord within two hours of parturition and transferred into EDTA (ethylenediaminetetraacetic acid) tubes so as to prevent the blood from clotting (Lopes et al , 2016). Blood films (thick and thin) were prepared within a period of 30 mins, following the techniques recommended by Cheesbrough (2005). Laboratory procedure preparing and staining of the thick blood smear. Two drops of placental blood sample was placed on a slide using a small pipette. Using the edge of a second slide, the drops of blood were joined and spread to make an even, thick smear and allowed to air-dry. The slide was placed on a staining rack, 5–7 drops of freshly prepared Giemsa solution (10%) was poured on the slide and allowed to stain for 10 minutes. The stain was then rinsed off the slides and the slides allowed to dry as recommended by Cheesbrough (2005). Preparation and staining of thin blood smear. One drop of placental blood was placed on a clean slide using a pipette. The edge of a second slide held steadily at an angle of 45º to the first, was used to spread the drop of blood to create the thin blood film. The thin film was fixed using absolute methanol. The slide was placed on a staining rack, 5–7 drops of freshly prepared Giemsa solution (10%) was poured on the slide and allowed to wait for 10 minutes. The stain was then rinsed off the slides and the slides allowed to dry as recommended by Cheesbrough (2005). Microscopic examination of slides for malaria parasite and determination of parasite density The stained placental blood smears were examined under X100 oil immersion lens of a light microscope. Malaria diagnosis was based on the identification of asexual or sexual stages of Plasmodium species on the thick blood smear while the thin blood smear was used for species identification. Parasite density was determined by counting the number of parasites per high power field in the thick blood smear. The slide was reported as negative if no parasite was identified per 100 high power microscopic fields. Data analysis Data obtained was entered into Microsoft Excel 2016 spread sheet, filtered and coded alongside data from the questionnaires. The data was then transferred and analyzed using The Statistical Package for Social Sciences (SPSS) version 21. Frequencies were calculated and variables were compared using Chi-square test. A regression analysis was done to determine the factors that were associated with the prevalence and associated risk factors of malaria. The results were presented using graphs (the graphs were plotted using graph pad prism version 8) and frequency tables were drawn to display the results. Significant levels were measured at 95% confidence interval, with significant difference recorded at p < 0.05. RESULTS Baseline characteristics of study participants A total of 258 participants were recruited for the study. The age ranged from 14 to 45 years with a mean ± SD of 27.72 ± 6.174 years. Subjects in the age range 21–30 years constituted the highest population 54.7% (141). A total of 74.0% (191) were married and had a monthly income less than 50,000FCFA, 69.4% (179). Majority 94.6% (244) were Christians, 46.1% (119) had attain secondary education and 34.5% (89) were traders while 3.1% ( 8 ) were house-wives and 79.8% (206) had less than 3 children. Those that took their prophylaxis effectively were 98.4% (254) and those that did not have any medical conditions were 97.7% (252) while among the 2.3% ( 6 ) participants with underlying diseases a majority 1.6% ( 4 ) of them had had HIV (Table 1 ). Table 1 Baseline characteristics of the study participants. Parameters Number(n) Proportion (%) Age (years) 11–20 35 13.6% 21–30 141 54.7% 31–40 75 29.1% 41–50 7 2.7% Marital Status Married 191 74.0% Cohabiting 19 7.4% Single 48 18.6% Divorced 0 0.0% Widow(er) 0 0.0% Monthly Income (FCFA) < 50,000 179 69.4% 50,000-100,000 75 29.1% > 100,000 4 1.6% Religion Christian 244 94.6% Muslim 14 5.4% Others 0 0.0% Level Education Primary 27 10.5% Secondary 119 46.1% Tertiary 112 43.4% None 0 0.0% Number of Children < 3 206 79.8% > 3 52 20.2% Hep B 1 0.4% Medical Condition HIV 4 1.6% HIV& Hep B 1 0.4% None 252 97.7% Occupation Civil Servants 35 13.6% Technician 62 24.0% Trader 89 34.5% Student 64 24.8% House wife 8 3.1% Prophylaxis (SP) Seldom 4 1.6% Often 254 98.4% NOTE 1 Hep B (hepatitis B): 2 HIV (Human Immunodeficiency Virus) Prevalence of placental cord blood malaria The overall prevalence of malaria in the study area was 3.9% (10/258) The highest prevalence 2.71% (7/258) of malaria was recorded in the age group 21–30 years while the lowest prevalence 0% was recorded in the age group of 41–50 years. There was no significant difference in the prevalence of malaria in the different age groups (p = 0.772). This can be seen in Fig. 1 . The prevalence of malaria among women of different educational level was equal among those with secondary 1.94% (5/258) and tertiary education 1.94% (5/258). However, this difference was insignificant with a p value of 0.542 as shown in Fig. 2. Prevalence of malaria with respect to gravidity (number of pregnancies) The highest prevalence of malaria 2.71% (7/258) was recorded amongst women with less than 3 children while the lowest prevalence of malaria 1.16% (3/258) was recorded amongst women with more than 3 children. An insignificant difference (p = 0.429) was seen with the number of pregnancies as shown in Fig. 3. Species of Plasmodium found in the study population The overall prevalence of malaria in the study area was found to be 4.0% (10/253). The specific Plasmodium species found were Plasmodium falciparum and Plasmodium malariae. The number of Plasmodium falciparum recorded a higher proportion (3.5) while Plasmodium malariae recorded a lower proportion (0.4). This is seen in Fig. 4 . Behavioral factors which affects malaria prevalence In this study, participants who used mosquito nets were more (93.4%, 241/258) compared to those who did not (6.6%, 17/258), and this factor was insignificantly associated with malaria (p = 0.392). Also, participants who put down their mosquito nets at night and tucked them under the mattress were more (98.8%, 255/258) compared to those who slept under the mosquito net at night and never tucked the net under the mattress (1.2%, 3/258), and this factor was not significantly associated with malaria (p = 0.726). Majority of the participants locked doors and windows in the evening (99.6%, 257/258) compared to those who did not (0.4%, 1/253), and this factor was insignificantly associated with malaria (p = 0.841). Those who did not live by streams were more (95.7%, 247/258) compared to those who lived by streams (4.3%, 11/258) and this factor was statistically insignificant to the prevalence of malaria (p = 0.496). Participants who did not live around bushes were more (73.6%, 190/258) as compared to those who lived by bushes (26.4%, 68/258), this factor was not significantly associated with malaria (p = 0.642). Majority of the participants (91.1%, 235/258) did not have screens on their doors and windows whereas minority (8.9%, 23/258) had screens on their doors and windows and this was not statistically significant (p = 0.313). Regarding the presence of stagnant water around their houses, most participants (90.3%, 233/258) did not have stagnant water around their houses while few (9.7%, 25/258) had stagnant water around their houses, this factor had an insignificant difference (p = 0.973). Many participants (47.7% 123/258) wore protective clothing in the evening sometimes compared to those who did not at all (41.1%, 106/258) or those who wore it every day (11.2%, 29/258), and this factor was not statistically significant (p = 0.277). Majority of the participants (98.4%, 254/258) took their anti-malaria drugs often compared to those who seldomly took it (1.6%, 4/253), this was statistically insignificant (p = 0.686). This can be seen in Table 2. Table 3 Influence of behavioral factors on the prevalence of malaria Risk factor Category Count Proportion (%) P value Sleeping under a mosquito net Yes 241 93.4% 0.392 No 15 5.9% Putting down of bed nets? At night 255 98.8% 0.726 In the Morning 3 1.2% Lock doors and windows during evening periods Yes 257 99.6% 0.841 No 1 0.4% Live by stream Yes 11 4.3% No 247 95.7% 0.496 Bushes around house Yes 68 26.4% No 190 73.6% 0.642 Pools of standing water around the house Yes 25 9.7% No 233 90.3% 0.973 Wear long dresses in the evening Yes 29 11.2% No 106 41.1% Sometime 123 47.7% 0.277 DISCUSSION A total number of 258 pregnant women were recruited for this study. Amongst these women 10 were positive for malaria while 248 were negative. In this study, the prevalence of placental malaria among asymptomatic pregnant women who delivered at the Regional Hospital Bamenda was 3.9%. This result is similar to a previous study carried out in Wolkite health center in Ethiopia which was 3.9% (Solomon et al ., 2020) but, lower than other results obtained from studies reported from Nigeria (Mokuolu et al ., 2009; Falade et al ., 2010; Bassey et al ., 2015), Cameroon (Mahamat et al ., 2020) and Sudan (Omer et al ., 2017), using placental blood microscopy. This prevalence variation might be due to differences in geographic location and malaria transmission intensity and it could also be due to that fact that many of the women enrolled for this study were constantly on malarial prophylaxis as a preventive measure against malarial infection which was routinely administered by their antenatal care givers. The lower prevalence in this study may be due to the high level of education among the parturients which may have contributed to their health awareness with a positive impact on their health and the effective malaria preventive measures utilized by the parturients including IPTpSP (98.4%) and ITN (94.1%); other factors may include a high level of community acquired immunity and the quality of antenatal care (Bassey et al ., 2015). Women aged 21–30 years were found to have a higher prevalence of placental malaria. This finding is consistent with the results of Oweisi et al . (2018), where parturients younger than 25 years of age were 5 times more likely to have placental malaria parasitaemia than those 25 years and older. This supports the findings of previous studies stating young maternal age as a risk factor for placental malaria (Okolie et al ., 2014; Babalola et al. , 2015) which could be attributed to lower levels of acquired immunity as well as the lack of pregnancy associated immunity against the placental-binding parasites (Babalola et al. , 2015). Educational level of parturients in this study did not show any significant association to placental malaria. Parturients in this study who had attained secondary and tertiary education were seen to have a high prevalence of placental malaria compared to parturients with primary education and no education at all. This result is in contrast with the results of Oweisi et al . (2018), conducted in Nigeria which observed that parturients who had none or primary level of education were 3 times more likely to have placental malaria compared to parturients with at least secondary level of education. The reverse results in this study maybe as a results of increase community sensitization on the risk of pregnancy associated malaria, consistent use of preventive measures (ITPM) and poor dressing of some parturients which exposes their skin to the vector. High educational standards usually affect health awareness and therefore has a positive impact on health (Ogbu et al ., 2015). The reverse may be the case in those with lower standards of education as they may not appreciate the burden of malaria in pregnancy and the importance of adherence to stipulated malaria preventive measures because of their limited understanding and knowledge (Ogbu et al ., 2015). As observed in this study, gravidity did not show any significant association to placental malaria. Parturients in this study with less than 3 children were seen to have a high prevalence of placental malaria compared to parturients with more than 3 children. This agrees with other studies carried out in Camerron (Tako et al. , 2005; Walker-Abbey et al. , 2005; Leke et al. , 2010), Central African Republic (Manirakiza et al ., 2011) and Nigeria (Makuolo et al ., 2009; Oweisi et al ., 2018) which found primiparous and secundiparous women to be at higher risk of malaria parasite infection than multiparous women. Anchang-Kimbi et al . (2009), also found an inconsistent association of parity with malaria parasite infection at delivery. Multiparous women in malaria-endemic regions are believed to form blocking antibodies that bind to placental chondroitin sulphate A during their subsequent pregnancies and prevent placental sequestration of Plasmodium falciparum (Maestre and Carmona-Fonseca, 2014). This explains why the burden of malaria in pregnancy is higher among women of low parity. As suggested by Tako et al . (2005), that this inconsistency may be due to the development with time, of a better immune response to malaria by primiparous and secundiparous mothers following repeated exposures to malaria parasites which makes them less dependent on anti-cytoadherence antibodies. Similar findings have been reported by researchers in Portharcourt, Nnewi and Ile Ife in Nigeria (Okolie et al ., 2014; Bassey et al ., 2015; Fehintola et al ., 2016). Our results revealed that Plasmodium falciparum was the most common but not the only species of malaria identified in this study. The finding is not in consonance with a study conducted in Nigeria were Plasmodium falciparum was the only parasite species detected in all the placental blood films in this study. The high prevalence of P. falciparum in this study confirms previous reports that placental malaria is an exclusive feature of Plasmodium falciparum infection in pregnancy (Srivastava et al ., 2010) and that Plasmodium falciparum is the most prevalent species in Cameroon accounting for about 98% of malaria cases in the country (MINSANTE, 2018). As a component of the malaria preventive measures during pregnancy, the world health organization has recommended the use of at least three doses of sulphadoxine-pyrimethamine combination with each dose given not less than 4 weeks apart in the second and third trimesters of pregnancy (Anchang-Kimbi et al. , 2014). In this study, majority 98.4% of the parturients had taken at two or more doses of sulphadoxine-pyrimethamine combination. Several studies have reported similar findings (Bassey et al ., 2015; Fehintola et al ., 2016; Babalola et al. , 2015) but however other studies carried out in Cameroon (Takem et al ., 2009; Tonga et al ., 2013) and South-Sudan (Napoleon et al ., 2011) have shown contradictory results. This variation maybe due to the provision of the medication at the antenatal clinic and administration as directly observed therapy (DOT) coupled with adequate female education and empowerment would likely be the reason for the contradictory finding. In this study, the level of utilization of LLINs (long lasting insecticidal nets) was generally high 93.4%. The consistent use of mosquito nets may be associated to the low prevalence of malaria, although it is not statistically significant. Similar findings were gotten by Tonga et al. (2013). It is essential that all stakeholders combine efforts to ensure successful implementation in the deployment of these various tools to achieve a continuous reduction in the burden of placental malaria. The present study shows that parturients who earned less than 50,000FCFA (83 USD) monthly had the highest prevalence of 96.1% whereas those who earned > 100,000FCFA (166 USD) had the lowest prevalence. The findings fall in line with that of Tonga et al. (2013), who mentioned that women with monthly income less than 28,000FCFA (46 USD) were more at risk of getting the malaria parasite than women with higher monthly income. Those who earned < 50,000FCFA (83 USD) in this study had the highest prevalence and this could be due to the fact that the money which they earn may not be enough to care for their basic needs and still take them through regular monthly checkups. CONCLUSIONS The overall prevalence of malaria was low. Parturients in the age group 21 to 30 years had the highest prevalence. Participants with secondary and tertiary level of education showed the highest level of prevalence. Parturients with less than 3 children had a higher prevalence (primiparous and secundiparous). The species of Plasmodium found was Plasmodium falciparum and Plasmodium malariae , with Plasmodium falciparum being more common than Plasmodium malariae. There was no significant relationship between prevalence and risk factors. Declarations COMPETING INTERESTS The authors declare that they have no competing interests. Author Contribution EEJE, ECB and SRA conceived and designed the study. All authors participated in the field work. EBC analysed the data. EEJE and MS wrote the first draft of the manuscript. All authors read and approved the final manuscript for submission. ACKNOWLEDGEMENTS We would like to thank the directors of the Regional Hospital Bamenda for giving us the authorization to carry out this study in their institution. We want to acknowledge women who willingly participated in the study. Finally, we would like to thank the laboratory staff of the medical facility who assisted in the collection and analysis of the samples References -World Health Organization. (2022). Available at i>https://www.who.int/news-room/fact-sheets/detail/malaria. Accessed on November 8st 2022. -Mbanefo A, Kuma N. Evaluation of Malaria Diagnostic Methods as a Key for Successful Control and Elimination Programs. Trop Med Infect Disease. 2020;5(2):102. hpps://doi.org/10.3390/tropicalmed5020102 . PMID: 32575405; PMCID: PMC 7344938. -Bakken L, Iversen PO. The impact of malaria during pregnancy on low birth weight in East-Africa: a topical review. 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Impact of placental malaria on maternal, placental and fetal cord responses and its role in pregnancy outcomes in women from Blue Nile State, Sudan. Malar J 20, 35 (2021). https://doi.org/10.1186/s12936-021-03580-x . -Amanuel T, Dache A, Dona A. Postpartum Hemorrhage and its Associated Factors Among Women who Gave Birth at Yirgalem General Hospital, Sidama Regional State, Ethiopia. Health Serv Res Manag Epidemiol. 2021;8:23333928211062777. 10.1177/23333928211062777 . PMID: 34869791; PMCID: PMC8640320. -Mitta K, Tsakiridis I, Dagklis T, Grigoriadou R, Mamopoulos A, Athanasiadis A, Kalogiannidis I. Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece. Medicina. 2023;59:1151. https://doi.org/10.3390/medicina59061151 . -Ngunyi YL, Halle-Ekane G, Tendongfor N, • Etheldreda Leinyuy Mbivnjo EL, Mbarga AE, Nembulefack D, Lo-oh CA, Egbe TO. 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Journal of Tropical Medicine , 2020 . https://doi.org/10.1155/2020/7209542 . -Okoro CI, Ihenetu FC, Dunga KE, Ozoude MM, Achigbu KI, Nwaoha CA, Nnodim J, Ogboi JS. Placenta and Cord Blood Malaria in Mothers and Neonates Attending Federal University Teaching Hospital, Owerri, Imo State South East Nigeria. Int J Trop DISEASE Health. 2023;44(8):13–22. https://doi.org/10.9734/ijtdh/2023/v44i81422 . -Unger HW, Hadiprodjo AJ, Gutman JR, • Briand V, Fievet N, Valea I, Tinto H, D’Alessandro U, Landis SH, Kulie FT, Ouma P, Oneko M, Mwapasa V, Slustsker L, Terlouw DJ, Kariuki S, Ayisi J, Nahlen B, Desai M, Madanitsa M, Phiri LK, Ashorn P, Maleta K, Tshefu-Kitoto A, Rogerson SJ. Fetal sex and risk of pregnancy-associated malaria in Plasmodium falciparum- endemic regions: a meta-analysis. Sci Rep. 2023;13:10310. https://doi.org/10.1038/s41598-023-37431-3 . -Flavio A, Cedric Y, Nadia NAC, Payne VK. Malaria and Helminth Coinfection among Children at the Douala Gyneco-Obstetric and Pediatric Hospital. J Trop Med. 2021. https://doi.org/10.1155/2021/3702693 . -Lopes LA, Bernardino E, Crozeta K, Guimarães PR. Good practices in collecting umbilical cord and placental blood. Rev Lat Am Enfermagem. 2016;24:e2770. 10.1590/1518-8345.0781.2770 . PMID: 27556876; PMCID: PMC5012498. -Cheesbrough M. (2005). District laboratory practices in tropical countries, part 2.2nd edition. Cambridge University Press , 2(1):462 pages. ISBN-13 978-0-511-34935-5 eBook (Net Library). -Solomon A, Kahase D, Alemayhu M. Prevalence of placental malaria among asymptomatic pregnant women in Wolkite health center, Gurage zone, southern Ethiopia. Trop Dis Travel Med Vaccines. 2020;6(1):1–8. https://doi.org/10.1186/s40794-020-00121-3 . -Mokuolu OA, Falade CO, Orogade AA, Okafor HU, Adedoyin OT, Oguonu TA, Dada-Adegbola HO, Oguntayo OA, Ernest SK, Hamer DH, Callahan MV. Malaria at parturition in Nigeria: Current status and delivery outcome. Infect Dis Obstet Gynecol. 2009. https://doi.org/10.1155/2009/473971 . PMCID: PMC2715570| PMID: 19639046. -Falade CO, Tongo OO, Ogunkunle OO, Orimadegun AE. Effects of malaria in pregnancy on newborn anthropometry. J Infect Developing Ctries. 2010;4(7):448–53. https://doi.org/10.3855/jidc.329 . -Bassey G, Nyengidiki TK, John CT. Prevalence of placenta Plasmodium parasitemia and pregnancy outcome in asymptomatic patients at delivery in a University Teaching Hospital in Nigeria. Niger J Clin Pract. 2015;18(1):27–32. hpps://doi.org/10.4103/0189-5117.199811 . - Omer SA, Idress HE, Adam I, Abdelrahim M, Noureldein AN, Abdelrazig AM, Elhassan MO, Sulaiman SM. Placental malaria and its effect on pregnancy outcomes in Sudanese women from Blue Nile State. Malar J. 2017;16:1–8. hpps:// doi.org/10.1186/s12936-017-2028-0 . -Oweisi PW, John CT, Omietimi JE, Aigere EOS, Allagoa DO, Kotingo EL. Pla-cental malaria parasitization at delivery: experience at a Nigerian tertiary hospital. Eur Sci J. 2018;14(9):243–59. https://doi.org/10.19044/esj.2018.v149p243 . - Okolie VE, Obiechina NJ, Okechukwu ZC, Oguejiofor CF, Okor L, Onyegbule AO, Udegbunam OI, Nwajiaku LSA, Ogbuokriri C, Egeonu R. Prevalence and Risk Factors for Placental Malaria in Nnewi, South East Nigeria. Int J Trop Disease Health. 2014;4(3):374–83. hpps://doi.org/10.9734/IJTDH/2014/8365 . -Babalola AS, Idowu OA, Sam-Wobo SO, Fabusoro E. Risk factors associated with occurrence of placenta malaria in a population of parturients in Abeokuta Ogun State, Nigeria. Malar World J. 2015;6(8):1–6. ISSN 2214–4374. -Ogbu GI, Aimakhu CO, Anzaku SA, Ngwan S, Ogbu DA. Prevalence of malaria parasitaemia among asymptomatic women at booking visit in a tertiary hospital, North- central Nigeria. J Reproductive Biology Health. 2015;3(1). hpps://doi.org/10.7243/2054-0841-3-1 . -Tako AE, Zhou A, Lohoue J, Leke R, Taylor DW, Leke RF. Risk factors for placental malaria and its effect on pregnancy outcome in Yaounde´, Cameroon. Am J Trop Med Hyg. 2005;72(3):236–42. PMID: 15772313. -Walker-Abbey A, Djokam RRT, Eno A, Leke RF, Titanji VP, Fogako J, Sama G, Thuita LH, Beardslee E, Snounou G, Zhou A. Malaria in pregnant Cameroonian women: the effect of age and gravidity on submicroscopic and mixed-species infections and multiple parasite genotypes. Am J Trop Med Hyg. 2005;72(3):229–35. https://doi.org/10.4269/ajtmh.2005.72.229 . PMID:15772312. -Leke RF, Bioga JD, Zhou J, Fouda GG, Leke RJ, Tchinda V, Megnekou R, Fogako J, Sama G, Gwanmesia P, Bomback G. Longitudinal studies of Plasmodium falciparum malaria women living in a rural Cameroonian village with high perennial transmission. Am J Trop Med Hygiene. 2010;83(5):996–1004. hpps://doi.org/10.4269/ajtmh.2010.10-0249 . PMCID: PMC2963958| PMID:21036826. -Manirakiza A, Serdouma E, Djalle D, Soula G, Laganier R, Madji N, Moyen M, Le Faou A, Delmont J. Relatively low prevalence of peripheral and placental Plasmodium infection at delivery in Bangui, Central African Republic. J Trop Med. 2011;434816. hpps://doi.org/10.1155/2011/434816 . -Anchang-Kimbi JK, Achidi EA, Nkegoum B, Sverremark-Ekstrom E, TroyeBlomberg M. Diagnostic comparison of malaria infection in peripheral blood, placental blood and biopsies in Cameroonian parturient women. Malar J. 2009;8(1):126. hpps://doi.org/10.1186/1475-2875-8-126 . -Maestre A, Carmona-Fonseca J. Immune responses during gestational malaria: a review of the current knowledge and future trend of research. J Infect Developing Ctries. 2014;8(4):391–402. hpps://doi.org/10.3855/jidc.3777 . -Anchang-Kimbi Jk, Achidi EA, Apinjoh TO, Mugri RN, Chi HF, Tata RB, Nkegoum B, Mendimi JMN, Sverremark-Ekstrom E, Troye-Blomberg M. Antenatal care visit attendance,intermittent preventive treatment during pregnancy(IPTp) and malaria parasitaemia at delivery. Malar J. 2014;13(1):1–9. hpps://doi.org/10.4269/ajtmh.2012.11-0433 . -Srivastava A, Gangnard S, Round A, Dechavanne S, Juillerat A, Raynal B, Faure G, Baron B, Ramboarina S, Singh SK, Belrhali H. (2010). Full-length extracellular region of the var2CSA variant of PfEMP1 is required for specific, high-affinity binding to CSA. Proceedings of the National Academy of Sciences , 107(11):4884–4889. hpps://doi.org/10.1073/pnas.1000951107 . -MINSANTE., Plan stratégique national de lutte contre le paludisme au Cameroun 2014–2018 , MINSANTE, Yaounde, Cameroon. -Takem EN, Achidi AE, Ndumbe PM. Use of intermittent preventive treatment for malaria by pregnant women in Buea, Cameroon. Acta Trop. 2009;112(1):54–8. hpps://doi.org/10.1016/j.actatropica.2009.06.007 . -Tonga C, Kimbi HN, Anchang-Kimbi JK, Nyabeyeu HN, Bissemou ZB, Lehman LG. Malaria risk factors in women on intermittent preventive treatment at delivery and their effects on pregnancy outcome in Sanaga-Maritime. Cameroon Public Libr Sci. 2013;8(6):e65876. hpps:// doi.org/10.1371/journal.pone.0065876 . -Napoleon RP, Anyangu AS, Omolocan J, Ongus JR. Preventing malaria during pregnancy: factors determining the use of insecticide-treated bed-nets and intermittent preventive therapy in Juba. South Sudan Med J. 2011;4(2):33–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3946733\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":272451206,\"identity\":\"52296ff9-8a7f-4aea-a322-142ef7a8796e\",\"order_by\":0,\"name\":\"Mungwi Synthia Njiwale\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Bamenda\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mungwi\",\"middleName\":\"Synthia\",\"lastName\":\"Njiwale\",\"suffix\":\"\"},{\"id\":272451207,\"identity\":\"c299fcd4-3912-49f6-9896-d068627a0d26\",\"order_by\":1,\"name\":\"Ebanga 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18:28:33\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":23752,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePrevalence of malaria with respect to age\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3946733/v1/1e17bc762c32236e3e64e800.png\"},{\"id\":51135221,\"identity\":\"ca729a7e-fb29-4298-b278-97cf20555bbe\",\"added_by\":\"auto\",\"created_at\":\"2024-02-14 18:28:33\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":54905,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePrevalence of malaria with respect to educational level\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3946733/v1/1c84f19cc3589f45e1f4139c.png\"},{\"id\":51136704,\"identity\":\"ab03545a-6223-4b0a-b5a9-d3c0145f9b37\",\"added_by\":\"auto\",\"created_at\":\"2024-02-14 18:36:33\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":27286,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePrevalence of malaria with respect to gravidity (number of pregnancies)\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3946733/v1/33b7ed53a3a57fcd08675e75.png\"},{\"id\":51135223,\"identity\":\"ab8e530c-05ed-472d-b5d7-93955527487e\",\"added_by\":\"auto\",\"created_at\":\"2024-02-14 18:28:33\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":49074,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eOccurrence of different species of \\u003c/strong\\u003e\\u003cem\\u003e\\u003cstrong\\u003ePlasmodium\\u003c/strong\\u003e\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3946733/v1/6e09b6ad94e1b4f723d160e2.png\"},{\"id\":51365108,\"identity\":\"3acad3a9-b348-4b8d-9135-decba2cd3ecd\",\"added_by\":\"auto\",\"created_at\":\"2024-02-20 09:53:14\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":617752,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3946733/v1/7e51c48c-202f-4c01-bc19-1320f7f55126.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Asymptomatic placental cord blood malaria in pregnant women attending the Bamenda Regional Hospital: A cross sectional study\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eMalaria still remains a major public health concern of most endemic areas of the world (WHO, 2022). In 2020, it was responsible for about 241\\u0026nbsp;million clinical cases of sickness and 627,000 deaths worldwide. About 95% of cases and 96% deaths were reported in the sub-Saharan Africa (WHO, 2022). Five species of the malaria parasite infect humans, namely \\u003cem\\u003ePlasmodium falciparum, P. vivax, P. ovale, P. malariae\\u003c/em\\u003e and \\u003cem\\u003eP. knowlesi\\u003c/em\\u003e (Mbanefo \\u003cem\\u003eet al\\u003c/em\\u003e., 2020; WHO, 2022). \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e, the deadliest species, accounts for 99.7% of infections in Sub-Saharan Africa (Mbanefo \\u003cem\\u003eet al\\u003c/em\\u003e., 2020). The parasites are transmitted to humans through the bite of infected female \\u003cem\\u003eAnopheles\\u003c/em\\u003e mosquitoes. In malaria high-transmission areas, some population groups are at considerably higher risk of infection with \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e and development of malaria morbidity or mortality than others. These include children less than five years of age and pregnant women. Malaria contributes significantly to perinatal disease burden in terms of pregnancy loss, prematurity due to preterm labour, and intrauterine growth retardation (Bakken \\u003cem\\u003eet al\\u003c/em\\u003e., 2021; Pons-Duran \\u003cem\\u003eet al\\u003c/em\\u003e., 2022).\\u003c/p\\u003e \\u003cp\\u003eMalaria is highly endemic in Cameroon. \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e is the predominant malaria parasite species with \\u003cem\\u003eAnopheles gambiae\\u003c/em\\u003e being the primary vector responsible for the transmission (WHO, 2021). The Government of Cameroon has made the fight against malaria a priority with a highlight in the country\\u0026rsquo;s health sector strategy and the adoption of strategies to curb the spread of the disease. Cameroon is among the 15 highest burden malaria countries, with 2.9% of global malaria cases and 2.4% of malaria deaths in 2020 (WHO, 2021).\\u003c/p\\u003e \\u003cp\\u003ePlacental malaria, defined as the accumulation of \\u003cem\\u003ePlasmodium\\u003c/em\\u003e-infected erythrocytes in the intervillous space in the placenta. The placental infection does not reflect the existence of peripheral infection over a short period preceding the delivery or whether it is related to infection during pregnancy. Susceptibility to this may be correlated to high exposure to malaria and repeated episodes of parasitaemia during the pregnancy (Uneke, 2007).\\u003c/p\\u003e \\u003cp\\u003eMother-to-child transmission of malaria constitutes one of the major problems compromising foetal development. It represents a risk factor for preterm birth, foetal growth restriction, and low birth weight (Uneke, 2007; Al-Obaidi and Taylor-Robinson, 2017). Mother malaria-related low birth weight is estimated to be up to 20% in an endemic area, with a relatively high risk of preterm delivery (Al-Obaidi and Taylor-Robinson, 2017; Owa \\u003cem\\u003eet al\\u003c/em\\u003e., 2017). The transplacental transmission of \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e from mother to foetus has been well-described (Uneke \\u003cem\\u003eet al\\u003c/em\\u003e., 2007; Zakama \\u003cem\\u003eet al\\u003c/em\\u003e., 2020; Chua \\u003cem\\u003eet al\\u003c/em\\u003e., 2021; Omer \\u003cem\\u003eet al\\u003c/em\\u003e., 2021). The direct burden of neonatal malaria infection in terms of prevalence is not well-described in malaria endemic areas (Al-Obaidi and Taylor-Robinson, 2017; Owa \\u003cem\\u003eet al\\u003c/em\\u003e., 2017).\\u003c/p\\u003e \\u003cp\\u003eThe course and outcome of pregnancy can be adversely influenced by placental malaria. The risk of primary postpartum hemorrhage is high in women who are already anaemic from placental malaria before labour (Amanuel \\u003cem\\u003eet al\\u003c/em\\u003e., 2021; Mitta \\u003cem\\u003eet al\\u003c/em\\u003e., 2023). Malaria is a known cause of puerperal pyrexia (Ngunyi \\u003cem\\u003eet al\\u003c/em\\u003e., 2020) and should be borne in mind while treating this condition. The need for adequate protection of pregnant women in malaria endemic area from the harmful effects of \\u003cem\\u003eP. falciparum\\u003c/em\\u003e is, therefore, absolutely essential (Fehintola \\u003cem\\u003eet al\\u003c/em\\u003e., 2016).\\u003c/p\\u003e \\u003cp\\u003eVarious studies on placental malaria parasitaemia and its effects on pregnancy and its outcomes have been conducted in different parts of the world and in Cameroon (Anchang-Kimbi \\u003cem\\u003eet al\\u003c/em\\u003e., 2015; Mahamat \\u003cem\\u003eet al\\u003c/em\\u003e., 2020; Okoro \\u003cem\\u003eet al\\u003c/em\\u003e., 2023; Unger \\u003cem\\u003eet al\\u003c/em\\u003e., 2023). Alhough a similar study has been done in the same hospital, they focused on the pediatrics department and the effect of high \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e prevalence of cord malaria on complement activation, oxidative stress (Mahamat \\u003cem\\u003eet al\\u003c/em\\u003e., 2020). However, this study was conducted to establish the prevalence as well as the risk factors of placental malaria parasitemia in this environment. It will surely go a long way to providing data for an evidence-based policy-making process in malaria control program and better appraisal of the baseline characteristic of placental malaria.\\u003c/p\\u003e\"},{\"header\":\"MATERIALS AND METHODS\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eStudy design and population\\u003c/h2\\u003e\\n\\u003cp\\u003eTwo hundred and fifty-eight persons were enrolled in this hospital-based cross-sectional study. It was carried out in the regional hospital of Bamenda from March, 2023 to May, 2023. A pretested close-ended questionnaire was administered to participants to facilitate the research. The study participants were pregnant women who voluntarily consented to the collection of blood from their cord during childbirth at the regional hospital in Bamenda, after they had been informed about the purpose of the study, its risks and benefits.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eETHICAL CONSIDERATIONS\\u003c/h2\\u003e\\n\\u003cp\\u003eThis study was approved by the research ethics committee of the Faculty of Health Sciences, of The University of Bamenda. The purpose of the study was explained to women who attend ante-natal clinic and all pregnant women were given consent forms and questionnaires prior to delivery before collecting blood from the placental cord. The questionnaire included the parturients\\u0026rsquo; socio-demographic information such as: age, marital status, occupation, level of education, monthly salary and religion. The parturients medical and clinical history was also included in the questionnaire.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eInclusion criteria\\u003c/h2\\u003e\\n\\u003cp\\u003ePregnant women who gave their informed consent prior to delivery were included in the study. Women who gave birth normally and those who gave through a caesarian section (CS) were included the study as well as those on prophylaxis were included in the study.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section3\\\"\\u003e\\n\\u003ch2\\u003eExclusion criteria\\u003c/h2\\u003e\\n\\u003cp\\u003eNon- pregnant women, pregnant women that did not give their consent prior to delivery were not included in the study. Or pregnant women with complications such as diabetes were excluded from the study.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section3\\\"\\u003e\\n\\u003ch2\\u003eEstimation of sample size\\u003c/h2\\u003e\\n\\u003cp\\u003eThe population sample size was determined using Lorenze\\u0026rsquo;s formula:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cimg src=\\\"data:image/png;base64,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\\\" alt=\\\"\\\" /\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e(Flavio., \\u003cem\\u003eet al.\\u003c/em\\u003e, 2021).\\u003c/p\\u003e\\n\\u003cp\\u003eWhere n\\u0026thinsp;=\\u0026thinsp;sample size,\\u003c/p\\u003e\\n\\u003cp\\u003ez\\u0026thinsp;=\\u0026thinsp;confidence interval at 95% (standard value\\u0026thinsp;=\\u0026thinsp;1.96)\\u003c/p\\u003e\\n\\u003cp\\u003ep\\u0026thinsp;=\\u0026thinsp;prevalence from previous study\\u0026thinsp;=\\u0026thinsp;21.33% it will be 0.2133 (Mahamat \\u003cem\\u003eet al\\u003c/em\\u003e., 2020)\\u003c/p\\u003e\\n\\u003cp\\u003eq = (1-p) expected non-prevalent\\u003c/p\\u003e\\n\\u003cp\\u003ed\\u0026thinsp;=\\u0026thinsp;margin of error at 5% (0.05).\\u003c/p\\u003e\\n\\u003cp\\u003eSample size (n)\\u0026thinsp;=\\u0026thinsp;1.96\\u003csup\\u003e2\\u003c/sup\\u003e(0.2133) (0.7867) / (0.05)\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;258 participants.\\u003c/p\\u003e\\n\\u003cp\\u003eThus, a minimum sample size of 258 pregnant women were recruited for the study.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eData collection\\u003c/h2\\u003e\\n\\u003cp\\u003eAfter obtaining a signed informed consent from the eligible participant, a semi-structured interviewer-administered questionnaire was filled. The questionnaire contained information that includes maternal age, marital status, educational status, occupation, gravidity, antenatal care,\\u003c/p\\u003e\\n\\u003cp\\u003emalaria preventive measures, placental blood microscopy for malaria parasite detection as well as parasite density. The questionnaire was given out to those who could read and write to fill it while for those who could not read or write, the questions were read out to them in Pidgin English, the lingua franca in the area.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section3\\\"\\u003e\\n\\u003ch2\\u003ePlacental blood collection\\u003c/h2\\u003e\\n\\u003cp\\u003eTwo millilitres of blood was collected from the placental cord within two hours of parturition and transferred into EDTA (ethylenediaminetetraacetic acid) tubes so as to prevent the blood from clotting (Lopes \\u003cem\\u003eet al\\u003c/em\\u003e, 2016). Blood films (thick and thin) were prepared within a period of 30 mins, following the techniques recommended by Cheesbrough (2005).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLaboratory procedure preparing and staining of the thick blood smear.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTwo drops of placental blood sample was placed on a slide using a small pipette. Using the edge of a second slide, the drops of blood were joined and spread to make an even, thick smear and allowed to air-dry. The slide was placed on a staining rack, 5\\u0026ndash;7 drops of freshly prepared Giemsa solution (10%) was poured on the slide and allowed to stain for 10 minutes. The stain was then rinsed off the slides and the slides allowed to dry as recommended by Cheesbrough (2005).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePreparation and staining of thin blood smear.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOne drop of placental blood was placed on a clean slide using a pipette. The edge of a second slide held steadily at an angle of 45\\u0026ordm; to the first, was used to spread the drop of blood to create the thin blood film. The thin film was fixed using absolute methanol. The slide was placed on a staining rack, 5\\u0026ndash;7 drops of freshly prepared Giemsa solution (10%) was poured on the slide and allowed to wait for 10 minutes. The stain was then rinsed off the slides and the slides allowed to dry as recommended by Cheesbrough (2005).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section3\\\"\\u003e\\n\\u003ch2\\u003eMicroscopic examination of slides for malaria parasite and determination of parasite density\\u003c/h2\\u003e\\n\\u003cp\\u003eThe stained placental blood smears were examined under X100 oil immersion lens of a light microscope. Malaria diagnosis was based on the identification of asexual or sexual stages of \\u003cem\\u003ePlasmodium\\u003c/em\\u003e species on the thick blood smear while the thin blood smear was used for species identification. Parasite density was determined by counting the number of parasites per high power field in the thick blood smear. The slide was reported as negative if no parasite was identified per 100 high power microscopic fields.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cimg 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\\\" alt=\\\"\\\" /\\u003e\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e\\n\\u003ch2\\u003eData analysis\\u003c/h2\\u003e\\n\\u003cp\\u003eData obtained was entered into Microsoft Excel 2016 spread sheet, filtered and coded alongside data from the questionnaires. The data was then transferred and analyzed using The Statistical Package for Social Sciences (SPSS) version 21. Frequencies were calculated and variables were compared using Chi-square test. A regression analysis was done to determine the factors that were associated with the prevalence and associated risk factors of malaria. The results were presented using graphs (the graphs were plotted using graph pad prism version 8) and frequency tables were drawn to display the results. Significant levels were measured at 95% confidence interval, with significant difference recorded at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eBaseline characteristics of study participants\\u003c/h2\\u003e\\n \\u003cp\\u003eA total of 258 participants were recruited for the study. The age ranged from 14 to 45 years with a mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD of 27.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.174 years. Subjects in the age range 21\\u0026ndash;30 years constituted the highest population 54.7% (141). A total of 74.0% (191) were married and had a monthly income less than 50,000FCFA, 69.4% (179). Majority 94.6% (244) were Christians, 46.1% (119) had attain secondary education and 34.5% (89) were traders while 3.1% (\\u003cspan class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e) were house-wives and 79.8% (206) had less than 3 children. Those that took their prophylaxis effectively were 98.4% (254) and those that did not have any medical conditions were 97.7% (252) while among the 2.3% (\\u003cspan class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e) participants with underlying diseases a majority 1.6% (\\u003cspan class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e) of them had had HIV (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv class=\\\"colspec\\\" align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/div\\u003e\\n \\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eBaseline characteristics of the study participants.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eParameters\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber(n)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eProportion (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge (years)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e11\\u0026ndash;20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e21\\u0026ndash;30\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e141\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e54.7%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"5\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMarital Status\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMarried\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e191\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e74.0%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCohabiting\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e19\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSingle\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e18.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDivorced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eWidow(er)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMonthly Income (FCFA)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;50,000\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e179\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e69.4%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e50,000-100,000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;100,000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eReligion\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eChristian\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e244\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e94.6%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMuslim\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOthers\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"4\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLevel Education\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrimary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.5%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSecondary\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e119\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e46.1%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTertiary\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e112\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber of Children\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;3\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e206\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e79.8%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e20.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHep B\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedical Condition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHIV\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e4\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e1.6%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHIV\\u0026amp; Hep B\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNone\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e252\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e97.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOccupation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCivil Servants\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTechnician\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24.0%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTrader\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e89\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e34.5%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStudent\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHouse wife\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eProphylaxis (SP)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSeldom\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOften\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e254\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e98.4%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"4\\\"\\u003e\\u003cstrong\\u003eNOTE\\u003c/strong\\u003e 1 Hep B (hepatitis B): 2 HIV (Human Immunodeficiency Virus)\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003ePrevalence of placental cord blood malaria\\u003c/h2\\u003e\\n \\u003cp\\u003eThe overall prevalence of malaria in the study area was 3.9% (10/258)\\u003c/p\\u003e\\n \\u003cp\\u003eThe highest prevalence 2.71% (7/258) of malaria was recorded in the age group 21\\u0026ndash;30 years while the lowest prevalence 0% was recorded in the age group of 41\\u0026ndash;50 years. There was no significant difference in the prevalence of malaria in the different age groups (p\\u0026thinsp;=\\u0026thinsp;0.772). This can be seen in Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\n \\u003cp\\u003eThe prevalence of malaria among women of different educational level was equal among those with secondary 1.94% (5/258) and tertiary education 1.94% (5/258). However, this difference was insignificant with a p value of 0.542 as shown in Fig.\\u0026nbsp;2.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003ePrevalence of malaria with respect to gravidity (number of pregnancies)\\u003c/h2\\u003e\\n \\u003cp\\u003eThe highest prevalence of malaria 2.71% (7/258) was recorded amongst women with less than 3 children while the lowest prevalence of malaria 1.16% (3/258) was recorded amongst women with more than 3 children. An insignificant difference (p\\u0026thinsp;=\\u0026thinsp;0.429) was seen with the number of pregnancies as shown in Fig.\\u0026nbsp;3.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSpecies of\\u003c/strong\\u003e \\u003cstrong\\u003ePlasmodium\\u003c/strong\\u003e \\u003cstrong\\u003efound in the study population\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eThe overall prevalence of malaria in the study area was found to be 4.0% (10/253). The specific \\u003cem\\u003ePlasmodium\\u003c/em\\u003e species found were \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e and \\u003cem\\u003ePlasmodium malariae.\\u003c/em\\u003e The number of \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e recorded a higher proportion (3.5) while \\u003cem\\u003ePlasmodium malariae\\u003c/em\\u003e recorded a lower proportion (0.4). This is seen in Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eBehavioral factors which affects malaria prevalence\\u003c/h2\\u003e\\n \\u003cp\\u003eIn this study, participants who used mosquito nets were more (93.4%, 241/258) compared to those who did not (6.6%, 17/258), and this factor was insignificantly associated with malaria (p\\u0026thinsp;=\\u0026thinsp;0.392). Also, participants who put down their mosquito nets at night and tucked them under the mattress were more (98.8%, 255/258) compared to those who slept under the mosquito net at night and never tucked the net under the mattress (1.2%, 3/258), and this factor was not significantly associated with malaria (p\\u0026thinsp;=\\u0026thinsp;0.726). Majority of the participants locked doors and windows in the evening (99.6%, 257/258) compared to those who did not (0.4%, 1/253), and this factor was insignificantly associated with malaria (p\\u0026thinsp;=\\u0026thinsp;0.841). Those who did not live by streams were more (95.7%, 247/258) compared to those who lived by streams (4.3%, 11/258) and this factor was statistically insignificant to the prevalence of malaria (p\\u0026thinsp;=\\u0026thinsp;0.496). Participants who did not live around bushes were more (73.6%, 190/258) as compared to those who lived by bushes (26.4%, 68/258), this factor was not significantly associated with malaria (p\\u0026thinsp;=\\u0026thinsp;0.642). Majority of the participants (91.1%, 235/258) did not have screens on their doors and windows whereas minority (8.9%, 23/258) had screens on their doors and windows and this was not statistically significant (p\\u0026thinsp;=\\u0026thinsp;0.313). Regarding the presence of stagnant water around their houses, most participants (90.3%, 233/258) did not have stagnant water around their houses while few (9.7%, 25/258) had stagnant water around their houses, this factor had an insignificant difference (p\\u0026thinsp;=\\u0026thinsp;0.973). Many participants (47.7% 123/258) wore protective clothing in the evening sometimes compared to those who did not at all (41.1%, 106/258) or those who wore it every day (11.2%, 29/258), and this factor was not statistically significant (p\\u0026thinsp;=\\u0026thinsp;0.277). Majority of the participants (98.4%, 254/258) took their anti-malaria drugs often compared to those who seldomly took it (1.6%, 4/253), this was statistically insignificant (p\\u0026thinsp;=\\u0026thinsp;0.686). This can be seen in Table\\u0026nbsp;2.\\u003c/p\\u003e\\n \\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eInfluence of behavioral factors on the prevalence of malaria\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth colspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRisk factor Category\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCount\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eProportion (%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSleeping under a mosquito net\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e241\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e93.4%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.392\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePutting down of bed nets?\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAt night\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e255\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e98.8%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.726\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIn the Morning\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLock doors and windows during evening periods\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eYes\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e257\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e99.6%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.841\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLive by stream\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.3%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e247\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e95.7%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.496\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBushes around house\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e26.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e190\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e73.6%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.642\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"2\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePools of standing water around the house\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e233\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e90.3%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.973\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd rowspan=\\\"3\\\" align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eWear long dresses in the evening\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e41.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSometime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e123\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e47.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.277\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eA total number of 258 pregnant women were recruited for this study. Amongst these women 10 were positive for malaria while 248 were negative. In this study, the prevalence of placental malaria among asymptomatic pregnant women who delivered at the Regional Hospital Bamenda was 3.9%. This result is similar to a previous study carried out in Wolkite health center in Ethiopia which was 3.9% (Solomon \\u003cem\\u003eet al\\u003c/em\\u003e., 2020) but, lower than other results obtained from studies reported from Nigeria (Mokuolu \\u003cem\\u003eet al\\u003c/em\\u003e., 2009; Falade \\u003cem\\u003eet al\\u003c/em\\u003e., 2010; Bassey \\u003cem\\u003eet al\\u003c/em\\u003e., 2015), Cameroon (Mahamat \\u003cem\\u003eet al\\u003c/em\\u003e., 2020) and Sudan (Omer \\u003cem\\u003eet al\\u003c/em\\u003e., 2017), using placental blood microscopy. This prevalence variation might be due to differences in geographic location and malaria transmission intensity and it could also be due to that fact that many of the women enrolled for this study were constantly on malarial prophylaxis as a preventive measure against malarial infection which was routinely administered by their antenatal care givers.\\u003c/p\\u003e \\u003cp\\u003eThe lower prevalence in this study may be due to the high level of education among the parturients which may have contributed to their health awareness with a positive impact on their health and the effective malaria preventive measures utilized by the parturients including IPTpSP (98.4%) and ITN (94.1%); other factors may include a high level of community acquired immunity and the quality of antenatal care (Bassey \\u003cem\\u003eet al\\u003c/em\\u003e., 2015).\\u003c/p\\u003e \\u003cp\\u003eWomen aged 21\\u0026ndash;30 years were found to have a higher prevalence of placental malaria. This finding is consistent with the results of Oweisi \\u003cem\\u003eet al\\u003c/em\\u003e. (2018), where parturients younger than 25 years of age were 5 times more likely to have placental malaria parasitaemia than those 25 years and older. This supports the findings of previous studies stating young maternal age as a risk factor for placental malaria (Okolie \\u003cem\\u003eet al\\u003c/em\\u003e., 2014; Babalola \\u003cem\\u003eet al.\\u003c/em\\u003e, 2015) which could be attributed to lower levels of acquired immunity as well as the lack of pregnancy associated immunity against the placental-binding parasites (Babalola \\u003cem\\u003eet al.\\u003c/em\\u003e, 2015).\\u003c/p\\u003e \\u003cp\\u003eEducational level of parturients in this study did not show any significant association to placental malaria. Parturients in this study who had attained secondary and tertiary education were seen to have a high prevalence of placental malaria compared to parturients with primary education and no education at all. This result is in contrast with the results of Oweisi \\u003cem\\u003eet al\\u003c/em\\u003e. (2018), conducted in Nigeria which observed that parturients who had none or primary level of education were 3 times more likely to have placental malaria compared to parturients with at least secondary level of education. The reverse results in this study maybe as a results of increase community sensitization on the risk of pregnancy associated malaria, consistent use of preventive measures (ITPM) and poor dressing of some parturients which exposes their skin to the vector. High educational standards usually affect health awareness and therefore has a positive impact on health (Ogbu \\u003cem\\u003eet al\\u003c/em\\u003e., 2015). The reverse may be the case in those with lower standards of education as they may not appreciate the burden of malaria in pregnancy and the importance of adherence to stipulated malaria preventive measures because of their limited understanding and knowledge (Ogbu \\u003cem\\u003eet al\\u003c/em\\u003e., 2015).\\u003c/p\\u003e \\u003cp\\u003eAs observed in this study, gravidity did not show any significant association to placental malaria. Parturients in this study with less than 3 children were seen to have a high prevalence of placental malaria compared to parturients with more than 3 children. This agrees with other studies carried out in Camerron (Tako \\u003cem\\u003eet al.\\u003c/em\\u003e, 2005; Walker-Abbey \\u003cem\\u003eet al.\\u003c/em\\u003e, 2005; Leke \\u003cem\\u003eet al.\\u003c/em\\u003e, 2010), Central African Republic (Manirakiza \\u003cem\\u003eet al\\u003c/em\\u003e., 2011) and Nigeria (Makuolo \\u003cem\\u003eet al\\u003c/em\\u003e., 2009; Oweisi \\u003cem\\u003eet al\\u003c/em\\u003e., 2018) which found primiparous and secundiparous women to be at higher risk of malaria parasite infection than multiparous women. Anchang-Kimbi \\u003cem\\u003eet al\\u003c/em\\u003e. (2009), also found an inconsistent association of parity with malaria parasite infection at delivery. Multiparous women in malaria-endemic regions are believed to form blocking antibodies that bind to placental chondroitin sulphate A during their subsequent pregnancies and prevent placental sequestration of \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e (Maestre and Carmona-Fonseca, 2014). This explains why the burden of malaria in pregnancy is higher among women of low parity. As suggested by Tako \\u003cem\\u003eet al\\u003c/em\\u003e. (2005), that this inconsistency may be due to the development with time, of a better immune response to malaria by primiparous and secundiparous mothers following repeated exposures to malaria parasites which makes them less dependent on anti-cytoadherence antibodies. Similar findings have been reported by researchers in Portharcourt, Nnewi and Ile Ife in Nigeria (Okolie \\u003cem\\u003eet al\\u003c/em\\u003e., 2014; Bassey \\u003cem\\u003eet al\\u003c/em\\u003e., 2015; Fehintola \\u003cem\\u003eet al\\u003c/em\\u003e., 2016).\\u003c/p\\u003e \\u003cp\\u003eOur results revealed that \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e was the most common but not the only species of malaria identified in this study. The finding is not in consonance with a study conducted in Nigeria were \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e was the only parasite species detected in all the placental blood films in this study. The high prevalence of \\u003cem\\u003eP. falciparum\\u003c/em\\u003e in this study confirms previous reports that placental malaria is an exclusive feature of \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e infection in pregnancy (Srivastava \\u003cem\\u003eet al\\u003c/em\\u003e., 2010) and that \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e is the most prevalent species in Cameroon accounting for about 98% of malaria cases in the country (MINSANTE, 2018).\\u003c/p\\u003e \\u003cp\\u003eAs a component of the malaria preventive measures during pregnancy, the world health organization has recommended the use of at least three doses of sulphadoxine-pyrimethamine combination with each dose given not less than 4 weeks apart in the second and third trimesters of pregnancy (Anchang-Kimbi \\u003cem\\u003eet al.\\u003c/em\\u003e, 2014). In this study, majority 98.4% of the parturients had taken at two or more doses of sulphadoxine-pyrimethamine combination. Several studies have reported similar findings (Bassey \\u003cem\\u003eet al\\u003c/em\\u003e., 2015; Fehintola \\u003cem\\u003eet al\\u003c/em\\u003e., 2016; Babalola \\u003cem\\u003eet al.\\u003c/em\\u003e, 2015) but however other studies carried out in Cameroon (Takem \\u003cem\\u003eet al\\u003c/em\\u003e., 2009; Tonga \\u003cem\\u003eet al\\u003c/em\\u003e., 2013) and South-Sudan (Napoleon \\u003cem\\u003eet al\\u003c/em\\u003e., 2011) have shown contradictory results. This variation maybe due to the provision of the medication at the antenatal clinic and administration as directly observed therapy (DOT) coupled with adequate female education and empowerment would likely be the reason for the contradictory finding.\\u003c/p\\u003e \\u003cp\\u003eIn this study, the level of utilization of LLINs (long lasting insecticidal nets) was generally high 93.4%. The consistent use of mosquito nets may be associated to the low prevalence of malaria, although it is not statistically significant. Similar findings were gotten by Tonga \\u003cem\\u003eet al.\\u003c/em\\u003e (2013). It is essential that all stakeholders combine efforts to ensure successful implementation in the deployment of these various tools to achieve a continuous reduction in the burden of placental malaria.\\u003c/p\\u003e \\u003cp\\u003eThe present study shows that parturients who earned less than 50,000FCFA (83 USD) monthly had the highest prevalence of 96.1% whereas those who earned\\u0026thinsp;\\u0026gt;\\u0026thinsp;100,000FCFA (166 USD) had the lowest prevalence. The findings fall in line with that of Tonga \\u003cem\\u003eet al.\\u003c/em\\u003e (2013), who mentioned that women with monthly income less than 28,000FCFA (46 USD) were more at risk of getting the malaria parasite than women with higher monthly income. Those who earned\\u0026thinsp;\\u0026lt;\\u0026thinsp;50,000FCFA (83 USD) in this study had the highest prevalence and this could be due to the fact that the money which they earn may not be enough to care for their basic needs and still take them through regular monthly checkups.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSIONS\",\"content\":\"\\u003cp\\u003eThe overall prevalence of malaria was low. Parturients in the age group 21 to 30 years had the highest prevalence. Participants with secondary and tertiary level of education showed the highest level of prevalence. Parturients with less than 3 children had a higher prevalence (primiparous and secundiparous). The species of \\u003cem\\u003ePlasmodium\\u003c/em\\u003e found was \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e and \\u003cem\\u003ePlasmodium malariae\\u003c/em\\u003e, with \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e being more common than \\u003cem\\u003ePlasmodium malariae.\\u003c/em\\u003e There was no significant relationship between prevalence and risk factors.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eCOMPETING INTERESTS\\u003c/h2\\u003e \\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eEEJE, ECB and SRA conceived and designed the study. All authors participated in the field work. EBC analysed the data. EEJE and MS wrote the first draft of the manuscript. All authors read and approved the final manuscript for submission.\\u003c/p\\u003e\\u003ch2\\u003eACKNOWLEDGEMENTS\\u003c/h2\\u003e \\u003cp\\u003eWe would like to thank the directors of the Regional Hospital Bamenda for giving us the authorization to carry out this study in their institution. We want to acknowledge women who willingly participated in the study. Finally, we would like to thank the laboratory staff of the medical facility who assisted in the collection and analysis of the samples\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003e-World Health Organization. (2022). Available at \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ei\\u0026gt;https://www.who.int/news-room/fact-sheets/detail/malaria. Accessed on November 8st 2022.\\u003c/span\\u003e\\u003cspan address=\\\"http://i%3Ehttps://www.who.int/news-room/fact-sheets/detail/malaria. 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South Sudan Med J. 2011;4(2):33\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Placental malaria, Prevalence, Risk Factors, Regional Hospital, Bamenda, Cameroon\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3946733/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3946733/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eMalaria in pregnancy has been a major health problem of humans through history and is a leading cause of preterm births, miscarriages, stillbirths and death. The aim of this study was to determine the prevalence of malaria in placental cord blood and the risk factors associated with it at the Regional Hospital Bamenda, Cameroon. Two hundred and fifty-eight samples were collected from the placental cord using a sterile syringe. Slides were prepared, stained using Giemsa (10%) and observed under the microscope. Risks factors were assessed via questionnaires. Data obtained was analysed using SPSS version 21. Chi square test was used to test for differences in proportions in different categories and regression analysis was also used to get the relationship between prevalence and risk factors in this study. The overall prevalence of placental cord blood malaria was 3.9% (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e) and the disease was more prevalent among parturients in the age group 21\\u0026ndash;30 years 2.71% (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e) than those of the age group 41\\u0026ndash;50 years who recorded zero prevalence. Parturients with secondary and tertiary level of education had the highest prevalence 5(1.94%) and those with less than 3 children recorded the highest prevalence 2.71% (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e) compared to those with more than 3 children 1.16% (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). The \\u003cem\\u003ePlasmodium\\u003c/em\\u003e species identified were \\u003cem\\u003ePlasmodium falciparum\\u003c/em\\u003e (3.5%) and \\u003cem\\u003ePlasmodium malariae\\u003c/em\\u003e (0.4%). The risk factors that predisposed the parturients in this study included; not sleeping under mosquito nets, living by streams, those with bushes around the house and those who did not take their anti-malaria drugs effectively. Malaria parasites were prevalent in the placental cord blood which means pregnant women are not free from this infection and it merits extra preventive and treatment measures.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Asymptomatic placental cord blood malaria in pregnant women attending the Bamenda Regional Hospital: A cross sectional study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-02-14 18:28:29\",\"doi\":\"10.21203/rs.3.rs-3946733/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"91533637-5add-4b30-9423-ea27f19a769d\",\"owner\":[],\"postedDate\":\"February 14th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-02-20T09:45:06+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-02-14 18:28:29\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3946733\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3946733\",\"identity\":\"rs-3946733\",\"version\":[\"v1\"]},\"buildId\":\"zQwnuV7TCBrMSSSToR1PI\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}