Epidemiological Profile and baseline characteristics of pregnant women attending antenatal clinics in malaria endemic communities within Ogun State Southwestern Nigeria

Epidemiological Profile and baseline characteristics of pregnant women attending antenatal clinics in malaria endemic communities within Ogun State Southwestern Nigeria | 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 Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological Profile and baseline characteristics of pregnant women attending antenatal clinics in malaria endemic communities within Ogun State Southwestern Nigeria Atinuke Olaleye, Gabriel Noblefather Uyaiabasi, Charles Elikwu, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8800686/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 Background Nigeria has one of the highest maternal mortality rates (MMR) worldwide, which is largely due to complications during pregnancy, delivery, and the postpartum period. Focused antennal clinic (ANC) visits are pivoted to reduce MMR. This study provides detailed baseline and demographic information of pregnant women from a large malaria in pregnancy study. Methods Pregnant women of 16–29 weeks gestation receiving care at our study sites were enrolled. At enrolment, the following data were collected: baseline demographic data (age, weight, educational status, ethnicity, and use of malaria preventive measures), obstetric information (gravidity, parity, history of adverse pregnancy outcomes [APOCs] and surgeries), laboratory investigations (haemoglobin levels, blood group, genotype, proteinuria, and glycosuria), and malaria parasitology evaluation. Data were analysed using Stata 17® and Microsoft Excel 2021®. Results A total of 520 pregnant women were enrolled, with an average age of 28.8 years and gestational age of 22 weeks. More participants had tertiary education and were of Yoruba heritage. Obstetric information revealed that 165 (32.0%) of the women were primigravidae, whereas 42.1% of the women had had more than 2 pregnancies. Half (178) of the women who were pregnant previously reported having at least one APOC, with miscarriage being the most prominent, and 101 had undergone previous surgical procedures. The prevalence of anaemia, proteinuria, and glucosuria were 62.3%, 13%, and 3.5%, respectively. Malaria positivity at enrolment was 27.3% (142), with 71.1% of the diagnosed cases being asymptomatic, whereas 28.9% were symptomatic. There was poor utilisation of malaria preventive measures (insecticide treated nets, insecticide sprays, and indoor residue spraying) with only 1 participant using all three methods and 41.2% using none. Conclusion Epidemiological data obtained from this study revealed that participants had high anaemia, previous APOC, high malaria parasite positivity, and low utilisation of malaria preventive measures. These may be strong indicators of why Nigeria has a very high MMR. Malaria pregnancy intermittent preventive treatment maternal mortality rates adverse pregnancy outcome anaemia Nigeria Background Nigeria’s population is estimated to be over 200 million people [ 1 ]. A large percentage of the population (≥ 40 million) are youths and women of childbearing age [ 2 ]. Nigeria has the highest morbidity and mortality rates for malaria globally and one of the highest maternal mortality ratios (MMR) [ 3 – 7 ]. Currently, the country is plagued with the emigration of skilled medical personnel to more developed countries for better economic opportunities [ 8 ]. This has therefore placed a strain on the decrepit health system, as the workforce needed to stem the tide of increasing mortality and morbidity is dwindling. In Africa, particularly in Nigeria, there is a high fertility rate among women of reproductive age, with 4.7 and 5.4 births per woman from 2015–2020 for Sub-Saharan Africa and Nigeria respectively [ 3 , 4 , 9 ]. Pregnancy often exposes already vulnerable women to increased risks for both the mother and her unborn foetus, such as maternal and foetal anaemia, malnutrition, and adverse pregnancy outcomes (APOC) [ 4 , 10 – 12 ]. Malaria in pregnancy (MIP) remains one of the leading causes of APOCs such as maternal anaemia, miscarriage, preterm delivery, intrauterine growth restriction (IUGR), and low birth weight (LBW) in malaria-endemic regions [ 10 , 13 , 14 ]. Women in moderate-to-high transmittance areas for malaria develop specific immunity to malaria after their first pregnancy. Hence, primigravidae women are at greater risk of MIP than to multigravida women [ 10 , 15 – 17 ]. The adverse effects of MIP are significantly mitigated by the regular administration of sulphadoxine-pyrimethamine (SP) as an intermittent preventive treatment during pregnancy (IPTp-SP), as recommended by the WHO [ 11 , 18 – 20 ]. The severity and frequency of MIP are dependent on the age, gestational age, gravidity, anaemia, and nutritional state of the pregnant woman. Hence, accurate determination of these parameters is essential for planning and efficiently managing MIPs and subsequently reducing of the country’s MMR [ 10 , 13 , 18 , 21 ]. The regular attendance of antenatal care (ANC) clinics by pregnant women in malaria-endemic areas is highly recommended by the World Health Organization (WHO), because ANC has been shown to improve the pregnancy outcome and wellbeing of both mothers and foetuses/neonates [ 11 , 22 , 23 ]. It plays a critical role in minimizing maternal and child mortality through appropriate monitoring and treatment interventions [ 18 , 24 – 26 ]. Data generated from ANC visits and pregnancy outcomes are critical for detecting changes in the epidemiology of MIP and deploying adequate intervention measures [ 7 , 27 ]. The data also give information on the progress made in SDG 3. This study presents recent baseline demographics and epidemiological parameters of pregnant women attending ANC clinics in different healthcare systems and hospitals in different communities within two local government areas (LGAs) in Southwest Nigeria. For Nigeria to meet its malaria control and eradication targets, there must be a continuous evaluation of our demographic profiles, as this evaluation is not static. The study was part of a larger malaria in-pregnancy study. Method Study Description and Sites This was a prospective observational study on the sociodemographic characteristics and epidemiological data of pregnant women attending ANC clinics within Ikenne and Remo North LGAs of Ogun State from June 2018 to May 2020. This was part of a larger study on the use of sulfadoxine-pyrimethamine as an IPTp in the management of MIP in Southwest Nigeria. Ikenne LGA, with headquarters in Ikenne town (located at 6 0 52'N 3 0 43'E), has a total land area of 179.4 km² and an estimated population of 202,600 people [1, 28]. It is approximately 60 km from the cosmopolitan city of Lagos but has a stable population. Remo North, with headquarters at Isara town (7 0 00'N 3 0 41'E) has a land area of 211.3 km² and aa estimated 101,600 people [1]. The study sites included antenatal clinics at Babcock University Teaching Hospital Ilishan Remo, BUTH (study focal site), Ilishan Community Hospital (ICH), Ikenne Primary Health Care Centre (IKPHC), Christ Apostle Church Spiritual and Healing Maternity Home (CAC), all within Ikenne LGA, and Isara General Hospital (ISH) in Remo North LGA; this is a secondary level facility. Study participants and enrolment Pregnant women visiting study clinics were counselled, and the study investigators explained the study to them. Consenting women who met the inclusion and exclusion criteria were recruited after verbal and written consent were obtained. The inclusion criteria were as follows: women who were confirmed to be pregnant with an estimated gestational age between 16 and 29 weeks, who provided consent, live within the study area, and who are were willing to deliver at the study sites. The exclusion criteria included: use of IPTp-SP in index pregnancy, history of allergy to sulphonamides or pyrimethamine drugs, HIV positive or comorbidities, severe anaemia (haemoglobin < 7 g/dL). Physical investigation and obstetric history The enrolled participants were physically examined by certified medical personnel. Demographic information such as age, educational level, tribe, body temperature, blood pressure, respiratory rate, weight, and height were entered into a specifically designed case record form (CRF). Obstetric examination was performed to determine the gestational age. Other information such as the use of insecticide-treated nets (ITNs), insecticide sprays, indoor residual spraying (IRS), and antimalarial use, were collected. Medical and surgical history Subject medical and surgical histories were obtained through interviews [45] or review of the subject’s medical records. Pre-existing conditions or signs and/or symptoms present in a subject prior to the first study drug administration were recorded. Laboratory analysis After physical examination, 5 ml of blood was withdrawn via venous puncture into sample EDTA bottles and used for malaria parasite identification, haemoglobin analysis, blood group determination, and molecular analysis. Urine was collected and the samples were analysed for glycosuria and proteinuria. Malaria was diagnosed using microscopy, rapid diagnostic test (mRDTs), and polymerase chain reaction (PCR), either singly or in combination. Data collection and statistical analysis All collected data were entered into the REDCap® online database [29, 30]. The data were analysed using Stata 17® and Microsoft Excel 2021®. Statistical analysis was performed by comparing the means of continuous variables, chi-square tests, and logistic regression for categorical data at 95% confidence level. Statistical values of p < 0.05 were considered significant. Ethical Considerations Ethical considerations for this study included the use of a multilayer approach because of cultural norms. Study investigators visited relevant stakeholders in the community to inform and seek support for the project from traditional rulers, primary health directors for the LGA, community health awareness officers, and health town hall meetings with the communities. Government approval for the study was obtained from the State Ministry of Health. At the time of enrolment, written informed consent was obtained from each participant and/or her husband. For patients less than 18 years, consent was obtained from the patient and husband or guardian. The study was approved by the Babcock University Research and Health Ethical Board, and an approval number BUHREC162/19 was issued. RESULTS Baseline Demographics and Epidemiology Data A total of 520 pregnant women were enrolled. BUTH had the highest degree of enrolment. The mean age of participants was 28.8 years; stratifying into three age groups (14-18, 19-34, 35-45 years, respectively) revealed that 428 (82.3%) of the participants were between the ages of 19 and 34, which is the optimal reproductive age for women, and this difference was statistically significant (χ 2 test p = 0.031) compared with the other groups (Table 1). The mean gestational age at enrolment was 22 weeks, but 25 (4.8%) participants were enrolled at 28-29 weeks. Analysis of educational level showed that 296 (56.9%) of the participants had tertiary education, of which 194 (65.5%) were enrolled at BUTH. Almost three-fourths (74.9%) of the participants were of the Yoruba speaking decent, since this is their domain (Table 1). Table 1: Baseline Characteristics of Participants Description BUTH CAC ICH IKPHC ISH Total n (%) Enrolment per site n (%) 232 (44.6) 92 (17.7) 75 (14.4) 70 (13.5) 51 (9.8) 520 Age at enrolment mean ± SD (years) 30.4 ± 4.4 27.0 ± 5.9 28.2 ± 5.7 26.9 ± 5.6 28.0 ± 6.1 28.8 ± 5.4 p-value 0.0001 a 0.0037 b 0.354 0.0052 c 0.3684 0.7530 Range 20 - 45 14 - 42 16 – 42 16 - 38 19 - 41 14 - 45 Age category (Years) n (%) 14-18 0 5 (1.0) 2 (0.4) 4 (0.8) 0 11 (2.1) 19-34 191 (36.7) 75 (14.4) 63 (12.1) 57 (11.0) 42 (8.1) 428 (82.3) d 35-45 41 (7.9) 12 (2.3) 10 (1.9) 9 (1.7) 9 (1.7) 81 (15.6) Gestation Age at enrolment Estimated gestation age mean ± SD (weeks) 19.7 ± 3.1 22.32 ± 3.6 21.2 ± 3.4 21.2 ± 3.9 23.6 ± 3.4 22.0 ± 3.6 p-value 0.0001 e 0.0008 f 0.5599 0.6032 0.0001 g 0.884 Range 15 - 28 16 - 29 16 – 28 16 - 29 16 - 28 15 -29 Educational Level n (%) No formal 0 0 1 (100) 0 0 1 (0.2) Primary 3 (8.8) 15 (44.1) 5 (14.7) 5 (14.7) 6 (17.6) 34 (6.5) Secondary 35 (18.5) 62 (32.8) 37 (19.6) 41 (21.7) 14 (7.4) 189 (36.4) Tertiary 194 (65.5) 15 (5.1) 32 (10.8) 24 (8.1) 31 (10.5) 296 (56.9) Ethnicity n Yoruba 145 81 64 51 46 387 (74.9) Igbo 60 7 4 9 3 83 (16.1) Hausa 3 0 0 0 0 3 (0.6) Other 23 4 6 9 2 44 (8.5) Key: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital a Statistically significantly higher mean age compared to study average age using t-test ( p < 0.0001), b Statistically significantly lower mean age compared to study average age using t-test ( p < 0.0037), c Statistically significantly lower mean age compared to study average age using t-test ( p < 0.0052), d Statistically significantly p = 0.031 using chi square test, e Statistically significantly lower gestation age compared to study mean age using t-test ( p < 0.0001), f Statistically significantly higher gestation age compared to study mean age using t-test (p < 0.0008), g Statistically significantly lower gestation age compared to study mean age using t-test (p < 0.0001). Obstetrics and clinical evaluations The obstetric data revealed that about approximately one-third of the women were primigravidae, whereas 217 (42.1%) had more than two pregnancies (Table 2). All participants younger than 19 years of age (11) were primigravida. Participants with a history of APOCs or high gravida preferred to enrol in the BUTH centre. Details of previous pregnancies and parity are shown in appendix 1. At enrolment, 178 (50.1%) Patients had a history of APOC; 135 (38.6%) had prior miscarriage, 28 (8.0%) hard stillbirths, 21.0 (6.2%) had low birthweights, 8 (2.3%) preterm deliveries, and 20 (5.7%) had neonatal deaths. See Table 2 and Appendix 1 for details. On clinical investigation, 37 (7.1%) participants reported having treated a medical condition in the last 30 days before the ANC visit, 9 (1.7%) of whom had co-morbidities such as hypertension, and only 9 (1.7%) participants were using medications for a pre-diagnosed co-morbidity (Table 2 and Appendix 2). A total of 101 (19.4%) of the participants reported to having undergone previous surgeries, of whom caesarean sections accounted for 81.2% of the surgeries. Details are shown in Table 2 and Appendix 2. Table 2: Obstetric characteristics Description BUTH CAC ICH IKPHC ISH Total n (%) or mean (SD) n (%) or mean (SD) n (%) or mean (SD) n (%) or mean (SD) n (%) or mean (SD) n (%) or mean (SD) Gravidity * 1 62 (27.0) 35 (38.5) 25 (33.8) 30 (42.9) 13 (25.5) 165 (32.0) 2 60 (26.1) 23 (25.3) 18 (24.3) 14 (20.0) 19 (37.3) 134 (26.0) >2 108 (47.0) 33 (36.3) 31 (41.9) 26 (37.1) 19 (37.3) 217 (42.1) range 1 - 8 1 - 8 1 - 8 1 - 5 1 - 6 1- 8 Parity * 1.0 ± 1.0 1.2 ± 1.4 1.1±1.6 0.9 ± 1.0 1.1 ±1.2 1.0 ± 1.2 Range 0-5 0-6 0-10 0-3 0-5 0-10 weight (kg) 14-18 0 50.2 ± 1.3 61.0 ± 3.0 56.0 ± 4.7 0 54.3 ± 2.1 19-34 70.0 ± 1.2 63.0 ± 1.2 65.7 ± 1.9 59.6 ± 1.4 66.7 ± 2.0 66.5 ± 0.7 35-45 74. 0 ± 2.4 68.5 ± 2.8 74.3 ± 2.7 65.1 ± 2.4 67.7 ± 4.8 71.5 ± 1.5 History of APOC 101 (59.4) 25 (43.9) 21 (42.0) 13 (32.5) 18 (47.4) 178 (50.1) History of previous miscarriage * n (%) 87 (51.8) 12 (21.4) 14 (29.2) 9 (22.5) 13 (34.2) 135 (38.5) Number of previous stillbirths * n (%) 18 (10.7) 3 (5.5) 1.0 (2.1) 3 (7.5) 3 (8.3) 28 (8.0) History of low-birth-weight baby * n (%) 7 (4.3) 5 (9.6) 6 (12.5) 1 (2.6) 2 (5.3) 21 (6.0) History of preterm delivery n * (%) 2 (1.2) 4 (7.1) 0 1 (2.5) 1 (2.6) 8 (2.3) History of neonatal death n * (%) 8 (4.8) 5 (9.1) 4 (8.2) 2 (5.0) 1 (2.6) 20 (5.7) History of alcohol use n (%) 13 (5.7) 8 (8.9) 4 (5.5) 11 (15.7) 5 (9.8) 41 (8.0%) only 2 subjects reported past smoking Medical history/concomitant disease α last 30 days n 14 6 0 15 2 37 (7.1%) Co-morbidities α 6 Nil Nil 3 Nil 9 (1.7%) History of past surgeries α n (%) 75 (74.3) 2 (2.0) 11 (10.9) 5 (5.0) 8 (7.9) 101 History of Caesarean sections α 52 (74.3) 2 (2.9) 7 (10.0) 2.0 (2.9) 7 (10.0) 70 (81.2%) Freq. No. of surgeries Freq. Frequency of past surgeries 101 (19.4) 1 76 (75.2) 2 20 (19.8) 3 5 (5.0) Key: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital, APOC = adverse pregnancy outcomes * Additional information on these parameters can be found in Appendix 1. α Additional information on these parameters can be found in Appendix 2. Laboratory investigations The prevalence of anaemia, defined as Hb < 10 g/dL, was 62.3%, whereas the prevalence of proteinuria and glucosuria was 13% and 3.5%, respectively. Blood group type O, 217 (41.7%), and AA genotype 208 (40.0%) were more prevalent. A total of 372 participants were tested for hepatitis B surface antigen, of whom 17 (3.3%) tested positive for the antigen (Table 3). However, none of the 362 subjects tested positive for viral disease (Table 3). The use rates of folic acid and iron supplements were both above 85%. Table 3: Laboratory Investigations Description BUTH n (%) or mean (SD) CAC n (%) or mean (SD) ICH n (%) or mean (SD) IKPHC n (%) or mean (SD) ISH n (%) or mean (SD) Total n (%) or mean (SD) Anaemia at enrolment n (%) 123 (53) 76 (82.6) 49 (65.3) 44 (62.9) 32 (62.7) 324 (62.3) p-value 0.017 h 0.000 i 0.613 0.929 0.951 Proteinuria n (%) 27 (12.2) 4 (4.4) 12 (16.0) 16 (25.4) 6 (12.2) 65 (13.0) Glucosuria n (%) 10 (4.5) 2 (2.2) 3 (4.0) 3 (4.8) 0 18 (3.6) Blood Group n A 38 1 12 7 9 67 (12.9%) B 36 1 19 9 3 68 (13.1%) O 112 4 33 41 27 217 (41.7%) AB 3 0 1 3 4 11 (2.1%) Not done 2 58 1 0 1 157 (30.2%) Genotype n AA 132 6 24 13 33 208 (40.0%) AS 47 2 5 3 6 63 (12.1%) AC 9 0 0 0 2 11 (2.1%) Not done 44 84 46 54 10 238 (45.8%) Hepatitis B surface antigen (HBsAg) n Positive 8 1 6 2 0 17 (3.3%) Negative 188 7 58 58 44 355 (68.3%) Not done 36 84 11 10 7 148 (28.5%) All 362 participants assessed for viral diseases tested Negative Folic acid usage 209 76 64 60 42 451 (86.7) Iron supplement usage 205 77 64 59 43 448 (86.2) Key: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital h Statistically significantly lower anaemic participants compared to study mean age using χ 2 -test i Statistically significantly lower anaemic participants compared to study mean age using χ 2 -test Parasitological assessment and use of preventive measures Malaria parasite positivity was detected via microscopy, RDT, PCR; singling or in combination in 142 (27.3%) patients. A detailed comparison of the three diagnostic methods has been reported elsewhere [31]. There were more asymptomatic cases, 101 (71.1%), than symptomatic cases 41 (28.9%). A total of 88 (16.9%) patients reported having malaria symptoms, but only 47 (53.4%) were Plasmodium parasite negative using all 3 diagnostic methods (Table 4). The use of malaria control measures was generally poor. Participants were more predisposed to using insecticide sprays 249 (48.8%) in their homes, compared to ITN 91 (17.5%) and IRS 8 (1.5%). Only 1 participant reported using all 3 preventive methods, whereas 214 (41.2%) reported using none. There was no statistically significant difference (χ2 test, p = 0.834) in malaria infections between participants who used malaria preventive measures and those who did not. Compared with multigravida individuals, primigravida individuals were less predisposed to using ITNs (statistically significant, χ2 test, p = 0.012). This group had statistically significantly (χ2 test, p < 0.000) higher malaria positivity at enrolment using RDT tests (Table 4). Table 4: Malaria diagnosis, use of preventive measures and treatment VISIT TIME POINT BUTH CAC ICH IKPHC ISH Total n (%) Malaria Positivity by mRDT at Enrolment Number of subject positive with malaria at V1 β n (%) 78 (54.9) 25 (17.6) 13 (9.2) 18 (12.7) 8 (5.6) 142 (27.3) Symptomatic Malaria 18 (43.9) 11 (26.8) 5 (12.2) 4 (9.8) 3 (7.3) 41 (28.9) Asymptomatic Malaria 60 (59.4) 14 (13.9) 8 (7.9) 14 (13.9) 5 (5.0) 101 (71.1) Participant with Malaria symptoms 38 (16.4) 18 (19.6) 12 (16.0) 12 (17.1) 8 (15.7) 88 (16.9) Symptoms with no parasites 20 (52.6) 7 (38.9) 7 (58.3) 8 (66.7) 5 (62.5) 47 (53.4) Primigravida 4 10 3 6 3 26 j Multigravida 3 7 5 3 2 20 Malaria Preventive Measures Participant usage of control measures n (%) 145 (62.5) 43 (46.7) 41 (54.7) 47 (67.1) 30 (58.8) 306 (58.8) k ITN Usage i n (%) 34 (14.7) 15 (16.3) 13 (17.3) 21 (30.0) 8 (15.7) 91 (17.5) Home insecticide usage last 1 month n (%) 122 (54.7) 36 (39.1) 34 (45.9) 31 (44.3) 26 (51.0) 249 (48.8) Indoor Residual Spraying (IRS) n (%) 3 (1.3) 2 (2.2) 1 (1.3) 1 (1.4) 1 (2.0) 8 (1.5) Used all three control measures 0 1 0 0 0 1 (0.19) Did not use any control measure 87 (37.5) 49 (53.3) 34 (45.3) 23 (32.9) 21 (41.2) 214 (41.2) k Use of ACT Medication No of participants who took ACTs prior study enrolment n 4 (28.6) 6 (42.9) 3 (21.4) 1 (7.1) 1 (7.1) 14 (2.7%) Number of positive subjects treated with ACTs n 46 23 15 7 7 98 Key: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital, ITN = insecticide treated nets, ACT = artemisinin combination therapy, microscopy, mRDT & PCR) β Parasitological diagnosis was performed using any or all malaria parasite diagnostic methods (microscopy, mRDT & PCR) j Primigravida women had higher malaria infection compared to multigravida women using χ 2 test p = 0.0001, i Primigravida women were statistically less likely to sleep under ITN than multigravida women using χ 2 test p = 0.012. k No statistically significant difference (χ 2 test, p = 0.834), in malaria infection between participants who used malaria preventive measures and those who did not DISCUSSION The high population of fertile young women in Nigeria was demonstrated in this study. Generating data and health indices with respect to pregnancy is essential for achieving the Global Strategy for Women’s, Children’s, and Adolescents’ health goal of ensuring the wellbeing of all women by 2020 [ 23 ]. This is also important in view of the new thrust towards the eradication of malaria and achievement of the sustainable development goals [ 12 , 32 ]. Anaemia during pregnancy has been shown to be a risk factor among pregnant women for poor outcomes during pregnancy leading to APOCs such as miscarriage, low birthweight, neonatal death, etc. [ 4 , 22 , 33 , 34 ]. The situation is worsened if there are complications during delivery such as prolonged labour, excessive tear, and postpartum haemorrhage [ 7 , 21 ]. More than half (62.3%) of the clients were anaemic at enrolment in this study. This proportion was higher in the peripheral health centre sites than at the teaching hospital. This is a major challenge, as the persistence of this problem may be an indicator of poor nutrition and poor care during pregnancy, which can lead to a risk of APOCs for the mother, while the baby may experience preterm delivery, low birth weight, and developmental issues [ 33 , 34 ]. The challenge with anaemia may be related to ignorance and/or poverty, due to the fact that significant number of the population live below the poverty line of less than two dollars a day [ 34 ]. The high prevalence of anaemia in this study is a paradox, as the majority of the clients were highly educated. More advocacy and continuing education should be directed at encouraging the use of iron supplements and good nutrition during pregnancy for all patients, irrespective of their economic or educational status. There were no participants with HbSS disease in our study. This was a good finding, considering that the study area has a stable sickle cell S gene allele prevalence [ 35 , 36 ]. This important finding may possibly be due to improved health education and awareness of the challenges that sickle cell patients face in our environment. The generally high level of education in Southwestern Nigeria may have also contributed to this progress in preventing HbSS disease [ 36 ]. Though this study was conducted in an area holoendemic for malaria; it was not surprising that 27.3% of the participants tested positive for malaria parasites at enrolment, however this was a source of concern. Being infected with malaria at such an early stage of pregnancy exposes the mother and foetus to myriad MIP-associated risks. The majority of malaria infections were asymptomatic (71.1%). Although 16.9% reported having symptoms before attending the clinic, only 2.7% had taken ACT to treat the illness. The reason for the low treatment of MIP as observed in this study requires further investigation. The use of malaria preventive measures in our study population was very low, which was similar across all the study sites; 41.2% of all participants did not use any form of the preventive measures. Nigeria, is highly endemic for malaria and relies strongly on these preventive measures to reduce the burden and transmission of the disease. The poor utilisation of malaria prevention measures could have contributed to the high number of parasite-positive participants seen at the commencement of the study. This use of ITNs was very poor, especially among primigravida women, which translated to a significantly high malaria infection rate at enrolment for this cohort compared with women with previous pregnancies, and possibly because primigravida are yet to develop adequate immunity to malaria during pregnancy [ 10 , 15 ]. More advocacy and enlightening campaigns on the importance and benefits of the use of preventive methods during pregnancy are needed. However, in the general population at the conclusion of the study, there was no significant difference in parasite infection rates between participants who used preventive methods and those who did not. This could be due to the habits of people staying outside the house for longer hours in the evenings and therefore are exposed to more effective mosquitoes’ bites. More investigations are needed to elucidate this phenomenon. Nigeria is known to have one of the highest MMRs globally due to pregnancy-related issues [ 3 , 4 ]. This study revealed that approximately 50% of the participants reported having had a previous APOC before enrolment into this study. The most common APOC reported was miscarriage. The reasons for this high level of risk of APOC in these women are yet to be well investigated, as the reasons for miscarriage were not elucidated in this study. However, history of previous miscarriage and stillbirth was greater in the BUTH cohort, while history of low birthweight and preterm delivery was higher in the other centres. The reason for these geographical differences is not fully understood but may be unrelated to BUTH being teaching hospital and tertiary facility; therefore, high-risk pregnancies report more often at this site. Preventive measures for these events are well known and must be developed and implemented by all stakeholders, with respect to the local milieu, if we intend to reduce deaths from maternal causes [ 21 , 24 , 37 ]. Although majority of participants in this study were within the optimal age range for pregnancy [ 38 – 40 ], the gestational age at commencement of ANC service and uptake of the IPTp-SP for some participants was as high as 29 weeks. This is a source of concern because it places pregnant mothers at risk for malaria and other comorbidities that may result in APOC. In their study to explore health literacy and seeking behaviour for pre-eclampsia, Ayokanmi et al. , reported that one of the reasons that make some pregnant women delay or not attend ANC regularly included distance to health facilities, self-medication, and the cost of attending the hospital [ 4 , 41 ]. This means that ANC and MIP advocacy should be targeted at all pregnant women, irrespective of their age or educational status. Over 50% of the participants had tertiary education, which could be attributed to Babcock University Teaching Hospital (BUTH) being the focal study centre. This was not the case in previous studies done in the same locality [ 28 , 41 ]. Education is an advantage for the pregnant women; good pregnancy outcomes has been positively related to increase level of education [ 25 ]. A unique feature of the study was the incorporation of different tiers of hospitals, which included a specialist tertiary institution (BUTH), a secondary state-level hospital that has subspecialties and serves as a referral centre to primary health centres (PHCs) and was able to perform CS (ISH). A community-level hospital (ICH), a primary health care centre (IKPHC), and a Christian spiritual healing home (CAC) that incorporates ANC services and is also able to perform uncomplicated vaginal deliveries. It should, however, be stated that the CAC spiritual healing home was approximately 500 meters from BUTH and was a stone throw from the ICH facilities, ensuring that patients can access emergency care in event of any complication during delivery. The choice of which hospital to access ANC service in our study was influenced in part by factors such as gravidity, previous pregnancy outcomes, traditional beliefs, the presence of amenities, educational status of the woman, and the influence of the parents of the couple [ 4 , 28 , 42 ]. This implies, in part, that, in addition to the physical, physiological, and mental stress that pregnancy bear on women; there is additional sociocultural and emotional stress, and these make the expecting mothers more open to suggestions [ 4 ]. The study team was unable to incorporate traditional birthing attendants/home (TBA) as one of the study sites, which was unfortunate since the TBAs still has a significant number of patrons. Attempts were made by the study team but were unsuccessful. The study team attempted to incorporate this group of healthcare providers but was restricted by legal and sociocultural issues. Some reasons attributed to the preference of TBAs over conventional hospitals by some expectant women included the perceptions that TBA practitioners were more empathic and gentle and did not speak harshly to them; they also cited the provision of herbal/traditional concoction that aided their delivery and reduced painful labour [ 4 , 28 ]. In addition, reported a greater tendency for conventional hospitals to perform CS rather than promote vaginal delivery, which some women want to avoid due cost and, in some cases, traditional values [ 4 , 28 ]. This is an issue that needs to be adequately addressed because such practices contribute to the high rates of MMR in our environment because supervision of childbirth is known to be poor outside formal healthcare centres [ 43 , 44 ]. The epidemiological data generated from our study provide insights and a much-needed evaluation of the status of antenatal clinics and management of pregnancy within the selected communities. This study provides a broad overview of the performance of maternal health intervention programs for pregnant women and highlights areas that require greater attention to significantly reduce the MMR for Nigeria. CONCLUSION This study generated critical information about the epidemiology of pregnant women within stable malaria endemic communities and their utilization of antenatal care services within the selected communities. It was observed that half of the participants were anaemic and had asymptomatic parasitaemia at enrolment. There was very poor utilisation of malaria preventive measures, which translated to high malaria parasite infections at enrolment. Most of the women were within the optimum age range for pregnancy. However, some women started ANC quite late into their pregnancy. The government and concerned agencies should strengthen community advocacy and patient education on the dangers of MIP, which may help the country reduce MMR rates and move towards achieving the SDG by 2030. Abbreviations ACT Artemisinin combination therapy ANC Antenatal care APOC Adverse pregnancy outcomes BUTH Babcock University Teaching Hospital CAC Christ Apostolic Church CRF Case report form CS Caesarean sections ICH Ilishan Community Hospital IKPHC Ikenne primary healthcare centre IPTp Intermittent Preventive Therapy in Pregnancy IPTp-SP Intermittent Preventive Therapy in Pregnancy with sulphadoxine-pyrimethamine IRS Indoor residual spraying ISH Isara General Hospital ITN Insecticide treated nets IUFD Intrauterine foetal death LGA Local Government Area MIP Malaria in Pregnancy MMR Maternal mortality rate mRDT Malaria Rapid diagnostic test PCR Polymerase chain reaction SP Sulphadoxine-pyrimethamine TBA Tradition birth attendant WHO World Health Organisation χ 2 Chi-square Declarations Human ethics and consent to participate A community approval was obtained for the study in the town hall meeting without prejudice to written informed consent for each participant or her hubby/guardian for patients less than 18 years. Due to cultural norms, as much as was possible consent was also obtained from spouses either directly or by telephone. All participants consented to the study by signing the informed consent form after detailed explanation of the study to them. Ethical approval This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from Babcock University Health Research Ethics Committee and Study approval number BUHREC392/16 and BUHREC162/19 were issued. All data were handled with strict confidentiality, and no personal identifiers were used in the analysis or reporting. Clinical Trial Number Not Applicable Consent for publication Not Applicable Availability of data and materials Additional data has been provided in the appendix. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This project has received funding from the EDCTP2 programme supported by the European Union. Grant Agreement number: 98867 IPTp-SP resistance in Nigeria TMA 2015 CDF – 973. The funders had no input in the work. Authors' contributions WO, OA, UGN and ECJ conceptualize the work and drafted the study protocols. WO, AOO and Akinyede A optimised the protocol and supervised the study execution. OA, IJ, Adepoju A and AO, carried out the study including patient interactions and data collection. UGN, OA and Adepoju A carried out the data analysis. UGN prepared the draft manuscript. WO, OA, AOO, Akinyede A and Adepoju A substantively revised. All authors consented to the final submitted version. Acknowledgements The authors wish to appreciate the efforts of Prof Grace Tayo, Babcock University and Ikenne LGA Health Services Department. References Nigeria and Ikenne and Remo North LGA population statistics. Available from: https://www.citypopulation.de/en/nigeria/admin/ogun/NGA028012ikenne/. Accessed 23 Jan 2024. National Malaria Elimination Programme (NMEP), National Population Commission (NPopC), National Bureau of Statistics (NBS), ICF International. Nigeria Malaria Indicator Survey 2015. Abuja (Nigeria) and Rockville (MD): NMEP, NPopC, NBS, ICF International; 2016. p. 190. World Health Organization. Trends in maternal mortality 2000–2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019. Izugbara CO, Wekesah F, Adedini SA. Maternal health in Nigeria: a situation update. In: Maternal and Child Wellbeing. Nairobi: African Population and Health Research Center; 2016. p. 42. Federal Ministry of Health, National Malaria Elimination Programme. National Malaria Policy. Abuja: Federal Ministry of Health; 2014. p. 39. World Health Organization. World malaria report 2021. 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Pan Afr Med J. 2016;24:156. De Beaudrap P, Turyakira E, Nabasumba C, Tumwebaze B, Piola P, Boum Y II, McGready R. Timing of malaria in pregnancy and impact on infant growth and morbidity: a cohort study in Uganda. Malar J. 2016;15:92. Desai M, Gutman J, Taylor SM, Wiegand RE, Khairallah C, Kayentao K, Ouma P, Coulibaly SO, Kalilani L, Mace KE, et al. Impact of sulfadoxine–pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis. 2016;62(3):323–33. Rogerson SJ, Desai M, Mayor A, Sicuri E, Taylor SM, van Eijk AM. Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem. Lancet Infect Dis. 2018;18(4):e107–18. Moya-Alvarez V, Abellana R, Cot M. Pregnancy-associated malaria and malaria in infants: an old problem with present consequences. Malar J. 2014;13:271. Rogerson SJ, Hviid L, Duffy PE, Leke RFG, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007;7(2):105–17. World Health Organization. WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine–pyrimethamine (IPTp-SP). Geneva: World Health Organization; 2014. Desai M, Hill J, Fernandes S, Walker P, Pell C, Gutman J, Kayentao K, Gonzalez R, Webster J, Greenwood B, et al. Prevention of malaria in pregnancy. Lancet Infect Dis. 2018;18(4):e119–32. Al Khaja KAJ, Sequeira RP. Drug treatment and prevention of malaria in pregnancy: a critical review of the guidelines. Malar J. 2021;20(1):62. Sotunsa JO, Adeniyi AA, Imaralu JO, Fawole B, Adegbola O, Aimakhu CO, Adeyemi AS, Hunyinbo K, Dada OA, Adetoro OO, et al. Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG. 2019;126(3):19–25. Dosoo DK, Chandramohan D, Atibilla D, Oppong FB, Ankrah L, Kayan K, Agyemang V, Adu-Gyasi D, Twumasi M, Amenga-Etego S, et al. Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross-sectional study. Malar J. 2020;19(1):381. World Health Organization. Operationalization of the adolescent health component of the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030. Cairo: WHO Regional Office for the Eastern Mediterranean; 2017. Fauveau V. Strategies for reducing maternal mortality. Lancet. 2006;368(9553):2121–2. Raru TB, Ayana GM, Zakaria HF, Merga BT. Association of higher educational attainment on antenatal care utilization among pregnant women in East Africa using DHS from 2010 to 2018: a multilevel analysis. Int J Womens Health. 2022;14:67–77. Olaleye AO, Walker O. Impact of health systems on the implementation of intermittent preventive treatment for malaria in pregnancy in sub-Saharan Africa: a narrative synthesis. Trop Med Infect Dis. 2020;5(3):120. Okusanya BO, Adetoro OO, Aboyeji P, Ekele BA, Etuk SJ, Chama CM, Dada OA, Oladapo OT. Establishing a nationwide maternal death and near-miss surveillance system in a low-income country: lessons, prospects and challenges. BJOG. 2019;126(Suppl 3):7–11. Umahi EN, Atinge S, Agbede C, Muhammad KU. Knowledge, perception, and satisfaction of mothers regarding antenatal and postnatal care services in Ikenne Local Government Area, Ogun State. Niger Health J. 2020;19(2):70–84. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Uyaiabasi GN, Olaleye A, Elikwu C, Funwei RI, Okangba C, Akinmade A, Akinyede A, Adeyemi OO, Walker O. The question of the early diagnosis of asymptomatic and subpatent malaria in pregnancy: implications for diagnostic tools in a malaria endemic area. Eur J Obstet Gynecol Reprod Biol X. 2023;18:100233. World Health Organization. Global technical strategy for malaria 2016–2030: 2021 update. Geneva: World Health Organization; 2021. Fite MB, Assefa N, Mengiste B. Prevalence and determinants of anaemia among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis. Arch Public Health. 2021;79(1):219. Ugwu NI, Uneke CJ. Iron deficiency anaemia in pregnancy in Nigeria: a systematic review. Niger J Clin Pract. 2020;23(7):889–96. Nwabuko O, Okoh D, Iyalla C, Omunakwe H. Prevalence of sickle cell disease among pregnant women in a tertiary health center in south-south Nigeria. Sub-Saharan Afr J Med. 2016;3(3):132–6. Adigwe OP, Onavbavba G, Onoja SO. Impact of sickle cell disease on affected individuals in Nigeria: a critical review. Int J Gen Med. 2023;16:3503–15. Federal Ministry of Health. National guidelines and strategies for malaria prevention and control during pregnancy. Abuja: Federal Ministry of Health; 2005. Adeniran A, Mobolaji-Ojibara M, Adesina K, Aboyeji A, Ijaiya M, Balogun O. Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria. J Med Trop. 2018;20(1):30–5. Ameyaw EK, Budu E, Sambah F, Baatiema L, Appiah F, Seidu AA, Ahinkorah BO. Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. PLoS One. 2019;14(8):e0220970. Mehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M, Haftu A, Hagose H, Kumsa H. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Northern Ethiopia: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):60. Ayokanmi I, Atulomah N, Johnson F, Ajayi OC, Nwachukwu BC. Health literacy and pre-eclampsia knowledge of pregnant mothers attending primary health care centers in Ikenne Local Government, Ogun State. Int J Public Health Pharmacol. 2022;2(2):1–12. Uyaiabasi GN, Umaru ML. Prevalence of malaria among women attending a tertiary hospital in Sokoto metropolis, north-western Nigeria. West Afr J Pharm. 2018;29(2):72–80. Izugbara CO, Wekesah F. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria. Health Policy Plan. 2018;33(1):1–8. Gontie GB, Wolde HF, Baraki AG. Prevalence and associated factors of malaria among pregnant women in Sherkole district, Benishangul Gumuz regional state, West Ethiopia. BMC Infect Dis. 2020;20(1):573. Adapted from Worldwide antimalarial resistance network (WWARN) annotated CRF template for use in clinical trials for patients with uncomplicated malaria (Ph II/III). http://www.wwarn.org/working-together/malaria-standards-CDISC Additional Declarations No competing interests reported. Supplementary Files Appendix.docx 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 Advisory Board 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-8800686","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595587893,"identity":"bf241513-e0d3-4f8d-84fd-a650ca1e82e5","order_by":0,"name":"Atinuke Olaleye","email":"","orcid":"","institution":"Two Hills Medical Clinic","correspondingAuthor":false,"prefix":"","firstName":"Atinuke","middleName":"","lastName":"Olaleye","suffix":""},{"id":595587894,"identity":"112e7d89-a04d-46e0-b316-1df7fdbe4571","order_by":1,"name":"Gabriel Noblefather 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10:27:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29869,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-8800686/v1/d84917fd5bb635378d9b6309.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological Profile and baseline characteristics of pregnant women attending antenatal clinics in malaria endemic communities within Ogun State Southwestern Nigeria","fulltext":[{"header":"Background","content":"\u003cp\u003eNigeria\u0026rsquo;s population is estimated to be over 200\u0026nbsp;million people [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A large percentage of the population (\u0026ge;\u0026thinsp;40\u0026nbsp;million) are youths and women of childbearing age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nigeria has the highest morbidity and mortality rates for malaria globally and one of the highest maternal mortality ratios (MMR) [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Currently, the country is plagued with the emigration of skilled medical personnel to more developed countries for better economic opportunities [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This has therefore placed a strain on the decrepit health system, as the workforce needed to stem the tide of increasing mortality and morbidity is dwindling.\u003c/p\u003e \u003cp\u003eIn Africa, particularly in Nigeria, there is a high fertility rate among women of reproductive age, with 4.7 and 5.4 births per woman from 2015\u0026ndash;2020 for Sub-Saharan Africa and Nigeria respectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Pregnancy often exposes already vulnerable women to increased risks for both the mother and her unborn foetus, such as maternal and foetal anaemia, malnutrition, and adverse pregnancy outcomes (APOC) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMalaria in pregnancy (MIP) remains one of the leading causes of APOCs such as maternal anaemia, miscarriage, preterm delivery, intrauterine growth restriction (IUGR), and low birth weight (LBW) in malaria-endemic regions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Women in moderate-to-high transmittance areas for malaria develop specific immunity to malaria after their first pregnancy. Hence, primigravidae women are at greater risk of MIP than to multigravida women [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The adverse effects of MIP are significantly mitigated by the regular administration of sulphadoxine-pyrimethamine (SP) as an intermittent preventive treatment during pregnancy (IPTp-SP), as recommended by the WHO [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The severity and frequency of MIP are dependent on the age, gestational age, gravidity, anaemia, and nutritional state of the pregnant woman. Hence, accurate determination of these parameters is essential for planning and efficiently managing MIPs and subsequently reducing of the country\u0026rsquo;s MMR [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe regular attendance of antenatal care (ANC) clinics by pregnant women in malaria-endemic areas is highly recommended by the World Health Organization (WHO), because ANC has been shown to improve the pregnancy outcome and wellbeing of both mothers and foetuses/neonates [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It plays a critical role in minimizing maternal and child mortality through appropriate monitoring and treatment interventions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Data generated from ANC visits and pregnancy outcomes are critical for detecting changes in the epidemiology of MIP and deploying adequate intervention measures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The data also give information on the progress made in SDG 3.\u003c/p\u003e \u003cp\u003eThis study presents recent baseline demographics and epidemiological parameters of pregnant women attending ANC clinics in different healthcare systems and hospitals in different communities within two local government areas (LGAs) in Southwest Nigeria. For Nigeria to meet its malaria control and eradication targets, there must be a continuous evaluation of our demographic profiles, as this evaluation is not static. The study was part of a larger malaria in-pregnancy study.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eStudy Description and Sites\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a prospective observational study on the sociodemographic characteristics and epidemiological data of pregnant women attending ANC clinics within Ikenne and Remo North LGAs of Ogun State from June 2018 to May 2020. This was part of a larger study on the use of sulfadoxine-pyrimethamine as an IPTp in the management of MIP in Southwest Nigeria.\u003c/p\u003e\n\u003cp\u003eIkenne LGA, with headquarters in Ikenne town (located at 6\u003csup\u003e0\u003c/sup\u003e52\u0026apos;N 3\u003csup\u003e0\u003c/sup\u003e43\u0026apos;E), has a total land area of 179.4 km\u0026sup2; and an estimated population of 202,600 people [1, 28]. It is approximately 60 km from the cosmopolitan city of Lagos but has a stable population. Remo North, with headquarters at Isara town (7\u003csup\u003e0\u003c/sup\u003e00\u0026apos;N 3\u003csup\u003e0\u003c/sup\u003e41\u0026apos;E) has a land area of 211.3 km\u0026sup2; and aa estimated 101,600 people [1]. The study sites included antenatal clinics at Babcock University Teaching Hospital Ilishan Remo, BUTH (study focal site), Ilishan Community Hospital (ICH), Ikenne Primary Health Care Centre (IKPHC), Christ Apostle Church Spiritual and Healing Maternity Home (CAC), all within Ikenne LGA, and Isara General Hospital (ISH) in Remo North LGA; this is a secondary level facility. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy participants and enrolment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePregnant women visiting study clinics were counselled, and the study investigators explained the study to them. Consenting women who met the inclusion and exclusion criteria were recruited after verbal and written consent were obtained.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: women who were confirmed to be pregnant with an estimated gestational age between 16 and 29 weeks, who provided consent, live within the study area, and who are were willing to deliver at the study sites.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria included: use of IPTp-SP in index pregnancy, history of allergy to sulphonamides or pyrimethamine drugs, HIV positive or comorbidities, severe anaemia (haemoglobin \u0026lt; 7 g/dL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical investigation and obstetric history\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe enrolled participants were physically examined by certified medical personnel. Demographic information such as age, educational level, tribe, body temperature, blood pressure, respiratory rate, weight, and height were entered into a specifically designed case record form (CRF). Obstetric examination was performed to determine the gestational age. Other information such as the use of insecticide-treated nets (ITNs), insecticide sprays, indoor residual spraying (IRS), and antimalarial use, were collected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical and surgical history\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubject medical and surgical histories were obtained through interviews [45] or review of the subject\u0026rsquo;s medical records. Pre-existing conditions or signs and/or symptoms present in a subject prior to the first study drug administration were recorded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter physical examination,\u0026nbsp;5 ml of blood was withdrawn via venous puncture into sample EDTA bottles and used for malaria parasite identification, haemoglobin analysis, blood group determination, and molecular analysis. Urine was collected and the samples were analysed for glycosuria and proteinuria. Malaria was diagnosed using microscopy, rapid diagnostic test (mRDTs), and polymerase chain reaction (PCR), either singly or in combination.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll collected data were entered into the REDCap\u0026reg; online database [29, 30]. The data were analysed using Stata 17\u0026reg; and Microsoft Excel 2021\u0026reg;. Statistical analysis was performed by comparing the means of continuous variables, chi-square tests, and logistic regression for categorical data at 95% confidence level. Statistical values of \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05 were considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical considerations for this study included the use of a multilayer approach because of cultural norms. Study investigators visited relevant stakeholders in the community to inform and seek support for the project from traditional rulers, primary health directors for the LGA, community health awareness officers, and health town hall meetings with the communities. Government approval for the study was obtained from the State Ministry of Health. At the time of enrolment, written informed consent was obtained from each participant and/or her husband. For patients less than 18 years, consent was obtained from the patient and husband or guardian. The study was approved by the Babcock University Research and Health Ethical Board, and an approval number BUHREC162/19 was issued. \u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eBaseline Demographics and Epidemiology Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 520 pregnant women were enrolled. BUTH had the highest degree of enrolment. The mean age of participants was 28.8 years; stratifying into three age groups (14-18, 19-34, 35-45 years, respectively) revealed that 428 (82.3%) of the participants were between the ages of 19 and 34, which is the optimal reproductive age for women, and this difference was statistically significant (\u0026chi;\u003csup\u003e2\u003c/sup\u003e test \u003cem\u003ep\u003c/em\u003e = 0.031) compared with the other groups (Table 1). The mean gestational age at enrolment was 22 weeks, but 25 (4.8%) participants were enrolled at 28-29 weeks. Analysis of educational level showed that 296 (56.9%) of the participants had tertiary education, of which 194 (65.5%) were enrolled at BUTH. Almost three-fourths (74.9%) of the participants were of the Yoruba speaking decent, since this is their domain (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Baseline Characteristics of Participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"720\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUTH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIKPHC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eEnrolment per site n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e232 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e92 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e75 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e70 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e51 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eAge at enrolment mean \u0026plusmn; SD (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e30.4 \u0026plusmn; 4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e27.0 \u0026plusmn; 5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e28.2 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e26.9 \u0026plusmn; 5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e28.0 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28.8 \u0026plusmn; 5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.0037\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.0052\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.3684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.7530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e20 - 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e14 - 42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e16 \u0026ndash; 42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e16 - 38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e19 - 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e14 - 45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category (Years) n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e14-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e5 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e4 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e19-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e191 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e75 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e63 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e57 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e42 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e428 (82.3)\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e35-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e41 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e12 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e10 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e9 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e81 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestation Age at enrolment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eEstimated gestation age mean \u0026plusmn; SD (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19.7 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e22.32 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21.2 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e21.2 \u0026plusmn; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e23.6 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22.0 \u0026plusmn; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.0008\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.5599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.6032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0001\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e15 - 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e16 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e16 \u0026ndash; 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e16 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e16 - 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e15 -29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Level n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eNo formal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e1 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e15 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e6 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e34 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e35 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e62 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e37 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e41 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e14 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e189 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e194 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e15 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e32 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e24 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e31 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e296 (56.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eYoruba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e387 (74.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eIgbo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e83 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eHausa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e44 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eStatistically significantly higher mean age compared to study average age using t-test (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001), \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eStatistically significantly lower mean age compared to study average age using t-test (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0037), \u003csup\u003ec\u0026nbsp;\u003c/sup\u003eStatistically significantly lower mean age compared to study average age using t-test (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0052), \u003csup\u003ed\u0026nbsp;\u003c/sup\u003eStatistically significantly \u003cem\u003ep\u003c/em\u003e = 0.031 using chi square test, \u003csup\u003ee\u0026nbsp;\u003c/sup\u003eStatistically significantly lower gestation age compared to study mean age using t-test (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001), \u003csup\u003ef\u0026nbsp;\u003c/sup\u003eStatistically significantly higher gestation age compared to study mean age using t-test (p \u0026lt; 0.0008), \u003csup\u003eg\u0026nbsp;\u003c/sup\u003eStatistically significantly lower gestation age compared to study mean age using t-test (p \u0026lt; 0.0001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObstetrics and clinical evaluations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe obstetric data revealed that about approximately one-third of the women were primigravidae, whereas 217 (42.1%) had more than two pregnancies (Table 2). All participants younger than 19 years of age (11) were primigravida. Participants with a history of APOCs or high gravida preferred to enrol in the BUTH centre. Details of previous pregnancies and parity are shown in appendix 1. At enrolment, 178 (50.1%) Patients had a history of APOC; 135 (38.6%) had prior miscarriage, 28 (8.0%) hard stillbirths, 21.0 (6.2%) had low birthweights, 8 (2.3%) preterm deliveries, and 20 (5.7%) had neonatal deaths. See Table 2 and Appendix 1 for details.\u003c/p\u003e\n\u003cp\u003eOn clinical investigation, 37 (7.1%) participants reported having treated a medical condition in the last 30 days before the ANC visit, 9 (1.7%) of whom had co-morbidities such as hypertension, and only 9 (1.7%) participants were using medications for a pre-diagnosed co-morbidity (Table 2 and Appendix 2). A total of 101 (19.4%) of the participants reported to having undergone previous surgeries, of whom caesarean sections accounted for 81.2% of the surgeries. Details are shown in Table 2 and Appendix 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Obstetric characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"728\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUTH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIKPHC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003csup\u003e*\u003c/sup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e62 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e35 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e165 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e60 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e134 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e108 (47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e33 (36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19 (37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e217 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003erange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 - 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 - 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 - 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 - 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 - 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;1- 8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.0 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.9 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.1 \u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.0 \u0026plusmn; 1.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eweight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e14-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e50.2 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e61.0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e56.0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e54.3 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e19-34\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e70.0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e63.0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e65.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e59.6 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e66.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e66.5 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e35-45\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e74. 0 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e68.5 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e74.3 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e65.1 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e67.7 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e71.5 \u003cstrong\u003e\u0026plusmn;\u0026nbsp;\u003c/strong\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of APOC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e101 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e178 (50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of previous miscarriage\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e87 (51.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e135 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eNumber of previous stillbirths\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.0 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e28 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of low-birth-weight baby\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of preterm delivery n\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHistory of neonatal death n\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of alcohol use\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e41 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eonly 2 subjects reported past smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical history/concomitant disease\u003c/strong\u003e\u003csup\u003e\u0026alpha;\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;last 30 days\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e37 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCo-morbidities\u003csup\u003e\u0026alpha;\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of past surgeries\u003c/strong\u003e\u003csup\u003e\u0026alpha;\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e75 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Caesarean sections\u003c/strong\u003e\u003csup\u003e\u0026alpha;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e52 (74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.0 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e70 (81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFreq.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of surgeries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFreq.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eFrequency of past surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e101 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e76 (75.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e20 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital, APOC = adverse pregnancy outcomes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e Additional information on these parameters can be found in Appendix 1.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026alpha;\u003c/sup\u003e Additional information on these parameters can be found in Appendix 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory investigations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of anaemia, defined as Hb \u0026lt; 10 g/dL, was 62.3%, whereas the prevalence of proteinuria and glucosuria was 13% and 3.5%, respectively. Blood group type O, 217 (41.7%), and AA genotype 208 (40.0%) were more prevalent. A total of 372 participants were tested for hepatitis B surface antigen, of whom 17 (3.3%) tested positive for the antigen (Table 3). However, none of the 362 subjects tested positive for viral disease (Table 3). The use rates of folic acid and iron supplements were both above 85%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Laboratory Investigations\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUTH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIKPHC\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISH\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAnaemia at enrolment n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e123 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e76 (82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e49 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e44 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e32 (62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e324 (62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.017\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.000\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eProteinuria n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e27 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e12 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e16 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e65 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eGlucosuria n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e10 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e18 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8563%;\" colspan=\"7\"\u003eBlood Group n\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e67 (12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e68 (13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e217 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNot done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e157 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8563%;\" colspan=\"7\"\u003e\u003cstrong\u003eGenotype n\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e208 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e63 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e11 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNot done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e238 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8563%;\" colspan=\"7\"\u003e\u003cstrong\u003eHepatitis B surface antigen (HBsAg) n\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e17 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e355 (68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNot done\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e148 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 99.8563%;\" colspan=\"7\"\u003eAll 362 participants assessed for viral diseases tested Negative\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFolic acid usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e451 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 204px;\"\u003e\n \u003cp\u003eIron supplement usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 108px;\"\u003e\n \u003cp\u003e448 (86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eh\u003c/sup\u003e Statistically significantly lower anaemic participants compared to study mean age using \u0026chi;\u003csup\u003e2\u003c/sup\u003e-test\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ei\u003c/sup\u003e Statistically significantly lower anaemic participants compared to study mean age using \u0026chi;\u003csup\u003e2\u003c/sup\u003e-test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParasitological assessment and use of preventive measures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMalaria parasite positivity was detected via microscopy, RDT, PCR; singling or in combination in 142 (27.3%) patients. A detailed comparison of the three diagnostic methods has been reported elsewhere [31]. There were more asymptomatic cases, 101 (71.1%), than symptomatic cases 41 (28.9%). A total of 88 (16.9%) patients reported having malaria symptoms, but only 47 (53.4%) were \u003cem\u003ePlasmodium\u003c/em\u003e parasite negative using all 3 diagnostic methods (Table 4). The use of malaria control measures was generally poor. Participants were more predisposed to using insecticide sprays 249 (48.8%) in their homes, compared to ITN 91 (17.5%) and IRS 8 (1.5%). Only 1 participant reported using all 3 preventive methods, whereas 214 (41.2%) reported using none. There was no statistically significant difference (\u0026chi;2 test, \u003cem\u003ep\u003c/em\u003e = 0.834) in malaria infections between participants who used malaria preventive measures and those who did not. Compared with multigravida individuals, primigravida individuals were less predisposed to using ITNs (statistically significant, \u0026chi;2 test, \u003cem\u003ep\u003c/em\u003e = 0.012). This group had statistically significantly (\u0026chi;2 test, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.000) higher malaria positivity at enrolment using RDT tests (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Malaria diagnosis, use of preventive measures and treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"737\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVISIT TIME POINT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUTH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIKPHC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalaria Positivity by mRDT at Enrolment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNumber of subject positive with malaria at V1\u003csup\u003e\u0026beta;\u003c/sup\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e78 (54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e142 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eSymptomatic Malaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e41 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eAsymptomatic Malaria\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e60 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e101 (71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eParticipant with Malaria symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e38 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e88 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eSymptoms with no parasites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e20 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e47 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e26\u003csup\u003ej\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eMultigravida\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalaria Preventive Measures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eParticipant usage of control measures n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e145 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e43 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e41 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e47 (67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e306 (58.8)\u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eITN Usage\u003csup\u003ei\u003c/sup\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e34 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e91 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eHome insecticide usage last 1 month n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e122 (54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e36 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e34 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e31 (44.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e249 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eIndoor Residual Spraying (IRS) n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eUsed all three control measures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eDid not use any control measure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e87 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e49 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e34 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e214 (41.2)\u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eUse of ACT Medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo of participants who took ACTs prior study enrolment n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e14 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNumber of positive subjects treated with ACTs n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: BUTH = Babcock University Teaching Hospital Ilishan Remo, CAC = Christ Apostle Church Spiritual and Healing Maternity Home, ICH = Ilishan Community Hospital, IKPHC = Ikenne Primary Health Care Centre (IKPHC), ISH = Isara General Hospital, ITN = insecticide treated nets, ACT = artemisinin combination therapy, microscopy, mRDT \u0026amp; PCR)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026beta;\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eParasitological diagnosis was performed using any or all malaria parasite diagnostic methods (microscopy, mRDT \u0026amp; PCR)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ej\u003c/sup\u003e Primigravida women had higher malaria infection compared to multigravida women using \u0026chi;\u003csup\u003e2\u003c/sup\u003e test \u003cem\u003ep\u003c/em\u003e = 0.0001,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ei\u003c/sup\u003e Primigravida women were statistically less likely to sleep under ITN than multigravida women using \u0026chi;\u003csup\u003e2\u003c/sup\u003e test \u003cem\u003ep\u003c/em\u003e = 0.012.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ek\u003c/sup\u003e No statistically significant difference (\u0026chi;\u003csup\u003e2\u003c/sup\u003e test, \u003cem\u003ep\u003c/em\u003e = 0.834), in malaria infection between participants who used malaria preventive measures and those who did not\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe high population of fertile young women in Nigeria was demonstrated in this study. Generating data and health indices with respect to pregnancy is essential for achieving the Global Strategy for Women\u0026rsquo;s, Children\u0026rsquo;s, and Adolescents\u0026rsquo; health goal of ensuring the wellbeing of all women by 2020 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This is also important in view of the new thrust towards the eradication of malaria and achievement of the sustainable development goals [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnaemia during pregnancy has been shown to be a risk factor among pregnant women for poor outcomes during pregnancy leading to APOCs such as miscarriage, low birthweight, neonatal death, etc. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The situation is worsened if there are complications during delivery such as prolonged labour, excessive tear, and postpartum haemorrhage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. More than half (62.3%) of the clients were anaemic at enrolment in this study. This proportion was higher in the peripheral health centre sites than at the teaching hospital. This is a major challenge, as the persistence of this problem may be an indicator of poor nutrition and poor care during pregnancy, which can lead to a risk of APOCs for the mother, while the baby may experience preterm delivery, low birth weight, and developmental issues [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The challenge with anaemia may be related to ignorance and/or poverty, due to the fact that significant number of the population live below the poverty line of less than two dollars a day [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The high prevalence of anaemia in this study is a paradox, as the majority of the clients were highly educated. More advocacy and continuing education should be directed at encouraging the use of iron supplements and good nutrition during pregnancy for all patients, irrespective of their economic or educational status.\u003c/p\u003e \u003cp\u003eThere were no participants with HbSS disease in our study. This was a good finding, considering that the study area has a stable sickle cell S gene allele prevalence [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This important finding may possibly be due to improved health education and awareness of the challenges that sickle cell patients face in our environment. The generally high level of education in Southwestern Nigeria may have also contributed to this progress in preventing HbSS disease [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThough this study was conducted in an area holoendemic for malaria; it was not surprising that 27.3% of the participants tested positive for malaria parasites at enrolment, however this was a source of concern. Being infected with malaria at such an early stage of pregnancy exposes the mother and foetus to myriad MIP-associated risks. The majority of malaria infections were asymptomatic (71.1%). Although 16.9% reported having symptoms before attending the clinic, only 2.7% had taken ACT to treat the illness. The reason for the low treatment of MIP as observed in this study requires further investigation.\u003c/p\u003e \u003cp\u003eThe use of malaria preventive measures in our study population was very low, which was similar across all the study sites; 41.2% of all participants did not use any form of the preventive measures. Nigeria, is highly endemic for malaria and relies strongly on these preventive measures to reduce the burden and transmission of the disease. The poor utilisation of malaria prevention measures could have contributed to the high number of parasite-positive participants seen at the commencement of the study. This use of ITNs was very poor, especially among primigravida women, which translated to a significantly high malaria infection rate at enrolment for this cohort compared with women with previous pregnancies, and possibly because primigravida are yet to develop adequate immunity to malaria during pregnancy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. More advocacy and enlightening campaigns on the importance and benefits of the use of preventive methods during pregnancy are needed. However, in the general population at the conclusion of the study, there was no significant difference in parasite infection rates between participants who used preventive methods and those who did not. This could be due to the habits of people staying outside the house for longer hours in the evenings and therefore are exposed to more effective mosquitoes\u0026rsquo; bites. More investigations are needed to elucidate this phenomenon.\u003c/p\u003e \u003cp\u003eNigeria is known to have one of the highest MMRs globally due to pregnancy-related issues [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This study revealed that approximately 50% of the participants reported having had a previous APOC before enrolment into this study. The most common APOC reported was miscarriage. The reasons for this high level of risk of APOC in these women are yet to be well investigated, as the reasons for miscarriage were not elucidated in this study. However, history of previous miscarriage and stillbirth was greater in the BUTH cohort, while history of low birthweight and preterm delivery was higher in the other centres.\u003c/p\u003e \u003cp\u003eThe reason for these geographical differences is not fully understood but may be unrelated to BUTH being teaching hospital and tertiary facility; therefore, high-risk pregnancies report more often at this site. Preventive measures for these events are well known and must be developed and implemented by all stakeholders, with respect to the local milieu, if we intend to reduce deaths from maternal causes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough majority of participants in this study were within the optimal age range for pregnancy [\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], the gestational age at commencement of ANC service and uptake of the IPTp-SP for some participants was as high as 29 weeks. This is a source of concern because it places pregnant mothers at risk for malaria and other comorbidities that may result in APOC. In their study to explore health literacy and seeking behaviour for pre-eclampsia, Ayokanmi \u003cem\u003eet al.\u003c/em\u003e, reported that one of the reasons that make some pregnant women delay or not attend ANC regularly included distance to health facilities, self-medication, and the cost of attending the hospital [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This means that ANC and MIP advocacy should be targeted at all pregnant women, irrespective of their age or educational status.\u003c/p\u003e \u003cp\u003eOver 50% of the participants had tertiary education, which could be attributed to Babcock University Teaching Hospital (BUTH) being the focal study centre. This was not the case in previous studies done in the same locality [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Education is an advantage for the pregnant women; good pregnancy outcomes has been positively related to increase level of education [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA unique feature of the study was the incorporation of different tiers of hospitals, which included a specialist tertiary institution (BUTH), a secondary state-level hospital that has subspecialties and serves as a referral centre to primary health centres (PHCs) and was able to perform CS (ISH). A community-level hospital (ICH), a primary health care centre (IKPHC), and a Christian spiritual healing home (CAC) that incorporates ANC services and is also able to perform uncomplicated vaginal deliveries. It should, however, be stated that the CAC spiritual healing home was approximately 500 meters from BUTH and was a stone throw from the ICH facilities, ensuring that patients can access emergency care in event of any complication during delivery.\u003c/p\u003e \u003cp\u003eThe choice of which hospital to access ANC service in our study was influenced in part by factors such as gravidity, previous pregnancy outcomes, traditional beliefs, the presence of amenities, educational status of the woman, and the influence of the parents of the couple [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This implies, in part, that, in addition to the physical, physiological, and mental stress that pregnancy bear on women; there is additional sociocultural and emotional stress, and these make the expecting mothers more open to suggestions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study team was unable to incorporate traditional birthing attendants/home (TBA) as one of the study sites, which was unfortunate since the TBAs still has a significant number of patrons. Attempts were made by the study team but were unsuccessful. The study team attempted to incorporate this group of healthcare providers but was restricted by legal and sociocultural issues. Some reasons attributed to the preference of TBAs over conventional hospitals by some expectant women included the perceptions that TBA practitioners were more empathic and gentle and did not speak harshly to them; they also cited the provision of herbal/traditional concoction that aided their delivery and reduced painful labour [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In addition, reported a greater tendency for conventional hospitals to perform CS rather than promote vaginal delivery, which some women want to avoid due cost and, in some cases, traditional values [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This is an issue that needs to be adequately addressed because such practices contribute to the high rates of MMR in our environment because supervision of childbirth is known to be poor outside formal healthcare centres [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe epidemiological data generated from our study provide insights and a much-needed evaluation of the status of antenatal clinics and management of pregnancy within the selected communities. This study provides a broad overview of the performance of maternal health intervention programs for pregnant women and highlights areas that require greater attention to significantly reduce the MMR for Nigeria.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study generated critical information about the epidemiology of pregnant women within stable malaria endemic communities and their utilization of antenatal care services within the selected communities. It was observed that half of the participants were anaemic and had asymptomatic parasitaemia at enrolment. There was very poor utilisation of malaria preventive measures, which translated to high malaria parasite infections at enrolment. Most of the women were within the optimum age range for pregnancy. However, some women started ANC quite late into their pregnancy. The government and concerned agencies should strengthen community advocacy and patient education on the dangers of MIP, which may help the country reduce MMR rates and move towards achieving the SDG by 2030.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eACT\u003c/strong\u003e Artemisinin combination therapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANC\u003c/strong\u003e Antenatal care\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPOC\u003c/strong\u003e Adverse pregnancy outcomes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBUTH\u003c/strong\u003e Babcock University Teaching Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCAC\u003c/strong\u003e Christ Apostolic Church\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRF\u003c/strong\u003e Case report form\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCS\u003c/strong\u003e Caesarean sections\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICH\u003c/strong\u003e Ilishan Community Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIKPHC\u003c/strong\u003e Ikenne primary healthcare centre\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIPTp\u003c/strong\u003e Intermittent Preventive Therapy in Pregnancy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIPTp-SP\u003c/strong\u003e Intermittent Preventive Therapy in Pregnancy with sulphadoxine-pyrimethamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRS\u003c/strong\u003e Indoor residual spraying\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eISH\u003c/strong\u003e Isara General Hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eITN\u003c/strong\u003e Insecticide treated nets\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIUFD\u003c/strong\u003e Intrauterine foetal death\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLGA\u003c/strong\u003e Local Government Area\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMIP\u003c/strong\u003e Malaria in Pregnancy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMR\u003c/strong\u003e Maternal mortality rate\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emRDT\u003c/strong\u003e\u0026nbsp; Malaria Rapid diagnostic test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePCR\u003c/strong\u003e\u0026nbsp; Polymerase chain reaction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSP\u003c/strong\u003e Sulphadoxine-pyrimethamine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTBA\u003c/strong\u003e Tradition birth attendant\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e World Health Organisation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e Chi-square\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community approval was obtained for the study in the town hall meeting without prejudice to written informed consent for each participant or her hubby/guardian for patients less than 18 years. Due to cultural norms, as much as was possible consent was also obtained from spouses either directly or by telephone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants consented to the study by signing the informed consent form after detailed explanation of the study to them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from Babcock University Health Research Ethics Committee and Study approval number BUHREC392/16 and BUHREC162/19 were issued.\u0026nbsp;All data were handled with strict confidentiality, and no personal identifiers were used in the analysis or reporting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditional data has been provided in the appendix. \u0026nbsp;The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project has received funding from the EDCTP2 programme supported by the European Union. Grant Agreement number: 98867 IPTp-SP resistance in Nigeria TMA 2015 CDF \u0026ndash; 973. The funders had no input in the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWO, OA, UGN and ECJ conceptualize the work and drafted the study protocols. WO, AOO and Akinyede A optimised the protocol and supervised the study execution. OA, IJ, Adepoju A and AO, carried out the study including patient interactions and data collection. UGN, OA and Adepoju A carried out the data analysis. UGN prepared the draft manuscript. WO, OA, AOO, Akinyede A and Adepoju A substantively revised. All authors consented to the final submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to appreciate the efforts of Prof Grace Tayo, Babcock University and Ikenne LGA Health Services Department.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eNigeria and Ikenne and Remo North LGA population statistics. Available from: https://www.citypopulation.de/en/nigeria/admin/ogun/NGA028012ikenne/. Accessed 23 Jan 2024.\u003c/li\u003e\n \u003cli\u003eNational Malaria Elimination Programme (NMEP), National Population Commission (NPopC), National Bureau of Statistics (NBS), ICF International. Nigeria Malaria Indicator Survey 2015. Abuja (Nigeria) and Rockville (MD): NMEP, NPopC, NBS, ICF International; 2016. p. 190.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Trends in maternal mortality 2000\u0026ndash;2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.\u003c/li\u003e\n \u003cli\u003eIzugbara CO, Wekesah F, Adedini SA. Maternal health in Nigeria: a situation update. In: Maternal and Child Wellbeing. Nairobi: African Population and Health Research Center; 2016. p. 42.\u003c/li\u003e\n \u003cli\u003eFederal Ministry of Health, National Malaria Elimination Programme. National Malaria Policy. Abuja: Federal Ministry of Health; 2014. p. 39.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. World malaria report 2021. Geneva: World Health Organization; 2021.\u003c/li\u003e\n \u003cli\u003eSouza JP. The Nigeria Near-Miss and Maternal Death Survey: collaborative research generating information for action. BJOG. 2019;126(3):5\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eDevi S. Brain drain laws spark debate over health worker retention. 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Pan Afr Med J. 2016;24:156.\u003c/li\u003e\n \u003cli\u003eDe Beaudrap P, Turyakira E, Nabasumba C, Tumwebaze B, Piola P, Boum Y II, McGready R. Timing of malaria in pregnancy and impact on infant growth and morbidity: a cohort study in Uganda. Malar J. 2016;15:92.\u003c/li\u003e\n \u003cli\u003eDesai M, Gutman J, Taylor SM, Wiegand RE, Khairallah C, Kayentao K, Ouma P, Coulibaly SO, Kalilani L, Mace KE, et al. Impact of sulfadoxine\u0026ndash;pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight. Clin Infect Dis. 2016;62(3):323\u0026ndash;33.\u003c/li\u003e\n \u003cli\u003eRogerson SJ, Desai M, Mayor A, Sicuri E, Taylor SM, van Eijk AM. Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem. Lancet Infect Dis. 2018;18(4):e107\u0026ndash;18.\u003c/li\u003e\n \u003cli\u003eMoya-Alvarez V, Abellana R, Cot M. Pregnancy-associated malaria and malaria in infants: an old problem with present consequences. Malar J. 2014;13:271.\u003c/li\u003e\n \u003cli\u003eRogerson SJ, Hviid L, Duffy PE, Leke RFG, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007;7(2):105\u0026ndash;17.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine\u0026ndash;pyrimethamine (IPTp-SP). Geneva: World Health Organization; 2014.\u003c/li\u003e\n \u003cli\u003eDesai M, Hill J, Fernandes S, Walker P, Pell C, Gutman J, Kayentao K, Gonzalez R, Webster J, Greenwood B, et al. Prevention of malaria in pregnancy. Lancet Infect Dis. 2018;18(4):e119\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eAl Khaja KAJ, Sequeira RP. Drug treatment and prevention of malaria in pregnancy: a critical review of the guidelines. Malar J. 2021;20(1):62.\u003c/li\u003e\n \u003cli\u003eSotunsa JO, Adeniyi AA, Imaralu JO, Fawole B, Adegbola O, Aimakhu CO, Adeyemi AS, Hunyinbo K, Dada OA, Adetoro OO, et al. Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG. 2019;126(3):19\u0026ndash;25.\u003c/li\u003e\n \u003cli\u003eDosoo DK, Chandramohan D, Atibilla D, Oppong FB, Ankrah L, Kayan K, Agyemang V, Adu-Gyasi D, Twumasi M, Amenga-Etego S, et al. Epidemiology of malaria among pregnant women during their first antenatal clinic visit in the middle belt of Ghana: a cross-sectional study. Malar J. 2020;19(1):381.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Operationalization of the adolescent health component of the Global Strategy for Women\u0026rsquo;s, Children\u0026rsquo;s and Adolescents\u0026rsquo; Health, 2016\u0026ndash;2030. Cairo: WHO Regional Office for the Eastern Mediterranean; 2017.\u003c/li\u003e\n \u003cli\u003eFauveau V. Strategies for reducing maternal mortality. Lancet. 2006;368(9553):2121\u0026ndash;2.\u003c/li\u003e\n \u003cli\u003eRaru TB, Ayana GM, Zakaria HF, Merga BT. Association of higher educational attainment on antenatal care utilization among pregnant women in East Africa using DHS from 2010 to 2018: a multilevel analysis. Int J Womens Health. 2022;14:67\u0026ndash;77.\u003c/li\u003e\n \u003cli\u003eOlaleye AO, Walker O. Impact of health systems on the implementation of intermittent preventive treatment for malaria in pregnancy in sub-Saharan Africa: a narrative synthesis. Trop Med Infect Dis. 2020;5(3):120.\u003c/li\u003e\n \u003cli\u003eOkusanya BO, Adetoro OO, Aboyeji P, Ekele BA, Etuk SJ, Chama CM, Dada OA, Oladapo OT. Establishing a nationwide maternal death and near-miss surveillance system in a low-income country: lessons, prospects and challenges. BJOG. 2019;126(Suppl 3):7\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eUmahi EN, Atinge S, Agbede C, Muhammad KU. Knowledge, perception, and satisfaction of mothers regarding antenatal and postnatal care services in Ikenne Local Government Area, Ogun State. Niger Health J. 2020;19(2):70\u0026ndash;84.\u003c/li\u003e\n \u003cli\u003eHarris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)\u0026mdash;a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377\u0026ndash;81.\u003c/li\u003e\n \u003cli\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026rsquo;Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.\u003c/li\u003e\n \u003cli\u003eUyaiabasi GN, Olaleye A, Elikwu C, Funwei RI, Okangba C, Akinmade A, Akinyede A, Adeyemi OO, Walker O. The question of the early diagnosis of asymptomatic and subpatent malaria in pregnancy: implications for diagnostic tools in a malaria endemic area. Eur J Obstet Gynecol Reprod Biol X. 2023;18:100233.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Global technical strategy for malaria 2016\u0026ndash;2030: 2021 update. Geneva: World Health Organization; 2021.\u003c/li\u003e\n \u003cli\u003eFite MB, Assefa N, Mengiste B. Prevalence and determinants of anaemia among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis. Arch Public Health. 2021;79(1):219.\u003c/li\u003e\n \u003cli\u003eUgwu NI, Uneke CJ. Iron deficiency anaemia in pregnancy in Nigeria: a systematic review. Niger J Clin Pract. 2020;23(7):889\u0026ndash;96.\u003c/li\u003e\n \u003cli\u003eNwabuko O, Okoh D, Iyalla C, Omunakwe H. Prevalence of sickle cell disease among pregnant women in a tertiary health center in south-south Nigeria. Sub-Saharan Afr J Med. 2016;3(3):132\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eAdigwe OP, Onavbavba G, Onoja SO. Impact of sickle cell disease on affected individuals in Nigeria: a critical review. Int J Gen Med. 2023;16:3503\u0026ndash;15.\u003c/li\u003e\n \u003cli\u003eFederal Ministry of Health. National guidelines and strategies for malaria prevention and control during pregnancy. Abuja: Federal Ministry of Health; 2005.\u003c/li\u003e\n \u003cli\u003eAdeniran A, Mobolaji-Ojibara M, Adesina K, Aboyeji A, Ijaiya M, Balogun O. Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria. J Med Trop. 2018;20(1):30\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eAmeyaw EK, Budu E, Sambah F, Baatiema L, Appiah F, Seidu AA, Ahinkorah BO. Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. PLoS One. 2019;14(8):e0220970.\u003c/li\u003e\n \u003cli\u003eMehari MA, Maeruf H, Robles CC, Woldemariam S, Adhena T, Mulugeta M, Haftu A, Hagose H, Kumsa H. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Northern Ethiopia: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):60.\u003c/li\u003e\n \u003cli\u003eAyokanmi I, Atulomah N, Johnson F, Ajayi OC, Nwachukwu BC. Health literacy and pre-eclampsia knowledge of pregnant mothers attending primary health care centers in Ikenne Local Government, Ogun State. Int J Public Health Pharmacol. 2022;2(2):1\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eUyaiabasi GN, Umaru ML. Prevalence of malaria among women attending a tertiary hospital in Sokoto metropolis, north-western Nigeria. West Afr J Pharm. 2018;29(2):72\u0026ndash;80.\u003c/li\u003e\n \u003cli\u003eIzugbara CO, Wekesah F. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria. Health Policy Plan. 2018;33(1):1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eGontie GB, Wolde HF, Baraki AG. Prevalence and associated factors of malaria among pregnant women in Sherkole district, Benishangul Gumuz regional state, West Ethiopia. BMC Infect Dis. 2020;20(1):573.\u003c/li\u003e\n \u003cli\u003eAdapted from Worldwide antimalarial resistance network (WWARN) annotated CRF template for use in clinical trials for patients with uncomplicated malaria (Ph II/III). http://www.wwarn.org/working-together/malaria-standards-CDISC\u003c/li\u003e\n\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":"[email protected]","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":"Malaria, pregnancy, intermittent preventive treatment, maternal mortality rates, adverse pregnancy outcome, anaemia, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8800686/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8800686/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNigeria has one of the highest maternal mortality rates (MMR) worldwide, which is largely due to complications during pregnancy, delivery, and the postpartum period. Focused antennal clinic (ANC) visits are pivoted to reduce MMR. This study provides detailed baseline and demographic information of pregnant women from a large malaria in pregnancy study.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePregnant women of 16\u0026ndash;29 weeks gestation receiving care at our study sites were enrolled. At enrolment, the following data were collected: baseline demographic data (age, weight, educational status, ethnicity, and use of malaria preventive measures), obstetric information (gravidity, parity, history of adverse pregnancy outcomes [APOCs] and surgeries), laboratory investigations (haemoglobin levels, blood group, genotype, proteinuria, and glycosuria), and malaria parasitology evaluation. Data were analysed using Stata 17\u0026reg; and Microsoft Excel 2021\u0026reg;.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 520 pregnant women were enrolled, with an average age of 28.8 years and gestational age of 22 weeks. More participants had tertiary education and were of Yoruba heritage. Obstetric information revealed that 165 (32.0%) of the women were primigravidae, whereas 42.1% of the women had had more than 2 pregnancies. Half (178) of the women who were pregnant previously reported having at least one APOC, with miscarriage being the most prominent, and 101 had undergone previous surgical procedures. The prevalence of anaemia, proteinuria, and glucosuria were 62.3%, 13%, and 3.5%, respectively. Malaria positivity at enrolment was 27.3% (142), with 71.1% of the diagnosed cases being asymptomatic, whereas 28.9% were symptomatic. There was poor utilisation of malaria preventive measures (insecticide treated nets, insecticide sprays, and indoor residue spraying) with only 1 participant using all three methods and 41.2% using none.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEpidemiological data obtained from this study revealed that participants had high anaemia, previous APOC, high malaria parasite positivity, and low utilisation of malaria preventive measures. These may be strong indicators of why Nigeria has a very high MMR.\u003c/p\u003e","manuscriptTitle":"Epidemiological Profile and baseline characteristics of pregnant women attending antenatal clinics in malaria endemic communities within Ogun State Southwestern Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 10:27:47","doi":"10.21203/rs.3.rs-8800686/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"48daea79-4fce-4e65-ad56-c49ee7b09230","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T07:11:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 10:27:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8800686","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8800686","identity":"rs-8800686","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}