Household and maternal risk factors for malaria in pregnancy in a highly endemic area of Uganda: a prospective cohort study

• Published in: Malaria journal 2019-04, Vol.18 (1), p.144-9, Article 144
• Main Authors: Okiring, Jaffer, Olwoch, Peter, Kakuru, Abel, Okou, Joseph, Ochokoru, Harriet, Ochieng, Tedy Andra, Kajubi, Richard, Kamya, Moses R, Dorsey, Grant, Tusting, Lucy S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analysis; Antimalarials - therapeutic use; Area; Area of high malaria endemicity; Blood; Cohort analysis; Cohorts; Disease transmission; Education; Educational Status; Endemic Diseases; Family Characteristics; Female; Health aspects; Health risk assessment; Health risks; Histochemistry; Histopathology; HIV; Households; Houses; Housing; Human diseases; Human immunodeficiency virus; Humans; Malaria; Malaria - drug therapy; Malaria - epidemiology; Malaria in pregnancy; Metals; Metals (Materials); Mothers; Odds Ratio; Parasites; Placenta; Pregnancy; Pregnancy Complications, Parasitic - epidemiology; Pregnant women; Prospective Studies; Public health; Pyrimethamine; Residential areas; Residential construction; Risk assessment; Risk Factors; Socioeconomic Factors; Surveying; Uganda - epidemiology; Vector-borne diseases; Women; Womens health; Young Adult
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-019-2779-x

Malaria in pregnancy is a major public health challenge, but its risk factors remain poorly understood in some settings. This study assessed the association between household and maternal characteristics and malaria among pregnant women in a high transmission area of Uganda. A nested prospective study was conducted between 6th September 2016 and 5th December 2017 in Busia district. 782 HIV uninfected women were enrolled in the parent study with convenience sampling. Socioeconomic and house construction data were collected via a household survey after enrolment. Homes were classified as modern (plaster or cement walls, metal or wooden roof and closed eaves) or traditional (all other homes). Maternal and household risk factors were evaluated for three outcomes: (1) malaria parasitaemia at enrolment, measured by thick blood smear and qPCR, (2) malaria parasitaemia during pregnancy following initiation of IPTp, measured by thick blood smear and qPCR and (3) placental malaria measured by histopathology. A total of 753 of 782 women were included in the analysis. Most women had no or primary education (75%) and lived in traditional houses (77%). At enrolment, microscopic or sub-microscopic parasitaemia was associated with house type (traditional versus modern: adjusted risk ratio (aRR) 1.29, 95% confidence intervals 1.15-1.45, p