Burden of malaria during pregnancy in perennial transmission settings of two densely forested and remote blocks (Baihar and Birsa) of district Balaghat, Madhya Pradesh, central India.

Vidhan Jain, Ravendra Kumar Sharma, Man Mohan Shukla, Kuldeep K Khosla, Neeru Singh, Rajasubramaniam Shanmugam
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Abstract

Background Malaria in pregnancy (MIP) is a major public health problem due to the vulnerability of pregnant women to infections, resulting in adverse maternal/foetal outcomes in endemic areas. Methods We did a field-based study to assess the burden of MIP (prevalence at the time of enrolment and follow-up) and to identify risk factors for MIP in the Birsa and Baihar blocks of district Balaghat in Madhya Pradesh, which have perennial malaria transmission. Malaria screening (during 2015-2017) was done by microscopy and bivalent rapid diagnostic test (SD Bioline RDT, malaria antigen Plasmodium falciparum/Plasmodium vivax Pf/Pv). Dried blood spots were used for haemoglobin estimation. Sociodemographic details with past and present pregnancy status were obtained. A subset of pregnant women were followed up for malaria during pregnancy. Women were also screened for malaria post delivery. Malaria treatment was given as per the National Guidelines of 2013. Multivariate analysis was done to assess independent risk factors for malaria. Results A total of 1728 pregnant women were screened, of which 1651 were included in the final analysis. Malaria prevalence at first screening was 23.4% (Pf 88%). Prevalence and Pf parasitaemia both were significantly higher among primigravid (G1) compared to multigravid (G>2; p value 0.012 and 0.019, respectively). Pregnant women of the Baiga ethnic group were more likely to have malaria compared to those belonging to the Gond group (OR [95% CI]; 2.4 [1.7-3.4]; p<0.00001) and non-indigenous group (OR [95% CI]; 8.3 [3.9-19.7]; p<0.00001). Primigravid status of women, first and second trimester of pregnancy, women belonging to indigenous ethnic tribal group and cash crop insufficiency for whole year (a socioeconomic indicator) in the family were the independent risk factors for malaria. Conclusion MIP is a major public health problem in forested tribal settlements of Birsa and Baihar blocks of Balaghat district in Madhya Pradesh and requires immediate intervention.

印度中部中央邦巴拉格特地区两个森林茂密的偏远街区(Baihar 和 Birsa)常年传播疟疾的妊娠期疟疾负担。
背景 妊娠期疟疾(MIP)是一个重大的公共卫生问题,因为在疟疾流行地区,孕妇很容易受到感染,导致不良的母婴后果。方法 我们在中央邦巴拉格特地区的比尔萨和拜哈尔区块开展了一项实地研究,以评估妊娠期疟疾的负担(入院时和随访时的发病率),并确定妊娠期疟疾的风险因素。疟疾筛查(2015-2017 年期间)通过显微镜和二价快速诊断检测(SD Bioline RDT,疟疾抗原恶性疟原虫/间日疟原虫 Pf/Pv)进行。干血斑用于估算血红蛋白。此外,还获得了社会人口学方面的详细资料,以及过去和现在的怀孕状况。对一部分孕妇进行了孕期疟疾随访。产后也对妇女进行了疟疾筛查。疟疾治疗按照 2013 年国家指南进行。对疟疾的独立风险因素进行了多变量分析。结果 共有1728名孕妇接受了筛查,其中1651人被纳入最终分析。首次筛查时的疟疾流行率为 23.4%(Pf 为 88%)。与多胎妊娠(G>2;P 值分别为 0.012 和 0.019)相比,初产妇(G1)的感染率和 Pf 寄生虫血症率都明显较高。与贡德族孕妇相比,白加族孕妇更容易感染疟疾(OR [95% CI]; 2.4 [1.7-3.4]; p
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