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Assessing microscopic and rapid diagnostic tests for malaria among pregnant women with fever in Ondo State, Southwest Nigeria

Obstetrics & Gynecology International Journal
Waheed Folayan,1 Titilola M Afolabi,2 Oladipo B Akinmoladun,1 Feyijimi Egunjobi,1 Lynda Ozor,3 Tolulope Fagbemi,4 Bamgboye M Afolabi5

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Background: Malaria as a health burden in sub-Saharan Africa is well-known. Information about access to programs by pregnant women during early antenatal care (ANC) visits and the impact on the burden of malaria is limited.
Objective: To evaluate the utilization of malaria control services between 2014 and 2018 in Ondo State, Southwest Nigeria.
Materials and methods: Between 2014 and 2018, malaria-related indicators including the proportion of pregnant women with fever who were investigated with microscopy and Rapid Diagnostic Test (RDT) and who were given government-approved Sulphadoxine-pyrimethamine, were tracked in Ondo State, Nigeria. Data were captured using the District Health Information Management version 2.0 (DHISv2.0) and analyzed using Stata 13 statistical software.
Results: Throughout the study period, the mean (±sd) percentage of pregnant women with fever tested for malaria parasites with microscopy in all the LGAs was 2.71 (4.87) with the lowest and highest means (±sd) occurring in 2016 as 1.20 (1.71) and in 2018 as 5.47 (7.93) respectively with no significant difference (F-statistics=2.25; P-value=0.07).A statistically significant variation (F-statistics=34.90; P-value=0.0000001) was observed in the overall mean (±sd) proportion of pregnant women with fever who were tested for malaria with RDT over the study period with the lowest as 57.0 (15.2) in 2014 and the highest as 96.2 (4.1) in 2017.This level of significance was reflected mostly in the coastal (F-statistics=15.05; P-value=0.0000001) and in the rainforest (F-statistics=12.86; P-value=0.0000001) ecological zones of the state but much less in the Savannah ecological zone (F-statistics=3.23; P-value=0.04).There was no significant correlation (Pearson’s r=0.160, P-value=0.141) between fever cases that tested positive using microscopy and fever cases that tested positive with RDT. A noteworthy variation (F-statistics=3.96, P-value=0.005) was observed in the proportion of fever cases that tested positive with RDT but not with microscopy. Overall mean proportion of pregnant women with confirmed fever cases was 76.66 (15.06), mostly in the Savannah ecological system (81.84 (21.18) throughout the study period.
Conclusion: Data from this study suggests that RDT gradually replaced microscopy in testing for malaria among pregnant women in Ondo State of Nigeria. It also suggested that some ecological zones may be more underserved than others in assessing malaria in pregnancy. More technical and financial assistance are needed for the State Malaria Elimination Program to improve ANC service utilization.


Malaria in pregnancy, Malaria microscopy, RDT, Sulphadoxine-pyrimethamine, Ecological zones of Ondo State