Fetomaternal outcomes of pregnant women admitted with malaria at Parirenyatwa hospital and in Mashonaland East province of Zimbabwe

INTRODUCTION There are 300million to 500million people who are infected with malaria worldwide every year and the disease kills about 3million yearly. 90% of the cases occur in Sub-Saharan Africa where HIV is also prevalent. Malaria is one of the major contributing factors to fetal and maternal morbidity and mortality causing severe anemia, cerebral malaria, renal failure, miscarriage, stillbirth and low birth weight. Zimbabwe has made significant achievements in reducing the incidence of malaria in the general population according to the data from the Ministry of Health and Child Welfare Department of Malaria Control but the disease burden remains high[Figure 1]. Malaria is the fifth leading cause of maternal mortality in Zimbabwe [6]. However, there is limited data on the impact of the disease on high risk groups like pregnant women in Zimbabwe. This was done as a cross sectional descriptive survey to evaluate the effect of malaria on pregnant women and their fetuses. OBJECTIVE Main objective 1) To evaluate maternal and fetal outcomes of malaria in pregnancy 7 Other objectives 1) To assess factors which influence maternal and fetal outcomes. METHOD A cross sectional descriptive survey was done on pregnant women admitted with malaria over a period of 8 months (September 2011-April 2012). An interviewer administered questionnaire was used to gather information on women admitted in the antenatal or labour ward with a diagnosis of malaria. District hospitals (Mutoko, Murewa, Mudzi) in moderate to high seasonal malaria transmission located in Mashonaland East Province of Zimbabwe and one tertiary hospital, Parirenyatwa Hospital, were identified for the survey. RESULTS Of the 103 cases of malaria in pregnancy studied, there were 2(2%) maternal deaths, 6(6%) cases of severe anaemia and two cases of cerebral malaria. Maternal adverse outcome were influenced by booking status, human immunodeficiency virus(HIV) status, use of intermittent presumptive therapy(IPT), insecticide treated bed nets(ITNS) and late presentation to hospital. Ninety three cases were discharged from hospital without major complications. There were 24(23%) live term babies, 10(10%) preterm deliveries, 10(10%) cases of low birth weight, 6(6%) stillbirths, 9(9%) miscarriages and two cases of threatened miscarriages. Fifty two percent of the participants were still pregnant when they were 8 discharged from hospital. There was under utilization of IPT (45%) and ITNs (45%) by participants. CONCLUSION Malaria infection had adverse effects on both mother and foetus. It was associated with maternal mortality and morbidity. Anaemia, cerebral malaria and maternal death were the main maternal complications encountered in this survey. Maternal adverse outcomes were influenced by booking status, HIV status, use of IPT, ITNS and time taken to present to hospital after onset of disease. There was significant fetal wastage (15%) resulting from miscarriages (9%) and stillbirths (6%). Malaria infection was also associated with low birth weight (28%) and preterm delivery (10%). The survey also revealed that there was underutilization of prevention strategies (IPT and ITNs) by 45% of participants which was mainly due to failure to book or late booking for antenatal care (ANC). Case management was generally according to standard guidelines but participants were not adequately investigated in terms of other parameters such as complete blood count and renal function