Prevalence of Congenital Malaria in an Urban and a Semirural Area in Lagos; a Two-centre Cross-sectional Study

Background Congenital malaria is a recognized cause of morbidity and mortality in newborns. Signs and symptoms of congenital malaria are non-specific and could be confused with Neonatal sepsis. There has been a recent decline in malaria burden worldwide attributed to a new strategy recommended by the WHO including the use of intermittent preventive treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPT-SP) during pregnancy, long lasting insecticide treated nets (LLINs), malaria case management with Artemisinin-based combination therapy etc. This study sets out to determine the effect of this changes on the prevalence of congenital malaria in two centres in Lagos, Nigeria. Methods Using a cross-sectional observational descriptive design, a total of 291 mother and newborn pairs were enrolled from an urban area and a semi-rural area in Lagos between April and October 2014. About three-fifths of the total study population was derived from the urban centre. A predesigned questionnaire was used to extract basic physical and demographic information such as the use of IPT-SP during pregnancy. Malaria microscopy was carried out on the maternal blood samples, and;.the corresponding newborns’ heel prick and cord blood samples while the placenta tissues were examined for malaria pigments. Results Malaria parasitaemia, cord blood and congenital malaria were 0.34%, 0% and 0% respectively while that of placental malaria pigmentation was 18.9%. Placental malaria incidence was less in mothers who received IPT-SP in pregnancy (p = 0.016). Placental malaria incidence was higher in mothers ≤ 24 years (p = 0.044) and the less educated women had a higher prevalence of placental malaria (p = 0.001). The incidence of placental malaria was higher in the semi-rural area (92.7% v 7.3%, p = < 0.0001). Newborns of mothers with placental malaria had lower birth weight (2881.8 v 3100.7 g, p = 0.020) and smaller head circumference (34.3 v 35.1 cm, p = 0.006) Conclusion- This study demonstrated a significant decline in the prevalence of congenital malaria reflecting the recently reported decline in the burden of malaria in the general population in Africa. Use of IPT-SP during pregnancy, urban area residence and higher educational status appear to have been protective against malaria. A regular surveillance is however necessary considering the dynamics involved in malaria drug resistance.