Prevalence, Associated Factors of Peripheral and Placental Blood <i>Plasmodium</i> Infections and Effect of Antimalarial Treatment among Parturient Attending Health Facilities in Douala, Cameroon

Malaria in pregnancy is still a public health problem in malaria endemic countries of Africa and elsewhere due to chronic outcomes on maternal health and poor perinatal outcomes related to occurrence of placental malaria. Since the implementation of specific malaria control strategies in pregnant woman by health decision makers as recommended by the World Health Organization, the extend of placental malaria is not regularly assessed. This study aimed to assess prevalence of Plasmodium carriage in peripheral and placental blood, associated and the impact of antimalarial treatment among parturient in two healthcare facilities of Douala in Cameroon. This was a hospital-based cross-sectional study undergone from 2018 and 2019 among consenting pregnant women ready to delivery which consisted in i) collecting sociodemographic and obstetrical factors, ABO blood group and hemoglobin type, any malaria and antimalarial treatment, ii) detecting and counting of Plasmodium parasites in peripheral and placental blood. Data collected were statistically analyzed to find any association between prevalence of Plasmodium carriage and factors collected using SPSS.20 software and Chi square test considering a p-value < 5% as significant. A total of 123 parturient aged between 18 and 42 years were included in the study. Only Plasmodium falciparum asexual stage was detected by microscopy and RDT in peripheral blood and placental blood. All parturient who harboured Plasmodium in peripheral blood either by microscopy or malaria RDT had placental malaria. Prevalence of Plasmodium infection was higher in placental blood (23.6%) than peripheral blood (9.8%). Placental malaria was predominantly acute-active infection (71%). Plasmodium loads were higher in placental blood than peripheral blood and ranged between low and high in both bloods. Being of young maternal age , low educational level, blood group O and B, and hemoglobin type AA were associated to higher prevalence of placental malaria and peripheral carrying P. falciparum. No significant association was found between prevalence of Plasmodium infection in placenta and any gynecological and obstetrical features. However, being primigravid, primiparous, undergoing only four antenatal visits or less, taking less than three IPT-SP, not sleeping under a mosquito net daily or not having experienced any fever during the ongoing pregnancy. Placental Plasmodium infections persisted in 29.6% of parturient who were treatment appropriately for malaria during the pregnancy. Prevalence and parasitemia of P. falciparum infection was higher in placenta than peripheral blood. Young maternal age, low educational level, blood group O and B, and hemoglobin type AA were associated to P. falciparum infection in placenta and peripheral blood. Antimalarial treatment did not prevent placental malaria despite peripheral blood negative malaria.