Assessment of labor and delivery in pregnant women on sulfadoxine-pyrimethamine regimen in Yaoundé gynaeco-obstetric and paediatric hospital: a comparative study of 313 cases

Pascal Foumane, Felix Essiben, Julius Sama Dohbit, Carine Yondjeu Tongn, Esther Juliette Ngo Um Meka, Samuel Ojong, Emile Telesphore Mboudou


Background: Malaria is still a major public health problem in sub-Saharan Africa. The aim was to determine the prevalence of malaria infection at the onset of labor and the resulting complications.

Methods: We carried out a five-month cross-sectional study at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.  We used results from the rapid diagnostic test (RDT) to compare two groups of pregnant women admitted into the labor room. Women who tested positive were assigned to the exposed group versus negative to the non-exposed group. Independent factors associated with malaria infection were investigated by the logistic regression method.

Results: Up to 79.6% (249/313) of women had received the sulfadoxin-pyrimethamine regimen with 32.9% (82/249) receiving at least 3 doses.  Malaria infection was detected in 32.2% (101/313) of women. Only 14.9% (15/101) of the exposed group had received 3 doses of SP versus 31.6% (67/212) of the non-exposed group. After univariate analysis, malaria infection at the onset of labor was associated to premature rupture of membranes (OR=1.39; CI=1.01-1.94), fever during labor (OR=73.37; CI=64.80-681.95), non-reassuring fetal status (OR=2.08; CI=1.36-3.20), low birth weight (OR=1.65; CI=1.23-4.13), prematurity (OR=2.79; CI=2.12-367), a poor Apgar score at the 1st minute and postpartum fever (OR=3.19; CI=2.56-4.00). Linear logistic regression indicated that the occurrence of fever during labor (aOR=63.09), and low Apgar score at the first minute (aOR=6.27) remained significant and malaria infection was significantly associated to the single marital status (aOR=2.56) and a history of malaria during the current pregnancy (aOR=2.56).

Conclusions: Systematic RDTs is thus recommended at the last antenatal consultation to avoid identified complications.


Cameroon, Complications, Labor, Malaria, Pregnancy

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World Health Organization (WHO), authors. Malaria. http:// mediacentre/ factsheets/ fs094/ en/. [Updated April 2016].

Fokam EB, Ngimuh L, Anchang-Kimbi JK, Wanji S. Assessment of the usage and effectiveness of intermittent preventive treatment and insecticide-treated nets on the indicators of malaria among pregnant women attending antenatal care in the Buea Health District, Cameroon. Malar J. 2016;15:172.

Cisse M, Sangare I, Lougue G. Prevalence and risk factors for Plasmodium falciparum malaria in pregnant women attending antenatal clinic in Bobo-Dioulasso (Burkina Faso). BMC Infect Dis. 2014;14:631.

Tahita MC, Tinto H, Menten J. Clinical signs and symptoms cannot reliably predict Plasmodium falciparum malaria infection in pregnant women living in an area of high seasonal transmission. Malar J. 2013;12:464.

Matangila JR, Lufuluabo J, Ibalanky AL. Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo. Malar J. 2014;13:132.

Nwagha UI, Ugwu VO, Nwagha TU. Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria. Trans R Soc Trop Med Hyg. 2009;103(1):16-20.

Mbah, JO, Njoku OO, Agwu U, Nnachi AU. Incidence of antenatal malaria parasitaemia and the effect on the haemoglobin profile of pregnant women in Enugu east local government area, Enugu, Nigeria. Am J Epidemiol Infect Dis. 2015;3(5):88-94.

Snow RW, Guerra CA, Noor AM. The global distribution of clinical episode of Plasmodium falciparum malaria. Nature. 2005;434(7030):214-7.

Ghai RR, Thurber MI, El Bakry A. Multi-method assessment of patients with febrile illness reveals over-diagnosis of malaria in rural Uganda. Malar J. 2016;15:460.

World Health Organization (WHO), authors. Malaria in pregnant women. http:// malaria/ areas/ high_risk_groups/ pregnancy/ en/. [Updated April 2016].

Gajida AU, Iliyasu Z, Zoakah AI. Malaria among antenatal clients attending primary health care facilities in Kano state, Nigeria. Ann Afr Med. 2010;9(3):188-93.

Isah AY, Amanabo MA, Ekele BA. Prevalence of malaria parasitemia amongst asymptomatic pregnant women attending a Nigerian teaching hospital. Ann Afr Med. 2011;10(2):171-4.

White NJ, Breman JG. Malaria. In: Fauci AS, Braunwald E, Kasper DL. eds. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008:1280-1293.

Ndip LM, Egbe FN, Kimbi HK. Co-infection of malaria and typhoid fever in feverish patients in the Kumba health district, Southwest Cameroon: public health implications. IJTDH. 2015;9(4):1-11,

Orok DA, Usang, AI, Ikpan OO. Prevalence of malaria and typhoid fever co-infection among febrile patients attending college of health technology medical centre in Calabar, cross river state, Nigeria. Int J Curr Microbiol Appl Sci. 2016;5(4):825-35.

Bardají A, Sigauque B, Bruni L. Clinical malaria in African pregnant women. Malar J. 2008;7:27.

Hance P, Garnotel E, De Pina JL. Test immunochromatographique rapide de détection du paludisme. principes et stratégies d’utilisations. [Rapid immunochromatographic test for Plasmodium detection. Principles and strategies of uses]. Med Trop 2005;65:389-93. [french].

Kyabayinze DJ, Tibenderana JK, Nassali M. Placental Plasmodium falciparum malaria infection: Operational accuracy of HRP2 rapid diagnostic tests in a malaria endemic setting Malar J. 2011;10:306.

Minja DT, Schmiegelow C, Oesterholt M. Reliability of rapid diagnostic tests in diagnosing pregnancy-associated malaria in north-eastern Tanzania. Malar J. 2012;11:211.

Maltha J, Guiraud I, Lompo P. Accuracy of PfHRP2 versus Pf-pLDH antigen detection by malaria rapid diagnostic tests in hospitalized children in a seasonal hyperendemic malaria transmission area in Burkina Faso. Malar J. 2014;13:20.

Reyburn H, Mbakilwa H, Mwangi R. Rapid diagnostic tests compared with malaria microscopy for guiding outpatient treatment of febrile illness in Tanzania: randomized trial. Br Med J. 2007;334:403.

Briand V, Badaut C, Cot M. Placental malaria, maternal HIV infection and infant morbidity. Ann Trop Paediatr. 2009;29:71-83.

Parise ME, Ayisi JG, Nahlen BL. Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. Am J Trop Med Hyg. 1998;59(5):813-22.

Diakite OS, Kayentao K, Traoré BT. Superiority of 3 over 2 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine for the prevention of malaria during pregnancy in Mali: a randomized controlled trial. Clin Infect Dis. 2011;53(3):215-23.

Essiben F, Pascal F. Tsafack de Nguefack TMA. Pan Afr Med J. 2016;23:152.

Wanja EW, Kuya N, Moranga C. Field evaluation of diagnostic performance of malaria rapid diagnostic tests in western Kenya. Malar J. 2016;15:456.

Howson CP, Kinney M, Lawn JE. Born too soon: preterm birth matters. Reprod Health. 2013; 10(1):S5.

Thierry A. [Statistics Epidemiology]. Ed Maloine 2002;276. [french]

Mathanga DP, Campbell CH, Taylor TE. Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anemia among children in urban Malawi. Trop Med Int Health. 2006;11:1367-74.

Tagbor H, Bruce J, Browne E. Malaria in pregnancy in an area of stable and intense transmission: is it asymptomatic? Trop Med Int Health. 2008;13(8):1016-21.

Yeboah DF, Afoakwah R, Nwaefuna EK. Quality of sulfadoxine-pyrimethamine given as antimalarial prophylaxis in pregnant women in selected health facilities in central region of Ghana. J Parasitol Res. 2016;2016:923-46.

Brabin BJ. An analysis of malaria in pregnancy in Africa. Bull World Health Organization. 1983;61:1005-6.

McGregor IA, Wilson ME, Billewicz WZ. Malaria infection of the placenta in The Gambia, West Africa; its incidence and relationship to stillbirth, birthweight and placental weight. Trans R Soc Trop Med Hyg. 1983;77(2):232-44.

Duffy PE. Plasmodium inthe placenta: Parasite, parity, protection, prevention, and possibly preeclamsia. Parasitology. 2007;134(13):1877-81.

Rogerson SJ, Hivid L, Duffy PE. Malaria in pregnancy: Pathogenesis and immunity. Lancet Infect Dis. 2007;7:105-17.

Okoko BJ, Ota MO, Yamuah LK. Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mc gregor. J Health Popul Nutr. 2002;20(1):4-11.

Valea I, Tinto H, Drabo MK. An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anemia and perinatal mortality in Burkina Faso. Malar J. 2012;11:71.