CHAPTER ONE
INTRODUCTION
1.1 Background of the study
Malaria is a parasitic infection caused by the five species of Plasmodium that infect humans.1 The infection is primarily transmitted by the bite of an infected female Anopheles mosquito, but infections can also occur through exposure to infected blood products (transfusion malaria) and by congenital transmission.2 Malaria has a worldwide distribution, affecting people of all ages, with an enormous burden amounting to 300-500 million clinical cases per year, 80% of which occur in Africa.3 SubSaharan Africa has the largest burden of malarial disease, with over 90% of the world’s malaria related deaths occurring in this region.4, 5 In all malaria-endemic countries in Africa, between 20% and 50% of all hospital admissions are a consequence of malaria.6, 7 Every year, Malaria is said to cost Africa an estimated 12 billion dollars (US$ 12b) in lost productivity.6 It has been reported that malaria places a heavy burden on the African poor, this is because both direct and indirect costs associated with a malaria episode represent a substantial burden on the poorer households. Malaria infection during pregnancy is an enormous public health problem due to its adverse effects on the mother as well as the fetus. It is a major, preventable cause of maternal morbidity, mortality, and poor birth outcomes in sub-Saharan Africa. Pregnant women are at increased risk of more frequent and severe malaria, compared with non-pregnant women. In areas endemic for malaria, it is estimated that more than 30 million pregnant women are threatened by malaria annually and at least 25% of pregnant women are infected while about 10, 000 maternal deaths are attributed to the disease each year. Recent World Malaria Report indicates that Nigeria accounts for a quarter of all malaria cases in the 45 malaria-endemic countries in Africa, this clearly shows the challenge of malaria in Nigeria. Malaria is transmitted throughout Nigeria with 97% of the population at risk. It is endemic and is responsible for annual economic loss of N132 billion according to the National Malaria Control Programme. It is also responsible for 60% of outpatient visits to health facilities and 30% of hospitalizations. In addition, at least 50% of the population has at least one episode of malaria annually. In Enugu State, for example, malaria is responsible for 70% of outpatient attendance at the secondary healthcare facilities and over 80% of all diseases reported by primary healthcare facilities. Malaria directly accounts for about 11% of all maternal deaths in Nigeria, and indirectly contributes to additional 11% of maternal deaths mainly by being a leading cause of anaemia in pregnancy. Pregnant women in Nigeria, are mostly infected with Plasmodium falciparum, the most virulent Plasmodium with serious health consequences including anaemia, still- birth, and premature delivery. This explains why national efforts to reduce the high maternal and infant mortality place high premium on effective control of malaria in pregnancy. Recent studies have shown that among pregnant women, primigravidae are at highest risk of malarial infection and serious complications. Younger maternal age (particularly adolescence) carries a higher risk of infection and adverse effects. Second trimester is also known to carry one of the highest risks of infection.