Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya


In areas of sub-Saharan Africa where malaria is endemic, pregnant women are at a greater risk of malaria than non-pregnant women leading to significant adverse consequences including anemia, intrauterine growth retardation, low birth weight (LBW), and pre-term delivery. The Kenya Ministry of Health adopted Intermittent Preventive Treatment (IPT) and use of insecticide-treated nets (ITN) as a National strategy for malaria prevention in pregnancy. In this report, we evaluated the prevalence of malaria, the anthropometric measures of birth outcomes and the reasons for loss to follow up among pregnant women participating in an ongoing cohort study in Western Kenya. A total of 175 HIV-negative pregnant women enrolled at antenatal clinic of Chulaimbo sub-District hospital were longitudinally evaluated in a monthly follow-up visits through antenatal visits (up to 4 per mother) and delivery. Thirty three percent and 15% of the pregnant women were malaria positive by real-time quantitative (Q)-PCR and microscopy respectively at enrolment, while 54% and 23% of the pregnant women had malaria by Q-PCR and microscopy respectively at any time during follow-up. Of the enrolled study participants, 65% delivered at Chulaimbo hospital. Overall, 39% (69) of the pregnant women were lost to follow-up. The major reasons for loss to follow up were relocation from the study area (26%) and delivery at alternative health facilities (25%). The mean birth weight of the newborn infants was 3202 g (range, 2000 g - 4000 g). Only 5.3% of the infants weighed less than 2500 g (low birth weight). The mean head circumference was 34 cm (range, 30 cm - 39 cm) with mean Apgar score (at 10 minutes) ± S.D. of 9.8 ± 0.97. In conclusion, we observed decreased adverse pregnancy outcomes among our study population. We recommend a larger study of all pregnant women attending the Chulaimbo hospital so as to assess whether effectiveness of malaria and anemia control programs lead to improved birth outcomes.

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Daud, I. , Opinya, F. , Midem, D. , Kigani, M. , Bukusi, E. , Ng’ang’a, Z. , Sumba, P. , Dent, A. and Rochford, R. (2014) Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya. Health, 6, 2651-2656. doi: 10.4236/health.2014.619304.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organization U, UNFPA and the World Bank (2010) Trends in Maternal Mortality: 1990 to 2010. In Geneva, Switzerland.
[2] Macro: KNBoSKaI (2011) Kenya Demographic and Health Survey 2008-09. Calverton, Maryland, USA
[3] Desai, M., Phillips-Howard, P.A., Odhiambo, F.O., Katana, A., Ouma, P., et al. (2013) An Analysis of Pregnancy-Related Mortality in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya. PLoS One, 8.
[4] Lartey, A. (2008) Maternal and Child Nutrition in Sub-Saharan Africa: Challenges and Interventions. Proceedings of the Nutrition Society, 67, 105-108.
[5] Steketee, R.W. (2003) Pregnancy, Nutrition and Parasitic Diseases. Journal of Nutrition, 133, 1661S-1667S.
[6] Abu-Saad, K. and Fraser, D. (2010) Maternal Nutrition and Birth Outcomes. Epidemiologic Reviews, 32, 5-25.
[7] Steketee, R.W., Nahlen, B.L., Parise, M.E. and Menendez, C. (2001) The Burden of Malaria in Pregnancy in Malaria-Endemic Areas. The American Journal of Tropical Medicine and Hygiene, 64, 28-35.
[8] Sullivan, A.D., Nyirenda, T., Cullinan, T., Taylor, T., Harlow, S.D., et al. (1999) Malaria Infection during Pregnancy: Intrauterine Growth Retardation and Preterm Delivery in Malawi. The Journal of Infectious Disease, 179, 1580-1583.
[9] Brabin, B.J. (1983) An Analysis of Malaria in Pregnancy in Africa. Bulletin of the World Health Organization, 61, 1005-1016.
[10] McGregor, I.A. (1984) Epidemiology, Malaria and Pregnancy. The American Journal of Tropical Medicine and Hygiene, 33, 517-525.
[11] Rogerson, S.J., Chaluluka, E., Kanjala, M., Mkundika, P., Mhango, C. and Molyneux, M.E. (2000) Intermittent Sulfadoxine-Pyrimethamine in Pregnancy: Effectiveness against Malaria Morbidity in Blantyre, Malawi, in 1997-1999. Transactions of the Royal Society of Tropical Medicine and Hygiene, 94, 549-553.
[12] Shulman, C.E., Dorman, E.K., Cutts, F., Kawuondo, K., Bulmer, J.N., Peshu, N. and Marsh, K. (1999) Intermittent Sulphadoxine-Pyrimethamine to Prevent Severe Anaemia Secondary to Malaria in Pregnancy: A Randomised Placebo-Controlled Trial. Lancet, 353, 632-636.
[13] Parise, M.E., Ayisi, J.G., Nahlen, B.L., Schultz, L.J., Roberts, J.M., Misore, A., et al. (1998) 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. American Journal of Tropical Medicine and Hygiene, 59, 813-822.
[14] Daud, I., Ogolla, S., Amolo, A., Namuyenga, E., Simbiri, K., Bukusi, E.A., et al. (2014) Plasmodium falciparum Infection Is Associated with Epstein-Barr Virus Reactivation in Pregnant Women Living in Malaria Holoendemic Area of Western Kenya. Maternal and Child Health Journal, 1-9.
[15] Hermsen, C.C., Telgt, D.S., Linders, E.H., van de Locht, L.A., Eling, W.M., Mensink, E.J.B.M. and Sauerwein, R.W. (2001) Detection of Plasmodium falciparum Malaria Parasites in Vivo by Real-Time Quantitative PCR. Molecular and Biochemical Parasitology, 118, 247-251.
[16] Menendez, C., Ordi, J., Ismail, M.R., Ventura, P.J., Aponte, J.J., Kahigwa, E., et al. (2000) The Impact of Placental Malaria on Gestational Age and Birth Weight. Journal of Infectious Diseases, 181, 1740-1745.
[17] Yatich, N.J., Jolly, P.E., Funkhouser, E., Agbenyega, T., Rayner, J.C., Ehiri, J.E., et al. (2010) The Effect of Malaria and Intestinal Helminth Coinfection on Birth Outcomes in Kumasi, Ghana. American Journal of Tropical Medicine and Hygiene, 82, 28-34.
[18] Gebremariam, A. (2005) Factors Predisposing to Low Birth Weight in Jimma Hospital South Western Ethiopia. East African Medical Journal, 82, 554-558.
[19] Tako, E.A., Zhou, A., Lohoue, J., Leke, R., Taylor, D.W. and Leke, R.F. (2005) Risk Factors for Placental Malaria and Its Effect on Pregnancy Outcome in Yaounde, Cameroon. American Journal of Tropical Medicine and Hygiene, 72, 236-242.
[20] Yazdani, M., Tadbiri, M. and Shakeri, S. (2004) Maternal Hemoglobin Level, Prematurity, and Low Birth Weight. International Journal of Gynecology and Obstetrics, 85, 163-164.
[21] Bouyou-Akotet, M.K., Ionete-Collard, D.E., Mabika-Manfoumbi, M., Kendjo, E., Matsiegui, P.B., et al. (2003) Prevalence of Plasmodium falciparum Infection in Pregnant Women in Gabon. Malaria Journal, 2, 18.
[22] Menendez, C., D’Alessandro, U. and ter Kuile, F.O. (2007) Reducing the Burden of Malaria in Pregnancy by Preventive Strategies. Lancet Infectious Diseases, 7, 126-135.
[23] Desai, M., ter Kuile, F.O., Nosten, F., McGready, R., Asamoa, K., Brabin, B. and Newman, R.D. (2007) Epidemiology and Burden of Malaria in Pregnancy. Lancet Infectious Diseases, 7, 93-104.
[24] van Eijk, A.M., Bles, H.M., Odhiambo, F., Ayisi, J.G., Blokland, I.E., Rosen, D.H., et al. (2006) Use of Antenatal Services and Delivery Care among Women in Rural Western Kenya: A Community Based Survey. Reproductive Health, 3, 2.

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