Asymptomatic Plasmodium Infection and Its Associated Factors among Pregnant Women Attending Antenatal Consultation in Enugu North Local Government Area of Enugu State

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Published: 2024-04-25

Page: 53-67

Okeyobasi, I.A

Department of Applied Biology and Biotechnology, Enugu State University of Science and Technology, PMB 1660 Enugu, Nigeria.

Victor S Njom *

Department of Applied Biology and Biotechnology, Enugu State University of Science and Technology, PMB 1660 Enugu, Nigeria.

*Author to whom correspondence should be addressed.


Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions. It affects an estimated 30 million pregnant women in sub-Saharan Africa annually with 25% of maternal deaths each year. This study investigated Plasmodium parasitemia and its associated factors among malaria-asymptomatic pregnant women attending antenatal consultation in some selected hospitals in Enugu North, through blood smear microscopy and structured questionnaire interview of 440 randomly selected women. The result indicated a 27.9% prevalence of asymptomatic Plasmodium infection among studied subjects in Enugu North Local Government Area. The number of antenatal visits varied according to the age of women, previous pregnancy and occupation, education, gravidity, and age of pregnancy. Plasmodium parasitemia was more in young pregnant women, pregnant women who experienced pregnancy for the first time and those in their first trimester. Knowledge about a causative organism, and malaria symptom methods of transmission prevention and treatment, varied among the social status of the studied subjects.  There was a statistical association between asymptomatic Plasmodium infection with anaemia (p<0.05). Therefore, it is recommended that more awareness on the use of insecticide-treated nets and regular malaria tests should be done to ascertain malaria Plasmodium status, especially during pregnancy.

Keywords: Asymptomatic, plasmodium, pregnancy, anemia, knowledge

How to Cite

Okeyobasi, I.A, & Njom , V. S. (2024). Asymptomatic Plasmodium Infection and Its Associated Factors among Pregnant Women Attending Antenatal Consultation in Enugu North Local Government Area of Enugu State. Asian Journal of Advances in Medical Science, 6(1), 53–67. Retrieved from


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Adebayo, Ayodeji M, Oluwaseun O, Akinyemi, Eniola O. Cadmus. Knowledge of malaria prevention among pregnant women and female caregivers of under-five children in rural southwest Nigeria. PeerJ. 2015.3:e792.

Adefioye O, Adeyeba OA, Adeyeba WO, Hassan, Oyeniran OA. Prevalence of Malaria Parasite Infection among Pregnant Women in Osogbo, Southwest, Nigeria; 2007.

Anchang-Kimbi Judith K, Vera Ngenwie Nkweti, Helen Ngum Ntonifor, Tobias O. Apinjoh, Rolland Bantar Tata, Hanesh Fru Chi, and Eric Akum Achidi. Plasmodium falciparum parasitaemia and malaria among pregnant women at first clinic visit in the mount Cameroon area. BMC Infectious Diseases. 2015;15:1–10.

Ataíde, Ricardo, Alfredo Mayor, Stephen J. Rogerson. Malaria, primigravidae, and antibodies: Knowledge gained and future perspectives. Trends in Parasitology. 2014;30(2):85–94.

Awosolu, Oluwaseun Bunmi, Zary Shariman Yahaya, Meor Termizi Farah Haziqah. Prevalence, parasite density and determinants of falciparum malaria among febrile children in some peri-urban communities in southwestern Nigeria: A cross-sectional study. Infection and Drug Resistance. 2021;3219–32.

Babakhanyan, Anna. Antibody Response to VAR2CSA in Pregnant Cameroonian Women; 2013.

Bal, Madhusmita, Ramakanta Rana, Arundhuti Das, Hemant Kumar Khuntia, Nilam Somalkar, Niranjan Sahoo, Jyoti Ghosal, Sanghamitra Pati, Ambarish Dutta, Manoranjan Ranjit. ‘Neglected Malaria Parasites in Hard-to-Reach Areas of Odisha, India: Implications in Elimination Programme’. Malaria Journal. 2021; 20(1):482.

Bello, Surajudeen Oyeleke, Esther Solomon Audu, Ikrama Hassan, Efe Abolodje, Ishaku Bako. Asymptomatic malaria parasitaemia among HIV infected children and adolescents. Sahel Medical Journal. 2021;24(2):70–74.

Bousema, Teun, Lucy Okell, Ingrid Felger, Chris Drakeley. Asymptomatic malaria infections: Detectability, transmissibility and public health relevance. Nature Reviews Microbiology. 2014;12(12):833–40.

Bouyou-Akotet, Marielle K., Denisa E. Ionete-Collard, Modeste Mabika-Manfoumbi, Eric Kendjo, Pierre-Blaise Matsiegui, Elie Mavoungou, Maryvonne Kombila. Prevalence of plasmodium falciparum infection in pregnant women in Gabon. Malaria Journal. 2003;2:1–7.

Brabin, Bernard J. An analysis of malaria in pregnancy in Africa. Bulletin of the World Health Organization. 1983;61(6):1005.

Calis, Pinar, Lucia Vojtech, Florian Hladik, Michael G. Gravett. A review of ex vivo placental perfusion models: An underutilized but promising method to study maternal-fetal interactions. The Journal of Maternal-Fetal and Neonatal Medicine. 2022;35(25):8823–35.

Chijioke-Nwauche, Ifeyinwa, Omosivie Maduka, Abimbola Awopeju, Ibinabo Oboro, Nsirimobu Paul, Mark Ogoro, Godly Otto, Terhemen Kasso, Lucy Yaguo-Ide, and Claribel Abam. Malaria and Its Economic Burden among Pregnant Women in Rivers State, Nigeria. Open Journal of Obstetrics and Gynecology. 2020;10(04):571.

Chua, Caroline Lin Lin, Sebastian Kah Ming Khoo, Jun Long Ernest Ong, Gaurav Kumar Ramireddi, Tsin Wen Yeo, Andrew Teo. Malaria in pregnancy: From placental infection to its abnormal development and damage. Frontiers in Microbiology. 2021;12:777343.

Cohee, Lauren M., Charles Opondo, Siân E. Clarke, Katherine E. Halliday, Jorge Cano, Andrea G. Shipper, Breanna Barger-Kamate, Abdoulaye Djimde, Seybou Diarra, Aditi Dokras. Preventive malaria treatment among school-aged children in sub-saharan Africa: A systematic review and meta-analyses. The Lancet Global Health. 2020;8(12):e1499–1511.

Cribellier, Antoine, Jeroen Spitzen, Henry Fairbairn, Cedric Van De Geer, Johan L. Van Leeuwen, and Florian T. Muijres. Lure, Retain, and Catch Malaria Mosquitoes. How Heat and Humidity Improve Odour-Baited Trap Performance’. Malaria Journal. 2020;19:1–16.

Crooks, Rachel, Carol Bedwell, Tina Lavender. Adolescent experiences of pregnancy in low-and middle-income countries: A meta-synthesis of qualitative studies. BMC Pregnancy and Childbirth. 2022;22(1):702.

Desai, Meghna, Feiko O. Ter Kuile, François Nosten, Rose McGready, Kwame Asamoa, Bernard Brabin, Robert D. Newman. Epidemiology and burden of malaria in pregnancy. The Lancet Infectious Diseases. 2007;7(2):93–104.

Dicko, Alassane, Carsten Mantel, Mahamadou Aly Thera, Seydou Doumbia, Mouctar Diallo, Mahamadou Diakité, Issaka Sagara, Ogobara K. Doumbo. Risk Factors for Malaria Infection and Anemia for Pregnant Women in the Sahel Area of Bandiagara, Mali. Acta Tropica 2003;89(1):17–23.

Dike, Nkem, Obinna Onwujekwe, Juliana Ojukwu, Arthur Ikeme, Benjamin Uzochukwu, Elvis Shu. Influence of education and knowledge on perceptions and practices to control malaria in Southeast Nigeria. Social Science and Medicine. 2006;63(1):103–6.

Dosoo, David Kwame, Daniel Chandramohan, Dorcas Atibilla, Felix Boakye Oppong, Love Ankrah, Kingsley Kayan, Veronica Agyemang, Dennis Adu-Gyasi, Mieks Twumasi, Seeba Amenga-Etego. Epidemiology of Malaria among Pregnant Women during Their First Antenatal Clinic Visit in the Middle Belt of Ghana: A Cross Sectional Study. Malaria Journal. 2020;19:1–12.

Egbewale, Bolaji E, Akeem A Akindele, Samuel A. Adedokun, Olusola A Oyekale. ‘Prevalence of Asymptomatic malaria and anaemia among elderly population in Osun state southwestern, Nigeria. Int J Community Med Public Health. 2018;5(7):2650–56.

Ekeleme, NC, CE Ijioma, NA Unachukwu, PI Ejikem, JE Areh, CI Ogwu, EO Jeffery, IJ Esangbedo, AC Amuta, and PC Ojiri. Attitudes and practices of insecticide treated bed nets usage among rural dwellers in Oyo State, Nigeria. International Journal of Tropical Disease and Health. 2023;44(15):43–58.

Ellwanger, Joel Henrique, Jáder da Cruz Cardoso, José Artur Bogo Chies. Variability in human attractiveness to mosquitoes. Current Research in Parasitology and Vector-Borne Diseases. 2021;1:100058.

Emechebe, Cajethan, Andrew Enwa Okpe, Edu Michael Eyong, Charles Obinna Njoku. The rate of asymptomatic plasmodium parasitemia and placental parasitization in urban and rural areas of Cross River State, Nigeria. Open Access Macedonian Journal of Medical Sciences. 2022;10(B):438–44.

Feleke, Daniel Getacher, Aderaw Adamu, Angesom Gebreweld, Melkam Tesfaye, Wondmagegn Demisiss, Genet Molla. Asymptomatic malaria infection among pregnant women attending antenatal care in malaria endemic areas of North-shoa, Ethiopia: A cross-sectional study. Malaria Journal. 2020;19:1–6.

Fried, Michal, Patrick E. Duffy. ‘Malaria during Pregnancy’. Cold Spring Harbor Perspectives in Medicine. 2017;7(6): a025551.

Hwang, Jimee, Patricia M. Graves, Daddi Jima, Richard Reithinger S. Patrick Kachur, Ethiopia MIS Working Group. Knowledge of Malaria and Its Association with Malaria-Related Behaviors—Results from the Malaria Indicator Survey, Ethiopia. Plos One. 2007;5(7):e11692.

Lin, Jessica T, David L, Saunders, Steven R Meshnick. The Role of Submicroscopic Parasitemia in Malaria Transmission: What Is the Evidence? Trends in Parasitology. 2014;30(4):183–90.

Lopez, Luis, Cristian Koepfli. Systematic review of plasmodium falciparum and plasmodium vivax polyclonal infections: Impact of prevalence, study population characteristics, and laboratory procedures. Plos One. 2021;16(6):e0249382.

Mbohou Nchetnkou, Christian, Loick Pradel Kojom Foko, Leopold Gustave Lehman. Knowledge, attitude, and practices towards malaria among employees from enterprises in the town of Douala, cameroon. BioMed Research International; 2020.

Mens, Petra F, Edward C Bojtor, Henk DFH Schallig. Molecular Interactions in the Placenta during Malaria Infection. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2010;152(2):126–32.

MOORE, Kerryn A, Julie A Simpson, Jacher Wiladphaingern, Aung Myat Min, Mupawjay Pimanpanarak, Moo Kho Paw, Jathee Raksuansak, Sasithon Pukrittayakamee, Freya JI Fowkes, Nicholas J. White. ‘Influence of the Number and Timing of Malaria Episodes during Pregnancy on Prematurity and Small-for-Gestational-Age in an Area of Low Transmission. BMC Medicine. 2017;15:1–12.

Moxon, Christopher A, Matthew P Gibbins, Dagmara McGuinness, Danny A. Milner Jr, Matthias Marti. ‘New Insights into Malaria Pathogenesis. Annual Review of Pathology: Mechanisms of Disease. 2020;15:315–43.

Musarandega, Reuben, Michael Nyakura, Rhoderick Machekano, Robert Pattinson, Stephen Peter Munjanja. Causes of Maternal Mortality in Sub-Saharan Africa: A Systematic Review of Studies Published from 2015 to 2020. Journal of Global Health 11; 2021.

Naheda, Ansari, Sana Aqeel, Khadija Khan, Wajihullah Khan, Tamkin Khan. ‘Immunohistopathological Changes in the Placenta of Malaria-Infected Women in Unstable Transmission Setting of Aligarh. Placenta. 2022;127:52–61.

Nnaji, GA, Okafor CI, Ikechebelu JI. An evaluation of the effect of parity and age on malaria parasitaemia in pregnancy. Journal of Obstetrics and Gynaecology. 2006;26(8):755–58.

Nnamonu, Emmanuel Ikechukwu, Obiageli Constance Ejilibe, Pamela Amarachi Ndukwe-Ani, Godwin Chigozie Nwosu, Cyril Ali Imakwu, Kingsley Chukwujindu Ezugwu, Casmir Chiebuka Ekwueme. Pregnancy Malaria: Predisposing Factors, Burden and Management in Agrarian Settlements Southeast Nigeria. Intnl J Tropical Dis and Health. 2020;41(9):22–33.

Noori, Navideh Joshua L Proctor, Yvette Efevbera, Assaf P Oron. The effect of adolescent pregnancy on child mortality in 46 low-and middle-income countries. BMJ Global Health. 2022;7(5):e007681.

Nyamu, Gibson Waweru, Jimmy Hussein Kihara, Elvis Omondi Oyugi, Victor Omballa, Hajara El-Busaidy, and Victor Tunje Jeza. Prevalence and Risk Factors Associated with Asymptomatic Plasmodium Falciparum Infection and Anemia among Pregnant Women at the First Antenatal Care Visit: A Hospital Based Cross-Sectional Study in Kwale County, Kenya. Plos One. 2020; 15(10):e0239578.

ObEbE, Oluwasola Olaiya, Olaitan Olubunmi OlAjuyIgbE, Olufarati Oludunsin FAlOhuN. Prevalence of asymptomatic plasmodium falciparum infection in pregnant women in nigeria: a systematic review and meta-analysis. Annals of Parasitology. 2020;66(3).

Oboro M, IN Bob-Manuel N Chijioke O, Maduka T Kasso, Nwauche C. A prevalence of malaria among children under five years in the Niger delta region of Nigeria. Asian Journal of Paediatric Research. 2021;5(4):10–17.

Odoko, Joseph O, John E Moyegbone, Emmanuel A Agege, Omatseye A Akuirene, Charles C. Ofili, Samuel D. Nwajei, Ephraim E. Benson, Ezekiel U Nwose. Factors influencing utilization of insecticide-treated nets among pregnant women and children in bayelsa and rivers states, Nigeria. International Journal of Tropical Disease and Health. 2023; 44(11):55–69.

Okumu, Fredros O, Gerry F Killeen, Sheila Ogoma, Lubandwa Biswaro, Renate C. Smallegange, Edgar Mbeyela, Emmanuel Titus, Cristina Munk, Hassan Ngonyani, Willem Takken. Development and field evaluation of a synthetic mosquito lure that is more attractive than humans. Plos One. 2010;5(1):e8951.

Olaleye, Atinuke O, Oladapo Walker. Impact of health systems on the implementation of intermittent preventive treatment for malaria in pregnancy in sub-saharan Africa: A narrative synthesis. Tropical Medicine and Infectious Disease. 2020;5(3). DOI: 10.3390/tropicalmed5030134

Olorunniyi Omojola F, Kehinde Oluwaseun Alo, Iyabode Olamide Awelewa. Malaria parasite infection among the pregnant women who attended antenatal Care at Oke Iyinmi Primary Health Care Facility, Ado-Ekiti, Nigeria. International Public Health Journal. 2022;14(2).

Onditi Faith Isdorah. Pathology of placental malaria in baboons (Papio anubis) experimentally infected with plasmodium knowlesi; 2014.

Oridota ES, Onuoha SI, Sekoni AO, Akanmu ON, Olajide TO, Soriyan OO. Knowledge and utilization of insecticide treated net among antenatal clinic attendees of a Tertiary Hospital in Abuja, Nigeria. University of Lagos Journal of Basic Medical Sciences. 2022;1(2).

Osarfo Joseph, Gifty Dufie Ampofo, Harry Tagbor. Trends of malaria infection in pregnancy in ghana over the past two decades: A review. Malaria Journal. 2022;21(1):3.

Paris Véronique, Christopher Hardy, Ary A Hoffmann, Perran A Ross. How often are male mosquitoes attracted to humans? Royal society open science. 2023; 10(10):230921.

DOI: 10.1098/rsos.230921

Pehrson Caroline, Line Mathiesen, Kristine K Heno, Ali Salanti, Mafalda Resende, Ron Dzikowski, Peter Damm, Stefan R Hansson, Christopher L King, Henning Schneider. Adhesion of Plasmodium Falciparum Infected Erythrocytes in Ex Vivo Perfused Placental Tissue: A Novel Model of Placental Malaria. Malaria Journal. 2016;15:1–12.

Prasetyorini Nugrahanti, Nabila Erina Erwan, Rudi Priyo Utomo, Rivo Yudhinata Brian Nugraha, Loeki Enggar Fitri. The relationship between fetal weight with sequestration of infected erythrocyte, monocyte infiltration, and malaria pigment deposition in placenta of mother giving birth suffering from plasmodium vivax infection. Medical Archives. 2021; 75(4):291.

Rogerson Stephen J, Holger W Unger. Pregnancy and malaria: The perfect storm. Current Opinion in Infectious Diseases. 2022;35(5):410–16.

Rouamba Toussaint, Sékou Samadoulougou, Mady Ouédraogo, Hervé Hien, Halidou Tinto, Fati Kirakoya-Samadoulougou. Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: Household-based cross-sectional surveys in Burkina Faso, 2013 and 2017. Malaria Journal. 2021a;20(1):211.

Rouamba Toussaint, Sékou Samadoulougou, Mady Ouédraogo, Hervé Hien, Halidou Tinto, Fati Kirakoya-Samadoulougou. Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: Household-based cross-sectional surveys in Burkina Faso, 2013 and 2017. Malaria Journal. 2021b;20(1):211.

Sato, Shigeharu. Plasmodium— A brief introduction to the parasites causing human malaria and their basic biology. Journal of Physiological Anthropology. 2021;40(1):1.

Shamseddin Jebreil, Amin Ghanbarnejad, Abdoljabbar Zakeri, Farshid Abedi, Shaghayegh Khojasteh, Habibollah Turki. Molecular method is essential to identify asymptomatic malaria reservoirs: A successful experience in the malaria elimination program in Iran. Diagnostics 2022;12(12):3025.

Shretta Rima, Jenny Liu, Chris Cotter, Justin Cohen, Charlotte Dolenz, Kudzai Makomva, Gretchen Newby, Didier Ménard, Allison Phillips, Allison Tatarsky. Malaria Elimination and Eradication; 2018.

Smallegange Renate C, Geert-Jan van Gemert, Marga van de Vegte-Bolmer, Salvador Gezan, Willem Takken, Robert W. Sauerwein, James G. Logan. Malaria infected mosquitoes express enhanced attraction to human odor. PloS One. 2013;8(5):e63602.

Stratton Leeanne, Marie S O’Neill, Margaret E Kruk, Michelle L Bell. The persistent problem of malaria: Addressing the fundamental causes of a global killer. Social Science & Medicine 2008; 67(5):854–62.

Subussa Bereket Wake, Teferi Eshetu, Teshome Degefa, Musa Mohammed Ali. Asymptomatic plasmodium infection and associated factors among pregnant women in the Merti District, Oromia, Ethiopia. PLoS One. 2021;16(3):e0248074.

Sule-Odu AO, Akadri AA, Adeiyi TO, Sotunsa JO, Durojaiye BO, Oluwole AA. Prevalence of malaria parasitaemia amongst asymptomatic pregnant women in Sagamu. Tropical Journal of Obstetrics and Gynaecology. 2015;32(1):118–23.

Sumbele Irene Ule Ngole, Sharon Odmia Sama, Helen Kuokuo Kimbi, Germain Sotoing Taiwe. Malaria, moderate to severe anaemia, and malarial anaemia in children at presentation to hospital in the Mount Cameroon Area: A Cross-Sectional Study. Anemia; 2016.

Sumbele Irene Ule Ngole, Rene Ning Teh, Gillian Asoba Nkeudem, Sorelle Mekachie Sandie, Marcel Nyuylam Moyeh, Robert Adamu Shey, Cabirou Mounchili Shintouo, Stephen Mbigha Ghogomu, Gaber El-Saber Batiha, Luay Alkazmi. Asymptomatic and sub-microscopic plasmodium falciparum infection in children in the mount Cameroon area: A cross-sectional study on altitudinal influence, haematological parameters and risk factors. Malaria Journal. 2021;20:1–14.

Tairou Fassiatou, Saira Nawaz, Marc Christian Tahita, Samantha Herrera, Babacar Faye, Roger CK Tine. Malaria prevention knowledge, attitudes, and practices (KAP) among adolescents living in an area of persistent transmission in senegal: Results from a cross-sectional study. Plos One 2022;17(12):e0274656.

Uneke CJ. Diagnosis of plasmoduim falciparum malaria in pregnancy in Sub-Saharan Africa: The challenges and public health implications. Parasitology Research 2008;102:333–42.

Varo Rosauro, Carlos Chaccour, Quique Bassat. Update on malaria. Medicina Clínica (English Edition) 2020;155(9): 395–402.

Vincenz Claudius, Zachary Dolo, Serou Saye, Jennie L Lovett, Beverly I Strassmann. Risk factors for placental malaria, sulfadoxine-pyrimethamine doses, and birth outcomes in a rural to urban prospective cohort study on the Bandiagara Escarpment and Bamako, Mali. Malaria Journal. 2022;21(1):110.

Wang Penghua, Gong Cheng. Mosquito-borne pathogens hijack human body odors to promote transmission. Science China Life Sciences. 2023;66(1): 180–82.

World Health Organization. WHO Guidelines for Malaria, 3 June 2022. World Health Organization; 2022.

Zhou Guofa, Elizabeth Hemming-Schroeder, Maxwell Gesuge, Yaw A Afrane, Ming-Chieh Lee, Harrysone E Atieli, Andrew K Githeko, Guiyun Yan. Gaps between knowledge and malaria treatment practices after intensive anti-malaria campaigns in Western Kenya: 2004–2016. The American Journal of Tropical Medicine and Hygiene 2020; 102(6):1358.