Prevalence of asymptomatic Plasmodium species infection and associated factors among pregnant women attending antenatal care at Fendeka town health facilities, Jawi District, North west Ethiopia: A cross-sectional study

BACKGROUND: Malaria in pregnancy remains a major public health problem especially in sub-Saharan Africa. In malaria endemic areas, majority of pregnant women may remain asymptomatic but still associated with complications on the mother and her foetus. They also serve as reservoirs and act as transmitters of infection. Despite these effects, the prevalence of asymptomatic Plasmodium species infections among pregnant women attending antenatal care has not been yet studied at the study area. Therefore, the aim of this study was to assess the prevalence of asymptomatic Plasmodium species infections among pregnant women attending antenatal care at Fendeka town health facilities. METHODS: Health facility based cross -sectional study was conducted from February to March 2019. A total of 331 participants were enrolled by using convenient sampling technique. Socio-demographic and associated factors were collected by a face to face interview. All the 331 samples were tested using rapid diagnostic tests (RDTs) and microscopy. However, only 83 dried blood spot (DBS) samples out of 331 participants, were collected by using systematic random sampling technique for molecular analysis. Data was analysed using SPSS version 20. Descriptive statistics were used to determine the prevalence of asymptomatic Plasmodium species infections. Univariate logistic regression was employed to assess factors associated with asymptomatic Plasmodium species infection. Variables with P-value < 0.25 in the univariate logistic regression were selected for multivariate logistic regression analysis model. Odds ratios with 95% confidence intervals were calculated and P- values < 0.05 were considered as statistically significant. RESULTS: Overall, 37 (11.2%) asymptomatic Plasmodium species infections were detected using: RDTs, microscopy and real-time PCR altogether. The asymptomatic Plasmodium species infection prevalence was 17 (5.1%), 30 (9.1%) and 15(18.1%) using RDTs, microscopy and real-time PCR, respectively. Asymptomatic Plasmodium species infections were more likely to occur in primigravida (AOR: 4.51, 95% CI: 1.27-16.03), secundigravida (AOR: 3.87, 95% CI: 1.16-12.93), rural inhabitants (AOR: 4.51, 95% CI: 1.72-11.84) and in participants who did not use indoor residual spray (IRS) for the last one year (AOR: 3.13, 95% CI: 1.47-6.66). CONCLUSIONS: The prevalence of asymptomatic Plasmodium species infection was 11.2%. Pregnant women who reside in the rural area, primigravidae, secugravidae and those who did not utilize indoor residual spray for the last one year were at high risk of infection. Therefore, routine laboratory diagnosis of asymptomatic Plasmodium species infection among pregnant women should be adopted as a part of the antenatal care.