A Study on the Prevalence of Malaria in Pregnant Women in Ghana

This report investigates the prevalence of malaria among pregnant women in Ghana, a significant public health concern. The study aims to address the gap in understanding behaviors related to malaria and to aid in prevention and treatment strategies. The research includes a literature review, in-depth interviews, and a survey design to determine the prevalence of the disease in the Ashanti region of Ghana. The study identifies variables such as exposure to insecticide-treated nets and potential confounding factors like financial background and awareness. A clustered sampling method was used to determine a sample size of 400. The primary outcome is to prevent malaria in pregnant women and reduce maternal morbidity, while the secondary outcome is to prevent adverse effects on the foetus. The report concludes with implications for improving malaria prevention and treatment programs, including strategies to help pregnant women understand the risks and the importance of preventive measures. The study emphasizes the need for improved access to methods like ITNs and LLINs to reduce the burden of malaria in this vulnerable population. The report also includes the hypothesis, methods, and expected outcomes of the research, with a focus on the impact of malaria on maternal, foetal, and neonatal health.

Running Head: THE PREVALANCE OF MALARIA IN PREGNANT WOMEN IN
GHANA
The prevalance of malaria in pregnant women in Ghana
Name of the student:
Name of the University:
Author Note:

1The prevalance of malaria in pregnant women in Ghana
Abstract
Malaria in pregnancy is considered to be a leading cause of maternal morbidity and poor birth
outcomes which needs to be prevented with utmost urgency. As per the literature studies
almost 80% of the pregnant women were considered to be put in Intermittent Preventive
Treatment by the end of the year 2015. The negative impacts of malaria are initially
asymptomatic but the pathogen namely Plasmodium falciparum effects the maternal foetal
and neonatal health during pregnancy. This article is based on a report on the frequency of
the occurrence of malaria in Ghana especially in the pregnant women.
Table of Content

2The prevalance of malaria in pregnant women in Ghana
s
Aim of the study.....................................................................................................................3
Objective of the research.......................................................................................................3
Introduction...........................................................................................................................3
Background of the issue........................................................................................................4
Research Hypothesis.............................................................................................................5
Methods:................................................................................................................................5
 Study location and population.....................................................................................5
 Study design and variables..........................................................................................5
 Data collection (sample size, sampling methods, instruments)...................................6
Conclusion.............................................................................................................................7
References.............................................................................................................................8
Appendix.............................................................................................................................10

3The prevalance of malaria in pregnant women in Ghana
Aim of the study
The aim of this research study is to address the gap regarding the observation and
behaviours of pregnant women affected with malaria and to aid to prevention and treatment
attitudes.
Objective of the research
The objective of the research is
 To reduce the occurrence of malaria among pregnant women.
 To aid in reduction of the maternal anaemia amongst the pregnant woman.
 To promote reduction in the low birth weight amongst pregnant women.
Introduction
It is a global priority to control the immense health impact that is associated with malaria.
One of the approachable and achievable public health goals of National Malaria Control
Programme under the Ghana Health Service is prevention of the serious health impact of the
disease especially during pregnancy (Sappenfield, Jamieson & Kourtis, 2013). The World
health assembly has affectively set a goal of reducing the burden of malaria by 75% in the
year 2015 (Kovacs, Rijken & Stergachis, 2015). Women who are expecting are exclusively
vulnerable to the drugs that are used and there are a wide variety of anti-malarials that are
commercially available to combat the symptoms. A pharmacovigilance system is established
for detection, analysis and the rectification of any adverse effect that is encountered by the
pregnant women (Menaca et al., 2013). The adverse effects of the disease during pregnancy
occur on the maternal, foetal as well as neonatal health are majorly caused by Plasmodium
falciparum (Takem & D’Alessandro, 2013). Ghana is considered as a high malaria
transmission zone. The major risk lies in the fact that the symptoms of the malarial infection

4The prevalance of malaria in pregnant women in Ghana
is generally asymptomatic. This impacts the health of the mother causing severe anaemia and
is at high risk of maternal mortality. In Ghana malaria in the pregnancy is a public health
issue (Pell et al., 2013). Malaria in the pregnancy (MiP) in the endemic countries is
considered as a major health risk. The evidences based on the literature studies show that
pregnant women are more prone to the disease in comparison to the non-pregnant women due
to the immunological hormone changes as well as similar factors.
Background of the issue
Malaria continues to be a risk for the pregnant women and their babies. This is hyper
endemic in Ghana and in the pregnant women. It is the cause of 3.4% of the maternal deaths
and cases of 13.7% of the pregnant women admission has been observed in this region (Hill
et al., 2013). In the past few years effective intervention implementation has been exploited
to aid to this highly vulnerable population. The causal microorganism for malaria is
Plasmodium falciparum which is a species prevalent in Ghana and severely found in the
pregnant women (Pell et al., 2013). The first and second pregnancies are majorly affected by
this causal microbe. The prevalence of the parasite is high in the second and the third
trimesters and the rate of susceptibility to the clinical conditions of the disease is seen to
persist in the post-partum period as well (Desai et al., 2018). The pregnant women however
may not show any visible signs of the disease but they have a high parasite density in the
placenta as well as the peripheral blood. In the Roll Back Malaria strategy malaria in
pregnancy is considered to be a high priority area. The control of the impact of the disease
during pregnancy is dependent on two major factors that includes clearing parasitaemia in
course of the disease occurrence and prevention of the disease (Ampomah et al., 2014). The
main objective of the of the study is therefore to ensure and promote safe as well as
efficacious prevention strategy for malaria during the pregnancy and puerperium in the
course of reduction of morbidity and mortality in all the pregnant women and their babies.

5The prevalance of malaria in pregnant women in Ghana
Research Hypothesis
H0: Malaria affects the foetus of the pregnant women along with the infected women.
H1: Malaria does not affect the foetus of the pregnant women along with the infected
women.
Methods:
 Study location and population
The location of the study is restricted to the geographical location of Ghana. The sample
population of the study majorly involves the pregnant women inhabiting the region of
Ashanti in Ghana. Malarial is endemic in Ghana and almost around 27 million inhabitants are
susceptible to the disease. The investigation population consist of the women pregnant as
well as the non-pregnant residing in an epidemic area of malaria in Ghana known as Ashanti.
The target population is the pregnant women in the Ashanti region of Ghana.
 Study design and variables
The quantitative studies can be descriptive or experimental based on the size of the
sample. It ponders on the emotional insight exploiting the aim of the study. Quantitative
research can be a survey, correlational study, comparative study or an experimental study.
The survey study can be regarded as the best design for this chosen article as this would
ensure real time scenario of the disease prevalence and the consecutive approach that is
followed for prevention. This is a survey study that is exploited to determine the prevalence
of the disease. The survey method though laborious it is the most inexpensive method of data
extraction and it also ensures collecting detailed real time scenario of the study. The major
advantage of this survey study is to ensure reaching large population of people comparatively
easily as well as economically. It aids to provide quantifiable data in support of the research
topic. This promotes easy analysis. The local interviewers were educated and trained about

6The prevalance of malaria in pregnant women in Ghana
malaria, qualitative research methods and the ethics by the members involved in the research
study team. The training would exploit a detailed review on the interview guides to ensures
clarity and promotes better understanding as well as role-playing to prepare the team for
successful data collection. The data collection methods exploited are in-depth interviews
(IDIs) of the respondents collecting detailed and personal information (Laar, Laar &
Dalinjong, 2013). The additional information can be collected by exploiting focus groups.
The individuals involved in the interview team are segregated in teams of two with one
person taking the IDI and the other person taking the notes. The IDI should be conducted in
the regional language. A bed net should be provided for the pregnant women. The questions
are focused on the health concerns as well as the knowledge associated with the disease, the
respective views of the individual on the prevention and treatment of malaria. The questions
should also involve around the modern as well as the traditional approaches to prevent and
treat malaria. The questionnaire revolves around the availability and the affordability of the
modern methods. The questions should also focus on the protect plans they follow against
malaria during pregnancy. They should be asked whether they have been affected with
malaria in their pregnancy times or in other times (Owusu-Ofori et al., 2013).
 Data collection (sample size, sampling methods, instruments)
Clustered sampling method is exploited to involve the testing of the selected samples of a
given population. The efficiency of this sampling technique is to reduce costs by promoting
the efficiency of the sampling.
The expected prevalence of the population is 15%
Acceptable error: 5%
Design effect: 1.0
Cluster: 10

7The prevalance of malaria in pregnant women in Ghana
Confidence level: 95%
The p value is assumed to be 0.5 to maximize the error margin.
The formula exploited for sample size calculation is:
z¿ √ {(p*(1-p))/n} ≤ 5 %
z value is obtained from the Z table on the basis of the confidence level of 95%
The value of z= 1.96
1.96¿ √ {(0.5*(1-0.5))/n} ≤ 0.05
The n calculated was 400.
Hence, based on the calculation the estimated sample size is 400.
The primary outcome of the research article is to ensure prevention and eradication of
malaria that is prevalent in the pregnant women in comparison to the non-pregnant women.
This would reduce the rate of maternal morbidity. The secondary outcome of the research
study is that if the disease is prevented in the mother the foetus will also not be affected and
the pregnant women would give birth to healthy babies. It can be measured from the hospital
records by enlisting how many expecting mothers visited for the treatment of malaria.
The exposure factors of this epidemiological study includes several malarial control
interventions like exploiting insecticide treated nets (ITNs), Indoor residual spraying (IRS)
and rapid diagnostic test (RDTs) has contributed to the malaria control in Ghana. Exploiting
these exposures ensures positive outcome that aids in prevention of the disease even through
there is no proof of complete eradication of the same. Financial background and lack of
awareness on the disease can be regarded as a confounding factor for this survey.

8The prevalance of malaria in pregnant women in Ghana
Conclusion
The findings based on this article will ensure in yielding important understanding about
how the practices, knowledge and the attitude related to malaria may vary and it may vary
widely. It will ensure implications not only for the improvement of the effectiveness of the
implementation of the malaria prevention treatment programs. The efforts should ponder on
the strategies to aid pregnant women understand the risk even if the risk is low rated. The
outcome of the study is to promote prevention of the disease in pregnant women. The
exposure of the study are the factors that are exploited to prevent the cause of the disease.
This would ensure improved local access to prevention of malaria methods like ITNS and
LLINs in the attempt to reduce the burden of the disease in this population.

9The prevalance of malaria in pregnant women in Ghana
References
Ampomah, P., Stevenson, L., Ofori, M. F., Barfod, L., & Hviid, L. (2014). B-cell responses
to pregnancy-restricted and-unrestricted Plasmodium falciparum erythrocyte membrane
protein 1 antigens in Ghanaian women naturally exposed to malaria parasites. Infection and
immunity, 82(5), 1860-1871.
Desai, M., Hill, J., Fernandes, S., Walker, P., Pell, C., Gutman, J., ... & Cot, M. (2018).
Prevention of malaria in pregnancy. The Lancet infectious diseases, 18(4), e119-e132.
Hill, J., Hoyt, J., van Eijk, A. M., D'Mello-Guyett, L., ter Kuile, F. O., Steketee, R., ... &
Webster, J. (2013). Factors affecting the delivery, access, and use of interventions to prevent
malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS
medicine, 10(7), e1001488.
Kovacs, S. D., Rijken, M. J., & Stergachis, A. (2015). Treating severe malaria in pregnancy:
a review of the evidence. Drug safety, 38(2), 165-181.
Laar, A. S., Laar, A. K., & Dalinjong, P. A. (2013). Community perception of malaria and its
influence on health-seeking behaviour in rural Ghana: a descriptive study. Malaria World
Journal, 4(1), 1-4.
Menaca, A., Pell, C., Manda-Taylor, L., Chatio, S., Afrah, N. A., Were, F., ... & Pool, R.
(2013). Local illness concepts and their relevance for the prevention and control of malaria
during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative
study. Malaria journal, 12(1), 257.
Owusu-Ofori, A. K., Betson, M., Parry, C. M., Stothard, J. R., & Bates, I. (2013).
Transfusion-transmitted malaria in Ghana. Clinical infectious diseases, 56(12), 1735-1741.

10The prevalance of malaria in pregnant women in Ghana
Pell, C., Meñaca, A., Afrah, N. A., Manda-Taylor, L., Chatio, S., Were, F., ... & Pool, R.
(2013). Prevention and management of malaria during pregnancy: findings from a
comparative qualitative study in Ghana, Kenya and Malawi. Malaria journal, 12(1), 427.
Pell, C., Meñaca, A., Were, F., Afrah, N. A., Chatio, S., Manda-Taylor, L., ... & Ouma, P.
(2013). Factors affecting antenatal care attendance: results from qualitative studies in Ghana,
Kenya and Malawi. PloS one, 8(1), e53747.
Sappenfield, E., Jamieson, D. J., & Kourtis, A. P. (2013). Pregnancy and susceptibility to
infectious diseases. Infectious diseases in obstetrics and gynecology, 2013.
Takem, E. N., & D’Alessandro, U. (2013). Malaria in pregnancy. Mediterranean journal of
hematology and infectious diseases, 5(1).

11The prevalance of malaria in pregnant women in Ghana
Appendix
This survey exploits the risk of acquiring malaria for the women especially the expecting
mothers in the geographical location of Ashanti in Ghana. A survey for the prevalence and
prevention of malaria among expecting mothers are being performed in the region of Ashanti
in Ghana.
Interview release consent form:
You (interviewee) _______________ has been asked to give the information to (the
interviewer) ______________, a scholar affiliated to the esteemed university
_____________________ for preparing the background and the prevention of malaria in
pregnant women in Ghana. The anticipated time for completion of the interview is atleast two
hours. You can omit the questions you do not wish to answer.
I, ______________________, have read the above and acknowledge the same and
voluntarily allow _________________the full exploitation of this information and authorize
him to publish the same.
The questionnaire should include the following:
Serial
No.
Questions Yes/No
(√/X)
1. Are you aware of the common symptoms
of malaria?
2. Do you think it is harmful for malaria to be
left untreated in pregnant women?
3. Is malaria a contagious disease?
4. Is resources available for immediate aid
for the patients who have acquired
malaria?
5. Did you acquire malaria when you
conceived?
6. Have you suffered miscarriage in course of
acquiring malaria?
7. Did you give birth to baby with low
molecular weight after having malaria?

12The prevalance of malaria in pregnant women in Ghana
8. Are you aware of the preventive measures
to prevent malaria?
9. Do you regularly use ITNs or LLINS?