Assessment of the Nutritional Status and Risk Factors of Malaria among Pregnant Mothers in Owerri Rural Communities, Southeastern Nigeria ">

Research Article

Int J Nutr Sci. 2021; 6(1): 1048.

Assessment of the Nutritional Status and Risk Factors of Malaria among Pregnant Mothers in Owerri Rural Communities, Southeastern Nigeria

Onyeneke EN¹*, Ifeanacho MO², Amadi JA¹, Okeke PN¹ and Ukwujiagu CU³

¹Department of Nutrition and Dietetics, Imo State University, Nigeria

²Department of Nutrition and Dietetics, University of Portharcourt, Nigeria

³Department of Home Economics, Alvan Ikoku Federal College of Education, Nigeria

*Corresponding author: Onyeneke EN, Department of Nutrition and Dietetics, Imo State University, P.M.B. 2000 Owerri, Imo State, Nigeria

Received: March 10, 2021; Accepted: March 31, 2021; Published: April 07, 2021


Malaria during pregnancy remains a serious public health problem, with substantial risk for the mother, her fetus and the new born. A crosssectional study was conducted in Owerri rural hospitals among 150 pregnant mothers in Emekuku and Uratta rural communities in Owerri, Imo State using questionnaire. Ninety (90) pregnant women from Holy Rosary Hospital Emekuku and 60 pregnant women from Redeemed Jesus People hospital and maternity, Uratta, Owerri within the age range of 20-50 years were involved in this study. Anthropometric data, age, weight and height were collected using standard scale and the meter rule. Cluster analysis was applied for the identification of the groups with similar nutritional habits and anthropometric parameters. At the end of the data collection and analysis, it was obtained that 40.7% of the women lived in a moderately bushy environment, 13.3% in a very bushy environment, 6.6% lived in a bushy environment while 39.4% however lived in a very clean environment. In assessing the nutritional status the result indicates that 45.3% skipped meals while 54.7% do not. 82.7% of the women had a history of malaria while 17.3% had none. 22% of the pregnant women were malaria positive while 78% were negative. 56.7% of the women had mosquito net while 43.3% did not. 53.3% of the women disliked some food, 82% took supplement, and 36.7% took multivitamins. About 50 % of the pregnant women were overweight. The anthropometric characteristics of respondents showed that women from 40-50 years had high mean in their respective variables and no significant difference (p>0.05) in their ranges. The use of Insecticide-Treated Mosquito nets (ITNs) was found to be associated with malaria infection; pregnant women who did not use ITNs frequently were more affected by malaria as compared to those who did.

Keywords: Malaria; Risks; Pregnant women; Rural Community; Nutrition


Malaria is a major public health problem in 97 countries and territories in the tropics and subtropics. Globally, approximately 214 million cases of malaria occur annually and 3.2 billion people are at risk of infection [1]. Approximately 438,000 deaths were attributed to malaria in 2015, particularly in sub-Saharan Africa, where an estimated 90 % of all malaria deaths occur [1]. As a critical target of the Millennium Development Goals, in 2005, the World Health Assembly established a goal of reducing malaria cases and deaths by 75% between 2005 and 2015 [2]. Hence, over the past decade, there has been greatly renewed interest in research and innovations in diagnostic methods, drugs and vaccines, and the development of control measures to eradicate malaria [3]. As a result, between 2000 and 2013, the incidence rates of malaria fell by 30% globally, and by 34% in Africa [4].

Nigeria suffers the world’s greatest malaria burden, with approximately 51 million cases and 207,000 deaths reported annually (approximately 30% of the total malaria burden in Africa), while 97% of the total population (approximately 173 million) is at risk of infection [5]. Moreover, malaria accounts for 60% of outpatient visits to hospitals and led to approximately 11% maternal mortality and 30% child mortality, especially among children less than 5 years [6,7]. Studies have shown that 40% of pregnant African women present for the first time to antenatal clinics in the second trimester of their pregnancy [9]. The ITNs, part of the prevention package delivered during the first antenatal clinic visit would provide additional protection for the mother during the remaining trimesters of pregnancy and into the post-partum period, as well as protection for the newborn through at least the first year of life [9].

In Africa, 30 million women living in malaria endemic areas become pregnant each year. For these women, malaria is a threat both to themselves and to their babies, with up to 2 million newborn deaths each year as a result of malaria in pregnancy [9]. Pregnancy exacerbates malaria through a non-specific activity of the immune system. The protective anti-plasmodial activity is suppressed at pregnancy, which has clinical consequences with important public health implications on pregnant women [10,11]. The symptoms and complications of malaria during pregnancy differ with the intensity of malaria transmission and the level of immunity the pregnant women has acquired [9]. Malaria infection of the mother may result in a range of adverse pregnancy outcomes [7].

Human malaria is caused by the protozoan parasite of the genus Plasmodium. It lives in the red blood cells and is transmitted by the female anopheles mosquito [12]. Malaria is a disease with major health problems that has attracted global concerns; hence it is regarded as the most important parasitic disease [11], which causes spontaneous abortion, neonatal death, low birth weight and intrauterine growth retardation [8]. In these areas, the principal impact of malaria infection is associated with malaria related anaemia in the mother and with the presence of the parasites in the placenta. The resultant impairment of foetal nutrition contributing to low birth weight is a leading cause of poor infant survival and development [13].

More than 90% of the total Nigerian population is at risk of malaria and at least 50% of the population suffers from at least one episode of malaria each year [14]. The initiative ‘Roll Back Malaria’ launched in 1998 in partnership with the United Nations Children’s Fund (UNICEF), WHO and many other non-governmental agencies seems not to be producing effective results in some malarial endemic communities of Nigeria as malaria problem is still on the increase. Many studies have reported high prevalence rates of malaria in pregnancy in different parts of Nigeria, ranging from 19.7 to 72.0% [9,15,16]. With such reported high prevalence, there is a need to determine the extent of infection by Plasmodium falciparum in endemic communities of Nigeria as this will help in the proper management of the disease. The major objective of the study will be to assess the nutritional status and risk factors of malaria among pregnant mothers in Owerri rural communities. The results of the above study will be of immense significance to nutritionists-dietitians as it will provide knowledge on the risk factors of malaria and suggest avenues to combat them. Government policies can be channeled towards alleviating malaria in the community.

Materials and Methods

Study area

The above study was carried out at Holy Rosary Hospital Emekuku and Redeemed Jesus People Hospital and Maternity Uratta rural communities in Owerri, Imo State. Owerri geographically lies within latitude 5.4891° N and longitude 7.0176° E and is the capital city of Imo state in Southeastern, Nigeria, with a populace of 1,401,873 as at 2006, which has expanded significantly after over 10 years. The daytime temperatures of the territory extend from 18-34 °C [17]. Every day mean most reduced temperatures of 19°C and most elevated temperature of 28°C are normally seen in the region. The region has assessed evapotranspiration pace of 1450-1460 mm/yr. Additionally, there is typically low relative humidity from January to March just as of in November to December which are the long stretches of dry period. In the long periods of April to October, which are generally the wet period, relative humidity estimations of 97% are recorded [18]. Precipitation has stayed a significant ecological element, which could fundamentally impact natural examinations. The long periods of July and August are the time of concentrated precipitation in the examination zone coordinated by toward the north development of nautical air from the Atlantic Ocean. Exchange times of precipitation and daylight conditions are seen in the territory because of the zone claiming to the set up attributes of the overwhelming precipitation. The initiation of precipitation is in the period of April which last up to October. The yearly mean precipitation is inside 2500-4000 mm, with over 89% of the precipitation saw in the long stretch of May to October [18]. The power and consistency of the rainfalls just as the huge shallow spillover because of the steep water storehouses bring about genuine flooding of the territory. Frequently, the rainfalls are joined by genuine tempests along with overwhelming flooding and water flood.

Study design

A cross-sectional study was conducted among 150 pregnant mothers in Emekuku and Uratta rural communities in Owerri, Imo State, Nigeria. A predesigned and pretested questionnaire was used in the data collection to assess nutritional status and risk factors of malaria among of the respondents. The anthropometrical parameters included the measurement of body weight and height as well as waist, hip and arm circumferences (assessed with the means of a flexible tape with an approximation of 0.1 mm). BMI parameter was calculated to identify the underweight, overweight and obesity within the studied group.

Sample size determination

The sample for this study comprised of 150 pregnant mothers that was drawn from 2 rural communities in Owerri (Emekuku and Uratta), Imo State. Cluster analysis was applied for the identification of the groups with similar nutritional habits and anthropometric parameters. The population size was 230 and margin of error /test of significant =0.05 and from calculated as described by Okwa [9] and Onyeneke et al. [19], a sample size was estimated to be 150. Hence 150 pregnant mothers among 230 was used for the study.

Data analysis

One hundred (150) questionnaires was distributed among pregnant mothers and measurement was taken. Body height and mass was measured using a digital scale, with approximations of 0.5 cm and 0.1 kg, respectively. Circumferences of waist, hip and arm will be assessed. Numbers was used in the data collected from the respondents through questionnaire and will be analysed in frequencies and percentages.

Data collection

A validated pretested questionnaire was used to collect relevant data from the respondents on their personal data, nutritional status and risk factors of malaria.

Anthropometry: Anthropometric measurements of weight and height were obtained from all subjects. Weight was measured in light indoor clothing to the nearest 0.1 kg with a beam balance scale. Height was measured without shoes to the nearest 0.1 cm using a portable stadiometer. The researcher explained the exercise in a manner that the respondents would understand and participate actively.

Height measurements: A measuring rod or stadiometer was used to measure the height of the respondents. Shoes, socks and hair grips were removed. The back of the head, shoulder blades, buttocks, calves and heels was touching the vertical board. Legs were straight, with the head looking straight ahead. The horizontal line from the ear canal to the lower border of the eye socket will run parallel to the baseboard. Measurements were taken twice and average recorded.

Weight measurements: Weight was obtained using a weighing scale (bathroom scale). The weighing must be accurate to ± 0.1kg and calibrated frequently using standard. Weight was measured in Kilogram (kg). The scale was placed on a flat, hard, even surface, preferably not on a loose carpet or rug. The respondent being measured stood in the middle of the scale, feet slightly apart and remained still until the weight appeared on the display. Record was taken to the nearest 0.1 kg [1]. Measurements will be taken twice and average recorded.

Body Mass Index (BMI): BMI (Body mass index) is generally considered as a good indicator and used for the assessment of chronic energy deficiency of adults, especially in developing countries [20]. It is highly correlated with fat and fat-free mass and so the protein and fat reserves of body can be estimated [20]. The BMI (kg/m²) is computed as the ratio of the body weight in kg to height in m². Standard according to World Health Organization [1] for BMI classification is as follows; <18.5 as underweight, 18.5-24.9 as normal, 25-29.9 as overweight, 30-34.9 as obesity class I, 35-39.9 as obesity class II and >40 as gross obesity.

Waist circumference: It was measured with a flexible non-stretch tape measure, which was placed on the smallest area below the rib cage and at the level of belly button (umbilicus) around the waist, with the subject standing erect. Abdominal muscles relaxed arms by the side and feet together. The tape was held firm and the readings taken twice to the nearest 0.1 cm at the end of normal expiration (breathing out) and average recorded.

Hip circumference: A flexible non-stretch measure was used and it was placed at the point of greatest circumference around the hip region with the subject standing erect, arms at the sides. The rope was tightened to make close contact with the body but without indenting the soft tissues. The reading was taken twice to the nearest 0.1 cm and average recorded.

Waist-hip-ratio: The Waist to Hip Ratio (WHR) was calculated by dividing the waist Circumference (cm) by the height Circumference (cm). When WHR for men >0.95 cm and women >0.8cm indicates android obesity which means excess fat deposition around the waist and upper abdomen. It indicates high risk for diabetes and cardiovascular diseases. The classification for WHR for male and female is presented is as follows; when it is ≤0.95 or below for male and ≤0.80 for female is considered low risk; when it is 0.95-1.0 for male and 0.81-0.85 for female it is considered moderate and when >1.0 for male and >0.85 for female it is considered high risk [19,20].

Dietary assessment using 24hr recall: Food consumption pattern was assessed with the 24hr recall method. During the interview, samples of local household dishes and utensils (different sizes of bowls, plates, cups, glasses and spoons) was displayed to the participants. The 24hr recall method required participants to recall all food and beverages consumed during the previous 24hrs, food samples was used during the completion of these questionnaires to assist the participants in estimating portion sizes. One 24hr recall was completed for food consumed during the week and one completed for food consumed over the weekend. The weekend dietary intake may be different and therefore may not be the representative of the usual dietary pattern for most days. The questionnaire was completed in an interview situation.

Food frequency questionnaire: A food frequency questionnaire was used to express the data obtained from 24 hour dietary recall on each participant’s diet over a day period. All participants completed the FFQs in an individual interview with the assistance of a fieldworker or the researcher.

The participants were asked to provide detailed information regarding the types and amounts of all foods, beverages and nutritional supplements consumed over a period. All related foods were grouped together. Participants were asked to indicate their frequency of consumption of items per day.

Risk factors of malaria: Data on the risk factors of malaria such as respiratory distress, concomitant pneumonia, severe anemia, enlarged liver, low blood sugar, and hemoglobin in the urine with renal failure and acute respiratory distress syndrome. The knowledge of malaria preventions by the use of insecticide treated nets, mosquito repellants, draining standing water and environmental hygiene; and management such as use of malarial drugs like Artemeter, Lumefantrine, Mefloquine, or Sulfadoxine/Pyrimethamine tablets will be determined by the distribution of a validated and pretested questionnaire. Data was also collected on symptoms of the disease such as fever, headache, and tiredness and vomiting.

Data analysis

Statistical analysis of the data obtained from the study was carried out using IBM SPSS version 21. The Pearson’s correlation was carried out to determine the relationship between knowledge of the risk of malaria and nutritional status of the pregnant mothers.

Results and Discussion

Table 1 showed the basic characteristics of the women, 2% of the women are single, a higher number of them are married (95.3%) and only 2.7% of the women are divorced. The result also showed that 12% of the women are civil servants, 14.7% were house wives and 73.3% were traders. Because the research was carried out in the eastern part of Nigeria where Christianity is the main religion 98.7% of the women are Christians and only 1.3% are Muslims. 100% of them are from Igbo ethnic group. An age range of 20-50 was used in this research and 37.3% of the women are in the age range of 20-30, 61.3% were in the age range of 30-40 while 1.3% of the women were in the age range of 40-50 respectively.