ANALYSIS OF RISK FACTORS FOR PREGNANT WOMEN INFECTED WITH MALARIA

Analisis Faktor Resiko Ibu Hamil Yang Terinfeksi Malaria

Background: Malaria is a disease caused by protozoa infection of the genus Plasmodium transmitted through the bite of infected female Anopheles mosquitos. Malaria infection in pregnancy is detrimental to both the mother and the fetus. Several efforts to prevent and eradicate malaria have been implemented, but many pregnant women are still infected with malaria. Purpose: To know the risk factors for pregnant women infected with malaria. Methods: This study used the literature review method by searching for articles analyzing risk factors for pregnant women infected with malaria. Articles were searched from two databases, namely PubMed and Google Scholar. The keywords used are "Pregnant Women" AND "Infected Malaria". The inclusion criteria (IC) in the article search were publication year: articles published in the last 5 years from 2018-2023 with the subject of pregnant women infected with malaria; the paper should be full text, with a Cross-sectional and case-control study. Results: This study involves 10 articles discussing the analysis of risk factors for pregnant women infected with malaria. Some studies revealed that the host, agent, and environment highly determine the spread of malaria. The spread of malaria occurs when those three components support each other. Risk factors for malaria are pregnant women's residence, wire netting installation on ventilation, and use of mosquito nets and repellent. Conclusion: Based on the reviewed articles, it can be concluded that pregnant women who do not use mosquito nets and whose residences are close to standing water and bushes have a greater risk of getting malaria.

INTRODUCTION

Malaria is the central public health problem in tropical and subtropical countries (1). This disease still becomes a threat to society due to its high morbidity and mortality rates at reproductive age (2). Malaria is caused by protozoa infection of the genus Plasmodium transmitted through the bite of infected female Anopheles mosquitos. This disease attacks organs such as the brain, liver, and kidneys, and then parasites grow and reproduce in these organs (3). Its transmission is the same as other infectious diseases in general, namely determined by the host (humans and Anopheles mosquitoes), agent (plasmodium parasites), and environment (physical, chemical, biological, and social environment) (4,5).

Malaria is one of the most common infectious diseases found in various countries. Globally, there were 82.6 million babies born to pregnant women who are at risk of infection with Plasmodium (P) falciparum and P. vivax, which cause malaria. The incidence of malaria P. falciparum and P. vivax reaches 88.2 million (70%) out of the total 125,200,000 pregnancies (6). Of these, 54.4 million occurred in malaria-endemic areas in the Asia-Pacific region and 33 countries with moderate and high transmission in the African Region in 2020. The World Health Organization (WHO) estimated that 11.6 million (34%) out of 33,8 million pregnancies were exposed to malaria infection during pregnancy(7). Most cases of malaria were found in the African region (93%), followed by the Southeast Asian region (3.40%) and the Eastern Mediterranean region (2.10%) (8). In Indonesia, malaria cases reached 235,700 cases in 2020. The Ministry of Health reported 304,607 malaria cases in 2021(9). In pregnancy, malaria becomes a significant cause of morbidity and mortality, causing approximately 100,000 neonatal deaths and 10,000 maternal deaths each year(10).

Malaria is an infectious disease whose control efforts are a commitment to the Sustainable Development Goals (SDGs) until 2030(11). Malaria is a public health problem that can cause death, reduce work productivity and affect various aspects of life (11). Symptoms appear 10 to 15 days after being bitten by an Anopheles mosquito in the form of intermittent mild fever, headaches, muscle aches, chills, and feeling unwell (malaise) (12). This disease can affect all individuals regardless of age, gender, and pregnant women (3). Malaria infection in pregnancy is detrimental to both the mother and the fetus because it can increase the incidence of morbidity and mortality (13). In mothers, malaria infection can cause anemia, pulmonary oedema, cerebral malaria, kidney failure, and even death. In the fetus, it can cause premature labour, abortion, LBW, and death(14).

Pregnant women are more susceptible to parasite infection, and this susceptibility is most closely related to the immunological changes during pregnancy. The parasites causing malaria tend to accumulate in the placenta (15). Plasmodium causes malaria and hurts pregnancy and babies(16). Malaria infection in pregnancy is detrimental for both the mother and the fetus as it can increase the morbidity and mortality of both mother and fetus(17). In pregnant women, malaria can cause fever, anemia, hypoglycemia, acute pulmonary oedema, kidney failure, increased risk of premature birth, trigger an abortion, low birth weight (LBW), fetal weight less than gestational age (IUGR), and even death (18). Pregnant women can quickly contract malaria due to immune system changes during pregnancy, including cellular and humoral immunity, and an increase in cortisol hormone. This infection can worsen pregnancy, leading to severe anemia. The parasite can also affect blood supply to the placenta, causing it to invade and disrupt the transplacental transfer of food and oxygen, potentially causing pre-term birth.(19). Without proper and immediate handling, it will continue in the delivery process, which can also cause post-partum bleeding (20). This study aims to analyze the risk factors for pregnant women infected with malaria.

METHODS

This study used the literature review method by searching articles from specific databases. This study used secondary data obtained from the results of previous studies and not through direct observation. The inclusion criteria (IC) consist of IC1 article should be published in the journal, IC2 in the article search were publication year, namely articles published in the last 5 years from 2018-2023 with the subject of pregnant women infected with malaria, IC3 with Cross-sectional study and case-control, IC4the paper should be full text.

The article search used keywords (NOT, OR AND or AND NOT) to make searching for the required journal easier. The keywords used are "Pregnant Women" AND "Infected Malaria". Secondary data sources are articles related to the topic obtained from Google Scholar and PubMed. In IC1, published journals obtained 4,650 articles; in IC2, the researcher determined the publication year from 2018 to 2023, obtaining 4,600 articles. In IC3, the selection criteria were using the same type of method, while IC4 selected excluded journals due to duplicates and unsuitable article contents with the issue in this study. After selecting the articles according to the topic of this study, the researcher obtained 420 journals.

Further identification was carried out in more detail to determine relevant articles that meet the inclusion criteria in this literature review. Based on IC1-IC4 selection criteria, some articles were selected for further review. Then, they were reselectedbased on IC5, namely based on the compatibility of article titles and abstracts with the aim of this review literature, namely to have the main content related to risk factors in pregnant women infected with malaria. Finally, the researcher obtained 10 articles for further review. The process of identifying articles can be seen in Figure 1.

Figure 1.PRISMA Diagram

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