Trends of malaria infection in pregnancy in Ghana over the past two decades: a review

Abstract

Background: There has been a global decline in malaria transmission over the past decade. However, not much is known of the impact of this observation on the burden of malaria infection in pregnancy in endemic regions including Ghana. A narrative review was undertaken to help describe trends in malaria infection in pregnancy in Ghana. Among others, such information is important in showing any progress made in malaria in pregnancy control.

Methods: To describe trends in pregnancy-associated malaria infection in Ghana, a search and review of literature reporting data on the prevalence of asymptomatic Plasmodium falciparum infection in pregnancy was conducted.

Results: Thirty-six (36) studies, conducted over 1994-2019, were included in the review. In the northern savannah zone with largely seasonal malaria transmission, prevalence appeared to reduce from about 50-60% in 1994-2010 to 13-26% by 2019. In the middle transitional/forest zone, where transmission is perennial with peaks in the rainy season, prevalence apparently reduced from 60% in the late 1990 s to about 5-20% by 2018. In the coastal savannah area, there was apparent reduction from 28 to 35% in 2003-2010 to 5-11% by 2018-2019. The burden of malaria infection in pregnancy continues to be highest among teenagers and younger-aged pregnant women and paucigravidae.

Conclusions: There appears to be a decline in asymptomatic parasite prevalence in pregnancy in Ghana though this has not been uniform across the different transmission zones. The greatest declines were noticeably in urban settings. Submicroscopic parasitaemia remains a challenge for control efforts. Further studies are needed to evaluate the impact of the reduced parasite prevalence on maternal anaemia and low birthweight and to assess the local burden of submicroscopic parasitaemia in relation to pregnancy outcomes.

Keywords: Asymptomatic parasitaemia; Ghana; Malaria in pregnancy; Plasmodium falciparum; Prevalence; Trends.

Fig. 1

Map of Ghana showing the malaria epidemiological zones and the administrative regions (Source: Awine et al. [13])

Fig. 2

Flow diagram for literature search strategy

Fig. 3

Malaria in pregnancy test positivity rates in Greater Accra, Ashanti and the former Northern Region (2014–2020) (Source: DHIMS 2, April 2021. See Additional file 1: Table S1)