ANALYSIS OF MALARIA IN PREGNANCY (MIP) CARE AMONG FIRST ANTENATAL CARE (ANC) ATTENDEES IN UGANDA: A CASE STUDY OF KAMULI HOSPITAL
CHAPTER ONE
1.0 Introduction
This chapter presents the background to the study, statement of the problem, study objectives, research questions, scope, and significance of the study.
1.1 Background of the Study
Globally, maternal mortality has declined by approximately 38%. Despite this progress, an estimated 295,000 women died in 2017 from preventable pregnancy- and childbirth-related causes. Notably, over 94% of these deaths occurred in low- and middle-income countries, with adolescents disproportionately affected compared to older women (Woldeamanuel & Belachew, 2021). High maternal mortality rates in developing regions, particularly sub-Saharan Africa, have been strongly linked to low utilization of antenatal care (ANC) services. In countries such as Uganda, malaria during pregnancy remains a major contributing factor (Ukaegbu, 2020).
Globally, more than 125 million pregnancies are exposed to malaria annually, with sub-Saharan Africa accounting for a substantial share of this burden. Although the effects of malaria in pregnancy on maternal and neonatal outcomes are well documented, the impact of infection timing—especially during the first trimester—remains insufficiently explored. Pregnant women in malaria-endemic areas are more susceptible to infection than non-pregnant women, with a threefold increased risk of severe malaria and mortality rates approaching 50% in severe cases. Malaria parasites, particularly Plasmodium falciparum, accumulate in the placenta, contributing to maternal illness and adverse birth outcomes such as low birth weight, particularly in Africa (WHO, 2017; Belay et al., 2022).
In many developing countries, including Uganda, early initiation of antenatal care remains suboptimal. According to the Uganda Demographic and Health Survey (UDHS, 2016), only about 52% of pregnant women begin ANC visits within the first trimester (Tripathy & Mishra, 2023). Yet, early and adequate ANC attendance is widely recognized as a critical strategy for reducing maternal and neonatal morbidity and mortality. The World Health Organization initially recommended four ANC visits, but revised its guidelines in 2016 to eight contacts, with the first occurring within the first 12 weeks of pregnancy (Engdaw et al., 2023).
In response, Uganda adopted the focused antenatal care model in 2003 and later updated it to align with WHO recommendations, emphasizing a continuum of care that includes eight ANC contacts, skilled delivery, and postnatal care (Tessema et al., 2021). Although 97% of women receive at least one ANC service from a skilled provider, only about 30% initiate care in the first trimester, and maternal morbidity and mortality rates remain high (Chilot et al., 2023).
Malaria during pregnancy poses serious risks not only to the mother but also to the unborn child. Infection leads to destruction of red blood cells, causing anemia characterized by fatigue, weakness, dizziness, and shortness of breath (Tackie et al., 2021). Furthermore, malaria increases the likelihood of complications such as preterm birth, intrauterine growth restriction (IUGR), low birth weight, miscarriage, and stillbirth (Sangho et al., 2021; Tarekegn et al., 2021). Severe cases may result in life-threatening conditions including cerebral malaria and organ failure (Maduka et al., 2020).
Malaria remains a significant global public health concern. In 2016, approximately 216 million malaria cases were recorded worldwide, resulting in about 445,000 deaths. Over 88% of this burden occurs in Africa, with pregnant women and children under five being the most affected groups. In Africa, malaria contributes significantly to maternal anemia, low birth weight, and infant mortality (Anchang-Kimbi, 2020; Olarewaju, 2020).
In Uganda, over 90% of pregnant women are at risk of malaria infection, placing the country among the highest-burden nations globally. Malaria accounts for nearly 50% of outpatient visits among pregnant women, 15–20% of hospital admissions, and up to 20% of hospital deaths (Chijioke, 2020). The Uganda Malaria Indicator Survey (2018) further highlights high levels of malaria parasitaemia across the country, with varying degrees of endemicity (UDHS, 2021).
1.2 Statement of the Problem
According to the World Health Organization, malaria during pregnancy contributes to approximately 10,000 maternal deaths globally each year. Despite concerted efforts by the Government of Uganda and development partners to reduce malaria prevalence among pregnant women, the disease continues to account for a significant proportion of morbidity—estimated at around 40% relative to other illnesses.
Pregnant women are particularly vulnerable due to weakened immunity, increasing their risk of severe malaria, anemia, and related complications such as fatigue, dizziness, and breathlessness (Buhuguru Nasanairo, 2021). In Uganda, malaria remains a major cause of healthcare utilization, contributing to approximately 50% of outpatient visits, 15–20% of hospital admissions, and up to 20% of hospital deaths among pregnant women (Chijioke, 2020).
Malaria in pregnancy is associated with adverse outcomes including miscarriage, low birth weight, preterm delivery, congenital infections, and perinatal mortality (CDC, 2019). The condition is often asymptomatic, making detection difficult, especially during early pregnancy. Additionally, the sequestration of parasites in the placenta complicates diagnosis and treatment.
Despite the known risks, malaria prevalence remains high among women attending their first antenatal care visit. This is often linked to delayed ANC initiation, missed preventive interventions, and limited awareness. It is against this background that this study seeks to analyze malaria in pregnancy (MIP) care among first ANC attendees, with specific reference to Kamuli Hospital.
1.3 Objectives of the Study
1.3.1 General Objective
To analyze malaria in pregnancy (MIP) care among women attending their first antenatal care visit in Uganda, with a focus on Kamuli Hospital.
1.3.2 Specific Objectives
i. To examine community-related factors influencing malaria prevalence among pregnant women.
ii. To assess health system–related factors contributing to malaria prevalence among pregnant women.
iii. To determine individual-level factors associated with malaria among pregnant women.
1.4 Research Questions
i. What community-related factors influence malaria prevalence among pregnant women?
ii. What health system factors contribute to malaria prevalence among pregnant women?
iii. What individual factors are associated with malaria prevalence among pregnant women?
1.5 Conceptual Framework
The study conceptualizes malaria in pregnancy as the dependent variable, influenced by community, health system, and individual factors, with a focus on care among first ANC attendees.
CHAPTER TWO: LITERATURE REVIEW
2.0 Overview
This section reviews existing literature on community, health system, and individual factors influencing malaria prevalence among pregnant women.
2.1 Community-Related Factors
Community-level determinants significantly influence malaria prevalence. These include geographic location, climate conditions, access to healthcare services, infrastructure, health awareness, and socioeconomic status. Populations residing in malaria-endemic areas with limited access to healthcare and preventive measures such as insecticide-treated nets are particularly vulnerable (Semakula et al., 2023; Aschale et al., 2019).
2.2 Health-Related Factors
Health-related factors include immune suppression during pregnancy, parasite density, placental malaria, and access to quality antenatal care services. Delayed ANC attendance, inadequate screening, and limited use of preventive interventions contribute to increased malaria risk. Drug resistance and gaps in healthcare provider capacity further exacerbate the situation.
2.3 Individual Factors
Individual determinants include behavior, knowledge, and health status. Factors such as non-use of bed nets, delayed ANC initiation, poor nutrition, previous malaria exposure, and underlying health conditions (e.g., HIV) increase vulnerability. Age and parity also influence susceptibility.
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter outlines the methods to be used in conducting the study.
3.2 Research Design
A cross-sectional survey design will be employed.
3.3 Study Population
The study will target healthcare workers and patients at Kamuli Hospital.
3.4 Sample Size Determination
Using the Krejcie and Morgan (1970) table, a sample of 36 respondents will be selected from a population of 40.
3.5 Sampling Techniques
Purposive sampling will be used to select participants with relevant information.
3.6 Data Collection Methods
Data will be collected using questionnaires, interviews, and document review.
3.7 Data Analysis
Quantitative data will be analyzed using SPSS version 24.
