Impact of schistosomiasis infection on maternal and neonatal outcomes in pregnancy: a prospective cohort study in Nigeria

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BACKGROUND: Schistosomiasis, a neglected tropical disease, affects approximately 40 million women of reproductive age contributing to preventable anaemia during pregnancy, intrauterine growth retardation and low birth weight. In spite of the high prevalence rate of this disease among school aged children in Abakaliki, no study in Abakaliki has looked at the burden of Schistosomal infection in pregnancy with a view to determining maternal and neonatal outcomes. OBJECTIVE: To determine the association between schistosomal infection and maternal anemia, low birth weight, and other neonatal outcomes in Abakaliki. MATERIALS AND METHODS: This was a prospective cohort study involving 94 randomly selected pregnant women with schistosomal infection and 94 matched controls without schistosomal infection. Pregnant women included were at 34 to 36 weeks of gestation. The Kato-Katz technique was used for identification and quantification of the S. mansoni, and S. japonicum, parasites in the stool, while the Ziel-Neilson stain was used for detection of the S. haematobium parasites in the urine. The patients were followed up until delivery to determine maternal and neonatal outcomes. The data were analysed using IBM SPSS version 20. The level of significance is at P - value < 0.05. RESULTS: The prevalence of schistosomiasis in the study area was (94/968) 9.71%. The predominant species identified was Schistosoma haematobium (61/94; 64.9%). Nulliparous women were more likely to have heavy schistosomiasis infections than multiparous women (OR 6.09, 95% CI 2.3 - 15.68; P =0.0001). Neonates of women infected with schistosomiasis had low birth weight compared with the control group (2.91 ±0.70kg vs. 3.20±0.60kg, P = 0.002). Placental mass was lower in cohort of women with the disease compared with the control (0.49±0.08kg vs. 0.52±0.09kg, P = 0.02). All the cohort of women with schistosomiasis were anaemic (28±1.9 vs. 30 ±2.1, P = < 0.0001). Burden of maternal anaemia was very high among cohort with heavy infection compared with those that had light infection (OR = 2.4 95%CI1.02-5.9, P = 0.04). Schistosoama haematobium infection was more likely to cause lower maternal haematocrit levels than Schistosoama mansoni infection was (OR 4.72 95% CI 1.87-11.95, P < 0.001). CONCLUSION: Schistosomiasis in pregnancy is associated with adverse maternal and neonatal outcomes. S. haematobium was more likely to cause maternal anaemia than S. mansoni. We recommend routine antenatal screening of Schistosomiasis infection in the study area and the need to consider routine administration of praziquantel to antenatal attendee in the study area.

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