title: The epidemiology of malaria among pregnant women attending antenatal clinics in an area with intense and highly seasonal malaria transmission in northern Ghana.
abstract: OBJECTIVE
  To describe the factors associated with malaria infection and anaemia in pregnancy in northern Ghana.
  
  
  METHODS
  We studied 3642 pregnant women of all gravidities and gestational age of 18-32 weeks who attended an antenatal clinic in the Kassena-Nankana district of Ghana between June 2004 and July 2006. Blood samples were examined for haemoglobin concentrations and parasitaemia, and we obtained socio-demographic data, an obstetric history, information on their past and current state of health and bed net use.
  
  
  RESULTS
  The overall prevalence of malaria parasitaemia during pregnancy was 47%. Older age [adjusted odds ratio (AOR) 0.65, 95% CI 0.54-0.78], multigravidity (AOR 0.51, 95% CI 0.42-0.61) and third trimester of pregnancy (AOR 0.85, 95% CI 0.73-0.99) were associated with a decreased risk of parasitaemia. Enrollment during the rainy or post-rainy season was associated with an increased risk of parasitaemia (AOR 2.59, 95% CI 2.20-3.04 and AOR 3.12, 95% CI, 2.60-3.74 respectively). Malaria infection was associated with an increased risk of anaemia among young women. The prevalences of anaemia (Hb<11.0 g/dl) and severe anaemia (Hb<7.0 g/dl) during pregnancy were 72% and 2% respectively. The risk of anaemia was lower in older women (AOR 0.79, 95% CI, 0.64-0.97), multigravidae (AOR 0.67, 95% CI 0.55-0.83) and in educated women (AOR 0.81, 0.68-0.98).
  
  
  CONCLUSIONS
  The prevalence of malaria parasitaemia and anaemia among pregnant women in Kassena-Nankana district is high with marked seasonal variation. Targeting of interventions to the high transmission season and to paucigravidae may be appropriate in this setting.
authors.affiliation: Dodowa Health Research Centre, Dodowa, Ghana. caclerk@gmail.com
authors.forename: Christine Alexandra
authors.initials: CA
authors.lastname: Clerk
authors.forename: Jane
authors.initials: J
authors.lastname: Bruce
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
mesh_terms: D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000453:epidemiology / Q000469:parasitology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D020073:Gravidity; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D018512:Parasitemia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000469:parasitology; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology*; D012307:Risk Factors; D012621:Seasons; D055815:Young Adult