JRTPH Journal of Rural and Tropical Public Health 6: 24-32, 2007 25 Published by the Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Australia The effect of insecticide treated bed net use on malaria episodes, parasitaemia and haemoglobin concentration among primigravidae in a peri-urban settlement in southeast Nigeria Igwe PC MBChB 1 , Inem V MBBS MPH 2 , Ebuehi OM MBBS MSc MPH 2 , Afolabi BM MBBS MSc 3 1. Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnnewi, Anambra state, Nigeria 2. Institute of Child Health and Primary Care, College of Medicine, University of Lagos 3. World Health Organization Roll Back Malaria Unit Nigeria Corresponding author: Olufunke Margaret Ebuehi funkebuehi@yahoo.co.uk Abstract Between 80-90% of the world’s malaria cases occur in sub Sahara Africa and approximately 19 -24 million pregnant women are at risk for malaria and its adverse consequences. The major impact of Malaria in pregnancy has severe negative effects on maternal health and birth outcomes including maternal anaemia, high incidence of miscarriages and low birth weight. Primigravidae and secundigravidae are most at risk. Due to increased and spreading malaria parasite resistance to first line antimalarials like chloroquine and sulphadoxine–Pyrimethamine in sub-Saharan Africa, the available tools for malaria control in pregnancy are now very limited. One of the most commonly used tool for preventing malaria in pregnancy is insecticide treated bed nets (ITNs), which have been shown to reduce the number of infective mosquito bites by 70-90% in a variety of ecologic settings. In Nigeria, the current use of ITNs among pregnant women and children under 5 years, is just 1%, according to the Nigeria Demographic and Health Survey (NDHS). This study aimed at examining the effects of the use of ITNs on episodes of uncomplicated malaria, frequencies of malaria parasitaemia and anaemia among two hundred and eight primigravidae. The design was an analytical case control. One hundred and four subjects received ITNs between August 2003 and January 2004 and the other 104 subjects acted as controls. Data were obtained using the new World Health Organization antenatal care classifying form and the basic component checklist, and a structured interviewer-administered, 30-item questionnaire. Laboratory tests were done to obtain data on episodes of malaria, levels of malaria parasitaemia, mean haemoglobin concentration and anaemia. The results in test group showed 28.9% and 20% reduction in episodes of uncomplicated malaria and in frequency of malaria parasitaemia at 38 weeks gestation, respectively. However, there was no difference in mean haemoglobin concentration and in frequency anaemia between the test and control groups. The use of ITNs by primigravidae in this peri-urban settlement in south eastern Nigeria, showed significant reductions in episodes of uncomplicated malaria and malarial parasitaemia. Keywords: ITN, Malaria, Primips Introduction Malaria is a serious health care problem in tropical and subtropical regions of the world with far- reaching medical, socio-economic consequences for the countries in which it is found. Each year approximately about 300 million malaria episodes and 2.5 million deaths are reported worldwide with 80% of them occurring in sub-Saharan Africa. In endemic areas, clinical episodes and mortality are more frequent and severe among pregnant women than non-pregnant (D’alessandro et al 1996). In these areas pregnant women generally remain asymptomatic despite sequestration of parasitised erythrocytes in the placenta microcirculatory system. In contrast, in unstable malaria transmission areas, pregnant women are prone to severe malaria (Singh et al 1999, Kochar et al 1998). Many studies have proved that placental malaria is associated with low birth weight and increased neonatal mortality, and that this association is demonstrated only in first pregnancies. Pregnant women with parasitaemia are susceptible to anaemia and hypoglycaemia (Kochar et al 1997, Mc Gregor 1984, Steketee et al 1988). In the Gambia, Bray and Anderson (1979) observed that pregnancy caused an increase in prevalence and density of Plasmodium falciparum. Redd et al (1996) found that the highest parasite densities were observed in primigravidae and secondigravidae with a progressive fall in density as parity increased. The increase in malaria prevalence and density was at its peak early in the second trimester and decreased over the second half of pregnancy but there was no increase in malaria occurrence at parturition and with age. In other surveys (Bray and Anderson 1979, Verhoeff 1999) in rural Malawi, it was observed that peak prevalence of malaria in the post rainy season period, were highest in primigravidae, followed by secondigravidae, and multigravidae.