MALARIA DURING PREGNANCY AND EFFECTS ON WHITE BLOOD CELL COUNTS: A STUDY OF PREGNANT WOMEN IN A MAJOR TERTIARY INSTITUTION IN ABA, ABIA STATE, NIGERIA
Main Article Content
Abstract
Malaria remains a major mosquito-borne public health concern in Nigeria, and pregnant women are particularly vulnerable due to altered immunity. A cohort study was conducted to understand the effect of malaria on white blood cell counts among pregnant women in Aba metropolis, Abia state. Blood samples were collected from consented pregnant women to test for malaria parasites using Giemsa stained thick and thin films. Full blood count was done to determine their haematological parameters. Low and high white blood cell counts was defined as WBC<6.0x103μL and WBC > 12-16 x103 μL respectively according to WHO standard. Data on absolute lymphocytes, monocytes and granulocytes were also collected. Semi-structured questionnaires were administered to the women to obtain information on their socio-demographic and obstetric data. Out of a total of 225 pregnant women examined, 34 tested positives resulting to 15.1% prevalence. Age related prevalence showed that women in their late reproductive age, 45-54 years had the highest rate (23.8%) of malaria infection, while women in their mid-reproductive age 35-44 years had the lowest rate (9.3%); though there was no statistical association (χ2=1.259, P=0.739). Malaria prevalence in relation to gravidity varied significantly among the study participants (χ2=14.306, P<0.0001) as primigravid women showed a higher rate 16(17.2%) than the multigravidae 18(13.6%). Women in their first trimester showed a significantly higher prevalence rate (21.6%) than women in their second 1(14.6%) and third trimesters 6(8.7%) (χ2=15.193, P<0.0001 and χ2=9.085, P=0.011 respectively). The mean values of total WBC count, lymphocytes and granulocytes were shown to be higher in the malaria infected participants than in the non-infected group except for the monocyte counts. Differences in the mean values were statistically significant (p<0.05) with exception to total WBC count and granulocytes (P=0.131 and P=0.063 respectively). Malaria during pregnancy is linked with an increase in total and differential white blood cells among pregnant women, even though they are still within normal range. These findings are useful for malaria diagnosis, prognosis and guiding therapeutic interventions.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Baird, J. K. (2009). Malaria zoonoses. Travel medicine and infectious disease 7(5): 269–77.
Cheesbrough, M. (2009). District Laboratory Practice in Tropical Countries, vol.1 2, part 1-2, Cambridge University Press, Edinburg Building, UK
Chua, C. L., Robinson, L. J., Baiwog, F., Stanisic, D. I., Hamilton, J. A., Brown, G.V. Rogerson, S. J. and Boeuf, P. (2015). High numbers of circulating pigmented polymorphonuclear neutrophils as a prognostic marker for decreased birth weight during malaria in pregnancy. International Journal of Parasitology. 45:107–11.
Cutts, J. C., Agius, P. A., Zaw, L., Powell, R., Moore, K., Draper, B., Simpson, J. A. and Fowkes, F. J. I. (2020). Pregnancy specific malarial immunity and risk of malaria in pregnancy and adverse birth outcomes: a systematic review. BMC Medicine 18 :14
Desai, M., O ter Kuile, F., Nosten, F., McGready, R., Brabin, B. and Newman, R. D. (2007). Epidemiology and burden of malaria in pregnancy. The Lancet infectious Diseases, 7(2):93-104
Ejike, B. U., Ukpai, O. M., Ihemanma, C. A., Ajuga, M. U. and Eme, G. F. (2022). Impact of malaria infection on the haematological profile of pregnant women in southeastern, Nigeria. Nigerian Journal of Parasitology.43(1): 78-84
Enato, E., Okhamafe, A., Okpere, E., and Oseji, F. (2007). Prevalence of Malaria during Pregnancy and Antimalarial Intervention in an Urban Secondary Health Care Facility in Southern Nigeria. Medical principles and Practice; 16(3): 240–3.
Erhart, L. M., Yingyuen, K., Chuanak, N., Buathong, N., Laoboonchai, A., Miller, R. S., Meshnick, S. R., Gasser, R. A. Jr. and Wongsrichanalai, C. (2004). Hematologic and clinical indices of malaria in a semi-immune population of western Thailand. American Journal of Tropical Medicine and Hygiene, 70:8–14.
Foghi, B.O., Nduka, F.O. and Nzeako, S.O. (2021). Effect of malaria on some haematological parameters among pregnant women in Delta state, Nigeria. International Journal of Tropical Diseases and Health; 42(16):21-29
Huffman, J. W. (2025). Pregnancy. Encyclopaedia Britannica Editors. Health and Medicine. Accessed 25th November, 2025
Igbeneghu, C. and Odaibo, A. B. (2013). Impact of Acute Malaria on Some Haematological Parameters in a Semi-Urban Community in Southwestern Nigeria, IDOSI Publications, Acta Parasitologica Globalis, 4(1): 1-5
Iqbal, W. (2010). Hematological manifestations in malaria. Haematology Update. 2:35–37.
Jadhav, U. M., Singhvi, R. and Shah, R. (2003). Prognostic implications of white cell differential count and white cell morphology in malaria. Journal of Postgraduate Medicine, 49:218-221
Kotepui, M., Phunphuech, B., Phiwklam, N., Chupeerach, C., Duangmano, S. (2014). Effect of malaria infection on haematological parameters in population near Thailand-Myanmar border. Malaria Journal; 13:218
McKenzie, F. E., Prudhomme, W. A., Magill, A. J., Forney, J. R., Permpanich, B., Lucas, C., Gasser, R. A., Jr. and Wongsrichanalai, C. (2005). White blood cell count and malaria. The Journal of Infectious Diseases, 192(2): 323-330
Modiano, D., Sirima, B. S. Konate, Sanou, I. and Sawadogo, A. (2001). Leucocytosis in severe malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene.95: 175-176
Obebe, O. O, Falohun, O., Olajuyigbe, O. O., Lawani, M., Ajayi, O. (2018). Impact of asymptomatic Plasmodium falciparum on haematologcal parameters of pregnant women at first antenatal visit in south-western, Nigeria. Tanzania Journal of Health Research 20(2): 4
Ogbodo, E., Ezeugwunne, I., Eze B., Njoku, C., Oguaka, V., Amah, A., Akunneh-Wariso, C., Ejiofor, D., Iheukwumere, C., Ebere, M. (2018). The effect of malaria on some haematological parameters of pregnant women in Nnewi Anambra State, Nigeria. International Journal of Development Research, 8(10):23353-23358
Ogbodo, S. O., Nwagha, U. I., Okaka, A. N., Ogenyi, S. C., Okoko, R. O. and Nwagha, T. U. (2009). Malaria parasitaemia amongst pregnant women in a rural community of eastern Nigeria; Need for combined measures. Nigerian Journal of Physiological Science, 24:95-100.
Okafor, I. P., Ezekude, C., Oluwole, E. O., and Onigbogi, O. O. (2019). Malaria in pregnancy: A community-based study on the knowledge, perception and prevention among Nigerian women. Journal of Family Medicine and Primary care, 8(4): 1359-1364
Okoye, C. R, Umeanaeto, P. U, Umeh, S. O, and Obijiofor, E. O. (2024). Association of Malaria in Pregnancy to Socio-Demographic Factors and Utilization of Preventive Measures in Awka Metropolis, South-Eastern, Nigeria. South Asian Journal of Parasitology, 7 (2):152–164.
Osaro, E., Abdulrahaman, A. and Erhabor, T. (2019). Effect of malaria parasitaemia on some haematological parameters of pregnant women of African Descent in specialist hospital Sokoto, North Western Nigeria. JOJ Nurse Health Care; 10(4):555795
Ozougwu (2018). Changes in White Blood Cells Differentials associated with adult malaria-infected patients. Journal of Advances in medical and pharmaceutical sciences 16(1): 1-5
Rocha, B. C., Marques, P. E., Leoratti, F. M. S., Junqueira, C., Pereira, D. B. and Antonelli, L. (2015). Type I interferon transcriptional signature in neutrophils and low-density granulocytes are associated with tissue damage in malaria. Cell Reports. 13:2829–41.
Sahle, T., Yemane, T. and Gedefaw, L. (2017). Effect of malaria infection on hematological profiles of people living with human immunodeficiency virus in Gambella, southwest Ethiopia BMC Hematology 17:2
Schantz-Dunn, J. and Nour, N. M. (2009). Malaria and pregnancy: a global health perspective. Reviews in Obstetrics and Gynecology, 2(3):186-92
Steketee, R. W. (2001). The burden of malaria in pregnancy in malaria-endemic areas. American Journal of Tropical Medicine and Hygiene, 64(2):28-35.
Stephen, S. J. Pollina E., Getachew, A., Taesse, E., Lema, V. M. and Molyneux, M. E. (2003). Placental monocyte infiltrates in response to Plasmodium falciparum malaria infection and their association with adverse pregnancy outcomes. American Journal of Tropical Medicine and Hygiene 68: 115-119
Ukibe, S. N., Ukibe, N. R., Mbanugo, J. I. and Ikeakor, L. C. (2016). Prevalence of malaria among pregnant women attending antenatal clinics in hospitals in Anambra State, south-east, Nigeria. Nigerian Journal of Parasitology Volume 37(2): 240-244
Umeanaeto, P. U., Odagwe, C., Onwuagana, I. C., Irikannu, K. C., Onwuachusi, G. L., Akulue, J. C. and Afulukwe, S. C. (2022). Malaria Parasitemia and Anemia Among Pregnant Women Attending General Hospital, Enugwu-Ukwu, Southeastern Nigeria. International Journal of Pathogen Research, 11 (1-2):1–7.
Van Eijk, A. M., Ayisi, J. G., Ter Kuile, F. O. Misore, A. O. Otieno, J. A., Rosen, D. H., Kager, P.A., Steketee, R. W. and Nahlen, B. L. (2003). “HIV increases the risk of malaria in women of all gravidities in Kisumu, Kenya,” AIDS, 17(4), 595–603,
Warimwe, G. M. Murungi, L. M., Kamuyu, G., Nyangweso, G. M., Wambua, J., Naranbhai, V., Fletcher, H. A., Hill, A.V.S., Bejon, P., Osier, F.H., and Marsh, K. (2013). The ratio of monocytes to lymphocytes in peripheral blood correlaes with increased susceptibility to clinical malaria in Kenyan children. PLoS ONE, 8(2)
World Health Organization (2014). Malaria. Fact Sheet Accessed 12th December, 2025.
World Health Organization (2021). World Malaria Report 2021. Accessed 12th November, 2025.