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High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana

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Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P. falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana.


The study was conducted during two seasons; October–November 2020 (dry season, n = 124) and May–June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%).


Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia.


Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings.

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Data supporting the findings of this work are captured here. Raw data can be made available upon reasonable request.


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The research was supported by DANIDA (grant MAVARECA-II; 17-02-KU). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency. NGA was supported by a MAVARECA-II PhD studentship. We thank all the study participants and the numerous midwives, medical doctors, physician assistants, medical laboratory scientist and nurses in the various health facilities (Abura Dunkwa District Hospital, Moree Health Centre, Effutu Health Centre, Cape Coast and Mercy Women’s Catholic Hospital, Mankessim) for their enormous support. Special thank you to the Department of Immunology, Noguchi Memorial Institute for Medical research field team members including Rev. Alex Danso-Coffie and Sophia Ampaw for supporting in participant recruitment and enrolment.

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MO and NGA conceived the idea, and designed the study together with LH, MdPQ and GAA. NGA, BA, AP and EKB conducted data collection and data curation. NGA conducted data analysis and interpretation of findings, and wrote the first draft manuscript. MO, LH, MdPQ and GAA critically reviewed the manuscript. All authors read, improved and approved the final manuscript. LH and MO secured the funding and supervised the study.

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Correspondence to Michael F. Ofori.

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Anabire, N.G., Aculley, B., Pobee, A. et al. High burden of asymptomatic malaria and anaemia despite high adherence to malaria control measures: a cross-sectional study among pregnant women across two seasons in a malaria-endemic setting in Ghana. Infection 51, 1717–1729 (2023).

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