Parasitic worms, known medically as helminths, remain a major public health concern in tropical regions like Nigeria. Among these parasites, nematodes—commonly called roundworms—are the most frequently encountered in clinical practice. Unlike flatworms, nematodes possess an unsegmented, cylindrical body covered by a tough, flexible outer layer called a cuticle. They feature a complete digestive tract running from a distinct mouth to an anus, and separate male and female sexes. In midwifery practice, understanding these organisms is vital because pregnant women often harbor heavy parasite burdens due to physiological shifts in immunity. Common species affecting mothers include *Ascaris lumbricoides*, hookworms (*Necator americanus* and *Ancylostoma duodenale*), and *Trichuris trichiura*. These infections compromise maternal nutritional status, directly contributing to high rates of pregnancy anaemia and poor birth outcomes.
Several key roundworm species impact maternal health across Nigerian communities. Recognizing them helps midwives anticipate specific clinical challenges:
Transmission dynamics of nematodes are deeply tied to environmental sanitation, water supply, and agricultural practices. Hookworm larvae hatch in soil contaminated with faeces and actively penetrate the human skin, usually through bare feet. In contrast, *Ascaris* and *Trichuris* are acquired via the faecal-oral route through the ingestion of embryonated eggs present on unwashed vegetables, contaminated soil, or unpotable water. Geophagia, the traditional practice of consuming clay or soil during pregnancy, creates a direct pathway for ingesting infectious nematode ova. Midwives must screen for and counsel against geophagia during antenatal health talks, as soil-eating is a major vector for heavy worm burdens in local populations.
While many nematode infections remain asymptomatic when worm loads are low, heavy infections produce systemic debility. Intestinal roundworms compete for host nutrients, leading to malabsorption, stunting, and severe vitamin deficiencies. The most critical complication for pregnant women is iron-deficiency anaemia caused by hookworm blood loss, which increases the risk of postpartum haemorrhage, premature delivery, and low birth weight infants. Heavy *Ascaris* infestations can occasionally cause acute surgical emergencies like bowel obstruction. Furthermore, maternal malnutrition resulting from chronic parasitism impairs fetal intrauterine growth and diminishes neonatal iron stores.
Diagnosing intestinal nematode infections relies primarily on parasitological examination of stool samples. Routine microscopic analysis using saline and iodine wet mounts detects characteristic eggs of *Ascaris*, hookworms, and *Trichuris*. Quantitative techniques like the Kato-Katz thick smear method help estimate worm burden by counting eggs per gram of faeces. In busy antenatal clinics across Nigeria, routine stool microscopy is not always feasible for every client due to resource constraints. Instead, healthcare providers often rely on clinical indicators, such as unexplained microcytic hypochromic anaemia, combined with syndromic presumptive treatment protocols recommended by public health guidelines.
Treating pregnant women requires a careful balance between maternal health benefits and fetal drug safety. World Health Organization guidelines recommend single-dose preventive chemotherapy with benzimidazoles—specifically Albendazole (400 mg) or Mebendazole (500 mg)—after the first trimester of pregnancy. These medications are poorly absorbed systemically, limiting potential teratogenic risks while effectively clearing intestinal nematodes. Midwives must withhold deworming tablets during the vulnerable first trimester of organogenesis. Pregnant women should also receive routine iron and folic acid supplementation alongside deworming to successfully correct co-existing anaemia.
Medical treatment alone cannot stop reinfection without parallel improvements in environmental sanitation and hygiene behavior. Midwives play a crucial role in community health education by promoting safe water consumption, proper sewage disposal, and the construction of sanitary latrines. Handwashing education with soap before eating and after using the toilet interrupts the faecal-oral transmission cycle of *Ascaris* and *Trichuris*. Discouraging barefoot walking in endemic farming zones helps prevent hookworm larval penetration. Integrating parasite control into primary healthcare ensures long-term reductions in maternal morbidity and supports healthier generations across Nigerian communities.