Abstract
Congenital Malaria (CM) is an underestimated and under-researched problem in Colombia, despite its severe clinical, epidemiological, economic, and public health consequences. The objective was to determine the general frequency of CM, the specific frequency of CM by diagnostic test and plasmodial species, and identify its associated factors. A retrospective study was carried out using the records of 567 newborns. qPCR and Thick Blood Smear (TBS) were performed. The frequency of infection was determined with a 95% confidence interval. Associated factors were identified by non-parametric tests and odds ratios; the confusion was controlled with a logistic regression model. All cases corresponded to submicroscopic CM (negative with TBS and positive with PCR), and the frequency was 12.2% (95%CI = 9.4–14.9). The detection was statistically higher in the umbilical cord with 16,2% (95%CI = 12.4–19.9) versus peripheral blood of the newborn with 2.2% (95%CI = 0.7–4.9). CM was statistically higher in newborn whose mothers had malaria in the last year, gestational and placental malaria. The median birth weight in newborn infected with CM was lower compared to the one of healthy neonates. Because the control program in Colombia is based on TBS, it must be improved with the inclusion of other tests that allow the detection of submicroscopic CM. In addition, the program has other limitations such as do not have specific actions for pregnant women and have a passive surveillance system. These difficulties do not allow to show the magnitude of CM, its consequences on neonatal and infant health, constituting a serious problem of health injustice.
Highlights
Malaria associated with pregnancy (MAP) is a serious clinical-epidemiological problem for 125 million women in the world every year, but the real impact of the infection in the infant population and the magnitude of Congenital Malaria (CM) is unknown [1]
The highest proportion of mothers were affiliated to the subsidized healthcare insurance, were adolescents or young women; 32.8% were in their first pregnancy; only 15% were nulliparous; 14% have had an abortion; 30% had anemia during pregnancy, and 25.1% had a history of malaria (Table 2)
A frequency of 12.2% (95%CI = 9.4–14.9) was found, which is lower than those reported in studies from Africa that used a similar case definition, that is, positive by Thick Blood Smear (TBS) or PCR in peripheral or cord blood samples, in which prevalences between 18.6% and 56.8% were reported [7, 11]
Summary
Malaria associated with pregnancy (MAP) is a serious clinical-epidemiological problem for 125 million women in the world every year, but the real impact of the infection in the infant population and the magnitude of Congenital Malaria (CM) is unknown [1]. In Colombia in 2019, 74,409 malaria cases were reported, and only 0.6% (n = 455) were in pregnant women [2], which would wrongly reflect a low risk of CM.
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