Abstract
BackgroundMalaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest. This paper models the burden of MiP and associated foetal losses and maternal deaths, in rural Madhya Pradesh, India.MethodsNumber of pregnancies per year was estimated from the number of births and an estimate of pregnancies that end in foetal loss. The prevalence of MiP, risk of foetal loss attributable to MiP and case fatality rate of MiP were obtained from the literature. The estimated total number of pregnancies was multiplied by the appropriate parameter to estimate the number of MiP cases, and foetal loss and maternal deaths attributable to MiP per year. A Monte Carlo simulation sensitivity analysis was done to assess plausibility of various estimates obtained from the literature. The burden of MiP in tribal women was explored by incorporating the variable prevalence of malaria in tribal and non-tribal populations and in forested and non-forested regions within Madhya Pradesh.ResultsEstimates of MiP cases in rural Madhya Pradesh based on the model parameter values found in the literature ranged from 183,000–1.5 million per year, with 73,000–629,000 lost foetuses and 1,500–12,600 maternal deaths attributable to MiP. The Monte Carlo simulation gave a more plausible estimate of 220,000 MiP cases per year (inter-quartile range (IQR): 136,000–305,000), 95,800 lost foetuses (IQR: 56,800–147,600) and 1,000 maternal deaths (IQR: 650–1,600). Tribal women living in forested areas bore 30% of the burden of MiP in Madhya Pradesh, while constituting 18% of the population.ConclusionAlthough the estimates are uncertain, they suggest MiP is a significant public health problem in rural Madhya Pradesh, affecting many thousands of women and that reducing the MiP burden should be a priority.
Highlights
Malaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest
The number of MiP cases per year was estimated by the following model: Foetal loss rate (y) = proportion of pregnancies ending in spontaneous abortion + percent of pregnancies ending in stillbirth = 0.15+ 0.04 . 0.20 Proportion of pregnancies ending in live births (b) = 1-"foetal loss rate" (y) = 1-0.2 = 0.8
The prevalence of MiP measured in health facility based studies in Madhya Pradesh was substantially higher, and varied remarkably ranging from 6.4% to 55% [15,16,17,18,19] (Table 1)
Summary
Malaria in pregnancy (MiP) is inadequately researched in India, and the burden is probably much higher than current estimates suggest. This paper models the burden of MiP and associated foetal losses and maternal deaths, in rural Madhya Pradesh, India. In high malaria-transmission settings such as much of Africa, the primary adverse outcomes of malaria in pregnancy (MiP) are low birth-weight babies and maternal anaemia. In low-transmission settings such as India, where the population is not sufficiently exposed to malaria to develop immunity by adulthood, MiP can have more serious consequences for both the foetus and mother including spontaneous abortion, stillbirth, and maternal death [1].
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