Impact of congenital malaria in some maternity hospitals in Kinshasa: an analytical cross-sectional study involving 482 newborns from febrile mothers

The study was designed to determine the true prevalence of congenital, cord, and placental malaria in General Hospital Minna, North Central Nigeria. Peripheral blood smears of near-term pregnant women, as well as the placental, cord, and peripheral blood smears of their newborn babies, were examined for malaria parasites, using the Giemsa staining technique. Out of 152 pregnant women screened, 21 (13.82%) of them were infected with malaria parasites. Of the 152 new born babies, 4 (2.63%) showed positive peripheral parasitaemia. Placental parasitaemia was 7/152 (4.61%), while cord blood parasitaemia was 9/152 (5.92%). There were strong associations between peripheral and cord malaria parasitaemia and congenital malaria (P < 0.05). Plasmodium falciparum occurred in all, and none had mixed infection. The average birth weights of the babies delivered of nonmalarious pregnant women were higher than those delivered by malarious pregnant women, though not significant (P > 0.05). Malaria parasitaemia occurred more frequently in primigravidae than multigravidae.

Congenital malaria is increasingly reported among babies born to mothers continually residing in endemic areas. Given the high morbidity and mortality associated with malaria it is pertinent to determine its current status among newborns in Lagos, Nigeria. The aim was to determine the incidence of congenital malaria in newborn babies delivered at the Lagos University Teaching Hospital and also to determine the frequency of parasitaemia in their mothers and placentae. A cross-sectional study of mothers attending the antenatal clinic of the Lagos University Teaching Hospital was done. The Sociodemographic and clinical characteristics of mothers were documented. Samples of maternal, placental, cord and neonatal blood were taken and stained with Giemsa and examined for malaria parasites. Neonatal samples were examined at birth, on days 3, 7, 14 and 28. One hundred mothers and their placentae, as well as 104 babies and their cord blood were studied. The incidence of congenital malaria was 16/104 (15.3%) and parasite counts ranged from 47 to 1019/mul. Plasmodium falciparum was the predominant species. There was a strong association between placental, maternal, cord and neonatal parasitaemia. All the babies with congenital malaria had infected mothers, placentae and cords (p < 0.0001). In conclusion congenital malaria is not uncommon in Lagos nowadays, and there are relatively high rates of maternal, placental and cord blood parasitaemia. It is, therefore, recommended that babies born to mothers with malaria should be screened for congenital malaria.

Malaria is a serious and potentially fatal parasitic infectious disease caused by several species of parasite belonging to the Plasmodium genus. The female Anopheles injects the parasite into humans in the form of a "sporozoite". This rapidly migrates via the bloodstream to the liver. Transmission can occur through mother-to-child transmission and transfusion of infected blood products. Objective: To study the prevalence of malaria among newborn babies in the paediatric ward of the CSRéf in Markala. Methodology: Cross-sectional, retrospective, descriptive study from 1st January to 30th December 2023. Results: The mean age at admission was 03 to 07 days and 08 to 14 days of life. The sex ratio was in favour of males (51%). The overall result for the prevalence of malaria according to the means of biological diagnosisused was 0.62% for the RDT compared with 56.52% for the GE. The weight range where the RDT was positive was weights over 3.5kg. The results for congenital malaria were 0% for RDT and 60% for GE. The sex-ratio was in favour of males (51%). The age range at admission was 3 to14 days. The highest number of cases was observed in the month of May. The overall prevalence of congenital malaria including the total number of babies with cord blood parasitaemia and peripheral blood parasitaemia was 18.6% and 56.8% respectively using microscopy and real-time PCR. The frequency of cases of submicroscopic congenital malaria (negative on thick blood smear and positive on PCR) was 12.2%). Theaverageadmissionweightofnewbornswas2.9kg+/-0.9andtheaveragebirthweightwas2,319g(160.03)and 83 (81.4%). Conclusion: Congenital and neonatal malaria is a public health problem in a malaria-endemic country such as Mali. We note a difference in diagnosis according to the different biological means of diagnosis (RDT and EW). Newborns showing signs of suspected sepsis should be screened and treated early.

Diagnosis of congenital malaria is complicated by the low density of the parasite circulating in the cord blood and/or the peripheral blood of the newborns. Molecular techniques are significantly more sensitive than blood smears in detecting low-level parasitemia. This study investigated the prevalence of congenital malaria by the use of the real-time polymerase chain reaction (real-time PCR) in 102 babies born to mothers with microscopically confirmed infected placenta from Blue Nile state, Sudan. At delivery time, placental, maternal peripheral and cord blood samples in addition to samples collected from the newborns' peripheral blood were examined for malaria infection using Giemsa-stained thick smear and parasite DNA detection by real-time PCR. The overall prevalence of congenital malaria includes the total babies with cord blood parasitaemia and peripheral blood parasitaemia was 18.6 and 56.8% using microscopy and real-time PCR, respectively. Even though all the neonates were aparasitaemic by microscopy, 19 (18.6%) of the babies had congenital malaria detected by real-time PCR, 15 (25.9%) of the babies with congenital malaria were born to mothers with both placental and peripheral blood malaria infections detected using the two techniques. Congenital malaria was significantly associated with cord blood malaria infections, maternal age and maternal haemoglobin level (p < 0.001). This first study investigating congenital malaria in Blue Nile state, Sudan shows that malaria-infected placenta resulted in infant and cord blood infections.

Background: HIV and Plasmodium falciparum malaria co-infection annually complicates about one million pregnancies in sub-Saharan Africa. Congenital malaria (CM) has deleterious effects on newborns. Little is known about the effect of co-infections on the prevalence of CM in infants born by these women. This study was carried out to determine the prevalence of CM in newborns of mothers co-infected with HIV and malaria compared to HIV-negative mothers with malaria in Benin-City.Methods: Subjects were 162 newborns of mothers co-infected with HIV and malaria. Controls were 162 newborns of HIV negative malaria infected mothers. Blood film for malaria parasites was done on cord blood and peripheral blood on days 1, 3 and 7 in the newborns. Maternal peripheral blood film for malaria parasite was done at delivery and placental tissue was obtained for confirmation of placental malaria by histology. Diagnosis of malaria in blood films was by light microscopy.Results: The prevalence of CM in subjects was significantly higher than in controls (34.6% and 22.2%, p=.014). Profound immunodepression (maternal CD4 cell count <200 cell/mm3) was significantly associated with CM (p=.006). The major predictors of CM in subjects were maternal CD4 cell count <200 cell/mm3 and placental malaria while in controls placental malaria was the only predictor.Conclusions: Babies born to mothers co-infected with HIV and malaria are at increased risk for CM. All babies born by HIV positive mothers should be screened for CM.

SummaryThere is paucity of data on the risk factors associated with congenital malaria in Nigeria. This study assessed the risk factors for congenital malaria in a population of neonates delivered at the University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria. It was a prospective cross-sectional study of neonates who were delivered in the institution from 2 April 2003 to 15 April 2004 as well as their mothers. Thick and thin blood films were made from maternal, baby and cord blood as well as the placenta for each mother/baby pair to determine malaria parasite density counts and for species identification. The maternal samples were obtained as soon as labour was confirmed while the cord and baby's blood as well as placental smears were taken within 1 h of delivery. Data analysis was by means of descriptive and inferential statistics as well as univariate and multivariate logistic regression at the 95% confidence level using the statistical software SPSS for Windows Version 10. A total of 658 mother/baby pairs were recruited into the study within the 13-month period. Out of this number, 625 mother/baby pairs completed the study and their data were subsequently analysed. A total of 356 (56.96%) mothers and 203 (32.48%) babies were smear positive for Plasmodium falciparum. On univariate logistic regression with presence or absence of the congenital malaria as the dependent variable, six out of the 13 putative risk factors tested were statistically significant. These were low compared with higher socioeconomic classes (OR = 1.41, 95% CI = 1.18 – 1.69, p = 0.00); low compared with normal birth weight (OR = 2.14, 95% CI = 1.39 – 3.30, p = 0.001); positive placental malaria parasitaemia (OR = 6.29, 95% CI, 4.73 – 8.37, p = 0.000), positive maternal blood malaria parasitaemia (OR = 5.04, 95% CI = 3.74 – 6.78, p = 0.000), positive cord blood malaria parasitaemia (OR = 26.87, 95% = 15.79 – 45.74, p = 0.000) and parity of 0 – 1 compared with other parities (OR = 1.31, 95% CI = 1.11 – 1.55, p = 0.002). On multivariate logistic regression, three of the six factors that were significant on univariate logistic regression remained significant. These were: positive placental malaria parasitaemia (OR = 2.55, 95% CI = 1.45 – 4.47, p = 0.001); positive cord malaria parasitaemia (OR = 18.90, 95% CI = 10.68 – 33.46, p = 0.000 and parity of 0 – 1 compared with other parities (OR = 1.66, 95% CI = 1.09 – 2.52, p = 0.02). It was concluded that the risk factors for congenital malaria identified in this study emphasise the need for effective preventive and curative treatment of malaria not only during pregnancy but also during delivery in malaria endemic areas. Additionally, congenital malaria should now rank high among the list of differential diagnosis of fever in the newborn in such endemic areas.

BackgroundCongenital malaria has been considered a rare event; however, recent reports have shown frequencies ranging from 3% to 54.2% among newborns of mothers who had suffered malaria during pregnancy. There are only a few references concerning the epidemiological impact of this entity in Latin-America and Colombia.ObjectiveThe aim of the study was to measure the prevalence of congenital malaria in an endemic Colombian region and to determine some of its characteristics.MethodsA prospective, descriptive study was carried out in the mothers who suffered malaria during pregnancy and their newborns. Neonates were clinically evaluated at birth and screened for Plasmodium spp. infection by thick smear from the umbilical cord and peripheral blood, and followed-up weekly during the first 21 days of postnatal life through clinical examinations and thick smears.Results116 newborns were included in the study and 80 umbilical cord samples were obtained. Five cases of congenital infection were identified (four caused by P. vivax and one by P. falciparum), two in umbilical cord blood and three in newborn peripheral blood. One case was diagnosed at birth and the others during follow-up. Prevalence of congenital infection was 4.3%. One of the infected newborns was severely ill, while the others were asymptomatic and apparently healthy. The mothers of the newborns with congenital malaria had been diagnosed with malaria in the last trimester of pregnancy or during delivery, and also presented placental infection.ConclusionsCongenital malaria may be a frequent event in newborns of mothers who have suffered malaria during pregnancy in Colombia. An association was found between congenital malaria and the diagnosis of malaria in the mother during the last trimester of pregnancy or during delivery, and the presence of placental infection.

Congenital malaria diagnosis is challenging due to frequently observed low parasite density infections, while their clinical relevance during early infancy is not well characterized. In Nanoro health district (Burkina Faso), we determined the prevalence of congenital malaria by real-time quantitative PCR and we assessed the performance of rapid diagnosis test (RDT) and light microscopy (LM) to detect Plasmodium falciparum infections in cord-blood samples. In addition, we examined the usefulness of P. falciparum Histidine Rich Protein2 (PfHRP2) as surrogate biomarker of infection and explored association between congenital malaria and clinical outcomes. A prevalence of congenital malaria by qPCR of 4% (16/400) was found, which increased to 10% among newborns from mothers infected at delivery. RDT and LM showed poor performances indicating limited utility for congenital malaria screening in cord blood. Because PfHRP2 detection in cord blood could be affected by transplacental passage of parasite antigens, PfHRP2 might not be used as a surrogate biomarker of congenital malaria infections. There was no evidence of a significant clinical impact of congenital malaria on infant’s health from birth to 59 days of life. Case control studies including long-term follow up may provide additional understanding on the relevance of neonatal malaria infections.

Congenital transmission by protozoan parasites is a worldwide important public health problem. Congenital infections affects the mother and the fetus or newborn. It is still surprising that despite the abundant immunoepidemiological knowledge of congenital transmission of protozoan parasite, no definite etiology or predictive diagnostic tests have been identified. Understanding the mechanisms by which host/parasites infection and interaction occurs is one of the most important topics that will help find specific biomarkers of infection, prevent congenital transmission, maintain the health of the newborn, and develop safe and efficient treatments. In addition, understanding of the biological mechanisms of host/parasite interactions will facilitate protection of mothers and their families and reduce costs in health services. Moreover, this will lead to gain insight into epidemiological aspects and association with other pathologies and preserve the wellbeing of the newborn. In this special issue we have invited a few papers that address such issues. Congenital malaria is underestimated and usually associated with low-density cord parasitemia. However, it is increasingly recognized as a potentially serious complication of maternal malaria during pregnancy in Sub-Saharian Africa. Earliest epidemiological studies have reported prevalence varying widely in malaria-endemic areas from 0% to 33%. At birth, infections are usually asymptomatic with low parasitemia and the diagnosis by microscopy is often missed. Infection may occur by transplacental passage of parasites during disruption of the placental barrier at the time of delivery, with subsequent clinical illness in the newborn baby. A paper of this issue assessed the prevalence of congenital malaria during the dry season (period of low-mosquito density and low-malaria incidence) using peripheral and cord blood smears of new born babies in association with peripheral and placental blood smears of, respectively, near-term and term pregnant women. This study is interesting because the authors found that congenital malaria is not rare in their study area. Another paper is a literature review on the prevalence, burden, diagnosis, prevention, and control of congenital malaria in Sub-Saharian Africa. This review is of interest to individuals working in clinics and laboratory diagnostic of malaria but also to national governments and partners in Sub-Saharian Africa. The authors highlight the challenges in parasitological and clinical diagnosis, the challenges in prevention with the use of intermittent preventive treatment (IPT) and insecticide-treated nets (ITNs) and provides recommendation on how to strengthen the health system in Africa. Another paper reports the prevalence of transplacental malaria in Burkina Faso, a West African country, and determines the real burden of transplacental transmission. The authors show associations between levels of parasite in the maternal, placental, and umbilical cord blood. All papers about malaria published in this special issue show the interest of pursuing investigations for a better understanding of vertical transmission by malarial parasites. During congenital Chagas transmission, the parasite reaches the fetus by crossing the placental barrier. In the past few years congenital transmission of T. cruzi has increasingly become more important, and partly responsible for the “globalization of Chagas' disease,” constituting a public health problem of increasing relevance. The fact that only a percentage of the infected mothers transmit parasites to their fetuses raises the question of the ability of the placenta as well as the immunological status of mother and fetus/newborn to impair the parasite transmission. Therefore, it is thought that congenital Chagas disease is the product of a complex interaction between the parasite, the maternal, and fetus/newborn immune responses, and placental factors. Additionally, a paper of this special issue constitutes a morphological analysis by immunohistochemical and histochemical methods of placentas from women with chronic Chagas' disease. T. cruzi-infected placentas present destruction of the syncytiotrophoblast and villous stroma, selective disorganization of the basal lamina, and disorganization of collagen I in villous stroma. Changes in the extracellular matrix of placental tissues, together with the immunological status of mother and fetus, and parasite load may determine the probability of congenital transmission of T. cruzi. Another paper assayed the effect of T. cruzi on glucose transporter protein-1 (GLUT1), which is the main isoform involved in transplacental glucose transport. High glucose media as well as T. cruzi infection reduce GLUT1 expression. The effect of T. cruzi infection on GLUT1 expression may explain some of the clinical manifestation of congenital Chagas disease. Finally, a paper analyzing the congenital transmission of Chagas disease is a review about the role of possible local placental factors that contribute to the vertical transmission of the parasite. Additionally, in that review different available methods for studying the congenital transmission of T. cruzi are analyzed. In that context, the ex vivo infection of human placental chorionic villi by T. cruzi trypomastigotes constitutes an excellent tool for studying parasite infection strategies as well as possible local antiparasitic mechanisms. Ricardo E. Fretes Ulrike Kemmerling Demba Sarr

Congenital malaria is increasingly reported among babies born to mothers living in malaria endemic areas. The aim of this study was to determine the prevalence of congenital malaria among newborn babies delivered at Morogoro Regional Hospital, Tanzania. A cross-sectional study was conducted among 200 pregnant women attending delivery services at the hospital. Socio-demographic and obstetric information of the mothers was also collected. Samples of the placental, cord and peripheral blood smears of mothers and babies were stained with Giemsa and examined for malaria parasites. Plasmodiun falciparum was the dominant malaria parasite species. The prevalence of congenital malaria among newly born babies was 4.0% (95% CI, 1.2-6.8%). Prevalence of placental parasitaemia was 7.0% (95% CI, 3.3-10.7%), while prevalence of cord parasitaemia was 0.5% (95% CI, 0.0-1.5%). The prevalence of malaria among the mothers at delivery was 11.5% (95% CI, 6.9-16.1%). There was a strong association between placental, cord, maternal and congenital parasitaemia. All babies with congenital malaria had infected mothers and placentas (P<0.01). In conclusion, congenital malaria is still common in Tanzania especially in malaria endemic areas. It is important that blood smear from neonates are taken and examined for malaria parasite soon after birth. Malaria prevention measures such as intermittent preventive treatment, prompt management of all malaria cases and use of insecticide treated bed nets should be emphasized for all pregnant women.

The study was designed to determine the prevalence of congenital malaria, cord blood and placental malaria parasitaemia and the prevalence of clinical manifestations of congenital malaria. Ile-Ife is a holoendemic area for malaria. Placental, cord and peripheral blood smears of 120 newborn babies were examined for malaria parasites. They consisted of 104 (86.7 per cent) full term babies and 16 (13.3 per cent) preterm babies. Positive parasitaemia was found in 56 (46.7 per cent) of peripheral blood smears, 68 (56.7 per cent) and 65 (54.2 per cent) of the placental and cord blood smears respectively. There were strong associations between placental malaria and cord malaria parasitaemia and congenital malaria (p < 0.001). Congenital malaria has a high prevalence in Ile-Ife. There is a paucity of its clinical manifestations in the newborn. Only two babies had fever within 48 hours of birth.

Background: It is well documented that sub-Saharan Africa bears the highest burden of both malaria and HIV. Coinfection with both diseases is also well documented. Malaria parasites infecting the placenta lead to inflammation, intervillous fibrin deposition and infarction. This pathologic effect of malaria on the placental has led to the staging of placental malaria histology. These pathologic features may reflect different levels in the breach of the integrity of the placenta which may predispose to transmission of congenital malaria and possibly HIV. But few if any have examined the association of maternal placental malaria histology stages in HIV positive and negative mothers and the effects of these on their newborns (congenital malaria). Methods: Subjects were 162 newborns of HIV/malaria co-infected mothers and Controls were 162 newborns of HIV negative malaria infected mothers. Blood film for malaria parasites was done on cord blood and peripheral blood on days 1, 3 and 7 in the newborns. Maternal peripheral blood film for malaria parasite was done at delivery and placental tissue was obtained for confirmation of placental malaria by histology. Diagnosis of malaria in blood films was by light microscopy. Results: The placental malaria histology in HIV positive mothers were predominantly the chronic type (51.9%) and past type (54.6%) in HIV negative mothers respectively. Congenital malaria was significantly more in chronic types of placental malaria histology irrespective of maternal HIV status (p=0.017 in subjects and p= 0.000 in controls respectively) Conclusion: Babies born to mothers are at increased risk for congenital malaria if their placental malaria histology is of the chronic type compared to the other types (active and past) irrespective of maternal HIV status. This risk (chronic type) is highest in mothers with HIV; therefore, all babies born to HIV positive mothers should be screened for congenital malaria and managed as appropriate.

BackgroundPlacental malaria (PM) is characterized by Plasmodium parasite sequestration in the placenta. It is responsible for various adverse pregnancy outcomes, including maternal anaemia and low birth weight (LBW). This study aimed to assess prevalence and risk factors of PM, and gestational malaria (GM), together with the prevalence of congenital malaria (CM), maternal anaemia, and LBW among parturient women attending delivery ward of Metti Health Centre (Metti HC) in Majang Zone of Gambella Region, Southwest Ethiopia.MethodsA cross-sectional study involving 180 parturient women attending delivery ward of Metti HC was conducted from November 2022-March 2023. Sociodemographic, obstetric, and anti-malarial intervention data were collected. Capillary, placental and cord blood, and placental biopsy were collected to diagnose malaria using rapid diagnostic test (RDT), microscopy, quantitative polymerase chain reaction (qPCR), and histopathology. Haemoglobin concentration and blood group of the mother and weight of the newborn were determined. Statistical analyses were done by SPSS Version 26.0. Multivariable logistic regression analysis and Chi-square test were done to identify risk factors. Results were presented in text, tables and graphs.ResultsThe prevalence of GM, PM, CM, maternal anaemia, and LBW was 24.4% (95% CI 18.1–30.1), 34.4% (95% CI 27.4–41.4), 5.0% (95% CI 2.4–8.8), 41.7% (95% CI 34.6–49.0) and 27.8% (95% CI 21.6–34.6), respectively. Risk factors of GM were: presence of malaria history within the previous year (AOR: 5.10; 95% CI 1.64–15.83), lack of indoor residual spray (IRS) within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of antenatal care (ANC) contact during the index pregnancy (AOR: 3.96; 95% CI 1.44–10.87). Risk factors of PM were: presence of malaria history within the previous year (AOR: 2.98; 95% CI 1.05–8.45), and lack of ANC contact during the index pregnancy (AOR: 4.83; 95% CI 1.91–12.18). The risk of CM (p < 0.001), maternal anaemia (p < 0.001) and LBW (p < 0.001) increased with GM and PM.ConclusionThere is high prevalence of GM, PM, maternal anaemia, and LBW in the study area. The presence of GM and PM increased the risk of maternal anaemia, CM, and LBW. The identified risk factors should be considered to mitigate malaria among parturient women and its adverse outcomes.

Background: Congenital malaria can be a serious cause of morbidity and mortality in the neonates if not detected. Clinical features of congenital malaria are non-specific and could be confused with other forms of infections in the newborn. The study sets out to document presence of asymptomatic congenital malaria among neonates of mothers attending antenatal clinic in University of Medical Sciences Teaching Hospital, Akure. Methods: Mother-baby pairs were recruited into the study from the maternity section of the hospital, blood samples were taken from maternal peripheral blood, placental maternal side, cord blood and peripheral blood of the newborn babies and analyzed for presence of malaria parasite by microscopy methods. Data analyses were done using Statistical Package for the Social Sciences (SPSS) version 24.0 Results: Eighty-six (79.6%) of the babies were positive for malaria parasites, 59 (54.6%) of them were male children and 49(45.4%) were female. Fifty mothers (58.1%) had peripheral or placental parasitaemia. Babies of mothers who used long lasting insecticide treated nets (LLIN) and intermittent preventive therapy IPT-SP were significantly less infected while babies of first- and second-time mothers were significantly more infected. Majority of the babies 77/86 (89.5%) however had low intensity parasitaemia. Conclusions: Congenital malaria is no more a rare disease especially in endemic regions, prevention of mother-to-child transmission should be aggressively pursued.

Despite recent large-scale investments, malaria remains a major public health concern. Few studies have examined congenital malaria, defined as the presence of malaria parasitemia within the first 7 days of life, in endemic areas. This study aimed to determine the prevalence, to describe the clinical presentation, and to examine factors associated with congenital malaria in newborns aged up to 7 days attending Tororo General Hospital in Uganda. A total of 261 mother/baby pairs were recruited in this cross-sectional study. Giemsa-stained thick blood smears for malaria parasites and rapid malaria diagnostic tests were performed on capillary blood samples from all newborns and mothers, as well as on placental and cord samples from newborns delivered in the hospital. The prevalence of congenital malaria in the newborns was 16/261 (6.1%). No single clinical feature was associated with congenital malaria. However, there were associations between congenital malaria and maternal parasitemia (P < 0.001), gravidity of one (P = 0.03), maternal age < 19 years (P = 0.01), cord blood parasitemia (P = 0.01), and placental malaria (P = 0.02). In conclusion, congenital malaria is not rare in Uganda and there are no obvious clinical features associated with it in the newborn. Based on these findings, we recommend strengthening malaria prevention during pregnancy to reduce the occurrence of congenital malaria in newborns.