Abstract
BackgroundIt is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to malaria and when infected they present few or no symptoms. However, longitudinal cohort studies investigating the clinical presentation of malaria infection in pregnant women in stable endemic areas are lacking, and the few studies exploring this issue are unconclusive.MethodsA prospective cohort of women followed monthly during pregnancy was conducted in three rural dispensaries in Benin from August 2008 to September 2010. The presence of symptoms suggestive of malaria infection in 982 women during antenatal visits (ANV), unscheduled visits and delivery were analysed. A multivariate logistic regression was used to determine the association between symptoms and a positive thick blood smear (TBS).ResultsDuring routine ANVs, headache was the only symptom associated with a higher risk of positive TBS (aOR = 1.9; p < 0.001). On the occasion of unscheduled visits, fever (aOR = 5.2; p < 0.001), headache (aOR = 2.1; p = 0.004) and shivering (aOR = 3.1; p < 0.001) were significantly associated with a malaria infection and almost 90% of infected women presented at least one of these symptoms. Two thirds of symptomatic malaria infections during unscheduled visits occurred in late pregnancy and long after the last intermittent preventive treatment dose (IPTp).ConclusionThe majority of pregnant women were symptomless during routine visits when infected with malaria in an endemic stable area. The only suggestive sign of malaria (fever) was associated with malaria only on the occasion of unscheduled visits. The prevention of malaria in pregnancy could be improved by reassessing the design of IPTp, i.e. by determining an optimal number of doses and time of administration of anti-malarial drugs.
Highlights
It is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to malaria and when infected they present few or no symptoms
Even if the women remain asymptomatic and do not get a curative treatment or do not attend frequently antenatal visits (ANV), it is likely that SP intermittent preventive treatment during pregnancy (IPTp) has a long acting prophylactic effect which protects them for the duration of the pregnancy [9]
818 live singletons 18 live twins lost to follow-up had delivered outside the STOPPAM frame and, outcomes of deliveries were unknown. 836 women were known to have given birth, 128 thick blood smear (TBS) had not been performed due to a public health-workers’ strike, and malaria status was not available for these women
Summary
It is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to malaria and when infected they present few or no symptoms. It has been estimated that between 75,000 and 200,000 newborn deaths occur each year as a direct result of LBW due to malaria in pregnancy [1,4,5]. To prevent the consequences of MiP, the WHO recommends an intermittent preventive treatment during pregnancy (IPTp), an adequate management of clinical malaria, and the use of insecticide-treated nets. It is generally agreed that in high transmission areas, pregnant women have acquired a partial immunity to the disease and when infected they present no or few symptoms[6,7,8]. Even if the women remain asymptomatic and do not get a curative treatment or do not attend frequently antenatal visits (ANV), it is likely that SP IPTp has a long acting prophylactic effect which protects them for the duration of the pregnancy [9]
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