Placental Malaria is Rare Among Zanzibari Pregnant Women who did not Receive Intermittent Preventive Treatment in Pregnancy

Marya Plotkin,Julie Gutman,Asma Ramadhan Khamis,Alanna C Schwartz,Mwinyi I Msellem,Chonge Kitojo,Rachel P Chase,Peter D Mcelroy,Natalie Hendler,Elaine Roman,Khadija Said

doi:10.4269/ajtmh.13-0586

Abstract

Zanzibar has transitioned from malaria control to the pre-elimination phase, and the continued need for intermittent preventive treatment during pregnancy (IPTp) has been questioned. We conducted a prospective observational study to estimate placental malaria positivity rate among women who did not receive IPTp with sulfadoxine-pyrimethamine. A convenience sample of pregnant women was enrolled from six clinics on the day of delivery from August of 2011 to September of 2012. Dried placental blood spot specimens were analyzed by polymerase chain reaction (PCR); 9 of 1,349 specimens (0.7%; precision estimate = 0.2–1.1%) were PCR-positive for Plasmodium falciparum. Placental infection was detected on both Pemba (N = 3) and Unguja (N = 6). Placental malaria positivity in Zanzibar was low, even in the absence of IPTp. It may be reasonable for the Ministry of Health to consider discontinuing IPTp, intensifying surveillance efforts, and promoting insecticide-treated nets and effective case management of malaria in pregnancy.

Highlights

AND MATERIALSThe devastating consequences of malaria in pregnancy (MIP) on maternal and newborn health are well-documented
Pregnant women in areas of both stable and unstable malaria transmission are at increased risk for peripheral and placental Plasmodium falciparum infection, with symptomatic infections being more common in areas of unstable transmission.[1,2,3,4]
Since 2006, Zanzibar has scaled up long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), improved case detection with malaria rapid diagnostic tests, and introduced artemisinin-based combination therapy (ACT)

Summary

Introduction

The devastating consequences of malaria in pregnancy (MIP) on maternal and newborn health are well-documented. Pregnant women in areas of both stable and unstable malaria transmission are at increased risk for peripheral and placental Plasmodium falciparum infection, with symptomatic infections being more common in areas of unstable transmission.[1,2,3,4] The adverse maternal outcomes of MIP in both transmission settings include severe anemia and mortality, with higher case fatality rates in lower-transmission settings.[3,5,6] In addition, MIP is associated with low birth weight (LBW; < 2,500 g),[7] an important risk factors for infant mortality.[2,8,9].

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