Congenital Malaria Research Articles

Cryptic Congenital Malaria Infection Causing Fever of Unknown Origin in an Infant

Cryptic Congenital Malaria Infection Causing Fever of Unknown Origin in an Infant

Pregnancy outcomes in women with imported malaria in mainland France: A retrospective study from 2004 to 2014

ObjectivesThere is little data on pregnant women with imported malaria in high-income countries, especially regarding offspring outcomes. We wanted to determine pregnancy outcomes of imported malaria in pregnant women in mainland France. Patients and methodsWe conducted a retrospective, descriptive study of outcomes in pregnant women hospitalized with malaria from 2004 to 2014 in two regions of mainland France. An adverse outcome was defined as a miscarriage, stillbirth, preterm birth (<35 weeks of gestation), low birth weight (LBW) defined as less than 2500 g, or congenital malaria. ResultsOf 60 pregnancies, 5 were excluded because of elective abortions; 55 were investigated, of which 11 were primigravidae and 44 multigravidae. Pregnancies were singleton (n = 51) or twin (n = 4). Mean age was 30.4 years (range:19–45 y). Among the 55 cases, 9 ended in a miscarriage (8 singletons and 1 twin pregnancy) and 1 had a stillbirth at 21 weeks of gestation, all immediately after the malarial episode. 45 gave birth (29 vaginal deliveries and 16 caesarean sections) to 48 (42 singletons and 6 twins) newborns. Amongst these, 30 were healthy full-term newborns, 10 had LBW, and 8 were preterm. Overall, 26 of 55 (47.3%) pregnancies, and 29 of 59 (49.2%) offsprings had adverse outcomes. Compared to singleton pregnancies, twin pregnancies were associated with adverse outcomes (p = 0.0438). ConclusionsImported malaria has a severe impact on pregnancy outcomes. Prevention and management of imported malaria in pregnancy should be optimized.

Prospective study of malaria in pregnancy, placental and congenital malaria in Northwest Colombia

BackgroundPregnancy Associated Malaria (PAM) include malaria in pregnancy (MiP), placental malaria (PM), and congenital malaria (CM). The evidence available in Colombia on PAM focuses on one of the presentations (MiP, PM or CM), and no study longitudinally analyses the infection from the pregnant woman, passing through the placenta, until culminating in the newborn. This study determined the frequency of MiP, PM, and CM caused by Plasmodium vivax, Plasmodium falciparum, or mixed infections, according to Thick Blood Smear (TBS) and quantitative Polymerase Chain Reaction (qPCR). Identifying associated factors of PAM and clinical-epidemiological outcomes in northwestern Colombia.MethodsProspective study of 431 pregnant women, their placenta, and newborns registered in the data bank of the research Group “Salud y Comunidad César Uribe Piedrahíta” which collected information between 2014 and 2020 in endemic municipalities of the departments of Córdoba and Antioquia. The frequency of infection was determined with 95% confidence intervals. Comparisons were made with the Chi-square test, Student t-test, prevalence ratios, and control for confounding variables by log-binomial regression.ResultsThe frequency of MiP was 22.3% (4.6% using TBS), PM 24.8% (1.4% using TBS), and CM 11.8% (0% using TBS). Using TBS predominated P. vivax. Using qPCR the proportions of P. vivax and P. falciparum were similar for MiP and PM, but P. falciparum predominated in CM. The frequency was higher in nulliparous, and women with previous malaria. The main clinical effects of PAM were anaemia, low birth weight, and abnormal APGAR score.ConclusionsThe magnitude of infections was not detected with TBS because most cases were submicroscopic (TBS-negative, qPCR-positive). This confirmed the importance of improving the molecular detection of cases. PAM continue being underestimated in the country due to that in Colombia the control programme is based on TBS, despite its outcomes on maternal, and congenital health.

Plasmodium infections and associated risk factors among parturients in Jawi district, northwest Ethiopia: a cross-sectional study

BackgroundPregnant women have an increased risk of Plasmodium infections and disease. Malaria in pregnancy is a major public health problem in endemic areas. Assessment of the burden and risk factors of malaria in pregnancy across different malaria transmission settings is required to guide control strategies and for malaria elimination. Thus, the current study is generating such evidence from parturient women in northwest Ethiopia.MethodsA cross-sectional study was conducted among 526 pregnant women admitted to the delivery rooms of selected health facilities in Jawi district, northwest Ethiopia, between November 2021 and July 2022. Data on the socio-demographic, clinical, obstetric, and malaria prevention practices of pregnant women were collected using interviewer-administered questionnaires and from women’s treatment cards. Malaria was diagnosed by light microscopy, rapid diagnostic test, and multiplex real-time polymerase chain reaction. Risk factors for malaria were evaluated using bivariable and multivariable logistic regression models. A P-value of < 0.05 was considered statistically significant.ResultsAmong the examined parturient women, 14.3% (95% CI 11.4–17.5%) had Plasmodium infections. The prevalence of peripheral, placental, and congenital malaria was 12.2% (95% CI 9.5–15.3%), 10.9% (95% CI 8.2–14.1%), and 3.7% (95% CI 2.3–6.1%), respectively. About 90.6% of peripheral and 92% of placental Plasmodium infections were asymptomatic. Plasmodium infection at parturiency was independently predicted by maternal illiteracy (AOR = 2.03, 95% CI 1.11–3.74), primigravidity (AOR = 1.88, 95% CI 1.01–3.49), lack of antenatal care follow-up (AOR = 2.28, 95% CI 1.04–5.03), and history of symptomatic malaria during pregnancy (AOR = 4.2, 95% CI 2.32–7.59). Moreover, the blood group O phenotype was significantly associated with placental malaria among the primiparae.ConclusionsOverall, asymptomatic Plasmodium infections were prevalent among parturients in northwest Ethiopia. Maternal illiteracy, primigravidity, lack of antenatal care follow-up, and history of symptomatic malaria during pregnancy were the risk factors for malaria during parturiency. Thus, promotion of a healthy pregnancy through ANC follow-up, strengthening malaria prevention and control practices, and screening of malaria in asymptomatic pregnant women are suggested to reduce its burden in pregnancy.

Diagnostic value of rapid test for malaria among febrile neonates in a tertiary hospital in North-East Nigeria: a prospective cross-sectional study

ObjectiveThe WHO recommends testing using microscopy or rapid diagnostic test (RDT) before treatment for malaria. However, the use of RDT to diagnose neonatal malaria has not been widely validated with...

Malaria in pregnancy in India: a 50-year bird's eye.

In 2021, India contributed for ~79% of malaria cases and ~ 83% of deaths in the South East Asia region. Here, we systematically and critically analyzed data published on malaria in pregnancy (MiP) in India. Epidemiological, clinical, parasitological, preventive and therapeutic aspects of MiP and its consequences on both mother and child were reviewed and critically analyzed. Knowledge gaps and solution ways are also presented and discussed. Several electronic databases including Google scholar, Google, PubMed, Scopus, Wiley Online library, the Malaria in Pregnancy Consortium library, the World Malaria Report, The WHO regional websites, and ClinicalTrials.gov were used to identify articles dealing with MiP in India. The archives of local scientific associations/journals and website of national programs were also consulted. Malaria in pregnancy is mainly due to Plasmodium falciparum (Pf) and P. vivax (Pv), and on rare occasions to P. ovale spp. and P. malariae too. The overall prevalence of MiP is ~0.1-57.7% for peripheral malaria and ~ 0-29.3% for placental malaria. Peripheral Pf infection at antenatal care (ANC) visits decreased from ~13% in 1991 to ~7% in 1995-1996 in Madhya Pradesh, while placental Pf infection at delivery unit slightly decreased from ~1.5% in 2006-2007 to ~1% in 2012-2015 in Jharkhand. In contrast, the prevalence of peripheral Pv infection at ANC increased from ~1% in 2006-2007 to ~5% in 2015 in Jharkhand, and from ~0.5% in 1984-1985 to ~1.5% in 2007-2008 in Chhattisgarh. Clinical presentation of MiP is diverse ranging from asymptomatic carriage of parasites to severe malaria, and associated with comorbidities and concurrent infections such as malnutrition, COVID-19, dengue, and cardiovascular disorders. Severe anemia, cerebral malaria, severe thrombocytopenia, and hypoglycemia are commonly seen in severe MiP, and are strongly associated with tragic consequences such as abortion and stillbirth. Congenital malaria is seen at prevalence of ~0-12.9%. Infected babies are generally small-for-gestational age, premature with low birthweight, and suffer mainly from anemia, thrombocytopenia, leucopenia and clinical jaundice. Main challenges and knowledge gaps to MiP control included diagnosis, relapsing malaria, mixed Plasmodium infection treatment, self-medication, low density infections and utility of artemisinin-based combination therapies. All taken together, the findings could be immensely helpful to control MiP in malaria endemic areas.

Malaria in newborn: A missed entity for primary care physician.

Neonatal malaria and congenital malaria, though thought to be a rare entity in non-endemic areas but incidences from epidemic countries are eye openers. It is still thought by primary care physicians that its existence among neonates is not common even in endemic areas due to a low index of suspicion. In order to attain the objective set out in the global technical strategy against malaria 2016-2030, it is important to have a gravity of this disease in all age groups, especially in children and neonates in which misconception of low burden of infection results in underestimation of its morbidity and mortality in these age groups. This disease is only the tip of the iceberg due to unidentified, underreported and neglected illness and being a pointer towards higher circulation among society and pregnant women. So this review article highlights pathophysiology, epidemiology, clinical features, complications, prognosis, treatment and prevention of malaria in newborns and intends to bring awareness among the caregivers to understand the need for attention towards this neglected disease of neonates so that they should be able to identify and manage the disease in this vulnerable age group.

Knowlesi Malaria in Children.

The fifth malaria parasite causing malaria- Plasmodium knowlesi (Pk), is not a novel emergent species but was an undiagnosed species before the availability of molecular methods as a tool from diagnostics and sometimes confused with morphologically similar human malaria parasite P. malariae or P. falciparum. Now it is well-distributed species in Southeast Asia, especially in Malaysia. Since 2004, cases of Pk malaria are continuously being reported in adults. Though adult age, forest-related activities and a recent visit to forested areas are well-known factors, childhood did not remain untouched by this disease. Few pieces of research and reports in the literature indicate that Infection in children is uncomplicated, but this may be attributed to the scarcity of data and research in this field. Pk malaria in pregnant females and infants are being well reported, so this indicates that the problem is not only restricted to known factors related to the disease, but we should think out of the box and take action before the disease takes the form of significant health burden on the human population as P. vivax and P. falciparum species did in the past. With the reports in literature of Pk malaria in pregnancy and early infancy, the possibility of congenital and neonatal malaria also cannot be denied. So more and more research is needed to understand Pk malaria in the pediatric population clearly. So this running review covers the problem status, demographic profile, clinical and haematological features, diagnosis, management and outcome of Pk malaria in paediatric group worldwide. This review also discusses the gaps in our present knowledge of the real problem status, prevention, control, diagnosis and management of Pk malaria, particularly in this age group.

The Impact of Malaria among pregnant women in Papua New Guinea: A Systematic Review of Epidemiology, Prevention &amp; Treatment.

BACKGROUND:&#x0D; Malaria in pregnancy is a serious public health problem in Papua New Guinea (PNG), where both Plasmodium falciparum and P. vivax are endemic. Malaria infection during pregnancy can cause maternal anemia, low birth weight, preterm delivery and congenital malaria, which can have serious consequences for the health and survival of mothers and infants. The aim of this literature review was to assess &amp; summarize the current state of knowledge and practice on malaria epidemiology, prevention and treatment in pregnant women and their newborns in PNG, based on ten research papers published from 1986 to 2021.&#x0D; Subjects and Methods:&#x0D; This was a systematic review conducted by searching articles from Google Scholar database and Mendeley Elsevier database and PubMed. The inclusion criteria were namely articles published in 1900 to 2022 years, cross sectional design study, and using quantitative method. The study subjects were pregnant women who visited antenatal clinics with or without malaria, research locations in Papua New Guinea. The exclusion criteria were articles that did not available in full text and located not in Papua New Guinea. The articles were then critically appraised and synthesized according to five main themes: anemia and iron deficiency, submicroscopic malaria infections, placental malaria infection, and knowledge, attitudes and practices concerning malaria in pregnancy &amp; congenital malaria.&#x0D; Results:&#x0D; A total of 10 papers were included in the review, covering various aspects of malaria epidemiology, prevention and treatment in pregnant women and their newborns in PNG. The main findings of the papers were: (1) anemia was very common and associated with splenomegaly, iron deficiency and malaria infection; (2) submicroscopic infections were common, but not associated with maternal anemia or low birth weight; (3) placental malaria infection was detected in 18.5% of placentas, and was associated with maternal anemia, low birth weight and preterm delivery; (4) there was a general awareness of the term “malaria”, but it was often confused with other illnesses or pregnancy symptoms; (5) congenital malaria infection was detected in 5.6% of newborns, mostly due to P. falciparum.&#x0D; Conclusion:&#x0D; This literature review provided useful evidence and recommendations for improving malaria prevention and control in pregnant women and their newborns in PNG, but also highlighted the need for more research and action to address the remaining challenges and gaps. The review concluded that malaria in pregnancy is a serious public health problem in PNG that requires comprehensive and integrated approaches to achieve its elimination by 2030.&#x0D; Keywords: Malaria in pregnancy, Papua New Guinea, Anemia, Submicroscopic malaria infections, Placental malaria infection

Clinical and Parasitological Profiles of Gestational, Placental and Congenital Malaria in Northwestern Colombia.

This study compared the clinical-parasitological profiles of gestational (GM), placental (PM), and congenital (CM) malaria in northwestern Colombia. A cross-sectional study with 829 pregnant women, 549 placentas, and 547 newborns was conducted. The frequency of GM was 35.8%, PM 20.9%, and CM 8.5%. P. vivax predominated in GM; in PM, the proportion of P. vivax and P. falciparum was similar; in CM, P. falciparum predominated. The main clinical findings were headache (49%), anemia (32%), fever (24%), and musculoskeletal pain (13%). The clinical manifestations were statistically higher in P. vivax infections. In submicroscopic GM (positive with qPCR and negative with thick blood smear), the frequency of anemia, sore throat, and a headache was statistically higher compared with pregnant women without malaria. GM, PM, and CM reduce birth weight and head circumference. In Colombia, this is the first research on the clinical characteristics of GM, PM, and CM; contrary to evidence from other countries, P. vivax and submicroscopic infections are associated with clinical outcomes.

Placenta and Cord Blood Malaria in Mothers and Neonates Attending Federal University Teaching Hospital, Owerri, Imo State South East Nigeria

Introduction: In Malaria endemic countries, gestational and cord blood malaria prevalence are highly variable. A comprehensive study to determine the prevalence of placental and cord malaria has not been undertaken in Imo state, south eastern Nigeria. Thus, the need to determine prevalence of placenta and chord blood with Plasmodium falciparum infection among pregnant mothers and their neonates in Federal university teaching hospital Owerri, Imo State, Nigeria.&#x0D; Methodology: A hospital based cross sectional study was carried out between the months of July 2021 and June, 2022 in some public and private hospitals in Owerri, south eastern Nigeria. Malaria transmission is stable with a high seasonal transmission from July to October. Placental and umbilical cord blood was collected into an EDTA bottle from mothers who consented and their neonates respectively at delivery. The presence of Plasmodium speciewas assessed microscopically and quantified by WHO Certified Malaria Microscopists. Parasite density was determined using WHO malaria microscopy protocol. Malaria parasite density was grouped as 1-500parasites/µl, 501-5,000parasites/µl (low), 5,001–10,000 parasites/µl (high), and &gt;10,000 parasites/µl (very high) respectively for ease of analysis. Data was analyzed considering the parasite density grouping and parity while placenta and cord malaria prevalence were determined.&#x0D; Results: Placental and congenital malaria prevalence by microscopy was 21.3% vs. 8.2%. The primigravid had the highest infection rate of 33.0%. Considering the relationship between infection prevalence and parity of pregnancy, there was a significant difference P=.001. 4.2% of 119 neonate and 13.6% of 88 neonates from multigravid and primigravid mothers respectively examined had cord malaria. There was significant difference P=.002 comparing cord malaria infection prevalence and parity of pregnancy of matched mothers. The relationship between parasite malaria density and parity of pregnancy both in placental and cord malaria were not significant. Age group 20-25 years (45%) had the highest Prevalence while age groups 26-30 years recorded a prevalence of 33.3% for the primigravid and multigravid groups, respectively (P&lt;0.05). The Geo mean range of 220 (3-8,250) vs. 23(2-6,412) parasite/µl of blood were recorded in primipare vrs multipare group. The result of this study showed moderate placental malaria infection and a low prevalence of cord malaria by microscopy. The presence of malaria parasites in cord blood at delivery and non in maternal placental blood was also demonstrated. There is a significant association between ITN (Insecticide-Treated Net) usage compliance rate and gravidity (primigravid vs. multigravid) among pregnant mothers. There is also a statistically significant relationship between age and gravidity in the occurrence of placenta malaria, as indicated by the chi-square test results.&#x0D; Conclusion: Antenatal exposure to malaria parasites may have profound effects on the fetus therefore prevention of malaria infection during pregnancy which may reduce the incidence of adverse perinatal outcomes should be strongly advocated.

Frequency of Thrombocytopenia in Plasmodium VIVAX Malaria Among Children

Objective: The purpose of the study was to quantify the incidence of thrombocytopenia in paediatric plasmodium vivax malaria. Methods: After the approval from institution review board, this cross-sectional study was conducted at Department of Paediatrics, Hayatabad Medical Complex, Peshawar, from 5 October 2018 to 5 April 2019. A total of 172 children’s were recruited in this research. At first, those who had a sudden start of a fever without any other symptoms were chosen. It was determined that the patient had hepatosplenomegaly and was treated accordingly. Blood tests, such as thick and thin smear microscopy, were performed on people who were thought to have malaria. Patients who met the study's inclusion and exclusion criteria were considered for participation. The peripheral smear was used to test for thrombocytopenia in patients with vivax malaria. Results: Mean ± S. D of age of the study participants was 7±7.85years. Among the study participants, 65% were male and 35% were females. Mean ± S. D of fever duration of the study participants was 4 ± 2.73 days, with 33 % have fever duration less than and equal to 4 days, while 67% of the study participants have more than 4 days. In 5% of study participants previous history of malaria and malaria vivax was observed, and 3% of the study participants have suffered from congenital malaria. Mean ± S. D of gestational age of the study participants was 37 ±3.21 weeks. Among the 172 recruited participants 68% had thrombocytopenia. Conclusion: Our study concludes that the frequency of thrombocytopenia was 68% in children presenting with in plasmodium vivax malaria. Keywords: thrombocytopenia, plasmodium, vivax malaria, children

Malaria asociada al embarazo: revisión narrativa

Malaria infections increase the risk of complications in the mother-fetus binomial. In Venezuela, the casuistry of this vulnerable group has not been updated in recent years. The objective of this narrative review was to comprehensively describe what pregnancy-associated malaria is and its maternal, fetal and neonatal effects; trying to answer the following research question. All forms of pregnancy-associated malaria, including gestational, placental and congenital malaria, cause maternal-fetal and neonatal alterations that, if they progress, could lead to the death of this binomial. Physiopathology and immunopathology can explain the symptoms of pregnant women and the fetus, as well as their complications; depending on the parasitic form affecting. There are new updates in the diagnosis, prevention and treatment of this entity.

Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia

This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

Systematic Review: Prevalensi dan Dampak Infeksi Malaria pada Wanita Hamil dan Neonatal

Globally, malaria cases in the world reached 241 million cases in 2020 and increase from the previous year. Malaria infection in pregnant women was reported in 33 countries, and the cases were estimated at 11.6 million (34%). Malaria infection can increase maternal and fetal morbidity and mortality, including anemia in pregnancy, low birth weight, premature birth, stillbirth, and small gestation age, and congenital malaria. This article discusses pregnant women's malaria infection prevalence and maternal and neonatal outcomes. This paper is a systematic review by searching for articles using electronic databases from Pubmed and ScienceDirect using keywords “Malaria” and “Pregnancy” or “Pregnant Women” and “Outcome” or “Impact” and “Maternal” or “Neonatal”. The selection of articles used the PRISMA guidelines which were then analyzed in a narrative manner. Based on the article search results obtained 10 articles that meet the criteria for analysis. The prevalence of malaria infection in pregnancy is still high. Reported outcomes in pregnancy, birth, and neonates include preterm birth, low birth weight, small gestation age, maternal anemia, and maternal and neonatal mortality. The role of health workers is very important to prevent malaria infection in pregnancy so that it does not result in adverse health impacts for maternal and neonatal.

Prevalence, Risk Factors and Treatment Outcomes of Congenital Malaria among Neonates Hospitalized in Hospitals of Douala, Cameroon

Prevalence, Risk Factors and Treatment Outcomes of Congenital Malaria among Neonates Hospitalized in Hospitals of Douala, Cameroon

Malaria and pregnancy: a Venezuelan approach. Review article

Aim: to review and describe exhaustively the implications of malaria in pregnancy, including its maternal, fetal, and neonatal clinical manifestations and effects; immunopathology and pathophysiology; advancements in its diagnostics, histopathology, and treatment options; and epidemiology, particularly in Venezuela, a country where its data is almost non-existent. Methods: the information used to write this manuscript was obtained during a three-month period, between June and September 2022, from specialized literature, written in English and Spanish, related to malaria associated with pregnancy, mainly published during the last five years, using journals found in the most relevant medical digital archives, including PubMed, SciELO, Elsevier, Google Scholar, Latindex, and Cochrane Plus. Among the keywords used for obtaining this updated information were malaria; malaria in pregnancy; gestational malaria; placental malaria; congenital malaria. Results: all the clinical forms related to malaria in pregnancy, including gestational, placental, and congenital malaria, can cause maternal-fetal alterations, that, in case of progressing, could lead to the death of this binomial. Their pathophysiology and immunopathology can explain the gestational and fetal symptomatology, as well as their complications, depending on the parasite form that affected them. There are new updates regarding the diagnostics, prevention, and treatment of this medical entity. Conclusion: it is imperative to exalt the relevance of studying this disease in pregnant patients, especially in the Venezuelan topography, a focus of infection with a plethora of cases of said entity, whose lack of updated epidemiological data, regarding its prevalence and incidence, is profoundly preoccupying. Pregnant patients are not only one of the most vulnerable risk groups of this parasitosis, but also have the capacity of duplicating the risk of infecting the fetus.

Congenital and Placenta Malaria and Newborn Birth Weight in Asymptomatic HIV Positive Pregnant Women at Term

Background: Human Immuno-deficiency Virus (HIV) and Malaria infection independently are major contributors to adverse perinatal outcomes in sub-Saharan Africa. A co-infection of both in pregnancy has been associated with more deleterious birth weight- related neonatal outcomes. We assessed for congenital malaria and evaluated the birth weights of babies born to HIV positive mothers with and without evidence of placenta malaria at term delivery. Methods: This was a comparative cross-sectional study in which 90 low-risk, HIV positive pregnant women on highly active retroviral therapy (HAART), asymptomatic for malaria, with uncomplicated delivery, at the Lagos State University Teaching Hospital, were consecutively recruited to have their maternal venous, placenta and newborn blood samples assessed following delivery for malaria. A placenta biopsy was also done to assess for features of placenta malaria. Data obtained were expressed in frequencies and percentages and variables were tested as appropriate using an independent t-test, chi-square and spearman’s correlation. The level of significance was set at p&lt;0.05. Findings: The prevalence of placenta malaria and congenital malaria in the study was 11.1% and 0.0% respectively. Only 3.3% of the asymptomatic HIV positive, pregnant women at delivery had positive malaria tests of their venous blood samples. The mean neonatal packed cell volume at birth for women with and without placenta malaria was 43.6% and 44.9% respectively (p=0.044). The mean birth weight of the babies born to HIV positive women with and without placenta malaria was 2.7±0.2kg and 3.0±0.4kg respectively (p=0.008). The correlation between birth weight and CD4 count was positive but insignificant (r=0.069, p=0.515). Conclusion: Although, irrespective of placenta malaria status, congenital malaria is a rarity in babies of HIV positive pregnant women, the birth weight and packed cell volume of babies born to HIV positive women is significantly lower in this group of women with features of placenta malaria than in women without placenta malaria.

Frequency of placental malaria and its associated factors in northwestern Colombia, pooled analysis 2009-2020.

Knowledge about placental malaria (PM) is insufficient in the world, and incipient in Colombia where studies are few and recent. In this country, PM has been reported by Plasmodium vivax, Plasmodium falciparum, and mixed infection. The objective was to determine the frequency of PM and its associated clinical-epidemiological factors in mothers and neonates in northwestern Colombia, 2009–2020. A Retrospective pooled analysis with 602 placentas captured in five investigations. The diagnosis of PM was made with thick blood smear (TBS) and qPCR. The groups with and without PM were compared using the Chi-square test, Mann-Whitney test, and crude and adjusted prevalence ratios in a log-binomial model. The prevalence of PM was 27.7% with 92% (155/167) of submicroscopic cases; 41.3% by P. vivax, 44,3% by P. falciparum, and 14.4% by mixed infections. In the multivariate adjustment, PM was associated with the diagnosis of congenital malaria, low neonatal weight, gestational malaria, maternal anemia, previous malaria during pregnancy, and age between 25–43 years. This research is the investigation with the largest number of subjects for studying PM in Colombia, in the ecoepidemiological zone that produces more cases of malaria per year, finding a high prevalence of submicroscopic PM that caused serious maternal (anemia) and neonatal (congenital malaria and low neonatal weight) effects. The results show limitations in the timely diagnosis and treatment, given that the epidemiological surveillance program in Colombia is based on thick blood smear, which generates a substantial underestimation of the magnitude of PM, with serious effects and clinical risks. It is urgent to demand that the health authorities adopt measures such as prenatal control visits as soon as the pregnancy begins, monthly implementation of TBS, and active search for infected pregnant women in their homes and workplaces.

Congenital malaria: Frequency and epidemiology in Colombia, 2009-2020.

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.