Effects Of Malaria In Pregnancy Research Articles

Neurodevelopmental and neurobehavioral sequelae associated with in utero exposure to second-generation antidepressants: A systematic review

Effects of Malaria in Pregnancy (MiP) on Pregnancy Development and its Outcome: a Critical ReviewJoshua Djabanor, Elvis Quansah, Du-Bois Asante

Malaria during pregnancy: An insights of complications

Malaria is one of the leading causes of morbidity and mortality around the globe including Pakistan. Plasmodium vivax and Plasmodium falciparum are causing the majority of infections which are increasing and account for approximately 35-40% of cases. Several physiological and pathological changes occur due to adverse effects of malaria in pregnancy. The current study was conducted in District Headquarter Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan to govern the possessions and complications of malarial parasitaemia in pregnancy. Two thousand pregnant patients associated with malaria were included in this study. Regarding stage, and parity of pregnancy, malarial infections were found more common in primigravida and second gravida than in multigravida. Two commonest pathogens (Plasmodium vivax, and Plasmodium falciparum) were observed in pregnant patients. It was found that 84 (23.01%) of 365 women in their first pregnancy (P0) were parasitaemic. In 2nd, 3rd, and 4th pregnancies, almost 24.49, 28.94, 29.38, and 29.32% of women, respectively were parasitaemic. The maximum incidence of P. vivax was recorded in 3rd trimester followed by the 2nd, and 1st trimesters. Regarding pregnancy outcomes, 1.35% of patients developed puerperal pyrexia, 2.2 had an abortion, 5.50% neonatal death occurred, 6.90% patients had anemia, 1.25% patients have cerebral malaria, and a total of 6.6% complications were recorded in the current study. It is concluded that pregnant women are prone to malaria infections, causing spontaneous abortion, premature birth, reduce baby weight, and stillbirth, particularly in high-endemic areas.

Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review

BackgroundDespite the introduction of efficacious interventions for malaria control, sub-Saharan Africa continues to bear the highest burden of malaria and its associated effects on vulnerable populations, such as pregnant women and children. This meta-ethnographic review contributes to literature on malaria in pregnancy interventions in sub-Saharan Africa by offering insights into the multiple factors that motivate or demotivate women from accessing MiP interventions.MethodsA meta-ethnographic approach was used for the synthesis. Original qualitative research articles published from 2010 to November 2021 in English in sub-Saharan Africa were searched for. Articles focusing on WHO’s recommended interventions such as intermittent preventive treatment with sulfadoxine-pyrimethamine, long-lasting insecticidal nets and testing and treatment of Malaria in Pregnancy (MiP) were included. Selected articles were uploaded into Nvivo 11 for thematic coding and synthesis.ResultsTwenty-seven original qualitative research articles were included in the analysis. Main factors motivating uptake of MiP interventions were: (1) well organized ANC, positive attitudes of health workers and availability of MiP services; (2) Women’s knowledge of the effects of malaria in pregnancy, previous experience of accessing responsive ANC; (3) financial resources and encouragement from partners, relatives and friends and (4) favourable weather condition and nearness to a health facility. Factors that demotivated women from using MiP services were: (1) stock-outs, ANC charges and health providers failure to provide women with ample education on the need for MiP care; (2) perception of not being at risk and the culture of self-medication; (3) fear of being bewitched if pregnancy was noticed early, women’s lack of decision-making power and dependence on traditional remedies and (4) warm weather, long distances to health facilities and the style of construction of houses making it difficult to hang LLINs.ConclusionsHealth system gaps need to be strengthened in order to ensure that MiP interventions become accessible to women. Additionally, health managers need to involve communities in planning, designing and implementing malaria interventions for pregnant women. It is important that the health system engage extensively with communities to facilitate pregnant women and communities understanding of MiP interventions and the need to support pregnant women to access them.

Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi

BackgroundThe World Health Organization recommends three or more doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) to mitigate the negative effects of malaria in pregnancy (MIP). Many pregnant women in Malawi are not receiving the recommended number of doses. Community delivery of IPTp (cIPTp) is being piloted as a new approach to increase coverage. This survey assessed recently pregnant women’s knowledge of MIP and their experiences with community health workers (CHWs) prior to implementing cIPTp.MethodsData were collected via a household survey in Ntcheu and Nkhata Bay Districts, Malawi, from women aged 16–49 years who had a pregnancy resulting in a live birth in the previous 12 months. Survey questions were primarily open response and utilized review of the woman’s health passport whenever possible. Analyses accounted for selection weighting and clustering at the health facility level and explored heterogeneity between districts.ResultsA total of 370 women were interviewed. Women in both districts found their community health workers (CHWs) to be helpful (77.9%), but only 35.7% spoke with a CHW about antenatal care and 25.8% received assistance for malaria during their most recent pregnancy. A greater proportion of women in Nkhata Bay than Ntcheu reported receiving assistance with malaria from a CHW (42.7% vs 21.9%, p = 0.01); women in Nkhata Bay were more likely to cite IPTp-SP as a way to prevent MIP (41.0% vs 24.8%, p = 0.02) and were more likely to cite mosquito bites as the only way to spread malaria (70.6% vs 62.0% p = 0.03). Women in Nkhata Bay were more likely to receive 3 + doses of IPTp-SP (IPTp3) (59.2% vs 41.8%, p = 0.0002). Adequate knowledge was associated with increased odds of receiving IPTp3, although not statistically significantly so (adjusted odds ratio = 1.50, 95% confidence interval 0.97–2.32, p-value 0.066).ConclusionsWomen reported positive experiences with CHWs, but there was not a focus on MIP. Women in Nkhata Bay were more likely to be assisted by a CHW, had better knowledge, and were more likely to receive IPTp3+ . Increasing CHW focus on the dangers of MIP and implementing cIPTp has the potential to increase IPTp coverage.

Vivax malaria in pregnancy and lactation: a long way to health equity

BackgroundThe Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities.Case presentationA symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant.ConclusionAdverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.

A brief review on features of falciparum malaria during pregnancy.

Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.

Influence of the number and timing of malaria episodes during pregnancy on prematurity and small-for-gestational-age in an area of low transmission

BackgroundMost evidence on the association between malaria in pregnancy and adverse pregnancy outcomes focuses on falciparum malaria detected at birth. We assessed the association between the number and timing of falciparum and vivax malaria episodes during pregnancy on small-for-gestational-age (SGA) and preterm birth.MethodsWe analysed observational data collected from antenatal clinics on the Thailand-Myanmar border (1986–2015). We assessed the effects of the total number of malaria episodes in pregnancy on SGA and the effects of malaria in pregnancy on SGA, very preterm birth, and late preterm birth, by the gestational age at malaria detection and treatment using logistic regression models with time-dependent malaria variables (monthly intervals). World Health Organisation definitions of very preterm birth (≥28 and <32 weeks) and late preterm birth (≥32 and <37 weeks) and international SGA standards were used.ResultsOf 50,060 pregnant women followed, 8221 (16%) had malaria during their pregnancy. Of the 50,060 newborns, 10,005 (21%) were SGA, 540 (1%) were very preterm, and 4331 (9%) were late preterm. The rates of falciparum and vivax malaria were highest at 6 and 5 weeks’ gestation, respectively. The odds of SGA increased linearly by 1.13-fold (95% confidence interval: 1.09, 1.17) and 1.27-fold (1.21, 1.33) per episode of falciparum and vivax malaria, respectively. Falciparum malaria at any gestation period after 12–16 weeks and vivax malaria after 20–24 weeks were associated with SGA (falciparum odds ratio, OR range: 1.15–1.63 [p range: <0.001–0.094]; vivax OR range: 1.12–1.54 [p range: <0.001–0.138]). Falciparum malaria at any gestation period after 24–28 weeks was associated with either very or late preterm birth (OR range: 1.44–2.53; p range: <0.001–0.001). Vivax malaria at 24–28 weeks was associated with very preterm birth (OR: 1.79 [1.11, 2.90]), and vivax malaria at 28–32 weeks was associated with late preterm birth (OR: 1.23 [1.01, 1.50]). Many of these associations held for asymptomatic malaria.ConclusionsProtection against malaria should be started as early as possible in pregnancy. Malaria control and elimination efforts in the general population can avert the adverse consequences associated with treated asymptomatic malaria in pregnancy.

Effects of Malaria in Pregnancy (MiP) on Pregnancy Development and its Outcome: a Critical Review

Effects of Malaria in Pregnancy (MiP) on Pregnancy Development and its Outcome: a Critical Review

Global Call to Action: maximize the public health impact of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa.

Intermittent preventive treatment of malaria in pregnancy is a highly cost-effective intervention which significantly improves maternal and birth outcomes among mothers and their newborns who live in areas of moderate to high malaria transmission. However, coverage in sub-Saharan Africa remains unacceptably low, calling for urgent action to increase uptake dramatically and maximize its public health impact. The ‘Global Call to Action’ outlines priority actions that will pave the way to success in achieving national and international coverage targets. Immediate action is needed from national health institutions in malaria-endemic countries, the donor community, the research community, members of the pharmaceutical industry and private sector, along with technical partners at the global and local levels, to protect pregnant women and their babies from the preventable, adverse effects of malaria in pregnancy.

Quantifying low birth weight, preterm birth and small-for-gestational-age effects of malaria in pregnancy: a population cohort study.

BackgroundThe association between malaria during pregnancy and low birth weight (LBW) is well described. This manuscript aims to quantify the relative contribution of malaria to small-for-gestational-age (SGA) infants and preterm birth (PTB) in pregnancies accurately dated by ultrasound on the Thai-Myanmar border at the Shoklo Malaria Research Unit.Methods and FindingsFrom 2001 to 2010 in a population cohort of prospectively followed pregnancies, we analyzed all singleton newborns who were live born, normal, weighed in the first hour of life and with a gestational age (GA) between 28+0 and 41+6 weeks. Fractional polynomial regression was used to determine the mean birthweight and standard deviation as functions of GA. Risk differences and factors of LBW and SGA were studied across the range of GA for malaria and non-malaria pregnancies. From 10,264 newborns records, population centiles were created.Women were screened for malaria by microscopy a median of 22 [range 1–38] times and it was detected and treated in 12.6% (1,292) of pregnancies. Malaria was associated with LBW, PTB, and SGA compared to those without malaria. Nearly two-thirds of PTB were classified as LBW (68% (539/789)), most of which 83% (447/539) were not SGA. After GA 39 weeks, 5% (298/5,966) of non-LBW births were identified as SGA. Low body mass index, primigravida, hypertension, smoking and female sex of the newborn were also significantly and independently associated with LBW and SGA consistent with previous publications.ConclusionsTreated malaria in pregnancy was associated with an increased risk for LBW, PTB, and SGA, of which the latter are most important for infant survival. Using LBW as an endpoint without adjusting for GA incorrectly estimated the effects of malaria in pregnancy. Ultrasound should be used for dating pregnancies and birth weights should be expressed as a function (or adjusted for GA) of GA in future malaria in pregnancy studies.

Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes

BackgroundIntermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome.MethodsPregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and premature birth was analysed using intention-to-treat (ITT) and per-protocol (PP) analysis.ResultsData from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance.ConclusionThe risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal.

Malaria in pregnancy

Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10, 000 maternal deaths and to at least 200, 000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse. Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started. The Roll Back Malaria [RBM] campaign was launched as a strategy to curtail the incidence and scourge of malaria especially in the vulnerable groups including pregnant women. The Millennium Development Goals [MDGs] offer a new hope if adequately pursued to achieving eradication of malaria and its complications in pregnancy. There is need to support research into effectiveness and utilization of established and newer control measures.

Effects of Malaria in pregnancy on newborn anthropometry

Malaria in pregnancy remains a major cause of infant mortality through its contribution to preterm delivery, low birth weight and intrauterine death. During a cross-sectional study of 983 mothers delivering in a secondary health care facility in Ibadan, southwestern Nigeria, an area of high malaria transmission, the effect of maternal and placental malaria parasitaemia on newborn anthropometry was evaluated. Malaria parasitemia was detected by microscopy of Giemsa stained thick blood smears. Placental, maternal and combined placental and maternal malaria parasitaemia rates at the time of delivery were 13.1%, 12.7% and 11.1% respectively. The geometric mean parasite densities in maternal and placental smears were significantly higher in primigravid mothers than others (p = 0.004 and 0.002 respectively). Low birth weight rate was higher among babies born to mothers with maternal parasitaemia compared to those without (8.0 % versus 6.3%, p < 0.05). The mean birth weight was lower in neonates of mothers with peripheral and placental parasitaemia by 138 g and 122 g (p = 0.01 and 0.02) respectively, while the respective difference was up to 168 g and 151 g among primigravidae (p = 0.03 and 0.04). Neonates of mothers with maternal and placental parasitaemia had a lower mean length than those without parasitaemia (48.2 vs 49.2cm, p = < 0.0001 and 48.5 vs 49.2cm p = 0.02 respectively). Occiptofrontal circumference and ponderal indices were not significantly affected by maternal malaria parasitaemia. Malaria in pregnancy results in symmetric foetal growth restriction and the effect is more marked among primigravid mothers.

Prevalence, risk factors and effects of placental malaria in the UMTH, Maiduguri, North-eastern, Nigeria: A cross-sectional study

SummaryMost of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period.

The importance of understanding the local context: Women's perceptions and knowledge concerning malaria in pregnancy in rural Malawi

A current problem of malaria prevention programmes is that not enough attention is paid to understanding the local socio-cultural context prior to programme implementation. The aim of this study is to discover how Yao women in rural Malawi understand and explain malaria in pregnancy, how they perceive it and what type of knowledge they have on it. Women's knowledge of the adverse effects of malaria in pregnancy is also investigated. At first phase a total of 34 in-depth interviews were conducted. At second phase a KAP survey ( n = 248) was conducted for cross-validation of the qualitative information. The findings showed that there is neither a vernacular word for malaria nor malaria in pregnancy. Women used a local word, malungo, to refer to malaria. Malungo is an ambiguous disease term because of its multiple meanings which are used interchangeably to refer to many types of feverish illnesses of various causes, not only malaria. Most women did not perceive malungo during pregnancy as a serious illness. There were several other diseases from anaemia, STDs to cholera etc. that were perceived to be more dangerous than malungo. The local meaning of malungo also entailed an assumption that it is a common but fairly harmless illness. Women had limited knowledge of the adverse effects of malaria in pregnancy, the best-known adverse effect being miscarriage (28%, 52/189). A socio-cultural understanding of the implementation context is prerequisite for planning meaningful programmes for the pregnant women in rural Africa.

Maternal vitamin A supplementation and immunity to malaria in pregnancy in Ghanaian primigravids

Vitamin A supplementation is believed to enhance immune responses to infection but few studies have assessed its effects on anti-malarial immunity, especially during pregnancy when women are at increased risk from both vitamin A deficiency and pregnancy-associated malaria. The pathological effects of malaria in pregnancy are believed to be due to the sequestration of parasites in the placenta mediated via binding of variant surface antigens (VSA) expressed on the surface of P. falciparum infected red blood cells to placental chondroitin sulphate A (CSA). We conducted a randomized double-blind controlled trial of vitamin A supplementation in 98 primigravid Ghanaian women to investigate the effects of vitamin A supplementation on levels of IgG antibodies binding to VSA of a clinical, P. falciparum placental isolate and to two isolates selected (or not) for adherence to CSA in vitro (anti-VSACSA IgG or anti-VSA IgG). Placental malarial infection was determined by placental blood smear and histology. Vitamin A supplementation was non-significantly associated with a decreased risk of active or chronic-active placental malarial infection compared to past, resolved infection at delivery, as determined by histology (OR=0.42, P=0.13--adjusted for level of education). After adjustment for differences in baseline values, levels of anti-VSACSA IgG to a placental, CSA-adherent isolate (EJ-24) but not to two isolates selected for CSA-adhesion in vitro (FCR3CSA and BusuaCSA), were significantly lower in women receiving vitamin A supplementation than in women receiving placebo (P=0.002). There was no apparent effect of vitamin A supplementation to levels of Ab to non-CSA-adherent parasite isolates. The data suggest that the reduction in the levels of anti-VSACSA antibodies to the known placental malaria isolate may reflect reduced intensity or duration of placental parasitaemia in women receiving vitamin A supplementation. These observations are of potential public health significance and deserve further investigation.

Bed nets for the prevention of malaria and anaemia in pregnancy

A prospective comparison of the antimalarial efficacy of bed nets was conducted with 341 pregnant women living in a mesoendemic malarious area of the Thai-Burmese border. Women in 3 adjacent study sites were allocated at random to receive either a single size permethrin-impregnated bed net (PIB), a non-impregnated bed net (NIB), or to a control group who used either their own family size non-impregnated bed net (FNIB) or no net. In one study site, but not the other 2, PIB significantly reduced parasite densities and, together with FNIB, reduced the incidence of malaria in pregnancy from 56% to 33% (relative risk = 1·67, confidence interval = 1·07–2·61, P = 0·03, allowing for parity). Anaemia proved a more sensitive marker of bed net antimalarial efficacy than parasite rates. The incidence of anaemia (haematocrit <30%) at all study sites was significantly lower at delivery in the PIB (27%) and FNIB groups (21%) than in the NIB group (41%) or those using no net (56%). This suggests that a significant proportion of the malaria in pregnancy in this mesoendemic area was sub-patent. Both patent Plasmodium falciparum parasitaemia and anaemia were associated with a reduction in birth weight. Infant mortality was high (16%) and strongly associated with prematurity, low birth weight and maternal anaemia. PIB were well tolerated and had no apparent adverse effect on the pregnancy or infant development. Although the overall effect of bed nets on patent parasitaemia was marginal, they were associated with a significant reduction in maternal malaria-associated anaemia. PIB or FNIB reduce the adverse effects of malaria in pregnancy on the mother, and may also reduce subsequent infant morbidity and mortality.

Malaria and child health.

Pregnancy increases the risk of malaria in women especially the primiparous during the 2nd trimester. The effects of malaria in pregnancy on women from nonmalarious areas and on women from areas of unstable malarious areas are much more severe than those on women of stable malarious areas. Physicians have reported transplacental infection with all 3 types of malaria but congenital malaria is rare in areas of stable malaria. Malnourished children are less likely to experience the more serious complications of falciparum malaria than well nourished children. In endemic areas only a small percentage of infants 0-3 months old have malaria but prevalence of infection rises rapidly to about 90% by 1 year of age with most of these infants experiencing severe clinical malaria. Those children at most risk of life threatening malaria are those between 6 months-3 years old. The most important factor in the development of life threatening cerebral malaria is a delay in diagnosis so if malaria is suspected treatment should begin before parasitological confirmation. If a child has hypoglycemia and malaria these effects combined with anorexia vomiting and treatment using hypoglycemic agents and quinine may cause death or irrevocable brain damage. Other symptoms of malaria that must be treated prudently include renal failure respiratory problems and hyperpyrexia. In endemic areas children with sickle cell anemia experience painful bone crises and intensified anemia stimulated by malaria. Quartan malaria causes death from renal pathology more frequently than falciparum malaria in endemic areas of Africa. Quartan malaria mediates in the etiology of Burkitts lymphoma the most common malignant disease in childhood in tropical Africa.

Malaria in pregnancy.

Recent evidence suggests an increasing incidence of malaria among the civilian population of the United States. The effects of malaria in pregnancy can be serious to both mother and fetus. We present four patients with malaria during pregnancy and review the charts of 18 additional patients with malaria (two of whom were pregnant) in order to familiarize the reader with the general clinical picture. The currently recommended chemoprophylaxis and treatment are outlined.