Gestational Malaria Research Articles

Placental malaria and adverse pregnancy outcomes in Majang Zone of Gambella Region, Southwest Ethiopia: a histopathological and molecular study

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.

A model of pregnancy-associated malaria for inducing adverse pregnancy outcomes in ICR mouse

BackgroundBased on understanding of placental pathological features and safe medication in pregnancy-associated malaria (PAM), establishment of a stable pregnant mouse infection model with Plasmodium was urgently needed. MethodsICR mice with vaginal plugs detected were randomly divided into post-pregnancy infection (Malaria+) and uninfected pregnancy (Malaria−) cohorts. Age-matched mice that had not been mated were infected as pre-pregnancy infection group (Virgin control), which were subsequently mated with ICR males. All mice were inoculated with 1 × 106Plasmodium berghei ANKA-infected RBCs by intraperitoneal injection, and the same amount of saline was given to Malaria− group. We recorded the incidence of adverse pregnancy outcomes and the amounts of offspring in each group. ResultsThe Virgin group mice were unable to conceive normally, and vaginal bleeding, abortion, or stillbirth appeared in the Malaria+ group. The incidence of adverse pregnancy outcomes was extremely high and statistically significant compared with the control (Malaria−) group (P < 0.05), of which placenta exhibited pathological features associated with human gestational malaria. ConclusionsThe intraperitoneal injection of 1 × 106Plasmodium berghei ANKA-infected RBCs could establish a model of pregnancy-associated malaria in ICR mouse.

Hypertensive disorders of pregnancy in Western Brazilian Amazon: Associated factors and neonatal outcomes.

Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. This is a population-based cross-sectional study with 1521 mother-child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA-Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. The prevalence of HDP was 11.0% (95% CI: 9.5-12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), primigravida status (PR: 2.0; 95% CI: 1.5-2.7), pre-pregnancy obesity (PR: 2.7; 95% CI: 1.9-4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6-3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7-4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1-3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes.

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.

Prevention of Malaria in Pregnancy: Knowledge and Practical Attitudes of Pregnant Women at the Mother of the Health Reference of Kalaban Coro

The aim was to assess pregnant women's knowledge and practical attitudes towards malaria prevention. Materials and Methods: It was a prospective, cross-sectional, descriptive study over a period of 4 months from August 1, 2018 to November 30, 2018. The Results: The study was carried out in 324 pregnant women aged 15 to 40 years: 45.7% were illiterate; 98.5% were married, 28.3% were Bambara. The name "Sumaya" was the local name for malaria. The pregnant women had a good knowledge of modes of transmission, means of prevention and factors favoring mosquito reproduction. The insecticide-treated mosquito net was cited by the majority of pregnant women as a preventive measure against malaria, of which 83.3% used it and 68.2% impregnated at a rate of 6 months. Conclusion: At the end of our study we understood that our pregnant women have quite satisfactory knowledge about malaria. The distribution of ITNs and MS among pregnant women showed a benefit in terms of the occurrence of gestational malaria in our study.

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.

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.

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.

Frequency of gestational malaria and maternal–neonatal outcomes, in Northwestern Colombia 2009–2020

Research on Gestational Malaria (GM) is scarce in America's. In the few available studies in Colombia, the analysis of immunological or parasitological aspects predominates, with few analyzes of epidemiological aspects. The objectives were to determine the frequency of GM and submicroscopic infections (positive with PCR and negative with thick blood smears), to identify obstetric and malaria history associated with GM, and to describe maternal and neonatal outcomes associated with GM, in northwestern Colombia. A retrospective study with records of 825 pregnant women was conducted. qPCR and thick blood smear were performed. Frequencies were determined with 95% confidence intervals. Comparisons were made with the Chi-square test, Mann–Whitney U test, and prevalence ratios adjusted in a log-binomial model. The frequency of GM was 35.8% (95% CI 32.4–39.1) of submicroscopic infection was 16.2% (95% CI 13.7–18.8). According to the multivariable model, the subgroups with the highest frequency of GM were pregnant women without healthcare coverage (32.3%), in the third trimester of pregnancy (30.5%), nulliparous (35.6%), and with a previous diagnosis of malaria in the current pregnancy (64.0%). GM was associated with more frequency of gestational anemia, infection in neonates, and lower birth weight. The results indicate in a precise and direct way that malaria control in this northwestern region of Colombia is far from adequate, which is even more serious considering the affectations for the mother and the neonate.

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.

Inhibition of Heme Oxygenase-1 by Zinc Protoporphyrin IX Improves Adverse Pregnancy Outcomes in Malaria During Early Gestation.

The enzyme heme oxygenase-1 (HO-1) has cytoprotective effects by catalyzing the degradation of heme to produce carbon monoxide, iron and biliverdin. Furthermore, HO-1 activity has been associated with successful pregnancy. On the other hand, in the context of certain inflammatory conditions, HO-1 can induce iron overload and cell death. To investigate the role of HO-1 in gestational malaria, pregnant BALB/c mice were infected with Plasmodium berghei ANKA in early, mid and late gestation. We found that malaria affected the pregnancy outcome in the three periods evaluated. However, only poor pregnancy outcomes in early pregnancy were related to HO-1 upregulation, iron overload, lipid peroxidation and necrosis of the decidua, which were prevented by HO-1 inhibition. In conclusion, HO-1 expression must be finely tuned in gestational malaria to avoid the deleterious effect of increased enzyme activity.

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.

Berghei model of gestational is associated with decreased locomotion and increased maternal anxiety.

Gestational Malaria has adverse health effects on the mother and the neonate. It results in severe anemia, spontaneous abortion, stillbirths, cerebral malaria, and acute renal failure. At least 6 million worldwide are at risk of malaria infection in pregnancy, with at least 10,000 maternal deaths and 200,000 newborn deaths annually. It has been known as an obstetric, medical, and social problem requiring both multidisciplinary and multidimensional intervention; for this reason, this study investigated the effect of Gestational malaria on the cerebellum of adult female mice&#x0D; The study was performed on twenty-one mice (male and female) of almost the same age range and weighed about 16g to 22g, and they were divided into groups (infected and control group). The female mice were mated in the ratio of two to one male per cage. Pregnant mice were inoculated with Plasmodium berghei intraperitoneally. Bodyweight was taken regularly, and the animals went through neurobehavioral tests to measure fear, anxiety, locomotion, and balance. The mice were sacrificed after delivery, and the cerebellum was excised, weighed, and processed for histological analysis and stained with Hematoxylin &amp; Eosin stain and Nissl stain&#x0D; The study revealed significant (p&lt;0.05) alteration in body weight, fear, anxiety, balance, and locomotion. Histologically, there was a substantial decrease in the neuronal density and cell size of the cerebellum of the infected mice group compared with the control group&#x0D; Plasmodium berghei model of gestational malaria showed a reduction in locomotion and body weight and an increase in anxiety which was mediated via the morphological and functional derangement of the cerebellum&#x0D; &#x0D; Keywords: Gestational malaria, plasmodium Berghei, Anxiety, cerebellum, Locomotion.&#x0D;

Fetomaternal outcome in pregnancy with thrombocytopenia: A prospective study from one of the teaching health-care institutes of Ahmedabad, Gujarat

Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.

Overview of Epidemiology of Malaria Associated with Pregnancy in Northwestern Colombia, 1985-2020

Background: Knowledge about malaria associated with pregnancy (MAP) is scarce in Latin America and Colombia. Methodology: This paper presents an overview of studies captained in Pubmed, Lilacs, GoogleScholar and thesis repositories from six Colombian universities and bibliographic references of manuscripts. Results: The following topics have been described: study sites, infectious agents, genetic variation of Plasmodium in MAP, vector resistance to insecticides, incubation period, natural susceptibility and resistance to infection, immunity in MAP, frequency, coexistence of gestational (GM) and placental (PM) malaria, associated factors, efficacy of antimalarial treatment, material living conditions in MAP. The MAP has a high prevalence, with a high frequency of submicroscopic infections. There are cases of MAP due to P. falciparum, P. vivax, or both. Monotherapy with chloroquine or amodiaquine for MAP for P. vivax has efficacy greater than 95% and artemether-lumefantrine or artesunate-mefloquine 100% for P. falciparum. There are high rates of anemia in pregnancies (30-70%). In “The Region,” there is no problem of resistance of vectors to insecticides. MAP occurs in poor territories, with interaction of food insecurity, chronic malnutrition, dissatisfaction of basic needs, intestinal parasites, violence and abuse of human rights. Conclusions: MAP study is just beginning in Colombia; there are no programmes that effectively operate to detect and solve this problem; Government agencies, international health organizations, and private companies should finance the multidisciplinary and comprehensive research (natural and social) of the MAP, in order to know its main characteristics throughout the country and use that knowledge as a basis to seek solutions.

Preclinical Trial of Traditional Plant Remedies for the Treatment of Complications of Gestational Malaria.

Background: Most pregnant women living in high malaria endemic regions of Nigeria use herbal remedies for the management of malaria-in-pregnancy, rather than the commonly prescribed drugs. Remedies common to this area involve a suspension of A. indica (AI) leaves and in some cases, a suspension containing a mixture of AI and D. edulis (PS). Aim: This study examined the therapeutic efficacies of AI, PS, or a combination of AI and PS in a pregnant rat model for exoerythrocytic stages of Plasmodium falciparum parasite. Method: A predetermined sample size of 30 dams was used (for a power level and confidence interval of 95%), and divided equally into six groups made up of non-malarous dams, untreated malarous dams, and malarous dams either treated exclusively with 1 mL of 3000 mg/kg b.w AI, 1000 mg/kg b.w PS, AI + PS (50% v/v), or 25 mg/kg b.w CQ. Result: No maternal mortality was recorded. AI significantly improved maternal weight gain from 32.4 to 82.2 g and placental weight from 0.44 to 0.53 g. In the curative test, AI and AI + PS significantly reduced the average percentage parasitemia (APP) in the pregnant rats from >80% to <20%. No significant difference in the APP was found between the pregnant rats treated with any of CQ or AI during the suppressive test. Results for the prophylactic test of the study groups showed that the APP was significantly reduced from 24.69% to 3.90% when treated with AI and 3.67% when combined with PS. AI + PS reduced diastolic blood pressure from 89.0 to 81.0 mm/Hg and compared with that of the non malarous dams. AI or AI + PS significantly increased the platelet counts (103 µL) from 214.1 to 364.5 and 351.2, respectively. AI and AI + PS improved birth weight from 2.5 to 3.9 g and crown rump length from 2.6 to 4.1 cm. For biomarkers of preeclampsia, combining AI and PS led to the reversal of the altered levels of creatine kinase, lactate dehydrogenase, cardiac troponin, soluble Fms-Like Tyrosine Kinase-1, and placental growth factor. Conclusions: This study validates the use of A. indica for the treatment of gestational malaria due to its antiplasmodial and related therapeutic effects and in combination with pear seeds for the management of malaria-in-pregnancy-induced preeclampsia.

Malaria amongst febrile children: call for a pediatric malaria assessment tool.

In 2017, malaria accounted for 435 000 deaths worldwide. Eleven percent (11%) of these deaths occurred in the Democratic Republic of Congo (DRC), where malaria continues to be a leading cause of morbidity and mortality. Children are amongst the most vulnerable to malaria, which causes 40% of childhood deaths in the country. Although many risk factors for developing malaria have been identified, there is a paucity of data available on the sociodemographic risk factors for pediatric malaria. A cross-sectional study including 131 febrile children aged 2 months to 14 years presenting to Heal Africa Hospital due to febrile illness. Guardians of participants answered a questionnaire about household and maternal characteristics, as well as child symptomatology. Malaria status was confirmed via blood smear. Results were analyzed using the chi-square test, likelihood ratios and a logistic regression. The absence of father as head of household (p=0.011) and gestational malaria (p=0.044) were significantly associated with pediatric malaria. This study provides insight into sociodemographic risk factors associated with pediatric malaria in the DRC. While further investigation is required, this study highlights the benefit of considering these factors when approaching the febrile child. A pediatric malaria assessment tool incorporating socio-demographics, symptoms and physical exam findings may guide investigations to reduce unnecessary testing and provide better patient-centred care.

Intergenerational Association of Short Maternal Stature with Stunting in Yanomami Indigenous Children from the Brazilian Amazon.

To describe the factors associated to stunting in <5-year-old Yanomami Brazilian children, and to evaluate the association of short maternal stature to their offspring’s stunting. A cross-sectional study carried out in three villages in the Yanomami territory. We performed a census, in which all households with children < 5-years-old were included. The length/height-for-age z-score <−2 standard deviations was used to classify the children as stunted. Short maternal height was defined as <145 cm for adult women, and <−2 standard deviations of the height-for-age z-score for adolescent women. We used adjusted Poisson regression models to estimate prevalence ratios (PR) along the 90% confidence interval. We evaluated 298 children. 81.2% of children suffered from stunting and 71.9% of the mothers from short stature. In the bivariate analysis, a significant association of stunting with short maternal stature, gestational malaria and child’s place of birth were observed. Considering the variables of the children under five years of age, there were significant associations with age group, the child’s caregiver, history of malaria, pneumonia, and malnutrition treatment. In the adjusted hierarchical model, stunting was 1.22 times greater in the offspring of women with a short stature (90% CI: 1.07–1.38) compared to their counterparts. Brazilian Amazonian indigenous children living in a remote area displayed an alarming prevalence of stunting, and this was associated with short maternal height, reinforcing the hypothesis of intergenerational chronic malnutrition transmission in this population. In addition, children above 24 months of age, who were born in the village healthcare units and who had had previous treatment in the past for stunting presented higher rates of stunting in this study.

Mosquito Bed Net Preferences and Efficacy in the Prevention of Gestational Malaria in Yaounde, Cameroon

Malaria prevention methods are diverse. Their availability sometimes does not guarantee effective usage and the use of each method in isolation may not provide the necessary results for the fight against malaria. Pregnant women are relatively more vulnerable and so it is recommended that they should be protected against malaria. Proper protection will require the use of long lasting insecticide treated mosquito bed nets as major malaria prevention method. This study was designed to find out malaria prevalence and factors influencing the use of mosquito bet nets among pregnant women of Biyem-Assi Health District. Information on the knowledge of malaria and use of malaria prevention methods, especially bed nets was collected from 302 pregnant women attending prenatal clinics in health institutions within the Biyem-Assi Health District of Yaounde VI subdivision using a pretested questionnaire. Thick smear was prepared for screening Plasmodium parasites. Analysis was done using EPI INFO version 16 (Chicago IL USA) and test of Chi 2. The study revealed that malaria prevalence was 48.5%. The shape of mosquito net had a significant (P = 0.05) effect on its use and a reduction on prevalence of malaria. The use of mosquito bed net was 47.7% while some of the women (52.3%) did not use it. Profession significantly influenced (P ˂ 0.04) the use of mosquito bed nets. Some of the women did not use mosquito bed nets for different reasons such as heat, forgetfulness, neglect, dislike, etc. The shape and color influenced the use, but this was not significant. Use of mosquito bed nets as major malaria prevention methods is not considered as priority by pregnant women. Sensitization campaigns by government and NGOs should reduce malaria prevalence during pregnancy and give a priority position to mosquito bed nets.