Malaria In Pregnancy Research Articles

Prevention of malaria in pregnancy: The threat of sulfadoxine-pyrimethamine resistance.

Malaria infection in pregnancy can lead to adverse outcomes for both the pregnant person and fetus. The administration of intermittent preventative therapy (IPTp) with sulfadoxine-pyrimethamine (SP) during pregnancy (IPTp-SP) improves outcomes, including severe maternal anemia, placental malaria infection, and low infant birth weight. The WHO recommends IPTp-SP for pregnant individuals living in areas of moderate or high malaria transmission in Africa. The current regimen consists of two or more doses of SP starting as early as possible in the second trimester, at least 1 month apart. Unfortunately, rising Plasmodium falciparum SP resistance throughout Africa threatens to erode the benefits of SP. Recent studies have shown a decrease in IPTp-SP efficacy in areas with high SP resistance. Thus, there is an urgent need to identify new drug regimens that can be used for intermittent preventative therapy in pregnancy. In this review, we discuss recent data on P. falciparum SP resistance in Africa, the effect of resistance on IPTp-SP, and studies of alternative IPTp regimens. Finally, we present a framework for the ideal pharmacokinetic and pharmacodynamic properties for future IPTp regimens.

Prevalence and associated factors of oligohydramnios in pregnancies beyond 36 weeks of gestation at a tertiary hospital in southwestern Uganda

BackgroundOligohydramnios is associated with poor maternal and perinatal outcomes. In low-resource countries, including Uganda, oligohydramnios is under-detected due to the scarcity of ultrasonographic services. We determined the prevalence and associated factors of oligohydramnios among women with pregnancies beyond 36 weeks of gestation at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda.MethodsWe conducted a hospital-based cross-sectional study from November 2019 to March 2020. Included were women at gestational age > 36 weeks. Excluded were women with ruptured membranes, those in active labour, and those with multiple pregnancies. An interviewer-administered structured questionnaire was used to capture demographic, obstetric, and clinical characteristics of the study participants. We determined oligohydramnios using an amniotic fluid index (AFI) obtained using an ultrasound scan. Oligohydramnios was diagnosed in participants with AFI ≤ 5 cm. We performed multivariable logistic regression to determine factors associated with oligohydramnios.ResultsWe enrolled 426 women with a mean age of 27 (SD ± 5.3) years. Of the 426 participants, 40 had oligohydramnios, for a prevalence of 9.4% (95%CI: 6.8–12.6%). Factors found to be significantly associated with oligohydramnios were history of malaria in pregnancy (aOR = 4.6; 95%CI: 1.5–14, P = 0.008), primegravidity (aOR = 3.7; 95%CI: 1.6–6.7, P = 0.002) and increasing gestational age; compared to women at 37–39 weeks, those at 40–41 weeks (aOR = 2.5; 95%CI: 1.1–5.6, P = 0.022), and those at > 41 weeks (aOR = 6.0; 95%CI: 2.3–16, P = 0.001) were more likely to have oligohydramnios.ConclusionOligohydramnios was detected in approximately one out of every ten women seeking care at MRRH, and it was more common among primigravidae, those with a history of malaria in pregnancy, and those with post-term pregnancies. We recommend increased surveillance for oligohydramnios in the third trimester, especially among prime gravidas, those with history of malaria in pregnancy, and those with post-term pregnancies, in order to enable prompt detection of this complication and plan timely interventions. Future longitudinal studies are needed to assess clinical outcomes in women with oligohydramnios in our setting.

Impact of long lasting insecticidal nets on asymptomatic malaria during pregnancy, in a rural and urban setting in Cameroon

According to the world malaria report more malaria cases were reported in 2020 than in 2019, due to disruptions in the distribution of insecticide treated nets, caused by the COVID-19 pandemic. Consequently a projected 34.32% (11.6 million out of 33.8 million) pregnancies were exposed to malaria in the WHO African Region in 2020. This study was therefore designed to assess the impact of long lasting insecticidal nets (LLINs) on asymptomatic malaria in the pregnant women attending the Foumbot District Hospital (rural setting) and the Bamenda Regional Hospital (urban setting). This was a hospital based cross-sectional study done within three months from February to April 2021. A structured questionnaire and the CareStart™ Pf Malaria HRP2 qualitative rapid diagnostic test were used for data collection. Data were analysed using descriptive statistics, and Chi-square test. The relative risk, attributable risk, odds ratio, and likelihood ratio of malaria occurrence in exposed patients were determined by Chi-square (and Fisher's exact) test. The prevalence of asymptomatic malaria was 10.14% (63/621), with a higher prevalence among the pregnant women in the rural setting (12.21%; 37/303), than the urban setting (8.18%; 26/318). As indicated by the attributable risk, 21% of malaria incidence was attributed to absence of LLINs distribution in neighborhoods of the rural setting meanwhile 10% of malaria incidence is attributed to absence of LLINs distribution in neighborhoods of the urban setting. Regular screening for asymptomatic malaria in pregnancy and consistent free distribution of LLINs are recommended in endemic areas, especially in the rural settings.

The Relationship Between Knowledge And Attitudes Of Pregnant Women With Behaviors To Prevent Malari Complications In Pregnancy

Malaria in pregnancy can be caused by various types of Plasmodium malaria and Plasmodium falciparum is a plasmodium that has a bad impact that can increase maternal morbidity and mortality and has a bad impact on babies in the womb. In pregnant women, malaria can cause complications of anemia, cerebral malaria, pulmonary edema, kidney failure and can cause death. In the fetus it causes abortion, premature delivery, low birth weight, and fetal death. This research method uses descriptive with cross sectional research design. The study sample was 53 pregnant women who underwent Antenatal Care examinations at the Koya Barat Health Center in 2021. The sampling method used the Accidental Sampling technique. The results showed that the majority of respondents aged 20-35 years were 48 people (90.6%). Most of respondents' education is SMA 28 (52.8%). Good knowledge of 16 respondents (30.2%) and poor knowledge of 37 respondents (69.8%). Positive attitude of respondents as many as 19 respondents (35.8%) and negative attitudes of 34 respondents (64.2%). The behavior of the respondents is sufficient as many as 36 respondents (67.9%) and the behavior of the respondents is less as many as 17 respondents (32.1%). Conclusion There is a significant relationship between knowledge of pregnant women and the behavior of preventing malaria complications in pregnancy with a p-value of 0.045. There is no significant relationship between attitude and prevention of malaria complications in pregnancy with a p value of 0.502 at the Koya Barat Health Center. Efforts to prevent malaria must continue to be carried out in risk groups, namely pregnant women, in order to reduce the number of malaria cases and reduce maternal and infant mortality.

Effectiveness and compliance to the use of sulphadoxine-pyrimethamine as a prophylaxis for malaria among pregnant women in Port Harcourt, Rivers State, Nigeria.

Malaria during pregnancy escalates the damaging consequence to the mother and neonate. The usage of intermittent preventive treatment of malaria (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for averting the deleterious consequences of malaria in pregnancy. This study evaluated the effectiveness of, and compliance with the use of SP for malaria among pregnant women in Port Harcourt Rivers State, Nigeria. A total of 300 samples of maternal peripheral blood (MPB), 84 neonatal cord blood (NCB) and 84 placental blood (PLB) were collected from consenting mothers. Malaria parasitaemia were analysed using standard parasitological methods, and bio-data of consenting mothers were collected through questionnaires and from ANC records. Out of the samples examined for MPB, 59(19.7%) tested positive to malaria. Those with only primary education (57.1%) and women of age ≤ 20yrs (25%) had higher prevalence. Women who took SP had significantly lower prevalence (17.6%) than those that took other drugs (36.4%) (p < 0.05). Malaria prevalence was highest among women who had 3 months interval between each dose (39.1%), followed by those of 2months (23.7%) and those of 1 month (7.0%) (p < 0.05). The primigravidaes (22.8%) had an insignificantly higher prevalence than secundigravidae (19.4%) and multigravidae (15.9%). Also, 30.5% of women who registered in their third trimester of pregnancy had a significantly higher malaria parasitaemia than those who registered during their first 8.10%, or second trimesters, 19.4%. Of the 84 MPB-NCB-PLB pairedamples examined, 16.7%, 8.3% and 25% respectively were infected with malaria parasitaemia. On frequency of compliance, mothers who took SP once (37.5%) had a significantly higher MPB parasitaemia than those who took it twice (7.84%) and those of thrice (6.25%). Neonatal cord blood parasitaemia prevalence revealed that those that took SP once, that is, 25%, had a higher prevalence than others like those of twice (5.88%) and thrice (0%) respectively. The use and compliance of SP reduced the prevalence of malaria among pregnant women and their new-borns.

Drugs for Intermittent Preventive Treatment of Malaria in Pregnancy: Current Knowledge and Way Forward.

Malaria infection during pregnancy is an important driver of maternal and neonatal health in endemic countries. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention at each scheduled antenatal care visit, starting at the second trimester, in areas of high and moderate transmission. However, the increased resistance to SP in some endemic areas challenges its effectiveness. Furthermore, SP is contraindicated in the first trimester of pregnancy and in HIV-infected women on co-trimoxazole prophylaxis due to potential drug–drug interactions. Thus, in recent last decades, several studies evaluated alternative drugs that could be used for IPTp. A comprehensive literature review was conducted to summarize the evidence on the efficacy and safety of antimalarial drugs being evaluated for IPTp. Chloroquine, amodiaquine, mefloquine and azithromycin as IPTp have proven to be worse tolerated than SP. Mefloquine was found to increase the risk of mother-to-child transmission of HIV. Dihydroartemisin-piperaquine currently constitutes the most promising IPTp drug alternative; it reduced the prevalence of malaria infection, and placental and clinical malaria in studies among HIV-uninfected women, and it is currently being tested in HIV-infected women. Research on effective antimalarial drugs that can be safely administered for prevention to pregnant women should be prioritized. Malaria prevention in the first trimester of gestation and tailored interventions for HIV-infected women remain key research gaps to be addressed.

Retrospective evaluation of referral by community health workers on the uptake of intermittent preventive treatment of Malaria in pregnancy in Ohaukwu, Ebonyi State, Nigeria

BackgroundThe World Health Organization recommends a minimum of three doses of quality-assured sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp), in moderate to high malaria transmission areas in sub-Saharan Africa. Currently, coverage of IPTp lags behind coverage of antenatal care (ANC) visits; in Nigeria, 57% of women attended four or more ANC visits, whereas only 17% received the recommended three or more doses of IPTp. The innovative program aimed to close this gap by providing counseling on the benefits of comprehensive ANC, referral to ANC and community distribution of IPTp (C-IPTp), complementing IPTp at ANC. The study aimed to examine whether CHW referral to ANC improved the likelihood of receiving three or more doses of IPTp.MethodsThe data for this study were extracted from the maternity record books of 1437 pregnant women seen at 25 public health facilities in Ebonyi State, Nigeria. The outcome of interest was defined as the receipt of three or more doses of IPTp (IPTp3) and the independent variable was referral to ANC by a community health worker for any visit. Descriptive statistics were reported and the results from the multi-level regressions are reported as adjusted odds and prevalence ratios with corresponding 95% confidence intervals.ResultsOf the 936 women included in the analysis, 24.47% received the recommended three or more IPTp doses and 61.32% were referred by a community health worker (CHW) for at least one ANC visit. There was no difference in the mean number of ANC visits between women who received C-IPTp and those who received IPTp exclusively at a facility (2.40 vs 2.52; p = 0.374). There were no maternal characteristics associated with CHW referral. Women who were referred by a CHW had 60% greater odds (95% CI, 1.08–2.38) of receiving IPTp3 than those who were never referred.ConclusionThe results indicate that CHW referrals conducted within a C-IPTp program are associated with higher IPTp uptake but not fewer ANC visits and that CHWs applied the referral process equally. This strengthens the evidence base for C-IPTp scale-up, which could have a large impact in sub-Saharan Africa in mitigating existing health systems issues.

Prevalence and risk factors of malaria and anaemia and the impact of preventive methods among pregnant women: A case study at the Akatsi South District in Ghana.

AimThis study aimed to ascertain the prevalence and risk factors of malaria and anaemia as well as the impact of preventive methods among pregnant women at the Akatsi South District Hospital of Ghana.Subjects and methodsA hospital based cross-sectional study using simple random sampling technique was conducted among 200 pregnant women receiving antenatal care and laboratory services at the Akatsi District Hospital from May 2016 to July 2016. A semi-structured questionnaire was administered to obtain participants’ malaria preventive methods in addition to demographic and gestational details. Participants’ hemoglobin and malaria status were assessed using one milliliter (1 ml) whole blood collected from each participant following standard procedures. Factors that produced a p-value of ≤0.2 from the univariate model were included in the final model. Association between potential covariates and the outcomes was assessed using multivariate logistic regression. The Clopper-Pearson test statistic was used to determine the 95% confidence intervals of the outcome variables of interest. We also estimated the population attributable fraction (PAF) of anaemia due to malaria by substituting the adjusted relative risk estimates (RRi) (using the adjrr command in STATA) of anaemia due to malaria into the category-specific attributable formula. P-values of <0.05 were considered statistically significant.ResultsPrevalence of anaemia in pregnancy (AiP), malaria in pregnancy (MiP) and AiP/MiP comorbidity was 63.5% (95% CI:56.4–70.2), 11.0% (96% CI:7.0–16.2) and 10.5% (95% CI:6.6–15.6) respectively. Prevalence rates of AiP (66.7%) and MiP (18.5%) predominated among pregnant women aged < 20 years. PAF of AiP due to MiP was 34.5% (95% CI:23.8–43.6). High use of IPTp-SP, 64.0% (95% CI:56.9–70.6) and LLIN, 90.0% (95% CI:85.0–93.8) was observed in this study. Only 42.0% (95% CI:35.1–49.2) used repellent. Not being on the IPTp-SP program posed a 11.70 times risk of MiP (95% CI:2.32–58.96; p = 0.003) compared to pregnant women on the IPTp-SP program. Similarly, not sleeping under LLIN posed an 8.07 times risk of MiP (95% CI:1.98–32.2; p = 0.004) compared to pregnant women who slept under LLIN. Meanwhile, being positive for MiP posed a 12.10 times risk (95% CI:1.35–85.06; p = 0.025) of AiP compared to those negative for malaria whereas failure to attend ANC as scheduled posed 6.34 times risk (95% CI:1.81–22.19; p = 0.004) of AiP among the pregnant women studied.ConclusionThe prevalence of MiP and AiP among pregnant women in the Akatsi South District remains a great concern. High utilization of IPTp-SP and LLIN was observed with a resultant positive effect on malaria prevalence among pregnant women. Improved access to IPTp-SP and LLIN is hence encouraged to help further diminish the risk of malaria infection amongst pregnant women in the District.

Pregnancy and malaria: the perfect storm.

Malaria in pregnancy continues to exert a toll on pregnant women and their offspring. The burden of Plasmodium falciparum infection is especially large in Africa, and new data show lasting effects of maternal infection on the infant's neurocognitive development. Elsewhere, P. vivax infection causes relapsing infections that are challenging to prevent. Infection in first trimester of pregnancy is an area of increasing focus, and its adverse effects on pregnancy outcome are increasingly recognised. First-trimester infection is common and frequently acquired prior to conception. Although newer rapid diagnostic tests still have limited sensitivity, they may be useful in detection of early pregnancy malaria for treatment. Artemisinin-based combination therapies are efficacious in later pregnancy but have yet to be recommended in first trimester because of limited safety data. In Africa, intermittent preventive treatment in pregnancy (IPTp) with monthly sulfadoxine-pyrimethamine improves pregnancy outcomes, but sulfadoxine-pyrimethamine resistance is worsening. The alternative, IPTp with dihydroartemisinin-piperaquine, has greater antimalarial efficacy, but does not appear to improve pregnancy outcomes, because sulfadoxine-pyrimethamine has poorly understood nonmalarial benefits on birthweight. Novel IPTp regimens must be combined with interventions to strengthen protection from malaria infection acquired before and in early pregnancy.

Malaria Control with Bed Nets; Assessment of Corelates of its Effectiveness for Pregnant Women in Kwaebibirem

Objective: This study aimed to investigate correlates of the effectiveness of Insecticide-treated Bed Nets (ITNs) for prevention of malaria through pregnancy till delivery.Methodology: The hospital-based cross sectional study enrolled 413 Antenatal Care (ANC) attendants at the maternity ward of the Kade government hospital. Differential patterns of use of ITNs among women who had malaria during pregnancy and women who did not have malaria during pregnancy were compared across various variables. Self-reported information by participants were objectively validated from maternal health record books, patient folders and other relevant maternal health registers.Results: ITNs are an important malaria prevention and control intervention among pregnant women who report using them during pregnancy. The period prevalence of malaria through pregnancy however remained high among adolescents irrespective of ITNuse while tertiary educational background and exposure to Intermittent Preventive Therapy with Sulfadoxine-pyrimethamine (IPTp-SP) reduced risk of malaria in pregnancy irrespective of ITN use.Conclusion: Malaria morbidity was generally higher among pregnant women who did not use bed nets during pregnancy despite variations by maternal age, area of residence, gestational age, occupation type, marital status, parity, maternal educational background and IPTp-SP status.Recommendations: Strategies aimed to reduce the period prevalence of malaria during pregnancy should be intensified particularly targeting adolescents. Barriers to sustained universal access to ITNs and IPTp-SP should be eliminated while policies aimed toincrease formal education should be prioritized.

The Impact Of Malaria Parasites On The Placenta And Perinatal Outcome At Korle Bu Teaching Hospital, Accra, Ghana: A Case Control Study

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerablegroups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies.Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test.Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had nohistory of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p&lt;0.001).Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term.

Homeostasis Maintenance in Plasmodium-Infected Placentas: Is There a Role for Placental Autophagy During Malaria in Pregnancy?

Malaria represents a significant public health burden to populations living in developing countries. The disease takes a relevant toll on pregnant women, who are more prone to developing severe clinical manifestations. Inflammation triggered in response to P. falciparum sequestration inside the placenta leads to physiological and structural changes in the organ, reflecting locally disrupted homeostasis. Altogether, these events have been associated with poor gestational outcomes, such as intrauterine growth restriction and premature delivery, contributing to the parturition of thousands of African children with low birth weight. Despite significant advances in the field, the molecular mechanisms that govern these outcomes are still poorly understood. Herein, we discuss the idea of how some housekeeping molecular mechanisms, such as those related to autophagy, might be intertwined with the outcomes of malaria in pregnancy. We contextualize previous findings suggesting that placental autophagy is dysregulated in P. falciparum-infected pregnant women with complementary research describing the importance of autophagy in healthy pregnancies. Since the functional role of autophagy in pregnancy outcomes is still unclear, we hypothesize that autophagy might be essential for circumventing inflammation-induced stress in the placenta, acting as a cytoprotective mechanism that attempts to ensure local homeostasis and better gestational prognosis in women with malaria in pregnancy.

Asymptomatic malaria infection impact on maternal anemia in Delta State, Nigeria

Background and Purpose: Pregnant women are vulnerable due to the pregnancy-induced suppressed immunity in malaria-endemic areas. Asymptomatic malaria in pregnancy (MiP) threatens both the mother, fetus, and neonate via chronic placental malaria which impacts maternal-neonatal exchange. Some studies reported that MiP risk factors vary across locations, however, there are few studies on MiP and maternal anemia in Nigeria. The purpose of this study was to investigate the association between asymptomatic placental malaria infection and maternal anemia among parturients in Asaba, Delta State, Nigeria.&#x0D; Method: This study was developed with a quantitative methodology that utilized primary and secondary healthcare data from 483 subjects aged 18–49 years from four healthcare facilities between May and July 2021. The Socio-Ecological Model (SEM) framework was used to explain how parturients can achieve improved pregnancy outcome via the mobilization of multi-levels supports to enhance the compliance of parturients to malaria interventions. The research question and hypothesis were tested with the binomial logistic regression test.&#x0D; Result: The findings showed a statistically significant association between placental malaria parasitemia by microscopy (PMPM), intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine, use of complementary and alternative medicine (CAM), and maternal anemia in the study population. Also, the study revealed that positive PMPM, use of CAM, insecticides treated net (ITN) ownership, ITN frequent use, and antenatal care (ANC) attendance were the risk factors of maternal anemia among the study population.&#x0D; Conclusion: The findings of this study could inform malaria control policymaking in Asaba and Delta State on tracking and treating asymptomatic placenta malaria among underserved parturient accessing antenatal services.

Active case detection and treatment of malaria in pregnancy using LAMP technology (LAMPREG): a pragmatic randomised diagnostic outcomes trial—study protocol

IntroductionMalaria is one of the major public health problems in sub-Saharan Africa. It contributes significantly to maternal and fetal morbidity and mortality in affected countries. This study aims to evaluate...

Determinants of Intermittent Preventive Malaria Therapy Among Pregnant Women in A Nigerian Teaching Hospital

Background: Intermittent Preventive Treatment of malaria in Pregnancy (IPTp) is mostly issued in most antenatal clinics across the country but there have been reports of poor utilization of this prophylaxis. Objective: This study assessed the determinants of IPTp among pregnant women attending a tertiary hospital in southeast Nigeria. Methods: The study was a descriptive cross-sectional study in which a self-administered questionnaire was distributed to 250 pregnant women receiving antenatal care in the study hospital. The data collected were analyzed with the aid of SPSS, using descriptive and inferential statistics. A p-value of less than 0.05 was considered significant. Results: A majority of the participants responded positively to most of the factors assessed, however, none was statistically significant. Conclusion: Based on these findings, pregnant women at a tertiary hospital in southeast Nigeria are aware of IPTp, nevertheless, most fail to commence the medication at the correct time.

Review on the prevention of malaria among pregnant women attending antenatal clinic

The study visualizes the Prevention of Malaria among Pregnant Women Attending Antenatal Clinic. Malaria in pregnancy has been identified as a global health challenge because of the life-threatening complications it poses to both the mother and the unborn child. These complications include maternal anemia, premature delivery, low birth weight, miscarriage, congenital infection and perinatal mortality. Five different malaria parasite species cause malaria infection: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi. The increasing rate of malaria among pregnant women and the lack of adherence to malaria preventive measures have become a matter of great concern for health authorities and midwives. Different factors have been thought of as reasons for the increasing malaria rates. The study review malaria, malaria prevention and control during pregnancy, knowledge of pregnant women on risk factors of malaria, and the attitude of women about the risks of malaria during pregnancy. However, the study recommended that Health training institutions update their curriculum, considering the need for more education on malaria and its prevention policymakers.

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.

High Degree of Parasitemia Induces Placental Hypoxia and Low Birth Weight

Placental malaria causes low fetal weight associated with infiltration of monocytes and parasites in the placenta resulting in placental hypoxia. Hypoxia is characterized by HIF expression. HIF-1α expression responds early to the occurrence of hypoxia (&lt;24 hours) and HIF-2α promotes chronic hypoxia (&gt;24 hours). There were two groups in this study, namely the control group (10 pregnant mice without Plasmodium berghei infection) and the treatment group (10 pregnant mice infected with Plasmodium berghei). Pregnant mice were operated on on the 18th day after mating. The degree of parasitemia was measured by Giemsa staining. Expression of HIF-1α and HIF-2α in placental tissue was measured by immunohistochemistry. Results by paired t test, HIF-1α expression in the placental tissue in the treatment group was higher than the control group (p=0.02), HIF-2α expression in the placental tissue was higher in the treatment group than in the control group (0, 01) the fetal weight in the treatment group was lower than in the control group (p=0.01). By using SEM analysis, the degree of parasitemia caused high expression of HIF-1α in placental tissue (tcount = 4.625, ttable = 1.96). High expression of HIF-2α in placental tissue (tcount = 2.672 ttable = 1.96). The degree of parasitemia causes low fetal weight (tcount = 27.764 ttable = 1.96). The results also showed that HIF-1 caused low birth weight (tcount = 2.376 ttable=1.96) also HIF-2α caused low fetal weight (tcount = 4.267 ≥ 1.96). Conclusions the degree of parasitemia causes high expression of HIF-1α and HIF-2α in placental tissue and low birth fetuses. Expression of HIF-1α and HIF-2 also causes low birth weight.&#x0D; Keywords: malaria in pregnancy, degree of parasitemia, HIF-1α , HIF-2α , birth weight

Impact of Intermittent Presumptive Treatment for Malaria in Pregnancy on Hospital Birth Outcomes on the Kenyan Coast.

Intermittent preventive treatment (IPTp) for pregnant women with sulfadoxine-pyrimethamine (SP) is widely implemented for the prevention of malaria in pregnancy and adverse birth outcomes. The efficacy of SP is declining, and there are concerns that IPTp may have reduced impact in areas of high resistance. We sought to determine the protection afforded by SP as part of IPTp against adverse birth outcomes in an area with high levels of SP resistance on the Kenyan coast. A secondary analysis of surveillance data on deliveries at the Kilifi County Hospital between 2015 and 2021 was undertaken in an area of low malaria transmission and high parasite mutations associated with SP resistance. A multivariable logistic regression model was developed to estimate the effect of SP doses on the risk of low birthweight (LBW) deliveries and stillbirths. Among 27 786 deliveries, 3 or more doses of IPTp-SP were associated with a 27% reduction in the risk of LBW (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], .64-.83; P < .001) compared with no dose. A dose-response association was observed with increasing doses of SP from the second trimester linked to increasing protection against LBW deliveries. Three or more doses of IPTp-SP were also associated with a 21% reduction in stillbirth deliveries (aOR, 0.79; 95% CI, .65-.97; P = .044) compared with women who did not take any dose of IPTp-SP. The continued significant association of SP on LBW deliveries suggests that the intervention may have a non-malaria impact on pregnancy outcomes.

Pharmacometric and Electrocardiographic Evaluation of Chloroquine and Azithromycin in Healthy Volunteers.

Chloroquine and azithromycin were developed in combination for the preventive treatment of malaria in pregnancy, and more recently were proposed as coronavirus disease 2019 (COVID‐19) treatment options. Billions of doses of chloroquine have been administered worldwide over the past 70 years but concerns regarding cardiotoxicity, notably the risk of torsades de pointes (TdP), remain. This investigation aimed to characterize the pharmacokinetics and electrocardiographic effects of chloroquine and azithromycin observed in a large previously conducted healthy volunteer study. Healthy adult volunteers (n = 119) were randomized into 5 arms: placebo, chloroquine alone (600 mg base), or chloroquine with either 500 mg, 1,000 mg, or 1,500 mg of azithromycin all given daily for 3 days. Chloroquine and azithromycin levels, measured using liquid‐chromatography tandem mass spectrometry, and electrocardiograph intervals were recorded at frequent intervals. Time‐matched changes in the PR, QRS, and heart rate‐corrected JT, and QT intervals were calculated and the relationship with plasma concentrations was evaluated using linear and nonlinear mixed‐effects modeling. Chloroquine and azithromycin pharmacokinetics were described satisfactorily by two‐ and three‐compartment distribution models, respectively. No drug–drug interaction between chloroquine and azithromycin was observed. Chloroquine resulted in concentration‐dependent prolongation of the PR, QRS, JTc and QTc intervals with a minimal additional effect of azithromycin. QRS widening contributed ~ 28% of the observed QT prolongation. Chloroquine causes significant concentration‐dependent delays in both ventricular depolarization and repolarization. Co‐administration of azithromycin did not significantly increase these effects. The arrhythmogenic risk of TdP associated with chloroquine may have been substantially overestimated in studies which did not separate electrocardiograph QRS and JT prolongation.