Malaria In Pregnancy Research Articles

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

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

Factors affecting the uptake of optimal doses of intermittent preventive treatment of malaria in pregnancy using sulfadoxine pyrimethamine in Ghana: new evidence from the 2019 malaria indicator survey

Factors affecting the uptake of optimal doses of intermittent preventive treatment of malaria in pregnancy using sulfadoxine pyrimethamine in Ghana: new evidence from the 2019 malaria indicator survey

Assessment of Safe Motherhood Health Service Coverage, Birth Defects Detection and Child Disability Prevention Using Lot Quality Assurance Sampling in Central Uganda.

It is crucial to have satisfactory coverage of safe motherhood services in order to prevent birth defects and child disabilities. Mildmay Uganda Institute of Health Sciences (MIHS) implemented a safe motherhood project aimed at preventing birth defects and child disabilities. Three years after the project's implementation, a rapid cross-sectional health facility survey was conducted in 4 districts of central Uganda to assess the coverage of key safe motherhood and early childhood services. The Lot Quality Assurance Sampling approach was used to assess coverage of 16 indicators in the areas of ANC, skilled birth attendance, early childhood care, postnatal care, and knowledge about child disability prevention. A Decision Rule was set at 80% upper threshold to classify the performance of health facilities at the district level. The survey found that there was variation in performance across indicators and districts. All districts achieved the 80% coverage target in ANC first visit, mothers who received at least two doses of Fansidar for intermittent preventive treatment of malaria in pregnancy, and mothers with knowledge of the action to take in case they suspect childhood disability. Folic acid supplementation during pregnancy and screening for birth defects using the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score had overall coverage above the target, but one district each had coverage below target in each of these 2 indicators. The coverage target was not reached in the rest of the survey indicators in each of the districts. Well-performing districts, especially in indicators with inconsistent performance, offer valuable insights for learning and adapting interventions in districts that do not meet the desired coverage of those particular indicators. Considering the disparities in performance among different indicators and districts, project planners should adopt, modify and implement successful strategies in districts and indicators that perform well. By doing so, they can enhance the performance of under performing districts or indicators.

Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo

IntroductionMalaria in pregnancy is a major driver of maternal and infant mortality in sub-Saharan Africa. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) at antenatal...

Fetal sex and risk of pregnancy-associated malaria in Plasmodium falciparum-endemic regions: a meta-analysis

In areas of moderate to intense Plasmodium falciparum transmission, malaria in pregnancy remains a significant cause of low birth weight, stillbirth, and severe anaemia. Previously, fetal sex has been identified to modify the risks of maternal asthma, pre-eclampsia, and gestational diabetes. One study demonstrated increased risk of placental malaria in women carrying a female fetus. We investigated the association between fetal sex and malaria in pregnancy in 11 pregnancy studies conducted in sub-Saharan African countries and Papua New Guinea through meta-analysis using log binomial regression fitted to a random-effects model. Malaria infection during pregnancy and delivery was assessed using light microscopy, polymerase chain reaction, and histology. Five studies were observational studies and six were randomised controlled trials. Studies varied in terms of gravidity, gestational age at antenatal enrolment and bed net use. Presence of a female fetus was associated with malaria infection at enrolment by light microscopy (risk ratio 1.14 [95% confidence interval 1.04, 1.24]; P = 0.003; n = 11,729). Fetal sex did not associate with malaria infection when other time points or diagnostic methods were used. There is limited evidence that fetal sex influences the risk of malaria infection in pregnancy.

Skeletal muscle fibre type and enzymatic activity in adult offspring following placental and peripheral malaria exposure in foetal life.

Maternal malaria may restrict foetal growth. Impaired utero-placental blood flow due to malaria infection may cause hypoxia-induced altered skeletal muscle fibre type distribution in the offspring, which may contribute to insulin resistance and impaired glucose metabolism. This study assessed muscle fibre distribution 20 years after placental and/or peripheral in-utero malaria exposure compared to no exposure, i.e., PPM+, PM+, and M-, respectively. We traced 101 men and women offspring of mothers who participated in a malaria chemosuppression study in Muheza, Tanzania. Of 76 eligible participants, 50 individuals (29 men and 21 women) had skeletal muscle biopsy taken from m. vastus lateralis in the right leg. As previously reported, fasting and 30 min post-oral glucose challenge plasma glucose values were higher, and insulin secretion disposition index was lower, in the PPM+ group. Aerobic capacity (fitness) was estimated by an indirect VO2max test on a stationary bicycle. Muscle fibre sub-type (myosin heavy chain, MHC) distribution was analysed, as were muscle enzyme activities (citrate synthase (CS), 3-hydroxyacyl-CoA dehydrogenase, myophosphorylase, phosphofructokinase, lactate dehydrogenase, and creatine kinase activities. Between-group analyses were adjusted for MHC-I %. No differences in aerobic capacity were found between groups. Despite subtle elevations of plasma glucose levels in the PPM+ group, there was no difference in MHC sub-types or muscle enzymatic activities between the malaria-exposed and non-exposed groups. The current study did not show differences in MHC towards glycolytic sub-types or enzymatic activity across the sub-groups. The results support the notion of the mild elevations of plasma glucose levels in people exposed to placental malaria in pregnancy being due to compromised pancreatic insulin secretion rather than insulin resistance.

Superoxide dismutase activity levels in parturients on intermittent preventive treatment with sulphadoxine pyrimethamine and their controls at current confinements

Malaria prevention in pregnancy especially in endemic areas has been greatly emphasized. This is especially so during the antenatal periods. Malaria prevention is important for reducing the problems of malaria in pregnancy. Early trimester miscarriages, preterm labours, anaemia in pregnancy, small for date babies and increased admissions into special care baby units are some of the problems encountered that are traceable to malaria infection. It is also noteworthy that some favourable antioxidants have been noted to help pregnant women enjoy and cope with their pregnancies. In that same way, it has also been noted that optimal levels of superoxide dismutase is equally necessary to help pregnant women enjoy uneventful pregnancies as well as stay free from some problems associated with malaria in pregnancy. Objectives: We have comparatively and objectively assessed the plasma Levels of superoxide dismutase in Parturients on Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine and their Controls at Current Confinements. Method: This comparative study was conducted at the Obstetrics and Gynaecology Department of the Federal Medical Centre (FMC) Owerri, South East Nigeria. Owerri is widely known for its heavy malaria endemicity. Prior to participant recruitment, appropriate ethical clearance was applied for and obtained from the ethics committee of FMC Owerri. This enabled the commencement of the longitudinal recruitment of participants after due counseling and adequate informed consent involving both study groups. This bench-based research and cross-sectional descriptive study involved two hundred and ninety-six (296) consented participants. The participants were made to understand clearly the study protocol as well as satisfy the inclusion criteria for either the study (case) or control groups. Upon recruitment, participants were then followed up all throughout their entire antenatal course culminating in the delivery. The follow up enabled the collection of blood samples for the estimation of Superoxide Dimutase (SOD) plasma levels at delivery. The SOD levels were estimated using the Misra and Fridovich method, 1972. The ability of superoxide dismutase to inhibit the auto oxidation of adrenaline at pH 10.2 makes this reaction a basis for the SOD assay. Superoxide anion (O2) generated by the xanthine oxidase reaction is known to cause the oxidation of adrenaline to adrenochrome. The yield of adrenochrome produced per superoxide anion introduced increased with increasing pH and also with increasing concentration of adrenaline. These led to the proposal that auto oxidation of adrenaline proceeds by at least two distinct pathways, one of which is a free radical chain reaction involving superoxide radical and hence could be inhibited by SOD. Data analysis: Data computation and analysis were done using the computer Software Package for Social Science (SPSS) version 20.0 (SPSS, Inc, 2007, Chicago). Important descriptive statistics (mean, standard deviation, range, percentages etc) were determined for continuous variables. P-value less than (<0.05) at 95% confidence interval was considered statistically significant. Result: The mean serum level of superoxide dismutase (SOD) in the study group was 12.61 U/ml ± 3.105 while the minimum and maximum serum superoxide dismutase were 7 and 20 U/ml respectively. For their controls, the mean serum level of superoxide dismutase was 11.69 U/ml ± 2. 969. However, the minimum and maximum serum superoxide dismutase were 7 and 20 U/ml respectively. The difference was found to be statistically significant (p= 0.011) with odds ratio 1.12 (CI of 95% 1.024-1.193).

A qualitative study of health workers' perspectives on malaria case identification and management among pregnant women in Savelugu Municipality, Ghana.

Despite successes in malaria control interventions over the past two decades, malaria remains a major public health concern. Over 125 million women live in endemic areas and experience adverse pregnancy outcomes due to malaria. Understanding health workers' perspectives on malaria identification and management is important to informing policy changes on the control and eradication of the disease. This study explored the perspectives of health workers on malaria case identification and management among pregnant women in Savelugu Municipality, Ghana. A qualitative study with a phenomenology design was conducted among participants. Participants were purposively selected and interviewed using a semi-structured interview guide. Thematic analysis was performed and the results were presented as themes and sub-themes. Four themes and eight sub-themes regarding case identification and management of malaria in pregnancy were identified including malaria case identification training (trained and untrained), identification approach (signs/symptoms and routine laboratory test), diagnostic tools (rapid diagnostic test and microscopy) and management options. It revealed that attending malaria training programs was generally optional. Some of the participants had not undergone any refresher training for malaria identification after their formal training at health institutions. Participants identified malaria by its signs and symptoms. However, they often referred clients for routine laboratory tests for confirmation. When malaria is confirmed in pregnancy, quinine is used for first trimester treatment, while Artemisinin-based Combination Therapies are prescribed after the first trimester. Clindamycin was not used in the first trimester treatment. This study found that training programs were optional for health workers. Some participants have not received refresher training after graduating from health institutions. Treatment of confirmed cases did not include clindamycin for first trimester malaria infections. Malaria refresher training programs should be made mandatory for health workers. Every suspected case should be confirmed using Rapid Diagnostic Test or microscopy before treatment.

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.

Prevalence and risk factors for preterm delivery in UNIOSUN Teaching Hospital, Osogbo - A 5 year retrospective review

Introduction: Preterm delivery is the leading cause of death in the neonatal period. It causes 28% of perinatal mortality. In Nigeria, it is responsible for 40-60% of perinatal morbidity. According to a U.S. research, preterm births have surged globally. In 2016, 16.8% of singleton live births in Lagos, Nigeria, were preterm.Methods: It was a retrospective review of patients with singleton preterm delivery in UNIOSUN Teaching Hospital, Osogbo from July 2013 to June 2018. Case records of mothers/patients with preterm deliveries were retrieved. Information on the patients' age, parity, educational status, weight, body mass index, number of antenatal visits, identifiable causes of preterm delivery and others were all extracted.Result: During the research period, 2,234 babies were born, including 210 preterm singletons out of which 147 were reviewed. Singleton preterm birth prevalence was 9.4%.Of the 147 mothers, n (20.4) had premature rupture of membrane (PROM), hypertensive disorders in pregnancy occurred in n(17.0%), Urinary Tract Infection (10.8%) and malaria in pregnancy (6.1%).Conclusion: Preterm birth rates were low compared to recent rates in the country. PROM, malaria in pregnancy, UTI in pregnancy, hypertensive disorders in pregnancy and previous history of spontaneous miscarriage were important causes/risk factors for preterm delivery.

The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries.

Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.

Is TNF alpha a mediator in the co-existence of malaria and type 2 diabetes in a malaria endemic population?

Malaria remains a disease of public health importance globally, especially in sub-Saharan Africa. Malaria deaths reduced globally steadily between 2000-2019, however there was a 10% increase in 2020 due to disruptions in medical service during the COVID-19 pandemic. Globally, about 96% of malaria deaths occurred in 29 countries; out of which, four countries (Nigeria, the Democratic Republic of the Congo, the Niger, and the United Republic of Tanzania) accounted for just over half of the malaria deaths. Nigeria leads the four countries with the highest malaria deaths (accounting for 31% globally). Parallelly, sub-Saharan Africa is faced with a rise in the incidence of Type 2 diabetes (T2D). Until recently, T2D was a disease of adulthood and old age. However, this is changing as T2D in children and adolescents is becoming an increasingly important public health problem. Nigeria has been reported to have the highest burden of diabetes in Africa with a prevalence of 5.77% in the country. Several studies conducted in the last decade investigating the interaction between malaria and T2D in developing countries have led to the emergence of the intra-uterine hypothesis. The hypothesis has arisen as a possible explanation for the rise of T2D in malaria endemic areas; malaria in pregnancy could lead to intra-uterine stress which could contribute to low birth weight and may be a potential cause of T2D later in life. Hence, previous, and continuous exposure to malaria infection leads to a higher risk of T2D. Current and emerging evidence suggests that an inflammation-mediated link exists between malaria and eventual T2D emergence. The inflammatory process thus, is an important link for the co-existence of malaria and T2D because these two diseases are inflammatory-related. A key feature of T2D is systemic inflammation, characterized by the upregulation of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) which leads to impaired insulin signaling. Malaria infection is an inflammatory disease in which TNF-α also plays a major role. TNF-α plays an important role in the pathogenesis and development of malaria and T2D. We therefore hypothesize that TNF-α is an important link in the increasing co-existence of T2D.

Using Andersen’s behavioral model of health care use for intermittent preventive treatment of malaria in pregnancy in Nigeria

BackgroundStudies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen’s behavioral model of health care use to IPTp usage in Nigeria.MethodsThis study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%.ResultsRealised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets.ConclusionOptimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria.

Comparative efficacy of sulphadoxine-pyrimethamine and dihydroartemisinin-piperaquine against malaria infection during late-stage pregnancy in mice.

The introduction of artemisinin combination therapies (ACTs) against malaria infections opened up a window of possibilities to combat malaria in pregnancy. However, the usefulness of ACTs in all stages of pregnancy must be critically assessed. This study was designed to evaluate dihydroartemisinin-piperaquine (DHAP) as a suitable alternative to sulphadoxine-pyrimethamine (SP) in the treatment of malaria during third-trimester pregnancy in mice. Experimental animals were inoculated with a parasitic dose of 1x106Plasmodium berghei (ANKA strain) infected erythrocytes and randomly allocated into treatment groups. The animals received standard doses of chloroquine alone (CQ)[10 mg/kg], SP [25 mg/kg] and [1.25 mg/kg] and DHAP [4 mg/kg] and [18 mg/kg] combinations. Maternal and pupil survival, litter sizes, pup weight and still-births were recorded, while the effect of the drug combinations on parasite suppression, recrudescence and parasite clearance time were evaluated. The day 4 chemo-suppression of parasitemia by DHAP in infected animals was comparable to SP, and CQ treatment (P > 0.05). The mean recrudescence time was significantly delayed (p = 0.031) in the DHAP treatment group compared to the CQ treatment group, while, there was no recrudescence in animals treated with SP. The birth rate in the SP group was significantly higher than in the DHAP group (P < 0.05). There was 100% maternal and pup survival in both combination treatments comparable with the uninfected gravid controls. The overall parasitological activity of SP against Plasmodium berghei in late-stage pregnancy appeared better than DHAP. In addition, SP treatment resulted in better birth outcomes assessed compared to DHAP treatment.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Genetic diversity of Plasmodium falciparum among asymptomatic pregnant women on intermittent preventive treatment with sulfadoxine-pyrimethamine in Nigeria.

This study investigated the genetic diversity of Plasmodium falciparum among asymptomatic pregnant women on intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-Sp) in Osogbo, southwest Nigeria. Blood sample was obtained from consenting pregnant women attending antenatal clinics. Microscopy and Polymerase chain reaction (PCR) were employed to diagnose and analyse genetic diversity. Of the 301 samples, 53 (18%) and 83 (28%) were positive for P. falciparum by microscopy and PCR, respectively. Using the merozoite surface protein (msp)-1, msp-2, and glutamate-rich protein (glurp) genes of P. falciparum as polymorphic markers, the msp-1 gene showed nine alleles with R033 (66.7%) being predominant, followed by K1 (45.5%) and MAD20 (33.3%). The msp-2 gene had 16 alleles (eight each for FC27 and 3D7). The 3D7 alleles (82.1%) was significantly more than FC27 alleles (48.2%) (p = 0.0093). Nine alleles were detected with glurp gene, presenting with the highest monoclonal and the lowest polyclonal infection. The multiplicity of infection (MOI) of 1.5, 1.8, and 1.2 were obtained for msp-1, msp-2 and glurp genes. In light of the high P. falciparum genetic diversity among pregnant women on IPT-Sp in this study, additional strategies for preventing and controlling malaria in pregnancy might be required.

Immunopathology of Malaria in Pregnancy: Immune Cells Response to Infection

Immunopathology of Malaria in Pregnancy: Immune Cells Response to Infection

Malaria and HIV Co-Infection among Pregnant Women in Africa: Prevalence, Effect on Immunity and Clinical Management: Review

Malaria and HIV are geographically in the tropics and subtropics of the world, including sub-Saharan Africa. Understanding the overlapping effect of both infections, especially among pregnant women, is crucial in managing pregnant women during antenatal care visits, and postpartum babies. It was realized that the prevalence of malaria among HIV-positive pregnant women ranges between 31–61%, while for non-HIV infected pregnant women the prevalence still stands between 10 and 36%. Co-infection is between 0.52 and 56.3%. Even though the rate of mother-to-child transmission of HIV has dropped, MTCT of malaria still remains a problem. MTCT is associated with low birth-weight, anemia, and even immune dysregulation. The adoption of the Option B+ plan has proven to be effective in the fight against the MTCT of HIV. However, malaria in pregnancy still remains a problem. Concurrent administration of both antimalarial drugs and Cotrimozaxole to pregnant women is not recommended, because of the toxic effect of the interaction of both drugs. Nevertheless, studies looking at the effect of the current ART regimens on mothers and their children need to be carried out. Studies looking at exposed children over a longer period of time, to determine their susceptibility to malaria infection and also to monitor their immune response to malaria over time, are needed.

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Prevalence, Pattern and Perception of the Use of Traditional Herbs for Malaria Treatment among Pregnant Women in Oshodi-Isolo Local Government Area, Lagos, Nigeria

Background: Traditional herbs have been used for thousands of years to treat malaria and many pregnant women currently rely on them even with their questionable safety. This study aimed to assess the prevalence, pattern and perceptions of the use of traditional herbs for malaria treatment among pregnant women in Oshodi-Isolo Local Government Area, Lagos, Nigeria.&#x0D; Methods: This descriptive cross-sectional study included 410 pregnant women, selected by multistage sampling. Data were collected using an interviewer-administered questionnaire and analyzed using SPSS statistical software. The results of descriptive analysis and associations using the Chi- square test were presented in tables and charts.&#x0D; Results: The mean age of the respondents was 28±6.7years. About half, 193 (47.1%) of the respondents, used traditional herbs to treat malaria in pregnancy. The pattern of use was periodical as malaria prophylaxis 84 (43.5%) or based on the experiencing of symptoms considered to be due to malaria 80 (41.5%). Traditional herbs were used because they were considered natural and hence safer 113 (58.5%), cheaper 101 (52.3%), more effective 97 (50.3%), and more acceptable based on respondents' traditional beliefs 79 (40.0%).&#x0D; Conclusion: The majority of pregnant women who utilized traditional herbs did so only occasionally for the prevention and treatment of malaria. The perceptions of using herbal remedies to treat malaria during pregnancy were largely supportive of this practice. As vital as it is to inform pregnant women about the risks of utilizing herbs to treat malaria during pregnancy, consideration must also be given to regulating usage to ensure safety.