Malaria In Pregnant Women Research Articles

Prevalence and predictors of malaria in pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis

Malaria remains a significant threat to pregnant women in sub-Saharan Africa. This systematic review and meta-analysis aims to estimate the prevalence and identify predictors of malaria infection among pregnant women in the region. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive search of PubMed Central, Google Scholar, EMBASE, ScienceDirect, and Cochrane Library was conducted, including 15 studies published between 2013 and 2023. The pooled prevalence of malaria, calculated using a random-effects model, was 19.0% (95% CI: 0.13-0.26), with heterogeneity (I²=81.9%) reflecting geographical and climatic diversity. Prevalence rates ranged from 6.4% in Burkina Faso to 36.4% in Tanzania. Asymptomatic cases had a prevalence of 19.0% (95% CI: 0.10-0.38), while symptomatic cases were slightly lower at 17.0% (95% CI: 0.12-0.23). Predictors of malaria included maternal age, parity, insecticide-treated net usage, intermittent preventive treatment, trimester-specific risk, and education level. These findings underscore the need for targeted, context-specific interventions to mitigate malaria risk among pregnant women in sub-Saharan Africa and inform effective malaria control strategies.

Clinical Manifestations and Health Impact of Malaria in Pregnant Women

Malaria during pregnancy poses significant health risks, both to mothers and their unborn children, due to the unique physiological and immunological changes occurring during this period. This review provides a comprehensive examination of the clinical manifestations and health impacts of malaria in pregnant women, highlighting the severity of the disease across different trimesters and its implications for maternal and fetal health. Malaria during pregnancy can cause symptoms like fever, anemia, headaches, fatigue, and nausea, with complications varying by trimester. In the first trimester, malaria can lead to early pregnancy loss and congenital anomalies, while in the second trimester, it can exacerbate maternal anemia and affect fetal growth. The third trimester is associated with an increased risk of preterm labor and adverse fetal outcomes. Placental malaria, characterized by parasite accumulation in the placenta, impairs nutrient and oxygen transfer to the fetus, leading to intrauterine growth restriction, low birth weight, and increased stillbirth risk. Maternal complications include severe anemia, acute respiratory distress syndrome, and potential long-term health effects. HIV infection further complicates malaria during pregnancy, increasing risks for both mother and fetus. Age-related variations and socioeconomic factors also impact malaria severity and management. Effective management strategies include intermittent preventive treatment, insecticide-treated nets, and indoor residual spraying. Addressing malaria during pregnancy requires a multifaceted approach, including enhancing diagnostic tools, improving preventive measures, and ensuring equitable healthcare access. Keywords: Clinical Manifestations, Health, Malaria, Pregnant Women

Association between Epstein-Barr virus reactivation and severe malaria in pregnant women living in a malaria-endemic region of Cameroon.

Malaria kills nearly 619,000 people each year. Despite the natural immunity acquired to malaria, pregnant women and children under five die from severe forms of the disease in sub-Saharan Africa. Co-infection with acute Epstein-Barr Virus (EBV) infection has been shown to suppress the anti-malarial humoral responses, but little is known about the impact of EBV reactivation on malaria-associated morbidity. This study investigated the association between EBV reactivation and malaria severity in pregnant women living in a malaria-endemic region in Cameroon. A cross-sectional study was conducted on 220 pregnant women attending antenatal consultations in three health facilities in the West region of Cameroon. Malaria was diagnosed by microscopy, and Plasmodium species were identified by Nested PCR. Plasma samples were analyzed by ELISA for the presence of EBV nuclear antigen, EBV viral capsid antigen, and EBV early antigen to determine EBV reactivation. All statistics were performed using GraphPad Prism and SPSS software. The prevalence of malaria among pregnant women was 23.2%, of which 18.6% were P. falciparum mono-infections and 4.5% mixed infections (3.6% P. falciparum and P. malariae; 0.9% P. falciparum and P. ovale). 99.5% of the women were EBV seropositive, and 13.2% had EBV reactivation. Pregnant women with reactivated EBV were more likely to develop severe malaria than pregnant women with latent EBV (OR 4.33, 95% CI 1.08-17.25, p = 0.03). The median parasitemia in pregnant women with latent EBV was lower than in those with EBV reactivation (2816 vs. 19002 parasites/μL, p = 0.02). Our study revealed that lytic reactivation of EBV may be associated with the severity of malaria in pregnant women. Suggesting that, like acute infection, EBV reactivation should be considered a risk factor for severe malaria in pregnant women in malaria-endemic regions or could serve as a hallmark of malaria severity during pregnancy. Further detailed studies are needed.

Performance of rapid diagnostic test, light microscopy, and polymerase chain reaction in pregnant women with asymptomatic malaria in Nigeria

ObjectivesRapid diagnostic tests (RDTs) offer an attractive tool for diagnosing malaria in pregnancy. This study assessed the effectiveness of a Plasmodium falciparum–specific RDT compared with microscopy and polymerase chain reaction (PCR) in diagnosing asymptomatic malaria in pregnant women in southwest Nigeria. MethodsThe study included 406 asymptomatic pregnant women seeking antenatal care. Blood samples were collected and tested using RDT (SD Bioline, Standard Diagnostics Inc. Korea) and light microscopy and confirmed using nested PCR. ResultsThe study revealed that the malaria parasite positivity rate was 8.9% by RDT, 21% by microscopy, and 32% by nested PCR. RDT had a sensitivity of 51.4% and specificity of 69.5%, whereas microscopy had a sensitivity of 65.3% and specificity of 98.2%. The combined testing of microscopy and RDT had a sensitivity and specificity of 100%. The study also showed a high prevalence of mild anemia among participants. ConclusionsDespite the RDT's low sensitivity, its high negative predictive value suggests it could be useful in combination with microscopy in ruling out asymptomatic malaria in pregnancy. Further study will help identify more suitable RDTs for routine malaria diagnosis in Nigeria and strengthen malaria prevention programs in pregnant women.

Prevalence and risk factors of malaria among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital

Malaria, according to the World Health Organization (WHO), is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. In Uganda, the overall burden of malaria is high, and its adverse outcomes for the infected mother and the unborn child are widespread. This study was designed to assess the prevalence of malaria in pregnancy and its associated factors among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital. A hospital-based cross-sectional study was conducted. The study was conducted in the antenatal clinic of Hoima Regional Referral Hospital, in the Hoima district of Western Uganda from from February 2022 to April 2022. A sample size of 204 was used. Data was coded and entered into IBM SPSS version 25. Data was then analyzed and the Chi-square test and logistic regression were done to find the associated factors of malaria in pregnancy at a 95% confidence interval. Results shows that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital was 17.6%. This study showed that pregnant women remain particularly vulnerable to malaria and that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital is high. Therefore, seminars and media education programmes should be started or put in place to educate women on the risk of malaria during pregnancy. Girl child education should be promoted by the government, as educated women are associated with a lower of malaria during pregnancy. Keywords: Malaria, Anopheles mosquitoes, Plasmodium falciparum, Pregnant women

Prevalence of clinical malaria and associated symptoms in pregnant women at Hamusit health center, Northwest Ethiopia

BackgroundMalaria is the disease caused by intracellular parasites known as Plasmodium species and is mainly transmitted by blood sucking female Anopheles mosquitoes. During pregnancy, malaria results in severe complications to the mother, the fetus and the newborn. Symptoms of malaria, such as fever, malaise, headache, nausea and vomiting, in pregnant women can be mistakenly attributed solely to pregnancy. In Ethiopia, the prevalence of malaria in asymptomatic pregnant women has been well documented. However, studies indicating the prevalence and clinical presentation of malaria in pregnant women are lacking. Therefore, there is little information on the prevalence of malaria and significantly associated signs and symptoms in pregnant women. The aim of this cross-sectional study was to determine the prevalence of malaria and identify clinical signs and symptoms associated with malaria which suggest presence of malaria in pregnant women at Hamusit Health Center, Northwest Ethiopia. MethodsA health facility-based cross-sectional study was conducted on 231 malaria symptomatic pregnant women from April to June 2023. A convenience sampling technique was employed. The socio demographic and clinical data of the study participants was collected through face-to-face interview using questionnaire. Thick and thin blood films were prepared from capillary blood and stained with 10 % Giemsa. The stained blood smear was washed with clean water, air dried and examined under a light microscope. The Statistical Package for Social Sciences software version 20 (SPSS 20) was used to analyses data. Logistic regression was used to assess signs and symptoms associated with malaria. An adjusted odds ratio with a 95 % confidence interval was calculated, and a P value < 0.05 was considered statistically significant. ResultsThe overall prevalence of malaria among symptomatic pregnant women in the study area was 22.9 % (53/231) (95 % CI: 17.3–29 %). The most prevalent species was P. falciparum, with a frequency of 14.3 % (33/231) (95 % CI: 10 %–18.6 %), followed by P. vivax, 5.2 % (12/231) (95 % CI: (2.6 %–8.2 %). The remaining 3.5 % (8/231) (95 % CI: 1.8 %–6.7 %) were mixed infections of P. falciparum & P. vivax. Primigravidae (62.3 %) and first trimester pregnancies (52.8 %) were more affected. Malaria signs and symptoms mainly, fever [(P = 0.002, AOR (95%CI); 5.1(1.84, 14.30)], joint pain [(P = 0.001, AOR (95%CI); 7.8(2.24, 27.32)], vomiting [(P = 0.007, AOR (95%CI); 2.9(1.34, 6.43)], malaise [(P = 0.005, AOR (95%CI); 3.6(1.48, 8.67)] and fatigue [(P = 0.0039, AOR (95%CI); 2.1(1.04, 4.37)], were significantly associated with malaria infection in pregnant women. ConclusionsMalaria positivity in pregnant women with fever, joint pain, vomiting, malaise and fatigue is considerably high in the study area. These signs and symptoms in pregnant women are strong indicators of malaria infection.

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

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

Prevention of Malaria in Pregnant Women and Its Effects on Maternal and Child Health, the Case of Centre Hospitalier de Kingasani II in the Democratic Republic of the Congo.

This study aimed to evaluate scientific evidence of the benefit of the use of insecticide-treated nets (ITNs) and Intermittent preventive treatment (IPT) on the birth weight of newborns and the hemoglobin level of the mother when used to prevent malaria during pregnancy. This cross-sectional analytical study was conducted on 467 hospitalized women in the Maternity Ward of Centre Hospitalier de Kingasani II, in the Democratic Republic of the Congo. Data were collected using a structured questionnaire that was pre-tested during a face-to-face interview. Apart from basic statistics, the chi-square test was used to compare proportions. Multivariate analysis (logistic regression) was used to identify variables significantly associated with the 95% confidence interval (CI). The ITN ownership rate was 81% (95% CI: 77-84) and the ITN use rate was 66% (95% CI: 62-70). Sixty-five percent (95% CI: 60-69) reported having received at least three doses of IPT during pregnancy with sulfadoxine-pyramethemine (IPTp-SP). There was a statistically significant difference in hemoglobin levels between hospitalized women who did not use the ITN (9.4 g/dL IIQ: 8.7-9.9) and those who did (11 g/dL IIQ: 9.8-12.2). The non-use of the ITN was associated with low birth weight (aOR = 3.6; 95% CI: 2.1-6.2; p < 0.001) and anemia in pregnant women (cOR = 2.41; 95% CI: 1.16-5.01; p = 0.018). The use of ITN and taking at least three doses of ITP during pregnancy are associated with good birth weight. The number of doses of IPTp received during antenatal care is associated with the maternal hemoglobin level in the third trimester of pregnancy.

Knowledge, Practices and Attitudes of Traditional Birth Attendants towards Intermittent Preventive Treatment for Malaria Prevention among Pregnant Women within Ondo West Local Government Area of Ondo State, Nigeria

Intermittent preventive treatment (IPT) for malaria among pregnant women is a recommendation of the World Health Organization (WHO) to combat the various adverse outcomes of malaria in pregnant women. This adverse outcomes includes low birth weight, preterm delivery, severe anemia, maternal morbidity and mortality especially among primigravids. Traditional Birth Attendants (TBAs) has emerged as a significant influence in our society, particularly in the realm of maternal care and childbirth. Several economic, religious and socio-cultural factors have contributed to the preference of some pregnant women for the services of TBAs over medical facilities. Therefore, the study was carried out to assess the knowledge, practices and attitudes of traditional birth attendants within Ondo West Local Government area towards IPT for pregnant women reporting to them for care and delivery. The design employed in the study was descriptive cross-sectional survey. Data were collected by means of an adapted semi-structured interviewer administered-questionnaire. The analysis of the data was done using SPSS version 26.0. Demographic parameters were summarized with simple percentages and non-parametric chi-square test was used to determine the different associations of the variables. P values less than 0.05 were considered statistically significant. The findings indicated that most of the TBAs have good knowledge of the malaria vector and factors promoting the transmission of malaria. Majority (mean=82.9%) also demonstrated excellent understanding of the symptoms associated with malaria in pregnancy however, their knowledge on the risk associated with malaria in a pregnant woman remains comparably low (mean=61.1%) thereby affecting significantly their attitudes and practice to intermittent preventive treatment for malaria prevention. This is because 50% of the TBA have not heard about IPT (P=0.01) and therefore do not administer treatment to asymptomatic pregnant women as recommended by WHO (P=0.00) and report of this study shows that majority (57.40%) of them attend to more than 31 pregnant women in a year. There is need for a government-sponsored partnership between formal health workers and TBAs in this study to ensure they are trained, retrained and equipped. The integration of the TBAs into maternal health care will ensure the sustenance of government policy on the free treatment of all pregnant women intermittently for malaria as recommended by WHO.

Malaria Falciparum in Pregnancy: A Case Series from an Endemic Area

Malaria is a public health issue worldwide, especially in tropical areas such as Indonesia. Malaria in pregnant women leads to increased risks of anemia, low birth weight, and fetal death. In this study, we reported two cases of malaria in pregnancy in Sikka, East Nusa Tenggara, an endemic area, after several years with zero cases. The first case was malaria in the first trimester of pregnancy, while the second case was malaria with anemia and thrombocytopenia in the second trimester of pregnancy. Both patients were treated with supportive therapies and a combination of dihydroartemisinin-piperaquine (DHP) 1x3 tablets orally for three days, leading to a favourable outcome. Both cases showed that early diagnosis and combination therapy with the correct antimalarial agent is effective for malaria in pregnancy.

Haematological parameters associated with malaria in pregnant women attending general hospital Kaltungo, Gombe State, Nigeria

Malaria during and after pregnancy remained a major public health concern in the tropics andsubtropics. This becomes necessary to investigate the anaemic level of pregnant women attending General Hospital Kaltungo, Gombe State. The study was conducted in General Hospital, Kaltungo, Kaltungo Local Government Area of Gombe State. Cross-sectional survey was conducted on consecutive pregnant women attending ante-natal over a period of 6 months (January to June); in 2018. Data was obtained from 300 pregnant women. The pregnant women were between the ages of 17 to 45 years. About 5 ml of venous blood samples were taken from each patient in EDTA tubes for malaria parasite and haematological examinations. Analysis of Malaria parasites was done using microscopy techniques, while haematological indices (Packed Cell Volume, Haemoglobin and White Blood Cell) were analyzed. Out of the 300 pregnant women that took part in the study only 17 (5.67%) had malaria parasites. The haematological parameter of the pregnant women infected with malaria parasites; showed that those with normal PCV range about age, (37 ≥ years and above); had the highest number of pregnant women 2 (100%). The same pattern was also observed with similar age range on normal haemoglobin. The low prevalence of malaria parasites among pregnant women in Kaltungo, Gombe state, showed that the intervention programme is effective.

Safety and efficacy of dihydroartemisinin–piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

The cornerstone of malaria prevention in pregnancy, intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine, is contraindicated in women with HIV who are receiving co-trimoxazole prophylaxis. We assessed whether IPTp with dihydroartemisinin-piperaquine is safe and effective in reducing the risk of malaria infection in women with HIV receiving co-trimoxazole prophylaxis and antiretroviral drugs. For this randomised, double-blind, placebo-controlled clinical trial, women with HIV attending the first antenatal care clinic visit, resident in the study area, and with a gestational age up to 28 weeks were enrolled at five sites in Gabon and Mozambique. Participants were randomly assigned (1:1) to receive either IPTp with dihydroartemisinin-piperaquine at each scheduled antenatal care visit plus daily co-trimoxazole (intervention group) or placebo at each scheduled antenatal care visit plus daily co-trimoxazole (control group). Randomisation was done centrally via block randomisation (block sizes of eight), stratified by country. IPTp was given over 3 days under direct observation by masked study personnel. The number of daily IPTp tablets was based on bodyweight and according to the treatment guidelines set by WHO (target dose of 4 mg/kg per day [range 2-10 mg/kg per day] of dihydroartemisinin and 18 mg/kg per day [range 16-27 mg/kg per day] of piperaquine given once a day for 3 days). At enrolment, all participants received co-trimoxazole (fixed combination drug containing 800 mg trimethoprim and 160 mg sulfamethoxazole) for daily intake. The primary study outcome was prevalence of peripheral parasitaemia detected by microscopy at delivery. The modified intention-to-treat population included all randomly assigned women who had data for the primary outcome. Secondary outcomes included frequency of adverse events, incidence of clinical malaria during pregnancy, and frequency of poor pregnancy outcomes. All study personnel, investigators, outcome assessors, data analysts, and participants were masked to treatment assignment. This study is registered with ClinicalTrials.gov, NCT03671109. From Sept 18, 2019, to Nov 26, 2021, 666 women (mean age 28·5 years [SD 6·4]) were enrolled and randomly assigned to the intervention (n=332) and control (n=334) groups. 294 women in the intervention group and 308 women in the control group had peripheral blood samples taken at delivery and were included in the primary analysis. Peripheral parasitaemia at delivery was detected in one (<1%) of 294 women in the intervention group and none of 308 women in the control group. The incidence of clinical malaria during pregnancy was lower in the intervention group than in the control group (one episode in the intervention group vs six in the control group; relative risk [RR] 0·12, 95% CI 0·03-0·52, p=0·045). In a post-hoc analysis, the composite outcome of overall malaria infection (detected by any diagnostic test during pregnancy or delivery) was lower in the intervention group than in the control group (14 [5%] of 311 women vs 31 [10%] of 320 women; RR 0·48, 95% CI 0·27-0·84, p=0·010). The frequency of serious adverse events and poor pregnancy outcomes (such as miscarriages, stillbirths, premature births, and congenital malformations) did not differ between groups. The most frequently reported drug-related adverse events were gastrointestinal disorder (reported in less than 4% of participants) and headache (reported in less than 2% of participants), with no differences between study groups. In the context of low malaria transmission, the addition of IPTp with dihydroartemisinin-piperaquine to co-trimoxazole prophylaxis in pregnant women with HIV did not reduce peripheral parasitaemia at delivery. However, the intervention was safe and associated with a decreased risk of clinical malaria and overall Plasmodium falciparum infection, so it should be considered as a strategy to protect pregnant women with HIV from malaria. European and Developing Countries Clinical Trials Partnership 2 (EDCTP2) and Medicines for Malaria Venture. For the Portuguese and French translations of the abstract see Supplementary Materials section.

Prevalence of Malaria among Pregnant Women Attending Muhammad Abdullahi Wase Teaching Hospital Kano State, Nigeria

Malaria in pregnant women remains a major public health problem especially in sub-Saharan Africa. Approximately twenty five million pregnant women in sub-Saharan Africa live at risk of malaria. The study was carried out between July and August 2021, to determine the prevalence of malaria parasite among pregnant women attending Mohammad Abdullahi Wase Teaching Hospital Kano. Microscopic examinations of both thick and thin smears were made using Giemsa Stained solution. Out of one hundred and forty blood samples examined, 60(42.9%) were positive for plasmodium falciparum parasite infection. Age group 18-22 years recorded the highest prevalence rate of (17.90%) and the difference between the age group of the pregnant women was statistically significant (P&lt;0.05) .Primigravida women recorded highest infection rate (23.60%). However, those in first trimester recorded the highest prevalence of (25%) followed by those in the second trimester (13.57%). These results show that pregnant women are more predisposed to malaria infection as they are immunosuppressed especially at early stage and as a primigravida and as teenage mothers than multigravida and older mothers. The problem of P. falciparum in pregnant women can be prevented by the preventive package of intermittent preventive treatment (IPT) with sulfadoxine pyrimethamine (SP) at 2 doses given to the pregnant women during their antenatal clinical visits. During this study, the prevalence of malaria infection among pregnant women attending Muhammad Abdullahi Wase Teaching Hospital was notably higher. P. falciparum is the most common Plasmodium parasite in this region therefore, more special attention should be directed towards pregnant women who exhibit identified risk factors for malaria infection.

Dihydroartemisinin–piperaquine for prevention of malaria in pregnant women living with HIV

Dihydroartemisinin–piperaquine for prevention of malaria in pregnant women living with HIV

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lom&amp;#233; (Togo) in 2021: A Cross-Sectional Study

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lom&amp;#233; (Togo) in 2021: A Cross-Sectional Study

Prevalence of Malaria Parasite among Pregnant Women Attending to Saudi Kassala Teaching Hospital in Kassala State, Eastern Sudan.

Malaria during pregnancy is a priority area for malaria research and control as pregnant women represent a high risk group for severe malaria, and the presentation of malaria during pregnancy varies according to the level of transmission in the area; so the aim of this study is to determine the prevalence rates of malaria parasite among pregnant women attending to Saudi Kassala Teaching hospital in Kassala state, 2022. A cross-sectional study was carried out in Saudi Kassala Teaching hospital in Kassala State. This study involved one hundred and eighty-five blood samples collected from pregnant women who was then examined by using blood films and ICT for malaria, and the data were collected by a structured questionnaire and analyzed using SPSS version 21. The prevalence of malaria among pregnant women was 2.2% (95% CI: 0.006-0.054). There was no significant difference among the different age groups with respect to the prevalence of malaria (P value = 0.483). The prevalence of malaria in rural residency was 2.2%, and this was significantly more common than the urban residency (P value = 0.021). When compared across the gestational trimesters, there was no significant difference between them (P value = 0.518). The number of gravidity is not related to malaria infection (P value = 0.737). The presence of symptom compliant of malaria during pregnancy does not suggest the presence of malaria (P value = 0.152). No difference was found between the different educational levels with respect to the prevalence of malaria (P value = 0.362). The result showed that there was 1 (0.5%) negative result in ICT which was positive in blood film for malaria (BFFM) and there were 3 (1.6%) positive malaria parasites by both methods in all 185 samples with statistically insignificant differences (P = 0.703). Plasmodium falciparum was only species detected in this study. Malaria among pregnant women was more prevalent in rural areas. However, other factors such as age, gestational age, gravidity, and educational level do not affect the prevalence of malaria in pregnant women. The presence of symptomatic compliant of malaria during pregnancy does not suggest the presence of malaria. The use of ICT or BFFM has similar diagnostic outcome for malaria in pregnancy.

Performance of ultra-sensitive malaria rapid diagnostic test to detect Plasmodium falciparum infection in pregnant women in Kinshasa, the Democratic Republic of the Congo

BackgroundLow peripheral parasitaemia caused by sequestration of Plasmodium falciparum in the placenta hampers the diagnosis of malaria in pregnant women, leading to microscopy or conventional rapid diagnostic tests (RDTs) false-negative results. Although mainly asymptomatic, maternal malaria remains harmful to pregnant women and their offspring in endemic settings and must be adequately diagnosed. Ultra-sensitive RDTs (uRDTs) are thought to be more sensitive than RDTs, and their diagnostic performance was assessed in the current study in pregnant women living in Kinshasa, a stable malaria transmission area in the Democratic Republic of the Congo.MethodsTo assess and compare the diagnostic performances of both RDTs and uRDTs, 497 peripheral blood samples were tested using microscopy and quantitative polymerase chain reaction (qPCR) as the index and the reference tests, respectively. The agreement between the different diagnostic tests assessed was estimated by Cohen's Kappa test.ResultsThe median parasite density by qPCR was 292 p/μL of blood [IQR (49.7–1137)]. Using qPCR as the reference diagnostic test, the sensitivities of microscopy, RDT and uRDT were respectively [55.7% (95% CI 47.6–63.6)], [81.7% (95%CI 74.7–87.3)] and [88% (95% CI 81.9–92.6)]. The specificities of the tests were calculated at 98.5% (95% CI 96.6–99.5), 95.2% (95% CI 92.5–97.2) and 94.4% (95% CI 91.4–96.6) for microscopy, RDT and uRDT, respectively. The agreement between qPCR and uRDT was almost perfect (Kappa = 0.82). For parasite density (qPCR) below 100 p/µL, the sensitivity of RDT was 62% (95% CI 47.1–75.3) compared to 68% (95% CI 53.3–80.4) for uRDT. Between 100 and 200 p/µL, the sensitivity of RDT was higher, but still lower compared to uRDT: 89.4% (95% CI 66.8–98.7) for RDT versus 100% (95% CI 82.3–100) for uRDT. In both cases, microscopy was lower, with 20% (95% CI 10–33.7) and 47.3% (95% CI 24.4–71.1) respectively.ConclusionsuRDT has the potential to improve malaria management in pregnant women as it has been found to be slightly more sensitive than RDT in the detection of malaria in pregnant women but the difference was not significant. Microscopy has a more limited value for the diagnosis of malaria during the pregnancy, because of its lower sensitivity.

Plasmodium falciparum Genetic Diversity and Resistance Genotype Profile in Infected Placental Samples Collected After Delivery in Ouagadougou.

Intermittent preventive treatment with sulfadoxine-pyrimethamine is widely used for the prevention of malaria in pregnant women in Africa. Known resistance cases of sulfadoxine-pyrimethamine during pregnancy need to be follow up to support IPTp implementation in Burkina Faso. However, data on the development and spread of resistance to this molecule are lacking. This study aimed to investigating the genetic diversity of P. falciparum and the mutation prevalence in the dhfr and dhps genes infected from postpartum infected placentas. This was a prospective and cross-sectional study conducted between April 2019 and March 2020 in four health districts of Ouagadougou capital city. From the placentas collected after delivery, P. falciparum detection and mps1 and msp2 polymorphism analysis were performed by nested PCR. The resistance profile was checked after analyzing the mutation point on dhfr and dhps genes. PCR-positive samples were estimated at 96% for msp1 and 98% for msp2. The polymorphism analysis showed that the RO33 and 3D7 allelic families were the most widespread with 62.5% and 91.83%, respectively. Multiple infections by msp1 and msp2 were frequent with 12.50% and 92.92%, respectively. The prevalence of individual dhfr mutation point, 51I, 108A, and 59R, was 1.96, 15.68, and 7.84, respectively, and the dhps mutation point, 437G, was 3.92. There is no detected mutation at the point 164L and 540E. The triple (51I+108A+59R) in dhfr and quadruple (51I+108A+59R+ 437G) mutation were not found. The results showed that Plasmodium falciparum has a high genetic diversity of msp1 and msp2. This suggests that dhfr and dhps mutant genotypes are potential early warning factors in the increase in the sulfadoxine-pyrimethamine resistance.

The question of the early diagnosis of asymptomatic and subpatent malaria in pregnancy: Implications for diagnostic tools in a malaria endemic area.

Malaria in pregnancy (MIP) is a major healthcare challenge in low-income countries with high malaria endemicity. Early but accurate diagnosis and appropriate treatment is the hallmark of preventing disease progression/adverse outcomes in the mother, foetus and neonates. We assessed the comparative diagnostic performance of Malaria Rapid Diagnostic Test (mRDT), microscopy and PCR for malaria diagnosis in pregnant women for early detection of asymptomatic malaria in pregnant women. Five hundred and twenty Pregnant women attending study clinics within Ikene and Remo North LGAs with gestational age between 16 and 29 weeks, willing and consented; were enrolled into the study. Blood samples collected via venepuncture were screened for malaria using microscopy, mRDTs kits, and PCR techniques on their first visit (V1) and at delivery. The parasite positivity rates, sensitivity and specificity were calculated and compared for each technique using PCR as the standard. Data was entered into REDCap® online database and analysis done using Stata and MedCalc®. Average age of enrolled women was 28.8 years and mean gestational age was 21.0 weeks. The parasite positivity rates were 4.3%, 8.8% and 25.0% for microscopy, mRDT and PCR at V1 and was 2.4%, 3.4% and 43.4% at delivery, respectively. Sensitivity for microscopy and mRDT was 11.2% and 30.3% respectively at V1, while specificity was 98.2% and 98.5%. At delivery, the sensitivity reduced to 1.6% and 4.9%; while specificity was 96.9% and 97.6% respectively. Only 2.3% cases correlated with all three diagnostic methods. Our data showed a decrease in sensitivity of the diagnostic methods as pregnancy progressed, which may be due to very low parasitaemia, but high specificity. Our study demonstrated a high rate of subpatent parasitaemia amongst pregnant women. This finding therefore raises the question of the effect of subpatent parasitaemia on the health of the mother and foetus.

Knowlesi Malaria in Children.

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