Malaria-infected Pregnant Women Research Articles

Plasmodium Parasitaemia and Urine Alterations among Pregnant Women Attending Antenatal Care in Aba Metropolis, Abia State, Nigeria.

Malaria presents a huge threat to pregnant women, their foetus, and children below five years. This study is aimed at assessing malaria prevalence, associated clinical symptoms, and urine abnormalities among pregnant women in Aba metropolis, Abia State, Nigeria. A cross-sectional study involving 450 pregnant women purposively selected from nine health care centres was conducted. Data were analysed using SPSS version 26. The overall malaria prevalence rate was 68.4% (n = 308). Age group of 21-25 years had the highest prevalence rate of 20.4% (n = 92) while the least was recorded among the age group of 41-45 years (17 (3.8%)). Pregnant women in their first trimester had the greatest prevalence rate of 28.6% (n = 129), and the least prevalence was recorded among those in their third trimester (7 (15.6%)). The primigravidae were mostly infected at the rate of 27.7% (n = 125) whereas the multigravidae recorded the least prevalence of 85 (18.9%). Participants with secondary education were the most susceptible at the rate of 38.6% (n = 174). The infected participants exhibited significantly higher frequencies of reported fever (p > 0.001, OR 12.881, 95% CI 3.977-41.725) and headaches (p < 0.001, OR 4.688, 95% CI 1.819-12.083). However, cold, cough, body pains, poor appetite, and catarrh showed no significant association with malaria infection at p > 0.05. Participants using long-lasting insecticidal nets (LLINs) showed significantly lower prevalence rate of malaria infection (p < 0.001, OR 2.485, 95% CI 1.619-3.814). Malaria-infected participants showed statistically significant frequencies of proteinuria (p < 0.001, OR 274.14, 95% CI 16.91-4444.0), bilirubinuria (p < 0.001, OR 49.29, 95% CI 11.01-186.34), and urobilinogenuria (p < 0.001, OR 65.16, 95% CI 4.00-1062.40) than those not infected. Ascorbic acid, nitrate, and ketone showed no significant associations with malaria infection at p > 0.005. Infected participants had statistically significant amber and clear urine colour whereas there was no statistically significant difference between the pH levels of urine of the malaria-infected and malaria-noninfected pregnant women.

Erythrocyte Indices in Asymptomatic Malaria Infected Pregnant Women

Background: Red blood cell changes are one of the most common complications in malaria and they play a very crucial role in malaria pathogenesis. Malaria infections are one of the common causes of maternal anaemia especially during pregnancy. The aim of this study was to determine red cell indices of pregnant women with asymptomatic malaria.&#x0D; Place and Duration of Study: Department of Haematology and Antenatal Unit both of Enugu State University of Science and Technology Teaching Hospital, between June and September 2022.&#x0D; Methodology: The study population consisted of 90 pregnant women (65 pregnant women positive to malaria parasite without symptoms and 25 pregnant women negative to malaria parasite) and 26 control non-pregnant women. For the whole study population, red cell indices which include hemoglobin (HGB), packed cell volume (PCV), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width standard deviation (RDW-SD), red cell distribution width coefficient of variation (RDW-CV) were measured by automated haematology analyzer.&#x0D; Results: In the asymptomatic malaria group (AMG), 21 (32.3%) had mild anaemia (HGB level 9.0-10.0 g/dl), 11 (16.9%) had moderate anaemia (HGB level 7.0-8.0 g/dl) and 2 (3.1%) had severe anaemia (HGB level &lt;7.0 g/dl). Also in AMG group, the RDW-SD was 54.22 +/- 11.45 fl, whereas in control group it was 48.75 +/- 10.24 fl (p=0.002). Again in the AMG group the MCHC of those that had two pluses was 318.03 +/- 16.31 g/l, whereas in those that had one plus, it was 309 +/- 20.17 g/l. The comparison between the first, second and third trimester showed significant decrease in HGB (7.63 +/- 1.36 vs 11.64 +/- 0.72 g/dl) and PCV (26.98 +/- 5.14 vs 36.20 +/- 2.19 %) in third trimester compared to first trimester (p= &lt;0.001, &lt;0.001). whereas RDW-CV (18.96 +/- 5.04 vs 15.00 +/- 2.64 %) and RDW-SD (59.04 +/- 15.19 vs 49.16+/- 7.00 fl) (p= 0.002, 0.003) significantly increased in third trimester compared to first trimester&#x0D; Conclusion: This study found anaemia in asymptomatic malaria infected pregnant women, significant decrease in haemoglobin and packed cell volume at third trimester, higher MCHC in those with two pluses of malaria and significant increase in red cell distribution width at third trimester.

EFFECT OF MALARIA INFECTION ON HEPATIC AND RENAL FUNCTIONS IN PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT GENERAL HOSPITAL DUTSE, JIGAWA-NIGERIA

The effect of malaria infection on hepatic and renal functions in pregnancywas investigated. Three malarious and non-malarious pregnant women of age ranges 15 to 40 years with a mean (SD) of 23.5 (6.6) years and a median (IQR) of 20.5 (18.3 to 27) years were enrolled. Liver enzymes (AST, ALT and ALP) and Kidney (UCE) functions were determined using Randox standard assay kits. The levels of alkaline phosphatase (ALP) and albumin were significant as malaria infected pregnant women had significantly lowered levels of ALP and albumin compared to controls (21.3 vs 26.1 IU/L, P = 0.03 and 4.8 vs 6.0 g/dl P = 0.02). There was no significant difference between malaria infected pregnant women and their non-malarious counterparts (P &gt; 0.05) in their renal functions. There was no significant difference in mean concentrations of urea, creatinine, sodium, potassium and chloride regardless of the severity of malaria. Usually in pregnancy markers of liver function decrease due to expansion of extracellular fluid except alkaline phosphatase which is elevated due to its placental origin. Results of this study showed decreased level of ALP which could possibly be an indication that the parasite has not reached its hepatic stage. The severity of gestational malaria depends on the initial immunity of the pregnant woman. The impact of malaria on pregnancy and conversely, the impact of pregnancy on malaria, are two factors which must be put into consideration during gestational malaria

Developing a multivariate prediction model of antibody features associated with protection of malaria-infected pregnant women from placental malaria.

Plasmodium falciparum causes placental malaria, which results in adverse outcomes for mother and child. P. falciparum-infected erythrocytes that express the parasite protein VAR2CSA on their surface can bind to placental chondroitin sulfate A. It has been hypothesized that naturally acquired antibodies towards VAR2CSA protect against placental infection, but it has proven difficult to identify robust antibody correlates of protection from disease. The objective of this study was to develop a prediction model using antibody features that could identify women protected from placental malaria. We used a systems serology approach with elastic net-regularized logistic regression, partial least squares discriminant analysis, and a case-control study design to identify naturally acquired antibody features mid-pregnancy that were associated with protection from placental malaria at delivery in a cohort of 77 pregnant women from Madang, Papua New Guinea. The machine learning techniques selected 6 out of 169 measured antibody features towards VAR2CSA that could predict (with 86% accuracy) whether a woman would subsequently have active placental malaria infection at delivery. Selected features included previously described associations with inhibition of placental binding and/or opsonic phagocytosis of infected erythrocytes, and network analysis indicated that there are not one but multiple pathways to protection from placental malaria. We have identified candidate antibody features that could accurately identify malaria-infected women as protected from placental infection. It is likely that there are multiple pathways to protection against placental malaria. This study was supported by the National Health and Medical Research Council (Nos. APP1143946, GNT1145303, APP1092789, APP1140509, and APP1104975).

A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: A challenge for malaria elimination efforts.

BackgroundIn Sub-Saharan Africa (SSA), where malaria transmission is stable, malaria infection in pregnancy adversely affects pregnant women, fetuses, and newborns and is often asymptomatic. So far, a plethora of primary studies have been carried out on asymptomatic malaria infection in pregnant women in SSA. Nevertheless, no meta-analysis estimated the burden of asymptomatic malaria infection in pregnant women in SSA, so this meta-analysis was carried out to bridge this gap.MethodsPubMed, Web of Science, Scopus, Embase, and ProQuest were systematically searched for relevant studies published until 4 August 2020, and also the expansion of the search was performed by October 24, 2020. We assessed heterogeneity among included studies using I-squared statistics (I2). Publication bias was assessed by visual inspection of the funnel plot and further quantitatively validated by Egger’s and Begg’s tests. The pooled prevalence and pooled odds ratio (OR) and their corresponding 95% Confidence Interval (CI) were estimated using the random-effects model in Stata 15 software.ResultsFor this meta-analysis, we included 35 eligible studies. The overall prevalence estimate of asymptomatic Plasmodium infection prevalence was 26.1%% (95%CI: 21–31.2%, I2 = 99.0%). According to species-specific pooled prevalence estimate, Plasmodium falciparum was dominant species (22.1%, 95%CI: 17.1–27.2%, I2 = 98.6%), followed by Plasmodium vivax, Plasmodium malariae and Plasmodium ovale, respectively, found to be 3% (95%CI: 0–5%, I2 = 88.3%), 0.8% (95%CI: 0.3–0.13%, I2 = 60.5%), and 0.2% (95%CI: -0.01–0.5%, I2 = 31.5%). Asymptomatic malaria-infected pregnant women were 2.28 times more likely anemic (OR = 2.28, 95%CI: 1.66–3.13, I2 = 56.3%) than in non-infected pregnant women. Asymptomatic malaria infection was 1.54 times higher (OR = 1.54, 95%CI: 1.28–1.85, I2 = 11.5%) in primigravida women compared to multigravida women.ConclusionIn SSA, asymptomatic malaria infection in pregnant women is prevalent, and it is associated with an increased likelihood of anemia compared to non-infected pregnant women. Thus, screening of asymptomatic pregnant women for malaria and anemia should be included as part of antenatal care.

Maternal Expressions (Serum Levels) of Alpha Tumour Necrosis Factor, Interleukin 10, Interleukin 6 and Interleukin 4 in Malaria Infected Pregnant Women Based on Parity in a Tertiary Hospital in Southeast, Nigeria

Malaria has been reported as a condition caused by infestation with Plasmodium parasite specie, which is a great public health problem globally, particularly in developing countries like Nigeria. This study was carried out in Federal Medical Centre Umuahia in Abia State, Nigeria. The study was done to determine the maternal serum levels of alpha tumour necrosis factor, interleukin 10, interleukin 6, and interleukin 4 in malaria-infected pregnant women based on parities in Southeast, Nigeria. A total of 150 subjects between the ages of 18-45 years were recruited for the study comprising 50 subjects each of 3 parities (groups A-C). A commercial ELISA Kit was used to measure all the cytokines. Neither statistically significant differences were found for TNF-α (p=0.636), IL-10 (p=0.892), IL-6 (p=0.306) and IL-4 (p=0.222) between prime parity and second parity nor for TNF-α (p=0.356), IL-10 (p=0.896), IL-6 (p=0.304) and IL-4 (p=0.298) between prime parity and multi-parity of malaria-infected pregnant women. TNF-α (p=0.255), IL-10 (p=0.524), IL-6 (p=0.616), and IL-4 (p=0.672) between second parity and on multi-parity respectively. The study showed no changes in the cytokines studied among the malaria-infected pregnant women based on parities. It shows that the number of pregnancies in women infected with malaria has no changes in the levels of the cytokines studied.

Maternal Serum Levels of Alpha Tumour Necrotic Factor, Interleukin 10, Interleukin 6 and Interleukin 4 in Malaria Infected Pregnant Women Based on Their Gestational Age in Southeast, Nigeria

Malaria has been reported as a condition caused by infestation with Plasmodium parasite species, is a major public health problem globally especially in developing countries like Nigeria. This study was carried out in Federal Medical Centre Umuahia in Abia State, Nigeria. A study was done to determine the maternal serumlevels of alpha tumour necrotic factor, interleukin 10, interleukin 6and interleukin 4 in malaria infected pregnant women based on their gestational age in Southeast, Nigeria. A total of 150 subjects between the ages of 18-45 years were recruited for the study comprising of fifty (50) subjects each of the 3 trimesters. Commercial ELISA Kit by MELSIN Medical Co Limited was used to measure all the cytokines. The results of Table 1 showed no significant difference of TNF-α (p=0.346), IL-10 (p=0.059), IL-6 (p=0.811) and IL-4 (p=0.257) of malaria infected pregnant women at first trimester and second trimester respectively. The results of Table 2 showed no significant difference of TNF-α (p=0.642), IL-10 (p=0.678), IL-6 (p=0.551) and IL-4 (p=0.280) of malaria infected pregnant women at first trimester and third trimester respectively. The results of Table 2 showed no significant difference of TNF-α (p=0.062), IL-10 (p=0.016), IL-6 (p=0.352) and IL-4 (p=0.914) of malaria infected pregnant women at first trimester and third trimester respectively. The study showed no changes in the cytokines studied among the malaria infected pregnant women based on gestational ages except when IL-10 was compared between the subjects on second trimester and third trimester. This study shows that malaria infection does not changes these cytokines in pregnant women based on gestational ages except the il-10 when compared at second trimester and third trimester but changes when compared at other trimesters.

Possible Impact of Select Trace Mineral Deficiency in HIV Seropositive Pregnant Women with/without Malaria Co-infection in NAUTH, Nnewi, Nigeria

Aims: To evaluate the impact of HIV and malaria on serum Zinc (zn), Selenium (se) and Magnesium (mg) in HIV seropositive pregnant women in Nnewi, Nigeria.&#x0D; Study Design: This is a case-control study.&#x0D; Place and Duration of Study: Prevention of Mother to Child transmission (PMTCT) of HIV Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, (NAUTH), Nigeria, between December, 2017 and April, 2018.&#x0D; Methodology: We included 122 consented female participants; 32 HIV seropositive pregnant women with malaria parasitaemia, 30 HIV seropositive pregnant women without malaria parasitaemia, 30 Malaria infected pregnant women, 30 pregnant women without HIV or malaria parasitaemia, aged between 18 and 42 years. Screening for HIV antibodies and malaria parasite was double screened using National algorithm, rapid detection technique (RDT) and Giemsa staining microscopy technique respectively. Micronutrient levels were determined using atomic absorption spectrophotometry (AAS).&#x0D; Results: When the mean zn, sel and mg levels were compared between the test and control groups, significant decreases in serum zn (37.34 ± 6.7, 36.70 ± 4.39), sel (29.93 ± 6.02, 28.00 ± 5.04) and mg (2.41 ± 0.46, 2.33 ± 0.14) were observed in HIV seropositive pregnant participants with/without malaria co-infection when compared with their corresponding controls Zn (45.1 ± 7.83, 50.36 ± 8.73); Sel (31.46 ± 6.19, 31.96 ± 6.81); Mg (2.62 ± 0.30) and (P &lt; .05 respectively). Body mass index (BMI) was significantly decreased while diastolic blood pressure (DBP) and systolic blood pressure (SBP) were significantly increased in HIV seropositive pregnant women with malaria compared with their seronegative counterparts (P &lt; .05 respectively).&#x0D; Conclusion: The significant loss in BMI with derangement in serum zn, sel and mg levels in HIV seropositive pregnant women with/without malaria co-infection indicates high degree of malnutrition while the increased blood pressure suggests high blood pressure which might predispose the pregnant mothers to pre-eclampsia if not properly managed. Adequate micronutrient supplementation and effective anti malaria agent is strictly advocated in the routine management of HIV infected mothers during pregnancy to reduce the severity of the co-infection and adverse pregnancy complications especially in areas of malaria endemic transmissions.

Asymptomatic malaria infection among pregnant women attending antenatal care in malaria endemic areas of North-Shoa, Ethiopia: a cross-sectional study

BackgroundThe effort to reduce the burden of malaria should target transmission in the community by accurate identification of asymptomatic infections. In malaria-endemic areas, asymptomatic malaria infection is still associated with complications. Malaria during pregnancy is characterized by anaemia and placental malaria, leading to low birth weight and perinatal morbidity and mortality. This study aimed to provide reliable data on the burden of asymptomatic malaria among pregnant women in malaria endemic areas of North-Shoa, Ethiopia.MethodsCross-sectional study was carried out to assess the prevalence and predictors of asymptomatic malaria in pregnant women from November 2018 to January 2019. Multistage sampling technique was employed to include 263 study participants. Data were analysed using SPSS version 20.0 statistical software. In all comparisons, p-values ≤ 0.05 was considered as statistically significant.ResultsThe prevalence of asymptomatic malaria infection was 5.7% (15/263) and 3.4% (9/263) by using microscopy and RDTs, respectively. Plasmodium falciparum was a dominant species 9 (3.4%) and Plasmodium vivax accounted for 6 (2.3%) of Plasmodium infections as detected by microscopy. Multivariate analysis showed that ITN usage and haemoglobin level had a statistically significant association with Plasmodium infection after adjusting other possible factors. Compared to those who were using ITN always, the odds of Plasmodium infection was 18.16 times higher (95% CI 1.84–179.07) in pregnant women who were not using ITN, and 5.19 times higher (95% CI 0.55–49.21) in pregnant women who were using ITN sometimes. Asymptomatic malaria infected pregnant women were 3.78 times (95% CI 0.98–14.58) more likely to be anaemic compared to non-infected pregnant women.ConclusionThe present study showed asymptomatic malaria is prevalent in pregnant women and it has statistically significance association with the haemoglobin level of pregnant women. This indicates pregnant women have to be screened for asymptomatic malaria to avoid health consequences of malaria infection during pregnancy for the mother and fetus.

Proteomics Pipeline for Identifying Variant Proteins in Plasmodium falciparum Parasites Isolated from Children Presenting with Malaria.

Plasmodium falciparum variant antigens named erythrocyte membrane protein 1 (PfEMP1) are important targets for developing a protective immunity to malaria caused by P. falciparum. One of the major challenges in P. falciparum proteomics studies is identifying PfEMP1s at the protein level due to antigenic variation. To identify these PfEMP1s using shotgun proteomics, we developed a pipeline that searches high-resolution mass spectrometry spectra against a custom protein sequence database. A local alignment algorithm, LAX, was developed as a part of the pipeline that matches peptide sequences to the most similar PfEMP1 and calculates a weight value based on peptide's uniqueness used for PfEMP1 protein inference. The pipeline was first validated in the analysis of a laboratory strain with a known PfEMP1, then it was implemented on the analysis of parasite isolates from malaria-infected pregnant women and finally on the analysis of parasite isolates from malaria-infected children where there was an increase of PfEMP1s identified in 27 out of 31 isolates using the expanded database.

Impact of &lt;i&gt;Plasmodium falciparum&lt;/i&gt; malaria infection on serum cortisol, adrenocorticotropic hormone, pregnancy associated plasma protein-A and alpha-fetoprotein in pregnant women at Nnewi

The present study assessed the maternal cortisol, Adrenocorticotropic hormone (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) concentrations in malaria infected pregnant women. A total of 76 (40 apparently healthy pregnant and 36 malaria-infected pregnant) women aged 18-40 years were prospectively recruited. Early morning blood samples (5 ml) were collected from each subject at 1st and 2nd trimesters. 1 ml of whole blood was used for the diagnosis of P. falciparum malaria using malaria Plasmodium falciparum Rapid Test Device (RTD) and Giemsa stained thick blood smears for microscopic detection of P. falciparum parasites while the remaining 4 ml was centrifuged, separated and serum used for estimation of cortisol, ACTH, AFP and PAPP-A using ELISA-based method. The mean cortisol (125.80 ±30.80 ng/ml) and AFP (1.9 ±0.7 MoM) concentrations in malaria-infected pregnant women were significantly (p&lt;0.05) higher than those of normal pregnant women (86.70 ±3.30 and 1.5 ±0.7 respectively). Malaria-infected pregnant women had higher percentage of low birth weight babies (27.8%), preeclampsia (11.1%), premature rupture of membrane (11.1%), preterm delivery (30.6%), miscarriages (27.8%) and low APGAR score at one minute (2.8%). This shows the possible impact of malaria infection on pregnancy and birth outcomes. The increased cortisol concentration in malaria infected pregnant women shows that malaria infection in pregnancy increases the stress pregnant women are exposed to but the placental defect associated with increased placental permeability to AFP is not related to the effect of the stress (cortisol) and thus does not influence birth outcomes. Keywords: Plasmodium falciparum, pregnancy, cortisol, maternal serum markers, pregnancy outcome.

Association of Malaria Infection During Pregnancy With Head Circumference of Newborns in the Brazilian Amazon

Malaria during pregnancy is associated with adverse events for the fetus and newborn, but the association of malaria during pregnancy with the head circumference of the newborn is unclear. To investigate the association of malaria during pregnancy with fetal head growth. Two cohort studies were conducted at the general maternity hospital of Cruzeiro do Sul (Acre, Brazil) in the Amazonian region. One cohort study prospectively enrolled noninfected and malaria-infected pregnant women who were followed up until delivery, between January 2013 and April 2015. The other cohort study was assembled retrospectively using clinical and malaria data from all deliveries that occurred between January 2012 and December 2013. Data analyses were conducted from January to August 2017 and revised in November 2018. Clinical data from pregnant women and anthropometric measures of their newborns were evaluated. A total of 600 pregnant women were enrolled through volunteer sampling (prospective cohort study), and 4697 pregnant women were selected by population-based sampling (retrospective cohort study). After application of exclusion criteria, data from 251 (prospective cohort study) and 232 (retrospective cohort study) malaria-infected and 158 (prospective cohort study) and 3650 (retrospective cohort study) noninfected women were evaluated. Malaria during pregnancy. The primary end point was the incidence of altered head circumference in newborns delivered from malaria-infected mothers compared with that from noninfected mothers. Secondary end points included measures of placental pathology relative to newborn head circumference. In total, 4291 maternal-child pairs were analyzed. Among 409 newborns in the prospective cohort study, the mothers of 251 newborns had malaria during pregnancy, infected with Plasmodium vivax, Plasmodium falciparum, or both. Among 3882 newborns in the retrospective cohort study, 232 were born from mothers that had malaria during pregnancy. The prevalence of newborns with a small head (19 [30.7%] in the prospective cohort study and 30 [36.6%] in the retrospective cohort study) and the prevalence of microcephaly among newborns (5 [8.1%] in the prospective cohort study and 6 [7.3%] in the retrospective cohort study) were higher among newborns from women infected with P falciparum during pregnancy. Multivariate logistic regression analyses revealed that P falciparum infection during pregnancy represented a significant risk factor for the occurrence of small head circumference in newborns (prospective cohort study: odds ratio, 3.15; 95% CI, 1.52-6.53; P = .002; retrospective cohort study: odds ratio, 1.91; 95% CI, 1.21-3.04; P = .006). Placental pathologic findings corroborated this association, with more syncytial nuclear aggregates and inflammatory infiltrates occurring in placentas of newborns born with decreased head circumference. This study indicates that falciparum malaria during pregnancy is associated with decreased head circumference in newborns, which is in turn associated with evidence of placental malaria.

Malaria relief, one amino acid at a time

Malaria![Figure][1] Malaria-infected pregnant women in Malawi lack l-arginine. CREDIT: PAUL JEFFREY/ALAMY STOCK PHOTO Malaria infection during pregnancy can disrupt placental vasculature and cause complications. Nitric oxide plays a key role in placental vascular function, and its synthesis

Variations in the leukocyte and cytokine profiles between placental and maternal circulation in pregnancy-associated malaria.

BackgroundActivation of immune cells by malaria infection induces the secretion of cytokines and the synthesis of other inflammatory mediators. This study compared the cytokine levels and leukocyte count between malaria-infected peripheral and placental blood of pregnant women before delivery and postpartum. The cytokines assessed include interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-10 (IL-10).Materials and methodsThe subjects comprised 144 malaria-infected pregnant women and 60 malaria-infected women at post-partum stage (for placental blood collection). Others were 60 malaria-uninfected pregnant women and 40 malaria-uninfected women at postpartum stage (for placental blood collection). Forty malaria-infected and 40 malaria-uninfected nonpregnant women served as control subjects. The test groups were asymptomatic, and the control groups were apparently healthy subjects. All were aged between 17 and 44 years. Ethical approval for the study was obtained at Abia State University Teaching Hospital and Living Word Mission Hospital, Aba. Informed consent was obtained from the participants. Blood samples were aseptically collected initially from the maternal peripheral circulation and from the placenta on delivery, and tested for HIV and malaria using standard methods. IFN-γ, TNF-α, IL-4, IL-6 and IL-10 were measured by enzyme-linked immunosorbent assay technique. Kruskal–Wallis test was used for comparison of the groups.ResultsIFN-γ was significantly higher in the peripheral than in placental blood (P=0.001). IL-4 and IL-10 were significantly lower in the peripheral than in placental blood (P=0.001 and P=0.004, respectively). The total leukocytes, neutrophils and lymphocyte counts were significantly higher in the placenta than in peripheral blood (P=0.001), and the mixed differential count was significantly higher in the placenta than in peripheral blood (P=0.012).ConclusionThis study has shown that the cytokine levels and leukocyte counts may differ between the peripheral and placental blood of the same women. Therefore, measurement of parameters in the peripheral circulation may not always reflect the levels in the placental blood for the assessment of immune cellular response at the materno–fetal interface.

Effect of Artesunate on Peripheral Parasitaemia in Pregnant Women with Plasmodium Falciparum Infection

Objective: To determine the effect of artesunate on peripheral parasitaemia in pregnant women with Plasmodium falciparum infection.&#x0D; Methods: Pregnant women in second and third trimester with Plasmodium falciparum infection and their newborns were included in cohort prospective study in Sorong West Papua from September 2015 to February 2016. All pregnant women received 200 mg orally artesunate monotherapy for 7 days. Their newborns examined for weight at delivery and parasitaemia in placenta and cord blood. Parasitaemia diagnosis by Rapid Diagnostic Test and blood smear microscopy.&#x0D; Results: After artesunatemonotherapy, 82.5% (33/40) malariainfected pregnant women had negative parasitaemia (p=0.000) although 17.5% (7/40) of the pregnant women had positive parasitaemia. Parasitaemia also found in 10% (4/40) of placenta and 7.5% (3/40) of umbilical cord from newborns of malaria-infected pregnant women treated with artesunate. 70% (28/40) of the newborns in this study had normal weight.&#x0D; Conclusion: Artesunate reduces peripheral parasitaemia in the second and third trimester of pregnancy, and is associated with normal birth weight.&#x0D; [Indones J Obstet Gynecol 2017; 5-3: 135-138]&#x0D; Keywords: artesunate, low birth weight, peripheral parasitaemia

PERIPHERAL PARASITAEMIA AND ITS ASSOCIATION WITH PLASMA CYTOKINES LEVELS IN MALARIA-INFECTED PREGNANT WOMEN IN ABA, ABIA STATE, NIGERIA.

Background:Cytokines in pregnant female may not be a normal phenomenon as malarial infection is often associated with strong CD4+ cell activation and up-regulation of pro-inflammatory cytokines. We investigated the relationship between peripheral parasitaemia and plasma levels of cytokines among malaria infected pregnant women in Aba, Abia State, Nigeria.Materials and Methods:A total of 206 non-HIV positive asymptomatic malaria parasitaemic (n=144) and non-parasitaemic (n=62) pregnant women were recruited for this study alongside 80 non-pregnant women who served as positive (n=40) and negative (n=40) controls. Blood samples were aseptically collected from each subject and tested for HIV and malaria parasites using standard methods. Also, plasma levels of cytokines were measured using Th1/Th2 human cytokine ELISA kits (Abcam, UK). Analysis of Variance and Student’s t-test were used for Comparison of groups while Pearson’s Correlation Coefficient was used for tests of association.Results:The results revealed a mean parasite density of 685.56±484.55 parasites/µl of blood. Malaria infected pregnant subjects showed significantly higher levels of IFN-γ, TNF-α, IL-4, IL-6 and IL-10 when compared with their non-infected counterparts (P< 0.05). The cytokines evaluated were higher in moderate parasitaemia than mild parasitaemia. Positive correlation existed between peripheral parasite density (PPD) and IL-4 (r= 0.24, P=0.004), PPD and IL-6 (r = 0.35, P = 0.001) as well as PPD and IL-10 (r = 0.29, P = 0.001).Conclusion:This study showed that increase in peripheral parasitaemia increased levels of some plasma cytokines (IL-4, IL-6 and IL-10) but not IFN-γ and TNF-α in the malaria infected pregnant women studied.

Placental weight ratio affects placental mRNA expression of insulin-like growth factor-I and long isoform of the leptin receptor in Plasmodium falciparuminfected pregnant women.

Plasmodium falciparum infection during pregnancy is characterised by placental inefficiency caused by infected erythrocyte sequestration. Reduced placental efficiency leads to placental intrauterine adaptation for sustaining fetal growth, which is reflected by changes in the expression of placental genes involved in intrauterine growth regulation. Therefore, we aimed to determine whether the placental weight ratio, an indicator of placental efficiency, affects the placental expression of the components of the insulin-like growth factor axis and leptin signalling pathway in P. falciparum-infected pregnant women. A malaria case-only analysis of 50 P. falciparum-infected pregnant women in Timika, Papua, Indonesia, was conducted. The placental mRNA expression of insulin-like growth factor-I, insulin-like growth factor binding protein-1, leptin, and the long and short isoforms of the leptin receptor was measured through quantitative realtime PCR. The placental weight ratio exerted a positive effect on the placental mRNA expression of insulin- like growth factor-I (coefficient=6.10, p=0.002) and the long isoform of the leptin receptor (coefficient= 4.73, p=0.015) in malaria-infected pregnant women without fever or chill symptoms. Our results indicate that placental adaptive responses caused by adverse intrauterine conditions in P. falciparuminfected pregnant women vary depending on the presence or absence of fever and chill symptoms.

Improved infant hemoglobin (Hb) and blood glucose concentrations: The beneficial effect of maternal vitamin A supplementation of malaria-infected mothers in Ebonyi State, Nigeria

One hundred and fifty-two malaria-infected pregnant women whose pregnancies had advanced to the 6th month were randomised into two study groups – supplemented and placebo groups, after obtaining their approved consents. Ten thousand international units of vitamin A soft gels were administered to the supplemented group three times per week. Vitamin A soft gels devoid of their active ingredients were administered thrice weekly to the placebo group. Two hundred thousand international units of vitamin A was administered to the supplemented groups within 8 weeks postpartum. Placebo was given to the control group at same time after delivery. The regimen was continued in the two groups at three-month intervals until 12 months. Quarterly, 3 ml of venous blood was collected from each infant in the two groups and was used for the estimation of hemoglobin concentrations and determination of blood glucose levels. Hemoglobin concentrations were estimated using hemiglobincyanide method while the blood glucose levels were determined with a glucometer. Analysis of variance, Fisher’s least significant difference and t-test were used for data analysis. Statistical significance was established at p < 0.05. Both hemoglobin concentrations and blood glucose levels were significantly (p < 0.05) higher in the supplemented group than in the placebo group. The malaria infection mitigating effects of maternal vitamin A supplementation have been established in the present study and supported by previous studies. Vitamin A supplementation, fortification of foods with vitamin A and diversification of diets, are advocated for maintenance of good health and protection against some infectious diseases.

Malaria in pregnancy: a passive surveillance study of pregnant women in low transmission areas of Colombia, Latin America.

BackgroundMalaria causes a significant burden in highly endemic areas where children and pregnant women are more susceptible to severe disease and death, however, in low transmission settings malaria in pregnant women is less frequent. The aim of this study was to provide information of clinical profile, anti-parasite host immune responses and parasite genotyping of pregnant women with malaria in low endemic areas of Colombia.MethodsThis was a descriptive study conducted through passive surveillance in 1328 individuals from three endemic areas of Córdoba, Nariño and Chocó departments between 2011 and 2013. Trained physicians confirmed the pregnancy status and recorded clinical and epidemiological information. Haematological parameters, as well as hepatic and renal function, anti-malarial antibodies and parasite genotypes were evaluated.ResultsA total of 582 women presented with malaria infection, 34 of whom were pregnant (5.8 %), and most were infected by Plasmodium falciparum (n = 24). In 44 % (n = 15) of the women, the infection occurred during the first half of pregnancy. Although uncomplicated disease and parasitaemia ≤20,000 parasites/µL were common (n = 31), three women (8.8 %) infected by P. falciparum were classified as severe cases. Mild to moderate anaemia (68 %) and mild thrombocytopaenia (41 %) were the most frequent blood alterations and in four women acute renal failure was observed. Six women presented a second malaria episode during pregnancy mainly caused by P. vivax (n = 5), although no direct evidence of relapse was found by genotyping. Two out of the six women presenting a second malaria episode had severe malaria. A low prevalence of specific anti-parasite antibodies was found. Microsatellites indicated that all P. vivax infections involved multiple lineages whereas all but one P. falciparum infections harboured single genotypes.ConclusionsMost malaria infected pregnant women displayed uncomplicated malaria, although a few of them with a second malaria episode presented an increased risk of severe malaria which appeared to be associated with malaria transmission intensity and not with levels of anti-parasite antibodies. The effects of severe malaria in both mother and fetus warrant future studies in low transmission settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1125-9) contains supplementary material, which is available to authorized users.

Preponderance of bacterial isolates in urine of HIV-positive malaria-infected pregnant women with urinary tract infection.

This study examined HIV and malaria co-infection as a risk factor for urinary tract infections (UTIs) in pregnancy. The study group included 74 pregnant women, 20 to 42 years of age, who attended the antenatal clinic at the Specialist Hospital at Akure, Ondo State, Nigeria. Forty-four of the pregnant women were either HIV seropositive with malaria infection (HIV+Mal+) or HIV seropositive without malaria (HIV+Mal-). The remaining thirty pregnant women served as controls and included women HIV seronegative but with malaria (HIV-Mal+) and women HIV seronegative without malaria. UTI was indicated by a bacterial colony count of greater than 10⁵/mL of urine, using cysteine lactose electrolyte deficient medium (CLED) as the primary isolation medium. Bacterial isolates were characterized using convectional bacteriological methods, and antibiotics sensitivity tests were carried out using the disk diffusion method. A total of 246 bacterial isolates were recovered from the cultures, with a mean of 3.53 isolates per subject. Women who were HIV+Mal+ had the most diverse group of bacterial isolates and the highest frequency of UTIs. The bacterial isolates from the HIV+Mal+ women also showed the highest degree of antibiotic resistance. While pregnancy and HIV infection may each represent a risk factor for UTI, HIV and malaria co-infection may increase its frequency in pregnancy. The higher frequency of multiple antibiotic resistance observed among the isolates, particularly isolates from HIV+Mal+ subjects, poses a serious public health concern as these strains may aggravate the prognosis of both UTI and HIV infection.