Malaria Infection In Pregnant Women Research Articles

Malaria Infection in Pregnant Women attending Antenatal Care in relation to Socio-demographic Profile, Trimester, Parity and Gravidae in Parts of Adamawa State, Nigeria

Malaria Infection in Pregnant Women attending Antenatal Care in relation to Socio-demographic Profile, Trimester, Parity and Gravidae in Parts of Adamawa State, Nigeria

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.

Prevalence of Malaria Infection in Pregnant Women Attending Antenatal Clinics in Southern Senegal.

Despite marked progress in Senegal, three regions in the southeast part continue to have a high burden of malaria, but there have been no recent studies assessing the prevalence of malaria associated with pregnancy. This study aimed to determine the prevalence of malaria infection in pregnant women attending antenatal clinics in Senegal. During the malaria transmission season of 2019, pregnant women attending 11 health care facilities for a scheduled visit and those presenting unwell with signs of malaria were invited to participate in a malaria screening study. A finger prick blood sample was taken for malaria diagnosis by rapid diagnosis test (RDT) and polymerase chain reaction (PCR). A total of 877 pregnant women were enrolled, 787 for a scheduled antenatal consultation and 90 for an unscheduled consultation with signs of malaria. The prevalence of Plasmodium falciparum among the first group was 48% by PCR and 20% by RDT, and that among the second group was 86% by PCR and 83% by RDT. RDT sensitivity in capturing asymptomatic, PCR-positive infections was 9.2% but ranged from 83% to 94% among febrile women. The prevalence of infection by PCR in women who reported having received at least three doses of sulfadoxine pyrimethamine (SP) was 41.9% compared with 58.9% in women who reported they had not received any SP doses (prevalence ratio adjusted for gravidity and gestational age, 0.54; 95% CI, 0.41-0.73). The burden of P. falciparum infections remains high among pregnant women, the majority of which are not captured by RDT. More effective measures to prevent malaria infection in pregnancy are needed.

Prevalence of and risk factors for microscopic and submicroscopic malaria infections in pregnancy: a systematic review and meta-analysis

Malaria infections during pregnancy can cause adverse birth outcomes, yet many infections are undetected by microscopy. We aimed to describe the epidemiology of submicroscopic malaria infections in pregnant women in Asia, the Americas, and Africa using aggregated and individual participant data (IPD). For this systematic review and meta-analysis, studies (published Jan 1, 1997 to Nov 10, 2021) with information on both microscopic and submicroscopic infections during pregnancy from Asia, the Americas, or Africa, identified in the Malaria-in-Pregnancy Library, were eligible. Studies (or subgroups or study groups) that selected participants on the basis of the presence of fever or a positive blood smear were excluded to avoid selection bias. We obtained IPD (when available) and aggregated data. Estimates of malaria transmission intensity and sulfadoxine-pyrimethamine resistance, matched by study location and year, were obtained using publicly available data. One-stage multivariable logit and multinomial models with random intercepts for study site were used in meta-analysis to assess prevalence of and risk factors for submicroscopic infections during pregnancy and at delivery. This study is registered with PROSPERO, number CRD42015027342. The search identified 87 eligible studies, 68 (78%) of which contributed to the analyses. Of these 68 studies, 45 (66%) studies contributed IPD (48 869 participants) and 23 (34%) studies contributed aggregated data (11 863 participants). During pregnancy, median prevalence estimates were 13·5% (range 0·0-55·9, 66 substudies) for submicroscopic and 8·0% (0·0-50·6, 66 substudies) for microscopic malaria. Among women with positive Plasmodium nucleic acid amplification tests (NAATs), the median proportion of submicroscopic infections was 58·7% (range 0·0-100); this proportion was highest in the Americas (73·3%, 0·0-100), followed by Asia (67·2%, 36·4-100) and Africa (56·5%, 20·5-97·7). In individual patient data analysis, compared with women with no malaria infections, those with submicroscopic infections were more likely to present with fever in Africa (adjusted odds ratio 1·32, 95% CI 1·02-1·72; p=0·038) but not in other regions. Among women with NAAT-positive infections in Asia and the Americas, Plasmodium vivax infections were more likely to be submicroscopic than Plasmodium falciparum infections (3·69, 2·45-5·54; p<0·0001). Risk factors for submicroscopic infections among women with NAAT-positive infections in Africa included older age (age ≥30 years), multigravidity, and no HIV infection. During pregnancy, submicroscopic infections are more common than microscopic infections and are associated with fever in Africa. Malaria control in pregnancy should target both microscopic and submicroscopic infections. Bill & Melinda Gates Foundation through the Worldwide Antimalarial Resistance Network.

A cross-sectional study of risk factors associated with malaria diseases in pregnant women attending a state hospital Iwo Osun State, Southwest Nigeria

BackgroundMalaria disease has been a public health issue in pregnancy, posing a risk to the mother, foetus, and newborn. Risk factors for malaria disease play a significant role in evaluating any program to prevent malaria in pregnant women. The purpose of this study was to determine the possible risk factors for malaria disease in pregnant women at the State Hospital Iwo Osun State, Southwest Nigeria. ResultsIt was a cross-sectional, facility-based study. Two hundred and eighty-four (284) pregnant women showing up at the antenatal care for the first time during their present pregnancy from April to August 2018 were enlisted in this study. Blood samples were tested for malaria parasite using microscopy. Multiple logistic regression analysis was used to compare factors associated with malaria in pregnant women. The number of malaria cases was 53 (18.7%). Those that did not sleep under insecticides-treated nets were 202 (71.4%). About, 130 (46.3%) believe that bad water transmits malaria infection. There was no correlation between insecticides treated nets (ITNs) and education level (p = 0.727), with more malaria positive results in those who did not sleep with ITNs, 40 (75.5%). No association between knowledge on the cause of malaria diseases and the education level (p = 0.450). The participants in the different levels of education reported that malaria was transmitted by mosquitoes, sun and drinking bad water. Drinking bad water was reported most by 76(58.5%) and 37(28.5%) of those in secondary and tertiary education, respectively to transmit malaria. Age <= 25 years (OR =2.054, C.I. = 1.118 - 3.772, p = 0.019) and education below tertiary level (OR =2.704, C.I. = 1.214 - 6.024, p = 0.012) were reported to be significantly associated with risk factor to malaria infection in pregnant women. ConclusionThis study revealed that malaria is still a public health issue and risk factors such as; maternal age of 25 years or less and educational class less than tertiary education may be contributing to increase in prevalence of malaria among pregnant women in this study.

Case report : abortus with malaria falciparum in pregnancy

Malaria infection is still a global health problem. Malaria can affect all groups including pregnant women. Malaria infection in pregnant women can cause various dangerous complications, one of which is abortion. A 35-year-old pregnant woman was diagnosed with G6P5A0H5 uk 8-9 weeks with falciparum malaria. The patient was given Dihydroartemisin and piperacuine phosphate (DHP) therapy and symptomatic drugs. During observation the patient had no additional complaints and slowly returned to normal. One week later the patient experienced bleeding from the birth canal and was declared an abortion. There are several things that must be considered in the management of malaria in pregnant women such as resources, facilities and infrastructure available at first-level health facilities, and various matters regarding optimal maternal and fetal supervision so as to prevent various complications caused by malaria infection.

Systematic Review: Prevalensi dan Dampak Infeksi Malaria pada Wanita Hamil dan Neonatal

Globally, malaria cases in the world reached 241 million cases in 2020 and increase from the previous year. Malaria infection in pregnant women was reported in 33 countries, and the cases were estimated at 11.6 million (34%). Malaria infection can increase maternal and fetal morbidity and mortality, including anemia in pregnancy, low birth weight, premature birth, stillbirth, and small gestation age, and congenital malaria. This article discusses pregnant women's malaria infection prevalence and maternal and neonatal outcomes. This paper is a systematic review by searching for articles using electronic databases from Pubmed and ScienceDirect using keywords “Malaria” and “Pregnancy” or “Pregnant Women” and “Outcome” or “Impact” and “Maternal” or “Neonatal”. The selection of articles used the PRISMA guidelines which were then analyzed in a narrative manner. Based on the article search results obtained 10 articles that meet the criteria for analysis. The prevalence of malaria infection in pregnancy is still high. Reported outcomes in pregnancy, birth, and neonates include preterm birth, low birth weight, small gestation age, maternal anemia, and maternal and neonatal mortality. The role of health workers is very important to prevent malaria infection in pregnancy so that it does not result in adverse health impacts for maternal and neonatal.

Quantification of the dynamics of antibody response to malaria to inform sero-surveillance in pregnant women

BackgroundMalaria remains a major public health threat and tools sensitive to detect infections in low malaria transmission areas are needed to progress elimination efforts. Pregnant women are particularly vulnerable to malaria infections. Throughout pregnancy they access routine antenatal care, presenting a unique sentinel population to apply novel sero-surveillance tools to measure malaria transmission. The aim of this study was to quantify the dynamic antibody responses to multiple antigens during pregnancy so as to identify a single or multiple antibody response of exposure to malaria in pregnancy.MethodsThis study involved a secondary analysis of antibody responses to six parasite antigens [five commonly studied merozoite antigens and the variant surface antigen 2-chondroitin sulphate A (VAR2CSA), a pregnancy-specific erythrocytic antigen] measured by enzyme-linked immunosorbent assay (ELISA) over the gestation period until delivery (median of 7 measurements/woman) in 250 pregnant women who attended antenatal clinics located at the Thai-Myanmar border. A multivariate mixture linear mixed model was used to cluster the pregnant women into groups that have similar longitudinal antibody responses to all six antigens over the gestational period using a Bayesian approach. The variable-specific entropy was calculated to identify the antibody responses that have the highest influence on the classification of the women into clusters, and subsequent agreement with grouping of women based on exposure to malaria during pregnancy.ResultsOf the 250 pregnant women, 135 had a Plasmodium infection detected by light microscopy during pregnancy (39% Plasmodium falciparum only, 33% Plasmodium vivax only and 28% mixed/other species), defined as cases. The antibody responses to all six antigens accurately identified the women who did not have a malaria infection detected during pregnancy (93%, 107/115 controls). Antibody responses to P. falciparum merozoite surface protein 3 (PfMSP3) and P. vivax apical membrane antigen 1 (PvAMA1) were the least dynamic. Antibody responses to the antigens P. falciparum apical membrane antigen 1 (PfAMA1) and PfVAR2CSA were able to identify the majority of the cases more accurately (63%, 85/135).ConclusionThese findings suggest that the combination of antibodies, PfAMA1 and PfVAR2CSA, may be useful for sero-surveillance of malaria infections in pregnant women, particularly in low malaria transmission settings. Further investigation of other antibody markers is warranted considering these antibodies combined only detected 63% of the malaria infections during pregnancy.

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.

Prevalence and determinants of anaemia in women of reproductive age in Sudan: analysis of a cross-sectional household survey

BackgroundAnaemia is a global health problem and women in reproductive age (WRA) are amongst the most affected population. Its consequences include low birth weight and maternal mortality. This study aimed to assess the prevalence of anaemia and to identify its determinants in Sudanese women in reproductive age.MethodsA population-based cross-sectional study was conducted in Sudan in 2016. A multi-stage stratified cluster sampling design was executed with consideration of rural population, urban population, and internally displaced persons/refugees camps residents. All women in reproductive age (15–49 years), classified by pregnancy status, in the targeted households were surveyed and personal characteristic data were collected. Their haemoglobin level and malaria infection (using rapid diagnostic test, RDT) were assessed. The World Health Organization (WHO) haemoglobin level cut-off for defining anaemia and severe anaemia in pregnant and non-pregnant women was used. Logistic regression analyses were performed.ResultsA total of 4271 women (WRA) of which 421 (9.9%) pregnant women (PW) were included in the study. The overall anaemia prevalence in WRA was 35.6%. It was 36.0 and 35.5% in PW and non-pregnant women (NPW), respectively. The average haemoglobin level was found to be 113.9 g/L (SD 16.3) and 123.2 g/L (SD 15.7) for PW and NPW respectively. Severe anaemia prevalence was 1.2% in each group. In the logistic regression model, anaemia was associated with malaria infection in PW (aOR 4.100, 95%CI 1.523–11.039, p = 0.003), NPW (aOR 2.776, 95%CI 1.889–4.080, p < 0.001), and WRA (aOR 2.885, 95%CI 2.021–4.119, p < 0.001). Other identified determinants of anaemia in NPW was living in camps (aOR 1.499, 95%CI 1.115–2.017, p = 0.007) and in WRA was being in the poorest economic class (aOR 1.436, 95%CI 1.065–1.936, p = 0.018).ConclusionsAnaemia is a public health problem in Sudan. The study supported the association between malaria infection and anaemia, but not with low and moderate malaria transmission areas. Resources need to be allocated for all anaemic populations with special attention for the populations in most need and interventions need to be implemented based on local variations. Malaria control interventions, specifically case management, may have a major impact in reducing anaemia prevalence in low to moderate malaria transmission areas.

The correlation between inducible nitric oxide synthase (iNOS) expression and level of malondialdehyde (MDA) on placenta tissue of pregnant mice in malaria infection with intra uteri growth restriction

Malaria infection in pregnant women can cause various clinical manifestations, one of them is fetus low birth weight. Sequestrations of infected erythrocytes and macrophages on intervillous space has been revealed by previous study, however the mechanism of this sequestration in placenta insufficiency is still unknown. We suggested that local immunity on placenta tissue can induce the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) that can cause the destructions of placenta tissue due to the fetus low birth weight. This research was conducted to explore the path of immunity response on malaria placenta which involved the expression of inducible nitric oxide synthase (iNOS) and the level of malondialdehyde (MDA). This experimental laboratory study was done in pregnant Balb/c strain mice that infected with Plasmodium berghei in 9th day of pregnancy. Eighteen mice were divided into control group (pregnant mice) and treatment group (pregnant mice infected with Plasmodium berghei). iNOS expression was detected by using polyclonal antibody t iNOS, and level of MDA in the placenta tissue was measured by NTB assay. Fetal birth weight was measured on 15th day of pregnancy using analytic balance. The t-test independent showed a significant difference on iNOS expression between control group and treatment group (p

Prevalence of malaria infection in pregnant women attending Bamalli Nuhu Maternity Specialist Hospital, Kano, Nigeria

This study was conducted to determine the prevalence of malaria parasites in pregnant women attending Bamalli Nuhu Maternity Specialist Hospital Kano. A total of 250 blood samples of pregnant women were tested using field stain method and the parasites were identified using the standard identification keys. Out of which, 180 (72%) were found to be malaria parasite positive. The result of the present study revealed that Plasmodium falciparum had the highest rate of infection with about 68.8% while Plasmodium ovale was found to have an infection rate of 3.2%. The result revealed a highly significant difference within the means levels between the observed species (P. falciparum and P. ovale) (00000.1904***). Based on parity 94 (78.33%) Primigravidae, 61 (72.62%) Secundigravidae and 25 (54.35%) Multigravidae were infected respectively. The result of the findings also reveals that there is a significant difference within the levels of pregnant women Parity (0.01719*). It was concluded that more than half of the pregnant women were infected with malaria infection and P. falciparum was the predominant species then P. ovale. The findings of the study further proved that Primigravidae and Secundigravidae are more susceptible to malaria infection. More effort should be made in order to control malaria infection by providing better clinical management of the disease that includes curative and preventing measures. Keywords: Prevalence, Parity, Plasmodium, Pregnant Women, Infection rate

Submicroscopic malaria infections in pregnant women from six departments in Haiti.

To describe the epidemiology of malaria in pregnancy in Haiti. Cross-sectional study among pregnant women in six departments of Haiti. After obtaining informed consent, whole blood samples and demographic surveys were collected to investigate malaria prevalence, anaemia and socio-behavioural risk factors for infection, respectively. A total of 311 pregnant women were screened for Plasmodium falciparum infection using a rapid diagnostic test (RDT), microscopy and a novel, quantitative reverse transcriptase polymerase chain reaction method (qRT-PCR). Overall, 1.2% (4/311) of pregnant women were tested positive for malaria infection by both microscopy and RDT. However, using the qRT-PCR, 16.4% (51/311) of pregnant women were positive. The prevalence of malaria infection varied with geographical locations ranging between 0% and 46.4%. Additionally, 53% of pregnant women had some form of anaemia; however, no significant association was found between anaemia and submicroscopic malaria infection. The socio-behavioural risk factors identified to be protective of malaria infection were marital status (P < 0.05) and travel within one month prior to screening (P < 0.05). This study is the first to document the high prevalence of submicroscopic malaria infections among pregnant women in Haiti and identify social and behavioural risk factors for disease transmission.

Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific

PurposeThe Maternal Malaria and Malnutrition (M3) initiative has pooled together 13 studies with the hope of improving understanding of malaria–nutrition interactions during pregnancy and to foster collaboration between nutritionists and...

Pregnant women and infants as sentinel populations to monitor prevalence of malaria: results of pilot study in Lake Zone of Tanzania.

BackgroundAs malaria control interventions are scaled-up, rational approaches are needed for monitoring impact over time. One proposed approach includes monitoring the prevalence of malaria infection among pregnant women and children at the time of routine preventive health facility (HF) visits. This pilot explored the feasibility and utility of tracking the prevalence of malaria infection in pregnant women attending their first antenatal care (ANC) visit and infants presenting at 9–12 months of age for measles vaccination.MethodsPregnant women attending first ANC and infants nine to 12 months old presenting for measles vaccination at a non-probability sample of 54 HFs in Tanzania’s Lake Zone (Mara, Mwanza and Kagera Regions) were screened for malaria infection using a malaria rapid diagnostic test (RDT) from December 2012 to November 2013, regardless of symptoms. Participants who tested positive were treated for malaria per national guidelines. Data were collected monthly.ResultsOverall 89.9 and 78.1 % of expected monthly reports on malaria infection prevalence were received for pregnant women and infants, respectively. Among 51,467 pregnant women and 35,155 infants attending routine preventive HF visits, 41.2 and 37.3 % were tested with RDT, respectively. Malaria infection prevalence was 12.8 % [95 % confidence interval (CI) 11.3–14.3] among pregnant women and 11.0 % (95 % CI 9.5–12.5) among infants, and varied by month. There was good correlation of the prevalence of malaria among pregnant women and infants at the HF level (Spearman rho = 0.6; p < 0.001). This approach is estimated to cost $1.28 for every person tested, with the RDT accounting for 72 % of the cost.ConclusionsMalaria infection was common and well correlated among pregnant women and infants attending routine health services. Routine screening of these readily accessible populations may offer a practical strategy for continuously tracking malaria trends, particularly seasonal variation. Positivity rates among afebrile individuals presenting for routine care offer an advantage as they are unaffected by the prevalence of other causes of febrile illness, which could influence positivity rates among febrile patients presenting to outpatient clinics. The data presented here suggest that in addition to contributing to clinical management, ongoing screening of pregnant women could be used for routine surveillance and detection of hotspots.

Non-falciparum malaria infections in pregnant women in West Africa.

BackgroundNon-Plasmodium falciparum malaria infections are found in many parts of sub-Saharan Africa but little is known about their importance in pregnancy.MethodsBlood samples were collected at first antenatal clinic attendance from 2526 women enrolled in a trial of intermittent screening and treatment of malaria in pregnancy (ISTp) versus intermittent preventive treatment (IPTp) conducted in Burkina Faso, The Gambia, Ghana and Mali. DNA was extracted from blood spots and tested for P. falciparum, Plasmodium vivax, Plasmodium malariae and Plasmodium ovale using a nested PCR test. Risk factors for a non-falciparum malaria infection were investigated and the influence of these infections on the outcome of pregnancy was determined.ResultsP. falciparum infection was detected frequently (overall prevalence by PCR: 38.8 %, [95 % CI 37.0, 40.8]), with a prevalence ranging from 10.8 % in The Gambia to 56.1 % in Ghana. Non-falciparum malaria infections were found only rarely (overall prevalence 1.39 % [95 % CI 1.00, 1.92]), ranging from 0.17 % in the Gambia to 3.81 % in Mali. Ten non-falciparum mono-infections and 25 mixed falciparum and non-falciparum infections were found. P. malariae was the most frequent non-falciparum infection identified; P. vivax was detected only in Mali. Only four of the non-falciparum mono-infections were detected by microscopy or rapid diagnostic test. Recruitment during the late rainy season and low socio-economic status were associated with an increased risk of non-falciparum malaria as well as falciparum malaria. The outcome of pregnancy did not differ between women with a non-falciparum malaria infection and those who were not infected with malaria at first ANC attendance.ConclusionsNon-falciparum infections were infrequent in the populations studied, rarely detected when present as a mono-infection and unlikely to have had an important impact on the outcome of pregnancy in the communities studied due to the small number of women infected with non-falciparum parasites.

The Performance of a Rapid Diagnostic Test in Detecting Malaria Infection in Pregnant Women and the Impact of Missed Infections.

Intermittent screening and treatment in pregnancy (ISTp) is a potential strategy for the control of malaria during pregnancy. However, the frequency and consequences of malaria infections missed by a rapid diagnostic test (RDT) for malaria are a concern. Primigravidae and secundigravidae who participated in the ISTp arm of a noninferiority trial in 4 West African countries were screened with an HRP2/pLDH RDT on enrollment and, in Ghana, at subsequent antenatal clinic (ANC) visits. Blood samples were examined subsequently by microscopy and by a polymerase chain reaction (PCR) assay. The sensitivity of the RDT to detect peripheral blood infections confirmed by microscopy and/or PCR at enrollment ranged from 91% (95% confidence interval [CI], 88%, 94%) in Burkina Faso to 59% (95% CI, 48%, 70% in The Gambia. In Ghana, RDT sensitivity was 89% (95% CI, 85%, 92%), 83% (95% CI, 76%, 90%) and 77% (95% CI, 67%, 86%) at enrollment, second and third ANC visits respectively but only 49% (95% CI, 31%, 66%) at delivery. Screening at enrollment detected 56% of all infections detected throughout pregnancy. Seventy-five RDT negative PCR or microscopy positive infections were detected in 540 women; these were not associated with maternal anemia, placental malaria, or low birth weight. The sensitivity of an RDT to detect malaria in primigravidae and secundigravidae was high at enrollment in 3 of 4 countries and, in Ghana, at subsequent ANC visits. In Ghana, RDT negative malaria infections were not associated with adverse birth outcomes but missed infections were uncommon.

The prevalence of malaria at first antenatal visit in Blantyre, Malawi declined following a universal bed net campaign.

BackgroundPreventing malaria during pregnancy is important for the health of mothers and newborns. Interventions, which include distribution of bed nets and administration of intermittent preventive treatment (IPT), typically occur at the first antenatal visit, usually in the second or third trimester of pregnancy. In 2012, during the course of ongoing clinical studies of malaria among pregnant women in Malawi, a universal bed net campaign was implemented by the Government. This study tested the hypothesis that a universal bed net campaign would decrease the prevalence of malaria among pregnant women at their first antenatal visit.MethodsSome 1661 women were recruited for two studies from 2009 to 2014. Quantitative PCR (qPCR) was conducted from dried blood spots collected at the first antenatal care visit (prior to administration of IPT or any study interventions) from women who were in their first or second pregnancy and less than 28 weeks gestation by clinical assessment.ResultsOverall, 320 of 1629 (19.6 %) women tested for malaria at their first antenatal visit were infected. Malaria infection rates declined from 28.4 % before the universal bed net campaign, to 18.5 % in 2012, to 15.0 % in the years following the universal bed net campaign. The odds of malaria infection at the time of first antenatal visit in 2012 and the years following the bed net campaign were significantly lower than in the years prior to the intervention (OR 0.6, 95 % CI 0.4–0.8; and OR 0.4, 95 % CI 0.3–0.6, respectively). A similar pattern was observed for the prevalence of clinical malaria. The inverse trend was observed for reported bed net use. However bed net use and malaria infection were not significantly associated on the individual level.ConclusionsMalaria infection in pregnant women is common even after a bed net campaign in Malawi, though prevalence rates declined. These early infections may cause maternal anaemia and placental malaria resulting in adverse maternal and fetal outcomes. Infection early in pregnancy may also contribute to malaria transmission as pregnant women represent a significant untreated reservoir of parasites. Universal bed net distribution appears to have moderate success in preventing malaria early in pregnancy and these findings support continued efforts to target women early in pregnancy and all women of childbearing age.

High burden of malaria infection in pregnant women in a rural district of Zambia: a cross-sectional study.

BackgroundMalaria continues to be a major health problem in low-income countries. Consequently, malaria control remains a public health priority in endemic countries such as Zambia. Pregnant women and children under 5 years of age are among groups at high risk of malaria infection. Malaria infection is associated with adverse birth outcomes that affect the mother, foetus, and infant. Infection with HIV has been shown to increase the risk of malaria infection in pregnancy. The prevalence and the predictors of malaria infection among pregnant women resident in the Nchelenge District of northern Zambia were investigated.MethodsBetween November 2013 and April 2014, pregnant women in the catchment areas of two health centres were recruited during their first antenatal care visit. HIV testing was conducted as part of routine care. In addition, blood samples were collected from 1086 participants and tested for malaria infection using standard microscopy and polymerase chain reaction (PCR) techniques specific for Plasmodium falciparum. Multivariate logistic regression were conducted to examine the predictors of malaria infection.ResultsThe prevalence of malaria identified by microscopy was 31.8 % (95 % confidence intervals [CI], 29.0–34.5; N = 1079) and by PCR was 57.8 % (95 % CI, 54.9–60.8; N = 1074). HIV infection was 13.2 % among women on their first antenatal visit; the prevalence of malaria detected by PCR among HIV-uninfected and HIV-infected women was 56.7 % (531/936) and 65.2 % (90/138), respectively. In the final model, the risk of malaria infection was 81 % higher among pregnant women recruited from Nchelenge health centre compared to those attending the Kashikishi health centre (adjusted odds ratio = 1.81; 95 % CI, 1.38–2.37, P < 0.001), and HIV-infected women across health centres had a 46 % greater risk of malaria infection compared to HIV-uninfected women (adjusted odds ratio = 1.46; 95 %, 1.00–2.13, P = 0.045).ConclusionHigh burden of malaria detected by PCR in these pregnant women suggests that past prevention efforts have had limited effect. To reduce this burden of malaria sustainably, there is clear need to strengthen existing interventions and, possibly, to change approaches so as to improve targeting of groups most affected by malaria.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0866-1) contains supplementary material, which is available to authorized users.

Prevalence of malaria infection in pregnant women compared with children for tracking malaria transmission in sub-Saharan Africa: a systematic review and meta-analysis.

SummaryBackgroundIn malarious areas, pregnant women are more likely to have detectable malaria than are their non-pregnant peers, and the excess risk of infection varies with gravidity. Pregnant women attending antenatal clinic for their first visit are a potential pragmatic sentinel group to track the intensity of malaria transmission; however, the relation between malaria prevalence in children, a standard measure to estimate malaria endemicity, and pregnant women has never been compared.MethodsWe obtained data on malaria prevalence in pregnancy from the Malaria in Pregnancy Library (January, 2015) and data for children (0–59 months) were obtained from recently published work on parasite prevalence in Africa and the Malaria in Pregnancy Library. We used random effects meta-analysis to obtain a pooled prevalence ratio (PPR) of malaria in children versus pregnant women (during pregnancy, not at delivery) and by gravidity, and we used meta-regression to assess factors affecting the prevalence ratio.FindingsWe used data from 18 sources that included 57 data points. There was a strong linear relation between the prevalence of malaria infection in pregnant women and children (r=0·87, p<0·0001). Prevalence was higher in children when compared with all gravidae (PPR=1·44, 95% CI 1·29–1·62; I2=80%, 57 studies), and against multigravidae (1·94, 1·68–2·24; I2=80%, 7 studies), and marginally higher against primigravidae (1·16, 1·05–1·29; I2=48%, 8 studies). PPR was higher in areas of higher transmission.InterpretationMalaria prevalence in pregnant women is strongly correlated with prevalence data in children obtained from household surveys, and could provide a pragmatic adjunct to survey strategies to track trends in malaria transmission in Africa.FundingThe Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine, UK; US Centers for Disease Control and Prevention; and Wellcome Trust, UK.