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Masaku J, Mutuku F, Kihara JH, Mwandawiro C, Okoyo C, Kanyi H, Kamau J, Kaduka L, Ng’ang’a Z, Jeza VT. Helminthiasis and malaria co-infection among women of reproductive age in a rural setting of Kilifi County, coastal Kenya: A mixed method study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003310. [PMID: 38829897 PMCID: PMC11146690 DOI: 10.1371/journal.pgph.0003310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024]
Abstract
Soil transmitted helminthiasis (STH), Schistosoma haematobium and malaria co-infection lead to increased susceptibility to other infections and poor pregnancy outcomes among women of reproductive age (WRA). This study sought to establish risk factors, burden of co-infection with STH, S. haematobium and Plasmodium sp. among WRA in Kilifi County, Kenya.A mixed method cross-sectional study was conducted on 474 WRA in 2021. Simple random sampling was used to select WRA from four villages in two purposively sampled sub-counties. Study participants were interviewed, and stool samples collected and analysed using Kato-Katz technique for STH. Urine samples were collected for examination of S. haematobium while malaria microscopic test was done using finger prick blood samples. Further, 15 focus group discussions (FGDs) were conducted with purposively selected WRA and qualitative data analyzed thematically using Nvivo software. Quantitative and qualitative methods were triangulated to comprehensively strengthen the study findings. Prevalence of S. haematobium was 22.3% (95%CI: 13.5-36.9), any STH 5.2% (95%CI: 1.9-14.3) and malaria 8.3% (95%: 3.8-18.2). Co-infections between any STH and S. haematobium was 0.8% (95%CI: 0.2-3.2) and between S. haematobium and malaria 0.8% (95%CI: 0.2-3.1). Multivariable analysis showed increased odds of any STH infections among participants in Rabai Sub-County, (aOR = 9.74; p = 0.026), businesswomen (aOR = 5.25; p<0.001), housewives (aOR = 2.78; p = 0.003), and casual laborers (aOR = 27.03; p<0.001). Qualitative analysis showed that the three parasitic diseases were common and responsible for possible causes of low birth weight, susceptibility to other infections and complications such as infertility and cancer later in life.The study demonstrated that STH, S. haematobium and malaria are still a public health problem to WRA. Some of the associated risks of infection were geographical location, socio-economic and WASH factors. Hence the need to implement integrated control efforts of the three parasitic infection.
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Affiliation(s)
- Janet Masaku
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Francis Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Jimmy H. Kihara
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Henry Kanyi
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Joyce Kamau
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lydia Kaduka
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zipporah Ng’ang’a
- Department of Medical Laboratory Sciences, South Eastern Kenya University, Kitui, Kenya
| | - Victor T. Jeza
- Department of Medical Sciences, Technical University of Mombasa, Mombasa, Kenya
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Jugha VT, Anchang JA, Taiwe GS, Kimbi HK, Anchang-Kimbi JK. Association between malaria and undernutrition among pregnant women at presentation for antenatal care in health facilities in the Mount Cameroon region. PLoS One 2023; 18:e0292550. [PMID: 37824491 PMCID: PMC10569528 DOI: 10.1371/journal.pone.0292550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
In resource limited settings, malaria and undernutrition are major public health problems in pregnancy. Therefore, this study assessed the association between malaria infection and undernutrition among pregnant women in the Mount Cameroon area. This cross-sectional study enrolled 1,014 pregnant women consecutively over a year. A structured questionnaire was used to collect socio-demographic information and clinical data. Maternal nutrition was assessed using dietary diversity (DD). Peripheral blood samples collected were used for the diagnosis of malaria parasitaemia by microscopy whereas haemoglobin (Hb) levels were determined using an Hb meter. Logistic regression was used to determine factors associated with malaria and dietary diversity. The prevalence of malaria infection and undernutrition was 17.8% and 89.6% respectively. In addition, of those infected with malaria, geometric mean parasite density was 301/μL of blood (range: 40-9280) while mean DD score was 3.57±0.82 (range: 1-7). The odds of being infected with malaria parasitaemia was highest among women enrolled in the rainy season (OR = 1.58, P = 0.043), who were farmers (OR = 2.3, P = 0.030), had a household size of < 4 individuals (OR = 1.48, P = 0.026) and who were febrile (OR = 1.87, P < 0.001). Also, attending clinic visits in Mutengene Medical Centre (OR = 2.0, P = 0.012) or Buea Integrated Health Centre (OR = 2.9, P = < 0.001), being < 25 years (OR = 2.4, P = 0.002) and a farmer (OR = 10.6, P = 0.024) as well as < 4 clinic visits (OR = 1.62, P = 0.039) were identified as predictors of undernutrition. Furthermore, the association between malaria and DD was statistically significant (P = 0.015). In this study, undernutrition was highly frequent than malaria infection. Thus, there is an urgent need to improve maternal awareness through nutritional counselling and health campaigns on the benefits of consuming at least five food groups. Besides, improved maternal dietary nutrient intake is likely to have impact on the burden of malaria parasite infection.
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Affiliation(s)
- Vanessa Tita Jugha
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
| | - Juliana Adjem Anchang
- International Centre for Agricultural Research in the Dry Areas, ICARDA, Cairo, Eygpt
| | | | - Helen Kuokuo Kimbi
- Department of Animal Biology and Conservation, University of Buea, Buea, Cameroon
- Department of Biomedical Sciences, University of Bamenda, Bamenda, Cameroon
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
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Mtove G, Chico RM, Madanitsa M, Barsosio HC, Msemo OA, Saidi Q, Gore-Langton GR, Minja DTR, Mukerebe C, Gesase S, Mwapasa V, Phiri KS, Hansson H, Dodd J, Magnussen P, Kavishe RA, Mosha F, Kariuki S, Lusingu JPA, Gutman JR, Alifrangis M, Ter Kuile FO, Schmiegelow C. Fetal growth and birth weight are independently reduced by malaria infection and curable sexually transmitted and reproductive tract infections in Kenya, Tanzania, and Malawi: A pregnancy cohort study. Int J Infect Dis 2023; 135:28-40. [PMID: 37516425 PMCID: PMC10878282 DOI: 10.1016/j.ijid.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVES Malaria and sexually transmitted and reproductive tract infections (STIs/RTIs) are highly prevalent in sub-Saharan Africa and associated with poor pregnancy outcomes. We investigated the individual and combined effects of malaria and curable STIs/RTIs on fetal growth in Kenya, Tanzania, and Malawi. METHODS This study was nested within a randomized trial comparing monthly intermittent preventive treatment for malaria in pregnancy with sulfadoxine-pyrimethamine vs dihydroartemisinin-piperaquine, alone or combined with azithromycin. Fetal weight gain was assessed by serial prenatal ultrasound. Malaria was assessed monthly, and Treponema pallidum, Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and bacterial vaginosis at enrollment and in the third trimester. The effect of malaria and STIs/RTIs on fetal weight/birthweight Z-scores was evaluated using mixed-effects linear regression. RESULTS In total, 1435 pregnant women had fetal/birth weight assessed 3950 times. Compared to women without malaria or STIs/RTIs (n = 399), malaria-only (n = 267), STIs/RTIs only (n = 410) or both (n = 353) were associated with reduced fetal growth (adjusted mean difference in fetal/birth weight Z-score [95% confidence interval]: malaria = -0.18 [-0.31,-0.04], P = 0.01; STIs/RTIs = -0.14 [-0.26,-0.03], P = 0.01; both = -0.20 [-0.33,-0.07], P = 0.003). Paucigravidae experienced the greatest impact. CONCLUSION Malaria and STIs/RTIs are associated with poor fetal growth especially among paucigravidae women with dual infections. Integrated antenatal interventions are needed to reduce the burden of both malaria and STIs/RTIs.
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Affiliation(s)
- George Mtove
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania.
| | - R Matthew Chico
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, United Kingdom
| | - Mwayiwawo Madanitsa
- Kamuzu University of Health Sciences, Blantyre, School of Global and Public Health, Malawi; Malawi University of Science and Technology, Academy of Medical Sciences, Limbe, Malawi
| | - Hellen C Barsosio
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Omari Abdul Msemo
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania
| | - Queen Saidi
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Georgia R Gore-Langton
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, United Kingdom
| | - Daniel T R Minja
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania
| | - Crispin Mukerebe
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania
| | - Samwel Gesase
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania
| | - Victor Mwapasa
- Kamuzu University of Health Sciences, Blantyre, School of Global and Public Health, Malawi
| | - Kamija S Phiri
- Kamuzu University of Health Sciences, Blantyre, School of Global and Public Health, Malawi
| | - Helle Hansson
- University of Copenhagen, Centre for Medical Parasitology, Department of Immunology, Microbiology and Infectious Diseases, Copenhagen, Denmark
| | - James Dodd
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, United Kingdom
| | - Pascal Magnussen
- University of Copenhagen, Centre for Medical Parasitology, Department of Immunology, Microbiology and Infectious Diseases, Copenhagen, Denmark
| | - Reginald A Kavishe
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Franklin Mosha
- Kilimanjaro Clinical Research Institute and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - John P A Lusingu
- National Institute for Medical Research, Department of Research Program, Tanga, Tanzania
| | - Julie R Gutman
- Centers for Disease Control and Prevention, Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Atlanta, United States of America
| | - Michael Alifrangis
- University of Copenhagen, Centre for Medical Parasitology, Department of Immunology, Microbiology and Infectious Diseases, Copenhagen, Denmark
| | - Feiko O Ter Kuile
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, United Kingdom
| | - Christentze Schmiegelow
- University of Copenhagen, Centre for Medical Parasitology, Department of Immunology, Microbiology and Infectious Diseases, Copenhagen, Denmark
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Mondeilh A, Yovo E, Accrombessi M, Hounkonnou C, Agbota G, Atade W, Ladikpo OT, Mehoba M, Degbe A, Vianou B, Sossou D, Ndam NT, Massougbodji A, McGready R, Fievet N, Rijken MJ, Cottrell G, Briand V. Malaria Infections and Placental Blood Flow: A Doppler Ultrasound Study From a Preconception Cohort in Benin. Open Forum Infect Dis 2023; 10:ofad376. [PMID: 37577115 PMCID: PMC10414806 DOI: 10.1093/ofid/ofad376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow. Methods The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks' gestation (wg), and UA Doppler measurement was performed 1-3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow). Results Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2-16.3 and aOR 3.3, 95% CI = .9-11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler. Conclusions Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.
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Affiliation(s)
- Aude Mondeilh
- Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France
| | - Emmanuel Yovo
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
- Montpellier Interdisciplinary Center on Sustainable Agri-food Systems (MoISA), Université de Montpellier, Montpellier, France
| | - Manfred Accrombessi
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Cornelia Hounkonnou
- Centre d'investigation clinique, module épidémiologie clinique (CIC-EC 1425), Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche Clinique, AP-HP, Hôpital BichatParis, France
| | - Gino Agbota
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - William Atade
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | | | - Murielle Mehoba
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Auguste Degbe
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Bertin Vianou
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Dariou Sossou
- Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin
| | - Nicaise Tuikue Ndam
- Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France
| | | | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nadine Fievet
- Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France
| | - Marcus J Rijken
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gilles Cottrell
- Research Institute for Sustainable Development (IRD), UMR 261 MERIT, Université Paris Cité, Paris, France
| | - Valérie Briand
- Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France
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Saito M, McGready R, Tinto H, Rouamba T, Mosha D, Rulisa S, Kariuki S, Desai M, Manyando C, Njunju EM, Sevene E, Vala A, Augusto O, Clerk C, Were E, Mrema S, Kisinza W, Byamugisha J, Kagawa M, Singlovic J, Yore M, van Eijk AM, Mehta U, Stergachis A, Hill J, Stepniewska K, Gomes M, Guérin PJ, Nosten F, Ter Kuile FO, Dellicour S. Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis. Lancet 2023; 401:118-130. [PMID: 36442488 PMCID: PMC9874756 DOI: 10.1016/s0140-6736(22)01881-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malaria in the first trimester of pregnancy is associated with adverse pregnancy outcomes. Artemisinin-based combination therapies (ACTs) are a highly effective, first-line treatment for uncomplicated Plasmodium falciparum malaria, except in the first trimester of pregnancy, when quinine with clindamycin is recommended due to concerns about the potential embryotoxicity of artemisinins. We compared adverse pregnancy outcomes after artemisinin-based treatment (ABT) versus non-ABTs in the first trimester of pregnancy. METHODS For this systematic review and individual patient data (IPD) meta-analysis, we searched MEDLINE, Embase, and the Malaria in Pregnancy Library for prospective cohort studies published between Nov 1, 2015, and Dec 21, 2021, containing data on outcomes of pregnancies exposed to ABT and non-ABT in the first trimester. The results of this search were added to those of a previous systematic review that included publications published up until November, 2015. We included pregnancies enrolled before the pregnancy outcome was known. We excluded pregnancies with missing estimated gestational age or exposure information, multiple gestation pregnancies, and if the fetus was confirmed to be unviable before antimalarial treatment. The primary endpoint was adverse pregnancy outcome, defined as a composite of either miscarriage, stillbirth, or major congenital anomalies. A one-stage IPD meta-analysis was done by use of shared-frailty Cox models. This study is registered with PROSPERO, number CRD42015032371. FINDINGS We identified seven eligible studies that included 12 cohorts. All 12 cohorts contributed IPD, including 34 178 pregnancies, 737 with confirmed first-trimester exposure to ABTs and 1076 with confirmed first-trimester exposure to non-ABTs. Adverse pregnancy outcomes occurred in 42 (5·7%) of 736 ABT-exposed pregnancies compared with 96 (8·9%) of 1074 non-ABT-exposed pregnancies in the first trimester (adjusted hazard ratio [aHR] 0·71, 95% CI 0·49-1·03). Similar results were seen for the individual components of miscarriage (aHR=0·74, 0·47-1·17), stillbirth (aHR=0·71, 0·32-1·57), and major congenital anomalies (aHR=0·60, 0·13-2·87). The risk of adverse pregnancy outcomes was lower with artemether-lumefantrine than with oral quinine in the first trimester of pregnancy (25 [4·8%] of 524 vs 84 [9·2%] of 915; aHR 0·58, 0·36-0·92). INTERPRETATION We found no evidence of embryotoxicity or teratogenicity based on the risk of miscarriage, stillbirth, or major congenital anomalies associated with ABT during the first trimester of pregnancy. Given that treatment with artemether-lumefantrine was associated with fewer adverse pregnancy outcomes than quinine, and because of the known superior tolerability and antimalarial effectiveness of ACTs, artemether-lumefantrine should be considered the preferred treatment for uncomplicated P falciparum malaria in the first trimester. If artemether-lumefantrine is unavailable, other ACTs (except artesunate-sulfadoxine-pyrimethamine) should be preferred to quinine. Continued active pharmacovigilance is warranted. FUNDING Medicines for Malaria Venture, WHO, and the Worldwide Antimalarial Resistance Network funded by the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Makoto Saito
- WorldWide Antimalarial Resistance Network, Oxford, UK; Infectious Diseases Data Observatory, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Rose McGready
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | | | - Stephen Rulisa
- School of Medicine and Pharmacy, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Meghna Desai
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Eric M Njunju
- Department of Basic Sciences, Copperbelt University, Ndola, Zambia
| | - Esperanca Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique; Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | | | - Edwin Were
- Department of Reproductive Health, Moi University, Eldoret, Kenya
| | | | - William Kisinza
- National Institute of Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - Mike Kagawa
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | | | - Mackensie Yore
- VA Los Angeles and University of California, Los Angeles National Clinician Scholars Program, VA Greater Los Angeles Healthcare System Health Services Research and Development Service Center of Innovation, Los Angeles, CA, USA
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Andy Stergachis
- Department of Pharmacy, School of Pharmacy, and Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, UK; Infectious Diseases Data Observatory, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Melba Gomes
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland; School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Philippe J Guérin
- WorldWide Antimalarial Resistance Network, Oxford, UK; Infectious Diseases Data Observatory, Oxford, UK; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Feiko O Ter Kuile
- WorldWide Antimalarial Resistance Network, Oxford, UK; Infectious Diseases Data Observatory, Oxford, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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Simon N, Shallat J, Houck J, Jagannathan P, Prahl M, Muhindo MK, Kakuru A, Olwoch P, Feeney ME, Harrington WE. Peripheral Plasmodium falciparum Infection in Early Pregnancy Is Associated With Increased Maternal Microchimerism in the Offspring. J Infect Dis 2021; 224:2105-2112. [PMID: 34010401 PMCID: PMC8672744 DOI: 10.1093/infdis/jiab275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Placental malaria has been associated with increased cord blood maternal microchimerism (MMc), which in turn may affect susceptibility to malaria in the offspring. We sought to determine the impact of maternal peripheral Plasmodium falciparum parasitemia during pregnancy on MMc and to determine whether maternal cells expand during primary parasitemia in the offspring. METHODS We conducted a nested cohort study of maternal-infant pairs from a prior pregnancy malaria chemoprevention study. Maternal microchimerism was measured by quantitative polymerase chain reaction targeting a maternal-specific marker in genomic DNA from cord blood, first P falciparum parasitemia, and preparasitemia. Logistic and negative binomial regression were used to assess the impact of maternal peripheral parasitemia, symptomatic malaria, and placental malaria on cord blood MMc. Generalized estimating equations were used to assess predictors of MMc during infancy. RESULTS Early maternal parasitemia was associated with increased detection of cord blood MMc (adjusted odds ratio = 3.91, P = .03), whereas late parasitemia, symptomatic malaria, and placental malaria were not. The first parasitemia episode in the infant was not associated with increased MMc relative to preparasitemia. CONCLUSIONS Maternal parasitemia early in pregnancy may increase the amount of MMc acquired by the fetus. Future work should investigate the impact of this MMc on immune responses in the offspring.
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Affiliation(s)
- Neta Simon
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Jaclyn Shallat
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - John Houck
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | | | - Mary Prahl
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Mary K Muhindo
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Olwoch
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Margaret E Feeney
- Department of Pediatrics, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| | - Whitney E Harrington
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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7
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Harrington WE, Moore KA, Min AM, Gilder ME, Tun NW, Paw MK, Wiladphaingern J, Proux S, Chotivanich K, Rijken MJ, White NJ, Nosten F, McGready R. Falciparum but not vivax malaria increases the risk of hypertensive disorders of pregnancy in women followed prospectively from the first trimester. BMC Med 2021; 19:98. [PMID: 33902567 PMCID: PMC8077872 DOI: 10.1186/s12916-021-01960-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Malaria and hypertensive disorders of pregnancy (HDoP) affect millions of pregnancies worldwide, particularly those of young, first-time mothers. Small case-control studies suggest a positive association between falciparum malaria and risk of pre-eclampsia but large prospective analyses are lacking. METHODS We characterized the relationship between malaria in pregnancy and the development of HDoP in a large, prospectively followed cohort. Pregnant women living along the Thailand-Myanmar border, an area of low seasonal malaria transmission, were followed at antenatal clinics between 1986 and 2016. The relationships between falciparum and vivax malaria during pregnancy and the odds of gestational hypertension, pre-eclampsia, or eclampsia were examined using logistic regression amongst all women and then stratified by gravidity. RESULTS There were 23,262 singleton pregnancies in women who presented during the first trimester and were followed fortnightly. Falciparum malaria was associated with gestational hypertension amongst multigravidae (adjusted odds ratio (AOR) 2.59, 95%CI 1.59-4.23), whereas amongst primigravidae, it was associated with the combined outcome of pre-eclampsia/eclampsia (AOR 2.61, 95%CI 1.01-6.79). In contrast, there was no association between vivax malaria and HDoP. CONCLUSIONS Falciparum but not vivax malaria during pregnancy is associated with hypertensive disorders of pregnancy.
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Affiliation(s)
- Whitney E Harrington
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Kerryn A Moore
- London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Nay Win Tun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Stephane Proux
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Marcus J Rijken
- Utrecht University Medical Centre, Utrecht, the Netherlands
- Julius Centre Global Health, Utrecht, the Netherlands
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, UK.
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8
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Widyawaruyanti A, Ilmi H, Tumewu L, Prasetyo B, Hafid AF. A tablet derived from Andrographis paniculata complements dihydroartemisinin-piperaquine treatment of malaria in pregnant mice. J Basic Clin Physiol Pharmacol 2021; 33:175-183. [PMID: 33580999 DOI: 10.1515/jbcpp-2020-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The use of standard antimalarial drugs, such as dihydroartemisinin-piperaquine (DHP) for the treatment of malaria during pregnancy is limited due to the risk of teratogenicity. The alternative is therefore required although few exist. Here we show a phytopharmaceutical drug derived from Andrographis paniculata (AS201-01), which is effective as herbal antimalarial both in vitro and in vivo and may be a suitable alternative when used in complementary treatment with DHP. METHODS Plasmodium berghei infected pregnant BALB/c mice were divided into four groups: G1 (negative control), G2 (AS201-01), G3 (DHP), and G4 (combination of DHP and AS201-01). Pheripheral blood was collected during therapy for counting parasitemia. Placental samples were analyzed for the expression of IFN-γ, TNF- α, IL-10, placental parasite counts and foetal morphology. RESULTS Groups G4 and G3 both showed a 100% inhibition of peripheral parasitemia. However, the treatment in G4 was found to be less effective than that in G2 and G3 in preventing placental parasitemia. The G4 treatment was able to reduce the expression of IFN-γ and IL-10, whereas TNF-α was not significantly different from the control group. Foetal morphologic abnormalities were observed in all groups except G2; G4 showed lower percentage of abnormalities compared to G3 and G1. CONCLUSIONS A combination of A. paniculata tablet (AS201-01) with DHP has the potential to reduce the toxicity of DHP in malaria treatment.
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Affiliation(s)
- Aty Widyawaruyanti
- Natural Product Medicine Research and Development, Institute of Tropical Disease, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
| | - Hilkatul Ilmi
- Natural Product Medicine Research and Development, Institute of Tropical Disease, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
| | - Lidya Tumewu
- Natural Product Medicine Research and Development, Institute of Tropical Disease, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
| | - Budi Prasetyo
- Natural Product Medicine Research and Development, Institute of Tropical Disease, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Achmad Fuad Hafid
- Natural Product Medicine Research and Development, Institute of Tropical Disease, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmacy, Universitas Airlangga, C Campus Universitas Airlangga, Surabaya, Indonesia
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9
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Saito M, Briand V, Min AM, McGready R. Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:761-774. [PMID: 32946830 DOI: 10.1016/s2352-4642(20)30099-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/29/2022]
Abstract
All malaria infections are harmful to both the pregnant mother and the developing fetus. One in ten maternal deaths in malaria endemic countries are estimated to result from Plasmodium falciparum infection. Malaria is associated with a 3-4 times increased risk of miscarriage and a substantially increased risk of stillbirth. Current treatment and prevention strategies reduce, but do not eliminate, malaria's damaging effects on pregnancy outcomes. Reviewing evidence generated from meta-analyses, systematic reviews, and observational data, the first paper in this Series aims to summarise the adverse effects of malaria in pregnancy on the fetus and how the current drug treatment and prevention strategies can alleviate these effects. Although evidence supports the safety and treatment efficacy of artemisinin-based combination therapies in the first trimester, these therapies have not been recommended by WHO for the treatment of malaria at this stage of pregnancy. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine is contraindicated in the first trimester and provides imperfect chemoprevention because of inadequate dosing, poor (few and late) antenatal clinic attendance, increasing antimalarial drug resistance, and decreasing naturally acquired maternal immunity due to the decreased incidence of malaria. Alternative strategies to prevent malaria in pregnancy are needed. The prevention of all malaria infections by providing sustained exposure to effective concentrations of antimalarial drugs is key to reducing the adverse effects of malaria in pregnancy.
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Affiliation(s)
- Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Valérie Briand
- Infectious Diseases in Lower Income Countries, Research Institute for Sustainable Development, French National Institute of Health and Medical Research, University of Bordeaux, Bordeaux, France
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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10
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Tran EE, Cheeks ML, Kakuru A, Muhindo MK, Natureeba P, Nakalembe M, Ategeka J, Nayebare P, Kamya M, Havlir D, Feeney ME, Dorsey G, Gaw SL. The impact of gravidity, symptomatology and timing of infection on placental malaria. Malar J 2020; 19:227. [PMID: 32580739 PMCID: PMC7315526 DOI: 10.1186/s12936-020-03297-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background Placental malaria is associated with increased risk of adverse perinatal outcomes. While primigravidity has been reported as a risk factor for placental malaria, little is known regarding the relationship between gravidity, symptomatology and timing of Plasmodium falciparum infection and the development of placental malaria. Methods The aim of this study was to investigate the relationship between the development of placental malaria and gravidity, timing of infection, and presence of symptoms. This is a secondary analysis of data from a double-blind randomized control trial of intermittent preventive therapy during pregnancy in Uganda. Women were enrolled from 12 to 20 weeks gestation and followed through delivery. Exposure to malaria parasites was defined as symptomatic (fever with positive blood smear) or asymptomatic (based on molecular detection of parasitaemia done routinely every 4 weeks). The primary outcome was placental malaria diagnosed by histopathology, placental blood smear, and/or placental blood loop-mediated isothermal amplification. Multivariate analyses were performed using logistic regression models. Subgroup analysis was performed based on the presence of symptomatic malaria, gravidity, and timing of infection. Results Of the 228 patients with documented maternal infection with malaria parasites during pregnancy, 101 (44.3%) had placental malaria. Primigravidity was strongly associated with placental malaria (aOR 8.90, 95% CI 4.34–18.2, p < 0.001), and each episode of malaria was associated with over a twofold increase in placental malaria (aOR 2.35, 95% CI 1.69–3.26, p < 0.001). Among multigravid women, the odds of placental malaria increased by 14% with each advancing week of gestation at first documented infection (aOR 1.14, 95% CI 1.02–1.27, p = 0.02). When stratified by the presence of symptoms, primigravidity was only associated with placental malaria in asymptomatic women, who had a 12-fold increase in the odds of placental malaria (aOR 12.19, 95% CI 5.23–28.43, p < 0.001). Conclusions Total number of P. falciparum infections in pregnancy is a significant predictor of placental malaria. The importance of timing of infection on the development of placental malaria varies based on gravidity. In primigravidas, earlier asymptomatic infections were more frequently identified in those with placental malaria, whereas in multigravidas, parasitaemias detected later in gestation were associated with placental malaria. Earlier initiation of an effective intermittent preventive therapy may help to prevent placental malaria and improve birth outcomes, particularly in primigravid women.
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Affiliation(s)
- Erin E Tran
- Division of Maternal Fetal Medicine, Department of Obstetrics Gynecology & Reproductive Sciences, University of California San Francisco, 513 Parnassus Ave. HSE16, Box 0556, San Francisco, CA, 94143, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Morgan L Cheeks
- Division of Maternal Fetal Medicine, Department of Obstetrics Gynecology & Reproductive Sciences, University of California San Francisco, 513 Parnassus Ave. HSE16, Box 0556, San Francisco, CA, 94143, USA
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mary K Muhindo
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Paul Natureeba
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - John Ategeka
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Moses Kamya
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane Havlir
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Margaret E Feeney
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Grant Dorsey
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephanie L Gaw
- Division of Maternal Fetal Medicine, Department of Obstetrics Gynecology & Reproductive Sciences, University of California San Francisco, 513 Parnassus Ave. HSE16, Box 0556, San Francisco, CA, 94143, USA.
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11
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Thompson JM, Eick SM, Dailey C, Dale AP, Mehta M, Nair A, Cordero JF, Welton M. Relationship Between Pregnancy-Associated Malaria and Adverse Pregnancy Outcomes: a Systematic Review and Meta-Analysis. J Trop Pediatr 2020; 66:327-338. [PMID: 31598714 DOI: 10.1093/tropej/fmz068] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pregnancy-associated malaria (PAM) has been associated with adverse pregnancy outcomes like preterm birth (PTB) and low birthweight (LBW), which are among the leading causes of infant mortality globally. Rates of PTB and LBW are high in countries with a high burden of malaria. PAM may be a contributing factor to PTB and LBW, but is not well understood. METHODS We conducted a systematic review and meta-analysis of studies examining the relationship between PAM and PTB or LBW using PubMed. The title and abstract of all studies were screened by two reviewers, and the full text of selected studies was reviewed to ensure they met inclusion criteria. Information regarding study characteristics and of PTB and LBW births among women with and without PAM was abstracted for included studies. RESULTS Our search terms yielded 2237 articles, of which 18 met our final inclusion criteria. Eight studies examined associations between PAM and PTB, and 10 examined associations between PAM and LBW (population size ranging from 35 to 9956 women). The overall risk of LBW was 63% higher among women with PAM compared with women without PAM (95% CI = 1.48-1.80) and the risk of PTB was 23% higher among women with PAM compared with women without PAM (95% CI = 1.07-1.41). CONCLUSIONS These results indicate that infection with PAM is associated with PTB and LBW. Further understanding of the pathogenesis of disease and the immunologic changes that occur during pregnancy is essential for reducing the disproportional effects this disease has on this vulnerable population.
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Affiliation(s)
- Julie M Thompson
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,College of Veterinary Medicine, University of Georgia, 30602 Athens, GA, USA
| | - Stephanie M Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology, and Reproductive Services, University of California, San Francisco, 94158 San Francisco, CA, USA
| | - Cody Dailey
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA.,Odum School of Ecology, University of Georgia, 30602 Athens, GA, USA
| | - Ariella P Dale
- Colorado Department of Public Health & Environment, 80246 Denver, CO, USA
| | - Mansi Mehta
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Anjali Nair
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
| | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 30605 Athens, GA, USA
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12
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Moeller SL, Nyengaard JR, Larsen LG, Nielsen K, Bygbjerg IC, Msemo OA, Lusingu JPA, Minja DTR, Theander TG, Schmiegelow C. Malaria in Early Pregnancy and the Development of the Placental Vasculature. J Infect Dis 2020; 220:1425-1434. [PMID: 30590576 DOI: 10.1093/infdis/jiy735] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pregnancy malaria has a negative impact on fetal outcome. It is uncertain whether infections in early pregnancy have a clinical impact by impeding the development of the placental vasculature. METHODS Tanzanian women (n = 138) were closely monitored during pregnancy. Placentas collected at birth were investigated using stereology to establish the characteristics of placental villi and vessels. Placental vasculature measures were compared between women infected with malaria and controls. RESULTS Compared with controls, placentas from women infected with malaria before a gestational age (GA) of 15 weeks had a decreased volume of transport villi (mean decrease [standard deviation], 12.45 [5.39] cm3; P = .02), an increased diffusion distance in diffusion vessels (mean increase, 3.33 [1.27] µm; P = .01), and a compensatory increase in diffusion vessel surface area (mean increase, 1.81 [0.74 m2]; P = .02). In women who had malaria before a GA of 15 weeks diffusion vessel surface area and transport vessel length distance were positive predictors for birth weight (multilinear regression: P = .007 and P = .055 for diffusion surface area and transport length, respectively) and GA at delivery (P = .005 and P = .04). CONCLUSIONS Malaria infection in early pregnancy impedes placental vascular development. The resulting phenotypic changes, which can be detected at delivery, are associated with birth weight and gestational length. CLINICAL TRIALS REGISTRATION NCT02191683.
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Affiliation(s)
| | - Jens R Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, Aarhus University
| | - Lise G Larsen
- Department of Pathology, Zealand University Hospital, Naestved, Denmark
| | | | - Ib C Bygbjerg
- Division of Global Health, Department of Public Health
| | | | - John P A Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | | | - Thor G Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen
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13
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Weckman AM, Ngai M, Wright J, McDonald CR, Kain KC. The Impact of Infection in Pregnancy on Placental Vascular Development and Adverse Birth Outcomes. Front Microbiol 2019; 10:1924. [PMID: 31507551 PMCID: PMC6713994 DOI: 10.3389/fmicb.2019.01924] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
Healthy fetal development is dependent on nutrient and oxygen transfer via the placenta. Optimal growth and function of placental vasculature is therefore essential to support in utero development. Vasculogenesis, the de novo formation of blood vessels, and angiogenesis, the branching and remodeling of existing vasculature, mediate the development and maturation of placental villi, which form the materno-fetal interface. Several lines of evidence indicate that systemic maternal infection and consequent inflammation can disrupt placental vasculogenesis and angiogenesis. The resulting alterations in placental hemodynamics impact fetal growth and contribute to poor birth outcomes including preterm delivery, small-for-gestational age (SGA), stillbirth, and low birth weight (LBW). Furthermore, pathways involved in maternal immune activation and placental vascularization parallel those involved in normal fetal development, notably neurovascular development. Therefore, immune-mediated disruption of angiogenic pathways at the materno-fetal interface may also have long-term neurological consequences for offspring. Here, we review current literature evaluating the influence of maternal infection and immune activation at the materno-fetal interface and the subsequent impact on placental vascular function and birth outcome. Immunomodulatory pathways, including chemokines and cytokines released in response to maternal infection, interact closely with the principal pathways regulating placental vascular development, including the angiopoietin-Tie-2, vascular endothelial growth factor (VEGF), and placental growth factor (PlGF) pathways. A detailed mechanistic understanding of how maternal infections impact placental and fetal development is critical to the design of effective interventions to promote placental growth and function and thereby reduce adverse birth outcomes.
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Affiliation(s)
- Andrea M Weckman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michelle Ngai
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Julie Wright
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Chloe R McDonald
- SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada
| | - Kevin C Kain
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada.,Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada
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14
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Moeller SL, Schmiegelow C, Larsen LG, Nielsen K, Msemo OA, Lusingu JPA, Minja DTR, Theander TG, Bygbjerg IC, Nyengaard JR. Anemia in late pregnancy induces an adaptive response in fetoplacental vascularization. Placenta 2019; 80:49-58. [PMID: 31103067 DOI: 10.1016/j.placenta.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anemia during pregnancy may compromise fetal and newborn's health, however, little is known about how and when the fetoplacental vascularization is most vulnerable to anemia. METHODS Using systematic and isotropic uniform random sampling, placental samples were collected from 189 placentas in a cohort study of Tanzanian women whose hemoglobin concentration was measured throughout pregnancy. Fetoplacental vessels and villi were defined as exerting either a transport or diffusion function. The vascularization patterns for transport and diffusion vessels and villi were assessed by stereology. Blood vessel length, surface area and diffusion distance as well as placental villi volume were calculated. RESULTS Anemia from a gestational age of 23 weeks was significantly associated with increased fetoplacental vascularization in vessels and villi compared to women who were non-anemic throughout pregnancy. Transport surface vessel area: 0.31 m2 [95% CI: 0.18-0.55], P = 0.01; Transport villi volume 19.8 cm3 [95% CI: 6.37-33.2], P = 0.004, Transport vessel diameter 7.23 μm [95% CI: 1.23-13.3], P = 0.02. Diffusion vessel surface: 3.23 m2 [95% CI: 1.55-4.91], P < 0.001 and diffusion villi volume: 29.8 cm3 [95% CI: 10.0-49.5], P = 0.003). Finally, all the measured transport vessel and villi significantly parameters and diffusion vessel surface, vessel diameter and diffusion distance were associated with birth weight. DISCUSSION Increased fetoplacental vascularization related to anemia from a gestational age of 23 weeks in pregnancy together with the association between fetoplacental vascularity and birth weight suggest that the timing of anemia determines the effect on fetoplacental vascularization and underlines the clinical relevance for proper development of fetoplacental vasculature.
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Affiliation(s)
- Sofie L Moeller
- Division of Global Health, Department of Public Health, Oester Farimagsgade 5, Building 9, University of Copenhagen, DK-1014, Copenhagen, Denmark.
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Blegdamsvej 3B, University of Copenhagen, DK-2200, Copenhagen, Denmark.
| | - Lise G Larsen
- Department of Pathology, Zealand University Hospital, Naestved, DK-4700, Naestved, Denmark.
| | - Karsten Nielsen
- Department of Pathology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, C112, DK-8200, Aarhus, Denmark.
| | - Omari Abdul Msemo
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - John P A Lusingu
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - Daniel T R Minja
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - Thor G Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Blegdamsvej 3B, University of Copenhagen, DK-2200, Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Division of Global Health, Department of Public Health, Oester Farimagsgade 5, Building 9, University of Copenhagen, DK-1014, Copenhagen, Denmark.
| | - Jens R Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, C113, level 1, Palle Juul Jensens Boulevard 99, Aarhus University, DK-8200, Aarhus N, Denmark.
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15
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Rogerson SJ, Desai M, Mayor A, Sicuri E, Taylor SM, van Eijk AM. Burden, pathology, and costs of malaria in pregnancy: new developments for an old problem. THE LANCET. INFECTIOUS DISEASES 2018; 18:e107-e118. [PMID: 29396010 DOI: 10.1016/s1473-3099(18)30066-5] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 08/07/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
Over the past 10 years, knowledge of the burden, economic costs, and consequences of malaria in pregnancy has improved, and the prevalence of malaria caused by Plasmodium falciparum has declined substantially in some geographical areas. In particular, studies outside of Africa have increased the evidence base of Plasmodium vivax in pregnancy. Rapid diagnostic tests have been poor at detecting malaria in pregnant women, while PCR has shown a high prevalence of low density infection, the clinical importance of which is unknown. Erythrocytes infected with P falciparum that express the surface protein VAR2CSA accumulate in the placenta, and VAR2CSA is an important target of protective immunity. Clinical trials for a VAR2CSA vaccine are ongoing, but sequence variation needs to be carefully studied. Health system and household costs still limit access to prevention and treatment services. Within the context of malaria elimination, pregnant women could be used to monitor malaria transmission. This Series paper summarises recent progress and highlights unresolved issues related to the burden of malaria in pregnancy.
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Affiliation(s)
- Stephen J Rogerson
- Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia.
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfredo Mayor
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Elisa Sicuri
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, London, UK
| | - Steve M Taylor
- Division of Infectious Diseases and Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Anna M van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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16
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Kesteman T, Randrianarivelojosia M, Rogier C. The protective effectiveness of control interventions for malaria prevention: a systematic review of the literature. F1000Res 2017; 6:1932. [PMID: 29259767 PMCID: PMC5721947 DOI: 10.12688/f1000research.12952.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 12/22/2022] Open
Abstract
Background: Thanks to a considerable increase in funding, malaria control interventions (MCI) whose efficacy had been demonstrated by controlled trials have been largely scaled up during the last decade. Nevertheless, it was not systematically investigated whether this efficacy had been preserved once deployed on the field. Therefore, we sought the literature to assess the disparities between efficacy and effectiveness and the effort to measure the protective effectiveness (PE) of MCI. Methods: The PubMed database was searched for references with keywords related to malaria, to control interventions for prevention and to study designs that allow for the measure of the PE against parasitemia or against clinical outcomes. Results: Our search retrieved 1423 references, and 162 articles were included in the review. Publications were scarce before the year 2000 but dramatically increased afterwards. Bed nets was the MCI most studied (82.1%). The study design most used was a cross-sectional study (65.4%). Two thirds (67.3%) were conducted at the district level or below, and the majority (56.8%) included only children even if the MCI didn’t target only children. Not all studies demonstrated a significant PE from exposure to MCI: 60.6% of studies evaluating bed nets, 50.0% of those evaluating indoor residual spraying, and 4/8 showed an added PE of using both interventions as compared with one only; this proportion was 62.5% for intermittent preventive treatment of pregnant women, and 20.0% for domestic use of insecticides. Conclusions: This review identified numerous local findings of low, non-significant PE –or even the absence of a protective effect provided by these MCIs. The identification of such failures in the effectiveness of MCIs advocates for the investigation of the causes of the problem found. Ideal evaluations of the PE of MCIs should incorporate both a large representativeness and an evaluation of the PE stratified by subpopulations.
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Affiliation(s)
- Thomas Kesteman
- Fondation Mérieux, Lyon, France.,Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Christophe Rogier
- Malaria Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.,Ecole doctorale Sciences de la vie et de l'environnement, Université d'Antananarivo, Antananarivo, Madagascar.,Institute for Biomedical Research of the French Armed Forces (IRBA), Brétigny-Sur-Orge , France.,Unité de recherche sur les maladies infectieuses et tropicales émergentes - (URMITE), Marseille, France
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17
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Cates JE, Unger HW, Briand V, Fievet N, Valea I, Tinto H, D’Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, ter Kuile FO, Desai M, Dellicour S, Ouma P, Gutman J, Oneko M, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Madanitsa M, Mwapasa V, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu JPA, van Eijk AM, Bauserman M, Adair L, Cole SR, Westreich D, Meshnick S, Rogerson S. Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data. PLoS Med 2017; 14:e1002373. [PMID: 28792500 PMCID: PMC5549702 DOI: 10.1371/journal.pmed.1002373] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. METHODS AND FINDINGS We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies. CONCLUSIONS Pregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically.
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Affiliation(s)
- Jordan E. Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Holger W. Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Briand
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Nadine Fievet
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto D’Alessandro
- Medical Research Council Unit, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah H. Landis
- Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, Davis, California, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martina Oneko
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, PATH, Seattle, Washington, United States of America
| | - Dianne J. Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Mwayiwawo Madanitsa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - John P. A. Lusingu
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen R. Cole
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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18
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Moore KA, Simpson JA, Wiladphaingern J, Min AM, Pimanpanarak M, Paw MK, Raksuansak J, Pukrittayakamee S, Fowkes FJI, White NJ, Nosten F, McGready R. Influence of the number and timing of malaria episodes during pregnancy on prematurity and small-for-gestational-age in an area of low transmission. BMC Med 2017; 15:117. [PMID: 28633672 PMCID: PMC5479010 DOI: 10.1186/s12916-017-0877-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most evidence on the association between malaria in pregnancy and adverse pregnancy outcomes focuses on falciparum malaria detected at birth. We assessed the association between the number and timing of falciparum and vivax malaria episodes during pregnancy on small-for-gestational-age (SGA) and preterm birth. METHODS We analysed observational data collected from antenatal clinics on the Thailand-Myanmar border (1986-2015). We assessed the effects of the total number of malaria episodes in pregnancy on SGA and the effects of malaria in pregnancy on SGA, very preterm birth, and late preterm birth, by the gestational age at malaria detection and treatment using logistic regression models with time-dependent malaria variables (monthly intervals). World Health Organisation definitions of very preterm birth (≥28 and <32 weeks) and late preterm birth (≥32 and <37 weeks) and international SGA standards were used. RESULTS Of 50,060 pregnant women followed, 8221 (16%) had malaria during their pregnancy. Of the 50,060 newborns, 10,005 (21%) were SGA, 540 (1%) were very preterm, and 4331 (9%) were late preterm. The rates of falciparum and vivax malaria were highest at 6 and 5 weeks' gestation, respectively. The odds of SGA increased linearly by 1.13-fold (95% confidence interval: 1.09, 1.17) and 1.27-fold (1.21, 1.33) per episode of falciparum and vivax malaria, respectively. Falciparum malaria at any gestation period after 12-16 weeks and vivax malaria after 20-24 weeks were associated with SGA (falciparum odds ratio, OR range: 1.15-1.63 [p range: <0.001-0.094]; vivax OR range: 1.12-1.54 [p range: <0.001-0.138]). Falciparum malaria at any gestation period after 24-28 weeks was associated with either very or late preterm birth (OR range: 1.44-2.53; p range: <0.001-0.001). Vivax malaria at 24-28 weeks was associated with very preterm birth (OR: 1.79 [1.11, 2.90]), and vivax malaria at 28-32 weeks was associated with late preterm birth (OR: 1.23 [1.01, 1.50]). Many of these associations held for asymptomatic malaria. CONCLUSIONS Protection against malaria should be started as early as possible in pregnancy. Malaria control and elimination efforts in the general population can avert the adverse consequences associated with treated asymptomatic malaria in pregnancy.
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Affiliation(s)
- Kerryn A Moore
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia. .,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Moo Kho Paw
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jathee Raksuansak
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Sasithon Pukrittayakamee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Freya J I Fowkes
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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19
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Antenatal Practices Ineffective at Prevention of Plasmodium falciparum Malaria during Pregnancy in a Sub-Saharan Africa Region, Nigeria. Trop Med Infect Dis 2017; 2:tropicalmed2020015. [PMID: 30270874 PMCID: PMC6082074 DOI: 10.3390/tropicalmed2020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022] Open
Abstract
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 10³/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 10³ vs. secundi- (92.14 ± 4.72) × 10³ vs. multigravidae (65.22 ± 20.17) × 10³; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 10³ vs. multiparous (67.50 ± 20.97) × 10³ was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ² = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ² = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765⁻12.135)) and users (66.7% vs. 33.3%, χ² = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693⁻23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery.
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20
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Ome-Kaius M, Karl S, Wangnapi RA, Bolnga JW, Mola G, Walker J, Mueller I, Unger HW, Rogerson SJ. Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea. Malar J 2017; 16:35. [PMID: 28103875 PMCID: PMC5248505 DOI: 10.1186/s12936-017-1689-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 01/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background Doppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow. Methods Colour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated. Results Of 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P < 0.001; sensitivity 0.26, specificity 0.93). A low cerebroplacental Doppler ratio was associated with concurrently measuring small-for-gestational-age, and with low birth weight. Discussion/conclusion Both microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections. Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010 Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1689-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), Madang, Papua New Guinea
| | - Stephan Karl
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | | | - John Walpe Bolnga
- Department of Obstetrics and Gynaecology, Modilon General Hospital, Madang, Papua New Guinea
| | - Glen Mola
- Department of Obstetrics and Gynaecology, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Jane Walker
- Department of Radiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,Institut Pasteur, 28 Rue de Dr. Roux, 75015, Paris, France
| | - Holger Werner Unger
- Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.,Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Stephen John Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
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21
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Unger HW, Cates JE, Gutman J, Briand V, Fievet N, Valea I, Tinto H, d'Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, Ter Kuile F, Dellicour S, Ouma P, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Nahlen B, Desai M, Madanitsa M, Kalilani-Phiri L, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu J, Westreich D, van Eijk AM, Meshnick S, Rogerson S. Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific. BMJ Open 2016; 6:e012697. [PMID: 28003287 PMCID: PMC5223676 DOI: 10.1136/bmjopen-2016-012697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The 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 malariologists. PARTICIPANTS Data were pooled on 14 635 singleton, live birth pregnancies from women who had participated in 1 of 13 pregnancy studies. The 13 studies cover 8 countries in Africa and Papua New Guinea in the Western Pacific conducted from 1996 to 2015. FINDINGS TO DATE Data are available at the time of antenatal enrolment of women into their respective parent study and at delivery. The data set comprises essential data such as malaria infection status, anthropometric assessments of maternal nutritional status, presence of anaemia and birth weight, as well as additional variables such gestational age at delivery for a subset of women. Participating studies are described in detail with regard to setting and primary outcome measures, and summarised data are available from each contributing cohort. FUTURE PLANS This pooled birth cohort is the largest pregnancy data set to date to permit a more definite evaluation of the impact of plausible interactions between poor nutritional status and malaria infection in pregnant women on fetal growth and gestational length. Given the current comparative lack of large pregnancy cohorts in malaria-endemic settings, compilation of suitable pregnancy cohorts is likely to provide adequate statistical power to assess malaria-nutrition interactions, and could point towards settings where such interactions are most relevant. The M3 cohort may thus help to identify pregnant women at high risk of adverse outcomes who may benefit from tailored intensive antenatal care including nutritional supplements and alternative or intensified malaria prevention regimens, and the settings in which these interventions would be most effective.
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Jordan E Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Valerie Briand
- Institut de Recherche pour le Développement (IRD), Mère et enfant face aux infections tropicales (UMR216), Paris, France
- COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Nadine Fievet
- Institut de Recherche pour le Développement (IRD), Mère et enfant face aux infections tropicales (UMR216), Paris, France
- COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto d'Alessandro
- Medical Research Council Unit, The Gambia
- London School of Hygiene and Tropical Medicine, UK
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, California, USA
| | - Feiko Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dianne J Terlouw
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme Liverpool School of Tropical Medicine, Liverpool, UK
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | | | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mwayi Madanitsa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Linda Kalilani-Phiri
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Tampere Center for Child Health Research, Tampere, Finland
- Department for Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Faculty of Health Science, Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - John Lusingu
- Faculty of Health Science, Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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22
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Unger HW, Ashorn P, Cates JE, Dewey KG, Rogerson SJ. Undernutrition and malaria in pregnancy - a dangerous dyad? BMC Med 2016; 14:142. [PMID: 27645498 PMCID: PMC5029041 DOI: 10.1186/s12916-016-0695-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In low-resource settings, malaria and macronutrient undernutrition are major health problems in pregnancy, contributing significantly to adverse pregnancy outcomes such as preterm birth and fetal growth restriction. Affected pregnancies may result in stillbirth and neonatal death, and surviving children are at risk of poor growth and infection in infancy, and of non-communicable diseases in adulthood. Populations exposed to macronutrient undernutrition frequently reside in malaria-endemic areas, and seasonal peaks of low food supply and malaria transmission tend to coincide. Despite these geographic and temporal overlaps, integrated approaches to these twin challenges are infrequent. DISCUSSION This opinion article examines the current evidence for malaria-macronutrition interactions and discusses possible mechanisms whereby macronutrient undernutrition and malaria may interact to worsen pregnancy outcomes. Macronutrient undernutrition dysregulates the immune response. In pregnant women, undernutrition may worsen the already increased susceptibility to malarial infection and could impair development of protective immunity to malaria, and is likely to exacerbate the impact of placental malaria on fetal growth. Malarial infection, in turn, can drive nutritional depletion; poor gestational weight gain and weight loss in pregnancy increases the risk of adverse pregnancy outcomes. Despite a commendable number of studies and trials that, in isolation, attempt to address the challenges of malaria and undernutrition in pregnancy, few dare to venture beyond the 'single disease - single solution' paradigm. We believe that this may be a lost opportunity: researching malaria-nutrition interactions, and designing and implementing integrated interventions to prevent and treat these commonly co-existing and intertwining conditions, may markedly reduce the high burden of preterm birth and fetal growth restriction in affected areas. CONCLUSION We call for more collaboration between researchers studying malaria and nutrition in pregnancy, and propose a research agenda to address this important twin health problem.
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Affiliation(s)
- Holger W. Unger
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Victoria Australia
- Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Per Ashorn
- Department of Paediatrics, University of Tampere School of Medicine, Tampere, Finland
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Jordan E. Cates
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC USA
| | - Kathryn G. Dewey
- Program in International and Community Nutrition and Department of Nutrition, University of California, Davis, CA USA
| | - Stephen J. Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Victoria Australia
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23
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Bednar MM, Hauser BM, Zhou S, Jacobson JM, Eron JJ, Frank I, Swanstrom R. Diversity and Tropism of HIV-1 Rebound Virus Populations in Plasma Level After Treatment Discontinuation. J Infect Dis 2016; 214:403-7. [PMID: 27132284 DOI: 10.1093/infdis/jiw172] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/21/2016] [Indexed: 11/13/2022] Open
Abstract
Human immunodeficiency virus-infected people discontinuing therapy experience a rebound in the virus level (hereafter, "rebound virus") from a persistent reservoir. We examined 10 samples from patients in AIDS Clinical Trials Group study A5068 with rebound virus, using single-genome amplification and Primer ID deep sequencing, to assess env genetic diversity of the virus population. Most rebound-virus populations showed significant diversity. All env examined required high levels of CD4 for entry, consistent with selection of replication in CD4(+) T cells. These results indicate that most people discontinuing therapy release a diverse population of virus and that this released virus has entry features of virus selected for replication in CD4(+) T cells, rather than in myeloid cells.
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Affiliation(s)
| | | | | | - Jeffrey M Jacobson
- Departments of Medicine and Neuroscience Center of Translational AIDS Research, Lewis Katz School of Medicine at Temple University
| | | | - Ian Frank
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ronald Swanstrom
- Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill
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24
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Briand V, Saal J, Ghafari C, Huynh BT, Fievet N, Schmiegelow C, Massougbodji A, Deloron P, Zeitlin J, Cot M. Fetal Growth Restriction Is Associated With Malaria in Pregnancy: A Prospective Longitudinal Study in Benin. J Infect Dis 2016; 214:417-25. [DOI: 10.1093/infdis/jiw158] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/13/2016] [Indexed: 11/14/2022] Open
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25
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Unger HW, Ome-Kaius M, Karl S, Singirok D, Siba P, Walker J, Wangnapi RA, Mueller I, Rogerson SJ. Factors associated with ultrasound-aided detection of suboptimal fetal growth in a malaria-endemic area in Papua New Guinea. BMC Pregnancy Childbirth 2015; 15:83. [PMID: 25881316 PMCID: PMC4404558 DOI: 10.1186/s12884-015-0511-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/19/2015] [Indexed: 01/29/2023] Open
Abstract
Background Fetal growth restriction (FGR) is associated with increased infant mortality rates and ill-health in adulthood. Evaluation of fetal growth requires ultrasound. As a result, ultrasound-assisted evaluations of causes of FGR in malaria-endemic developing countries are rare. We aimed to determine factors associated with indicators of abnormal fetal growth in rural lowland Papua New Guinea (PNG). Methods Weights and growth of 671 ultrasound-dated singleton pregnancies (<25 gestational weeks) were prospectively monitored using estimated fetal weights and birthweights. Maternal nutritional status and haemoglobin levels were assessed at enrolment, and participants were screened for malaria on several occasions. FGR was suspected upon detection of an estimated fetal weight or birthweight <10th centile (small-for-gestational age) and/or low fetal weight gain, defined as a change in weight z-score in the first quartile. Factors associated with fetal weight and fetal weight gain were additionally assessed by evaluating differences in weight z-scores and change in weight z-scores. Log-binomial and linear mixed effect models were used to determine factors associated with indicators of FGR. Results SGA and low weight gain were detected in 48.3% and 37.0% of pregnancies, respectively. Of participants, 13.8%, 21.2%, and 22.8% had a low mid-upper arm circumference (MUAC, <22 cms), short stature (<150 cms) and anaemia (haemoglobin <90 g/L) at first antenatal visit. 24.0% (161/671) of women had at least one malaria infection detected in peripheral blood. A low MUAC (adjusted risk ratio [aRR] 1.51, 95% CI 1.29, 1.76, P < 0.001), short stature (aRR 1.27, 95% CI 1.04, 1.55, P = 0.009), and anaemia (aRR 1.27, 95% CI 1.06, 1.51, P = 0.009) were associated with SGA, and a low body mass index was associated with low fetal weight gain (aRR 2.10, 95% CI 1.62, 2.71, P < 0.001). Additionally, recent receipt of intermittent preventive treatment in pregnancy was associated with increased weight z-scores, and anaemia with reduced change in weight z-scores. Malaria infection was associated with SGA on crude but not adjusted analyses (aRR 1.13, 95% CI 0.95, 1.34, P = 0.172). Conclusion Macronutrient undernutrition and anaemia increased the risk of FGR. Antenatal nutritional interventions and malaria prevention could improve fetal growth in PNG.
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Affiliation(s)
- Holger Werner Unger
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea. .,Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Stephan Karl
- Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia.
| | - Dupain Singirok
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Peter Siba
- Papua New Guinea Institute of Medical Research (PNG IMR), 60, Goroka, Eastern Highlands Province 411, Papua New Guinea.
| | - Jane Walker
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Regina Alice Wangnapi
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research (WEHI), 1G Royal Parade, Parkville 3052, Melbourne, Australia. .,Barcelona Centre for International Health Research (CRESIB), Rosselo 132, 08036, Barcelona, Spain.
| | - Stephen John Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Post Office Royal Melbourne Hospital, Parkville, VIC 3050, Melbourne, Australia.
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