Prevalence of congenital malaria in minna, north central Nigeria

Global prevalence of congenital malaria: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis is to pool the prevalence of congenital malaria.

STUDY DESIGN

The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was strictly followed. The published studies were searched in international and national databases. Quality assessment for studied was performed using the modified Newcastle - Ottawa scale. Pooled Meta logistic regression was computed using OpenMeta Analyst software. The heterogeneity was explored by the subgroup and meta-regression method.

RESULTS

Twenty-four studies enrolling 8148 newborns were conducted. All the studies were high-quality studies. The prevalence of congenital malaria ranged from 0.0 % in Colombia to 46.7 % in Nigeria. The overall prevalence of congenital malaria was 6.9 % (95 % CI: 4.8-7.9 %) (562/8148). There was large heterogeneity in prevalence of congenital malaria estimates among the different settings (I² = 96.1 %). Hence the random effect model was used. In subgroup analyses, with respect to the type of malaria transmission, the prevalence of congenital malaria was significantly higher in areas characterized by unstable malaria transmission vs. the rate in areas with stable malaria transmission [16.8 % (95 % CI: 8.0-25.6 %) vs. 3.5 % (95 % CI: 2.3-4.6 %), Coefficient = 0.111; P = 0.035]. The results of additional sub- group (meta-regression) analyses showed a non-significant difference in prevalence of congenital malaria in study-sample sizes (Coefficient = -0.001, 95 % CI: -0.001 to 0.001), P-value = 0.534) and year of publication (C = -0.005; 95 % CI: -0.016 to 0.006), P-value = 0.369).

CONCLUSION

This meta-analysis showed a varied prevalence of congenital malaria across endemic areas and it was higher in areas with unstable malaria transmissions.

Relationship between placenta malaria and mother to child transmission of HIV infection in pregnant women in South East Nigeria

Background

This study determined the rate of mother-to-child transmission (MTCT) of HIV among HIV positive women with placenta malaria and factors associated with placenta malaria.

Methods

This was a prospective observational study of booked HIV positive pregnant women in labour. A smear for malaria parasite was made from blood taken from the placental tissue post-delivery. The baby HIV testing was done with DNA polymerase chain reaction at 6 weeks postpartum. Data on age, parity, gestational age, religion, address, highest educational attainment and knowledge about malaria prevention in pregnancy was obtained with questionnaires and analysed using SPSS version 20. The P-value was set at 0.05 providing a confidence interval of 95%.

Results

A total of 174 booked HIV women participated in this study. The placental malaria parasitaemia prevalence was 44.8%. Overall rate of MTCT of HIV infection was 17.2%. Number of infants with HIV infection among women with maternal placental malarial parasitaemia was 30/78 (38.5%), while it was 0/96 (0%) for women without placenta malaria. There was significant relationship between placenta malaria density and infant HIV status (P-value = 0.001). The relative risk for MTCT of HIV for women with placenta malaria Density > 5000 was 25% with 95% confidence interval of 11.41–54.76%.

Conclusion

The mother-to-child transmission rate of HIV was high among HIV positive women with placental malaria parasitaemia. There is the need to review the malarial treatment and prophylactic measures at least in this group of women and to establish the nature of relationship between placenta malaria and MTCT of HIV infection.

Congenital Malaria in Newborns Presented at Tororo General Hospital in Uganda: A Cross-Sectional Study

Despite recent large-scale investments, malaria remains a major public health concern. Few studies have examined congenital malaria, defined as the presence of malaria parasitemia within the first 7 days of life, in endemic areas. This study aimed to determine the prevalence, to describe the clinical presentation, and to examine factors associated with congenital malaria in newborns aged up to 7 days attending Tororo General Hospital in Uganda. A total of 261 mother/baby pairs were recruited in this cross-sectional study. Giemsa-stained thick blood smears for malaria parasites and rapid malaria diagnostic tests were performed on capillary blood samples from all newborns and mothers, as well as on placental and cord samples from newborns delivered in the hospital. The prevalence of congenital malaria in the newborns was 16/261 (6.1%). No single clinical feature was associated with congenital malaria. However, there were associations between congenital malaria and maternal parasitemia (P < 0.001), gravidity of one (P = 0.03), maternal age < 19 years (P = 0.01), cord blood parasitemia (P = 0.01), and placental malaria (P = 0.02). In conclusion, congenital malaria is not rare in Uganda and there are no obvious clinical features associated with it in the newborn. Based on these findings, we recommend strengthening malaria prevention during pregnancy to reduce the occurrence of congenital malaria in newborns.

Sub-microscopic Plasmodium falciparum infections in matched peripheral, placental and umbilical cord blood samples from asymptomatic Congolese women at delivery

In malaria-endemic areas, most pregnant women are susceptible to asymptomatic Plasmodium falciparum infections. We present here the results of a cross-sectional study conducted in Madibou, a southern district of Brazzaville in the Republic of Congo, between March 2014 and April 2015. The main aim was to characterize P. falciparum infections. Blood samples corresponding to peripheral, placental and cord from 370 asymptomatic malaria women at delivery were diagnosed for plasmodium infection by thick blood smears (microscopic infection). Sub-microscopic infection was detected by PCR, using the MSP-2 gene as marker. Microscopic infections were detected in peripheral, placental and cord blood samples with a prevalence of respectively 7.3% (27/370), 2.7% (10/370) and 0%. The negative samples were submitted to sub-microscopic detection, with respective prevalence of 25.4% (87/343), 16.7% (60/360) and 9.4% (35/370) (P < 0.001). We further investigated the genetic diversity of the parasite by characterizing MSP2 allelic families 3D7 (24 distinct alleles) and FC27 (20 distinct alleles). The total number of alleles for these two families were 31, 25 and 19 in peripheral, placental and cord samples respectively. The 3D7 MSP-2 was the predominant allelic family. The multiplicity of infections (MOI) in peripheral (mean 1.4 ± 0.01; range 1-4), placental (mean 1.2 ± 0.01; range 1-3) and cord samples (1.4 ± 0.01; range 1-3) were similar (P = 0.9) and are unaffected by age, gravidity or sulfadoxine-pyrimethamine. These results shown a high prevalence of sub-microscopic infection and a high genetic diversity of Plasmodium falciparum strains in Congo. Age, gravidity and doses of preventive treatment based on sulfadoxine-pyrimethamine do not interfere with the multiplicity of infections.

Human Genetic Markers and Structural Prediction of Plasmodium falciparum Multidrug Resistance Gene (pfmdr1) for Ligand Binding in Pregnant Women Attending General Hospital Minna

The study aims to determine the association of malaria infection with ABO blood groups and genotype and also to detect point mutations at positions 86, 184, 1034, and 1042 of the Plasmodium falciparum multidrug resistance gene (pfmdr1) in blood samples collected from pregnant women attending General Hospital Minna. Out of 250 pregnant women screened, 39 (15.60%) had malaria infection. Prevalence was higher in women, during the third trimester (46.15%), genotype AA (64.10%), and O blood group (53.84%) individuals when compared with others. There was significant (p < 0.05) decrease in Packed Cell Volume (PCV), hemoglobin (HGB), Red Blood Cells (RBC), and platelet (PLC) count in infected group when compared with noninfected group. Although, two of the isolates showed disrupted protein sequence at codon 1034-1042, no mutation was found in any of the P. falciparum isolates. Structural prediction of chemical ligand led to the identification of Neu5Acα2-3Galβ1-3/β1-4Glc/GlcNAc. This compound can theoretically bind and change the functional integrity of the pfmdr1 protein, thus providing a new window for malaria drug target.

Asymptomatic Plasmodium falciparum parasitaemia among pregnant women: a health facility based survey in Nassarawa-Eggon, Nigeria

BACKGROUND

Asymptomatic malaria parasitaemia remains an effective transmission pool for malaria during pregnancy, which can result in placenta parasitaemia and adverse pregnancy outcomes. This study examined asymptomatic malaria parasitaemia among pregnant women in the antenatal clinic in General Hospital, Nassarawa-Eggon, Nasarawa State, Nigeria.

MATERIALS AND METHODS

A cross-sectional hospital based survey was carried out among 242 apparently healthy pregnant women presenting for booking in an antenatal clinic between June and August 2014. An interviewer-administered semi-structured questionnaire was used to obtain information on socio-demographic data and possible risk factors for asymptomatic malaria parasitaemia. These women should not have taken antimalarial medicines two weeks prior to the interview. Microscopy was used to identify malaria parasites and haemoglobin levels were estimated. Data was analysed using Epi Info 3.5.3. Descriptive statistics such as means, standard deviations, proportions, and range were used to summarise the data and the Chi square test was used to test association between categorical explanatory variables and outcome variables.

RESULTS

Mean age (± SD) was 25.5 ± 5.5 years, 118 (48.8%) of the women were in the 25-34 years age group, while 153 (63.2%) were multigravidae. Asymptomatic Plasmodium falciparum infection was found in 55 women (22.7%; 95% CI: 18.0-28.7%) Among these, 36 (65.5%) were anaemic [OR: 2.0, CI: 1.1-3.8]. Long lasting insecticidal net (LLIN) was not used by 17 (30.9%) of the respondents. Younger age group (below 25 years) [AOR: 2.4, CI: 1.2-4.9] and non-usage of LLIN [AOR: 2.4, CI: 1.1-5.1] were significant predictors of asymptomatic malaria parasitaemia.

CONCLUSION

Asymptomatic malaria parasitaemia is a health challenge among pregnant women, especially in the younger age group and can predispose them to maternal anaemia. The supply and appropriate use of LLIN should be intensified.

Mother-to-Children Plasmodium falciparum Asymptomatic Malaria Transmission at Saint Camille Medical Centre in Ouagadougou, Burkina Faso

Background. Malaria's prevalence during pregnancy varies widely in parts of sub-Saharan Africa, including Burkina Faso. The objective of this study was to evaluate the incidence of mother-to-child malaria transmission during childbirth at St. Camille Medical Centre in the city of Ouagadougou. Methods. Two hundred and thirty-eight (238) women and their newborns were included in the study. Women consenting to participate in this study responded to a questionnaire that identified their demographic characteristics. Asymptomatic malaria infection was assessed by rapid detection test Acon (Acon Malaria Pf, San Diego, USA) and by microscopic examination of Giemsa-stained thick and thin smears from peripheral, placental, and umbilical cord blood. Birth weights were recorded and the biological analyses of mothers and newborns' blood were also performed. Results. The utilization of long-lasting insecticidal nets (LLINs) and intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) were 86.6% and 84.4%, respectively. The parasitic infection rates of 9.5%, 8.9%, and 2.8% were recorded, respectively, for the peripheral, placental, and umbilical cord blood. Placental infection was strongly associated with the presence of parasites in the maternal peripheral blood and a parasite density of >1000 parasites/µL. Conclusion. The prevalence of congenital malaria was reduced but was associated with a high rate of mother-to-child malaria transmission.

Pregnancy-associated malaria and malaria in infants: an old problem with present consequences

Albeit pregnancy-associated malaria (PAM) poses a potential risk for over 125 million women each year, an accurate review assessing the impact on malaria in infants has yet to be conducted. In addition to an effect on low birth weight (LBW) and prematurity, PAM determines foetal exposure to Plasmodium falciparum in utero and is correlated to congenital malaria and early development of clinical episodes during infancy. This interaction plausibly results from an ongoing immune tolerance process to antigens in utero, however, a complete explanation of this immune process remains a question for further research, as does the precise role of protective maternal antibodies. Preventive interventions against PAM modify foetal exposure to P. falciparum in utero, and have thus an effect on perinatal malaria outcomes. Effective intermittent preventive treatment in pregnancy (IPTp) diminishes placental malaria (PM) and its subsequent malaria-associated morbidity. However, emerging resistance to sulphadoxine-pyrimethamine (SP) is currently hindering the efficacy of IPTp regimes and the efficacy of alternative strategies, such as intermittent screening and treatment (IST), has not been accurately evaluated in different transmission settings. Due to the increased risk of clinical malaria for offspring of malaria infected mothers, PAM preventive interventions should ideally start during the preconceptual period. Innovative research examining the effect of PAM on the neurocognitive development of the infant, as well as examining the potential influence of HLA-G polymorphisms on malaria symptoms, is urged to contribute to a better understanding of PAM and infant health.

Malaria prevalence, anemia and baseline intervention coverage prior to mass net distributions in Abia and Plateau States, Nigeria

Background

Nigeria suffers the world’s largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country’s aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs).

Methods

Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization.

Results

Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%–40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%–42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%–81.0%) versus Plateau (57.1%, 95% CI: 50.6%–63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%–13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%–3.7%) in Abia and 14.5% (95% CI: 10.2%–20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau.

Conclusions

These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use—especially among age groups with highest observed malaria burden.

Malaria risk factors in women on intermittent preventive treatment at delivery and their effects on pregnancy outcome in Sanaga-Maritime, Cameroon

Malaria is known to have a negative impact on pregnant women and their foetuses. The efficacy of Sulfadoxine-Pyrimethamine (SP) used for intermittent preventive treatment (IPT) is being threatened by increasing levels of resistance. This study assessed malaria risk factors in women on intermittent preventive treatment with SP (IPT_p-SP) at delivery and their effects on pregnancy outcome in Sanaga-Maritime Division, Cameroon. Socio-economic and obstetrical data of mothers and neonate birth weights were documented. Peripheral blood from 201 mothers and newborns as well as placental and cord blood were used to prepare thick and thin blood films. Maternal haemoglobin concentration was measured. The overall malaria parasite prevalence was 22.9% and 6.0% in mothers and newborns respectively. Monthly income lower than 28000 FCFA and young age were significantly associated with higher prevalence of placental malaria infection (p = 0.0048 and p = 0.019 respectively). Maternal infection significantly increased the risk of infection in newborns (OR = 48.4; p<0.0001). Haemoglobin concentration and birth weight were lower in infected mothers, although not significant. HIV infection was recorded in 6.0% of mothers and increased by 5-folds the risk of malaria parasite infection (OR = 5.38, p = 0.007). Attendance at antenatal clinic and level of education significantly influenced the utilisation of IPT_p-SP (p<0.0001 and p = 0.018 respectively). Use of SP and mosquito net resulted in improved pregnancy outcome especially in primiparous, though the difference was not significant. Malaria infection in pregnancy is common and increases the risk of neonatal malaria infection. Preventive strategies are poorly implemented and their utilization has overall reasonable effect on malaria infection and pregnancy outcome.

Malaria in infants aged less than six months - is it an area of unmet medical need?

Despite the protection provided by several factors, including maternal antibodies, the burden of malaria in young infants may be higher than previously thought. Infants with congenital or neonatal malaria may have a different clinical presentation than older children, and diagnosis may be confused with other neonatal diseases due to an overlap of clinical manifestations. In addition, there is little information on the use of artemisinin-based combination therapy in young infants. There is the need for a more accurate estimate of the parasite prevalence and the incidence of clinical malaria in infants under 6 months old, as well as a better characterization of risk factors, pharmacokinetic profiles, safety and efficacy of currently available anti-malarial treatments, in order to develop evidence-based treatment guidelines for this population.