Prevalence of congenital malaria in high-risk Ghanaian newborns: a cross-sectional study

Plasmodium infections and associated risk factors among parturients in Jawi district, northwest Ethiopia: a cross-sectional study

BACKGROUND

Pregnant women have an increased risk of Plasmodium infections and disease. Malaria in pregnancy is a major public health problem in endemic areas. Assessment of the burden and risk factors of malaria in pregnancy across different malaria transmission settings is required to guide control strategies and for malaria elimination. Thus, the current study is generating such evidence from parturient women in northwest Ethiopia.

METHODS

A cross-sectional study was conducted among 526 pregnant women admitted to the delivery rooms of selected health facilities in Jawi district, northwest Ethiopia, between November 2021 and July 2022. Data on the socio-demographic, clinical, obstetric, and malaria prevention practices of pregnant women were collected using interviewer-administered questionnaires and from women's treatment cards. Malaria was diagnosed by light microscopy, rapid diagnostic test, and multiplex real-time polymerase chain reaction. Risk factors for malaria were evaluated using bivariable and multivariable logistic regression models. A P-value of < 0.05 was considered statistically significant.

RESULTS

Among the examined parturient women, 14.3% (95% CI 11.4-17.5%) had Plasmodium infections. The prevalence of peripheral, placental, and congenital malaria was 12.2% (95% CI 9.5-15.3%), 10.9% (95% CI 8.2-14.1%), and 3.7% (95% CI 2.3-6.1%), respectively. About 90.6% of peripheral and 92% of placental Plasmodium infections were asymptomatic. Plasmodium infection at parturiency was independently predicted by maternal illiteracy (AOR = 2.03, 95% CI 1.11-3.74), primigravidity (AOR = 1.88, 95% CI 1.01-3.49), lack of antenatal care follow-up (AOR = 2.28, 95% CI 1.04-5.03), and history of symptomatic malaria during pregnancy (AOR = 4.2, 95% CI 2.32-7.59). Moreover, the blood group O phenotype was significantly associated with placental malaria among the primiparae.

CONCLUSIONS

Overall, asymptomatic Plasmodium infections were prevalent among parturients in northwest Ethiopia. Maternal illiteracy, primigravidity, lack of antenatal care follow-up, and history of symptomatic malaria during pregnancy were the risk factors for malaria during parturiency. Thus, promotion of a healthy pregnancy through ANC follow-up, strengthening malaria prevention and control practices, and screening of malaria in asymptomatic pregnant women are suggested to reduce its burden in pregnancy.

Malaria in newborn: A missed entity for primary care physician

Neonatal malaria and congenital malaria, though thought to be a rare entity in non-endemic areas but incidences from epidemic countries are eye openers. It is still thought by primary care physicians that its existence among neonates is not common even in endemic areas due to a low index of suspicion. In order to attain the objective set out in the global technical strategy against malaria 2016-2030, it is important to have a gravity of this disease in all age groups, especially in children and neonates in which misconception of low burden of infection results in underestimation of its morbidity and mortality in these age groups. This disease is only the tip of the iceberg due to unidentified, underreported and neglected illness and being a pointer towards higher circulation among society and pregnant women. So this review article highlights pathophysiology, epidemiology, clinical features, complications, prognosis, treatment and prevention of malaria in newborns and intends to bring awareness among the caregivers to understand the need for attention towards this neglected disease of neonates so that they should be able to identify and manage the disease in this vulnerable age group.

Congenital Malaria and Its Associated Factors at Issaka Gazobi Maternity of Niamey in Niger

Background

Congenital malaria is a serious and common infection in tropical Africa. It has multiple consequences on the newborn and the mother.

Objective

The objective of this study is to calculate the prevalence of congenital malaria, describe its clinical signs, and analyze its associated factors. Methodology. It is a cross-sectional and prospective study, conducted at Issaka Gazobi Maternity of Niamey, from June 1 to November 30, 2017. The diagnosis was made by microscopy of a thick and thin blood smear of mother, newborn, and umbilical cord.

Results

Two hundred and forty-nine (249) consecutive newborn/mother pairs were included. The prevalence of congenital malaria infection was 26.51% (66/249) with a parasite density of 101 P/μl (SD: 47.3; [80; 320]). The prevalence of congenital malaria disease was 14.06% (35/249) with a parasite density of 108 P/μl (SD: 32.6; [40; 200]. All patients were infected with Plasmodium falciparum. 43% (18/35) of neonates had hyperthermia and did not have a sucking reflex, 8.5% (3/35) were anaemic, 11.42% (4/35) had convulsed, 20% (7/35) had a coma, and 45.71% (16/35) had a low birth weight. No deaths were recorded, and only the nonuse of bed nets was significantly associated with congenital malaria (p = 0.04).

Conclusion

In Niger, one out of four newborns is infected with Plasmodium. Infection can progress to congenital malaria disease. The use of mosquito nets and intermittent preventive treatment would reduce the incidence of congenital malaria.

Deleterious effects of malaria in pregnancy on the developing fetus: a review on prevention and treatment with antimalarial drugs

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.

Epidemiology of clinical congenital and neonatal malaria in endemic settings: a systematic review and meta-analysis

Background

In order to attain the objectives set out in the global technical strategy against malaria 2016–2030, it is important to have accurate epidemiological data on malaria in all age categories, including those which are often neglected because of an apparent low burden of disease. The current systematic review with meta-analysis synthesizes the epidemiology of clinical congenital and neonatal malaria in endemic areas.

Methods

PubMed, EMBASE, Global Index Medicus, and Web of Science were searched up to 30th October 2019, to identify observational studies reporting on congenital (0–7 days) and neonatal (0–28 days) malaria. No restriction related to language was applied. Study selection, data extraction, and methodological quality assessment were performed independently by two investigators. A random-effects meta-analysis was used to pool prevalence data. Prevalence were adjusted taking into account the variance due to diagnostic method and regional distribution. Subgroup analyses were performed to identify sources of heterogeneity in case of substantial heterogeneity. This review was registered in PROSPERO with number CRD42020150124.

Results

The bibliographical search identified 1,961 studies, of which 22 were finally retained with a total population of 28,083 neonates. The overall crude prevalence of clinical congenital malaria was 40.4‰ (95%CI 19.6–67.7; 17 studies). The adjusted prevalence considering the variance due to difference in region/country (hierarchical model) was 33.7‰ (95%CI 6.9–77.2). There was no difference between the prevalence of clinical congenital malaria in Africa 39.5‰ (95%CI 17.2–59.5; 15 studies) and outside Africa 56.3‰ (95%CI 0.0–406.1), p = 0.867. The overall crude prevalence of clinical neonatal malaria was 12.0‰ (95%CI 1.4–30.3; 12 studies), and the adjusted one (considering the variance due to diagnostic method and the region/country) was 12.9‰ (95%CI 0.1–39.7). There was no difference between the prevalence of clinical neonatal malaria in Africa 12.1‰ (95%CI 1.3–31.2; 11 studies) and outside Africa 12.5‰ (95%CI 0.0–52.9), p = 0.802.

Conclusion

This study suggests a high prevalence of clinical congenital and neonatal malaria. It calls for an intensification of preventive measures against malaria during pregnancy and in the neonatal period, and to consider neonates as a distinct age category in the elaboration of malaria treatment and prevention guidelines.

Congenital Malaria in Newborns Delivered to Mothers with Malaria-Infected Placenta in Blue Nile State, Sudan

Diagnosis of congenital malaria is complicated by the low density of the parasite circulating in the cord blood and/or the peripheral blood of the newborns. Molecular techniques are significantly more sensitive than blood smears in detecting low-level parasitemia. This study investigated the prevalence of congenital malaria by the use of the real-time polymerase chain reaction (real-time PCR) in 102 babies born to mothers with microscopically confirmed infected placenta from Blue Nile state, Sudan. At delivery time, placental, maternal peripheral and cord blood samples in addition to samples collected from the newborns' peripheral blood were examined for malaria infection using Giemsa-stained thick smear and parasite DNA detection by real-time PCR. The overall prevalence of congenital malaria includes the total babies with cord blood parasitaemia and peripheral blood parasitaemia was 18.6 and 56.8% using microscopy and real-time PCR, respectively. Even though all the neonates were aparasitaemic by microscopy, 19 (18.6%) of the babies had congenital malaria detected by real-time PCR, 15 (25.9%) of the babies with congenital malaria were born to mothers with both placental and peripheral blood malaria infections detected using the two techniques. Congenital malaria was significantly associated with cord blood malaria infections, maternal age and maternal haemoglobin level (p < 0.001). This first study investigating congenital malaria in Blue Nile state, Sudan shows that malaria-infected placenta resulted in infant and cord blood infections.

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.

Prevalence of Congenital Malaria in Kisangani, A Stable Malaria Transmission Area in Democratic Republic of the Congo

Background

Gestational malaria is a major public health problem. It produces fetal complications such as low birth weight, perinatal mortality, and congenital malaria. The present study is aimed at determining the prevalence of congenital malaria and its neonatal complications in the city of Kisangani.

Methods

We conducted a cross-sectional study in Kisangani from 1 January to 30 September 2018. Our study population was composed of 1248 newborns born in our study sites, during the period of our study. Just after their birth, we performed the thick drop smear in the placental print and in umbilical blood smear.

Results

The prevalence of congenital malaria was 13.98%; 69.23% of newborns who contracted congenital malaria were from 18- to 34-year-old mothers, 53.85% from primiparous mothers, 92.31% from mothers who took intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine, all (100%) from mothers using the insecticide-treated mosquito nets and 7.69% from HIV-positive mothers. Low birth weight and perinatal mortality were recorded in 76.92% and 7.69% of congenital malaria cases, respectively. Intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine had no effect on congenital malaria (FE = 0.5218; OR: 0.8, 95% CI: 0.1651-3.8769) and on low birth weight (FE = 0.3675; OR: 1.2308, 95% CI: 0.0037-0.1464); however, it seemed to have protective effect against perinatal mortality (FE = 0.0001; OR: 0.0233, 95% CI: 0.0037-0.1464).

Conclusion

Congenital malaria remains a major problem in stable malaria transmission area like Kisangani, and it is grafted by major perinatal complications, particularly low birth weight and perinatal mortality. We recommend an extended study to clarify the relationship between the outcome of pregnancy and the intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine.

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.

Stability and Hopf Bifurcation of a Vector-Borne Disease Model with Saturated Infection Rate and Reinfection

This paper established a delayed vector-borne disease model with saturated infection rate and cure rate. First of all, according to the basic reproductive number R ₀, we determined the disease-free equilibrium E ₀ and the endemic equilibrium E ₁. Through the analysis of the characteristic equation, we consider the stability of two equilibriums. Furthermore, the effect on the stability of the endemic equilibrium E ₁ by delay was studied, the existence of Hopf bifurcations of this system in E ₁ was analyzed, and the length of delay to preserve stability was estimated. The direction and stability of the Hopf bifurcation were also been determined. Finally, we performed some numerical simulation to illustrate our main results.

[Complicated Malaria in Chocó: clinical findings and data comparison with the monitoring system]

OBJECTIVES

To describe the epidemiological and clinical cases of complicated malaria and to establish the concordance of this information in the surveillance system.

METHODOLOGY

Information was obtained from medical records of cases reported in 2011 in the surveillance system and the Hospital San Francisco. We selected a clinical sample of 62 stories of 113 cases and health professionals reviewed the information. The presence of positive thick drop with one or more criteria of complication was taken into account to define if the clinical history corresponded to complicated malaria, according to guide national clinic and tab of the surveillance system. Statistical significance was determined with Chi square and the Kappa statistic.

RESULTS

The 37.0% of cases presented a complication, 63.0% had two or more complications. Major complications were thrombocytopenia and severe anemia, followed by hepatic complication, hiperparasitemia, renal insufficiency and cerebral malaria. In 3 of the 54 cases intravenous artesunate was used, quinine was used in 59.2%. Comparison of demographic variables and parasitic species between history and the surveillance system show no significant difference but type of complication was almost nil. The major reported complications do not appear on the notification tab.

DISCUSSION

Further studies need to be continued in order to contribute to the clinical characterization of malaria in the Department and Management interventions. Adjustments to format are recommended to strengthen analysis and decision-making.

Diagnosing congenital malaria in a high-transmission setting: clinical relevance and usefulness of P. falciparum HRP2-based testing

Congenital malaria diagnosis is challenging due to frequently observed low parasite density infections, while their clinical relevance during early infancy is not well characterized. In Nanoro health district (Burkina Faso), we determined the prevalence of congenital malaria by real-time quantitative PCR and we assessed the performance of rapid diagnosis test (RDT) and light microscopy (LM) to detect Plasmodium falciparum infections in cord-blood samples. In addition, we examined the usefulness of P. falciparum Histidine Rich Protein2 (PfHRP2) as surrogate biomarker of infection and explored association between congenital malaria and clinical outcomes. A prevalence of congenital malaria by qPCR of 4% (16/400) was found, which increased to 10% among newborns from mothers infected at delivery. RDT and LM showed poor performances indicating limited utility for congenital malaria screening in cord blood. Because PfHRP2 detection in cord blood could be affected by transplacental passage of parasite antigens, PfHRP2 might not be used as a surrogate biomarker of congenital malaria infections. There was no evidence of a significant clinical impact of congenital malaria on infant's health from birth to 59 days of life. Case control studies including long-term follow up may provide additional understanding on the relevance of neonatal malaria infections.

Submicroscopic and Asymptomatic Congenital Infection by Plasmodium vivax or P. falciparum in Colombia: 37 Cases with Placental Histopathology and Cytokine Profile in Maternal and Placental Blood

Problem. Congenital plasmodial infection (CPI) is a rare event, which has been little studied in Colombia. Objective. To measure the frequency of CPI and to describe the immune and histological characteristics in maternal blood and placentas when CPI occurs. Methodology. A cross-sectional study was carried out in northwest Colombia. A sample size of 39 unit analysis (a unit of analysis corresponds to the cord, placenta, and peripheral blood of a pregnant woman) was calculated using epidemiological and statistical parameters. Thick blood smear (TBS) and quantitative real-time polymerase chain reaction (qPCR) were used as diagnostic tests. Results and Conclusions. A total of 137 parturient women were studied. All cases of CPI were submicroscopic (TBS negative and qPCR positive) and asymptomatic infections. If the definition of CPI considers only detection of parasites in umbilical cord blood, regardless of what was found in peripheral or placental blood, the frequency of CPI was 27%. However, if that definition is stricter and includes simultaneous detection of parasites in maternal or placental blood with the same species, the frequency of CPI in this study was 13%.

Association of placental Plasmodium falciparum parasitaemia with maternal and newborn outcomes in the periurban area of Bobo-Dioulasso, Burkina Faso

The prevalence of placental malaria and its impact on maternal and newborn outcomes have been poorly documented in periurban settings of Burkina Faso. Peripheral and placental blood from 320 mothers, and cord blood from their newborns were collected through a cross-sectional study and used to prepare thick and thin blood films. Maternal haemoglobin concentration and birthweight were also measured. The overall malaria parasitaemia prevalence in peripheral, placental and cord blood was of 17·2, 9·1 and 0·9%, respectively.Plasmodium falciparumwas the sole species found in all cases and the mean parasite density in placental blood was 4·5 ± 0·8 parasitesµL−1. Primigravida (aOR: 3·5; 95% CI (1·1–11·2)) and women who did not use a bed net (aOR: 2·6; 95% CI (1·1–6·3)), were at higher odds of placental malaria infection. Women with placental parasitaemia were at increased odds of maternal anaemia (aOR: 3·1; 95% CI (1·3–7·4)). There was no odds difference for LBW between mothers with placental parasitaemia and those without. Placental malaria parasitaemia resulted in a significant mean birthweight reduction of 200 g. Placental malaria infection is higher in primigravida. Use of insecticide-treated bed nets should be therefore emphasized for primigravida during the first antenatal care visit.

Prevalence and diagnostics of congenital malaria in rural Burundi, a cross-sectional study

BACKGROUND

Congenital malaria, defined as the presence of asexual forms of malaria parasites in the peripheral blood during the first 7 days of life, remains a neglected area of research. Knowledge gaps exist about prevalence and management of malaria in this age group. The objective of this study was to evaluate the prevalence of congenital malaria and the validity of a rapid diagnostic test (RDT) for its diagnosis in rural Burundi.

METHODS

A cross-sectional study was conducted in a meso-endemic malaria context in Burundi among 290 mothers, and their newborns (n = 303), who delivered at the maternity departments of Kirundo and Mukenke Hospitals during March and April 2014. Peripheral blood samples were collected from all mothers/newborns pairs in order to examine the presence of malaria parasites with two RDT (SD-Bioline HRP2 and Carestart pan-pLDH) and a blood slide. In addition, quantitative real-time polymerase chain reaction (PCR) was performed from the newborn peripheral sample. Frequencies and proportions were calculated for categorical variables. Sensitivity and specificity were calculated with a 95 % confidence interval (CI).

RESULTS

None of the newborns were found positive by PCR (0/303; 95 % CI 0.0-1.3). The prevalence in newborns born from microscopy-positive mothers was 0 % (0/44; 95 % CI 0.0-8.0). Two newborns were positive with SD-Bioline HRP2 (0.7 %, 95 % CI 0.2-2.4) but none with Carestart pan-pLDH or microscopy. Sensitivity of the diagnostic tests could not be evaluated as no congenital malaria was detected. Specificity of SD-Bioline HRP2, Carestart pan-pLDH and microscopy to detect congenital malaria was 99.3 % (95 % CI 97.6-99.8), 100.0 % (95 % CI 98.3-100.0) and 100.0 % (95 % CI 98.8-100.0), respectively.

CONCLUSION

In Burundi or the Central African region, no recent prevalence studies for congenital malaria have been carried out. This study found that the prevalence of congenital malaria in two hospitals in Kirundo province is zero. RDT showed to have an excellent specificity and, therefore, can be used to rule out congenital malaria: the risk of overtreatment is low. However, as no cases of congenital malaria were detected, the study was not able to draw conclusions about the sensitivity of the RDT, nor about risk factors for congenital malaria. Further studies evaluating the sensitivity of RDT for diagnosis of congenital malaria are needed.

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.