CSU 82/2011: TWO ON MALARIA IN PREGNANCY

Thursday, 10th of March 2011

1) IMPACT OF MALARIA AT THE END OF PREGNANCY ON INFANT MORTALITY AND MORBIDITY

From Mozambique, additional evidence that the pregnant woman needs all the protections against malaria that the health system can provide. Do all endemic countries routinely give IPTp to pregnant women?
Full text is at http://jid.oxfordjournals.org/content/203/5/691.full.pdf+html
Good reading.
BD

1. Impact of Malaria at the End of Pregnancy on Infant Mortality and Morbidity
2. Azucena Bardají1, Betuel Sigauque2,3, Sergi Sanz1, María Maixenchs2, Jaume Ordi1, John J Aponte1,2, Samuel Mabunda4, Pedro L Alonso1,2 and Clara Menéndez1,2
+ Author Affiliations
1. 1Barcelona Centre for International Health Research and Department of Pathology, Hospital Clinic, Institut d'Investigacions Biomèdicas August Pi i Sunyer, Universitat de Barcelona, Spain
2. 2Manhiça Health Research Centre, Mozambique
3. 3National Institute of Health, Ministry of Health, Maputo, Mozambique
4. 4National Directorate of Health and National Malaria Control Program, Ministry of Health, Maputo, Mozambique
1. Reprints or correspondence: Azucena Bardají, MD, MSc, Barcelona Centre for International Health Research, Hospital Clinic, Universitat de Barcelona, Villarroel, 170, 08036 Barcelona, Spain (abardaji@clinic.ub.es).
Abstract
Background. There is some consensus that malaria in pregnancy may negatively affect infant's mortality and malaria morbidity, but there is less evidence concerning the factors involved.
Methods. A total of 1030 Mozambican pregnant women were enrolled in a randomized, placebo-controlled trial of intermittent preventive treatment with sulfadoxine-pyrimethamine, and their infants were followed up throughout infancy. Overall mortality and malaria morbidity rates were recorded. The association of maternal and fetal risk factors with infant mortality and malaria morbidity was assessed.
Results. There were 58 infant deaths among 997 live-born infants. The risk of dying during infancy was increased among infants born to women with acute placental infection (odds ratio [OR], 5.08 [95% confidence interval (CI), 1.77–14.53)], parasitemia in cord blood (OR, 19.31 [95% CI, 4.44–84.02]), low birth weight (OR, 2.82 [95% CI, 1.27–6.28]) or prematurity (OR, 3.19 [95% CI, 1.14–8.95]). Infants born to women who had clinical malaria during pregnancy (OR, 1.96 [95% CI, 1.13–3.41]) or acute placental infection (OR, 4.63 [95% CI, 2.10–10.24]) had an increased risk of clinical malaria during infancy.
Conclusions. Malaria infection at the end of pregnancy and maternal clinical malaria negatively impact survival and malaria morbidity in infancy. Effective clinical management and prevention of malaria in pregnancy may improve infant's health and survival.
• Received May 13, 2010.
• Accepted October 25, 2010.

2) From Malawi, evidence for administration of daily cotrimoxazole to seropositive pregnant women

Full text is at http://jid.oxfordjournals.org/content/203/4/464.full

Marked Reduction in Prevalence of Malaria Parasitemia and Anemia in HIV-Infected Pregnant Women Taking Cotrimoxazole With Or Without Sulfadoxine-Pyrimethamine Intermittent Preventive Therapy during Pregnancy in Malawi
1. Atupele Kapito-Tembo1,2,
2. Steven R. Meshnick1,
3. Michaël Boele van Hensbroek6,7,
4. Kamija Phiri3,
5. Margaret Fitzgerald5 and
6. Victor Mwapasa3,4
+ Author Affiliations
1. 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina
2. 2Ministry of Health and Population, Lilongwe
3. 3Malawi–Liverpool–Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre
4. 4Department of Community Health, College of Medicine, Blantyre
5. 5Médecins Sans Frontières (Belgium), Thyolo, and Malawi
6. 6Emma Children's Hospital Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
7. 7Liverpool School of Tropical Medicine, Liverpool, United Kingdom
1. Reprints or correspondence: Dr Victor Mwapasa, Dept of Community Health, College of Medicine, Mahatma Gandhi Campus, Microbiology Bldg, Private Bag 360, Chichiri, Blantyre 3, Malawi (vmwapasa69@gmail.com).

Abstract

Background. Effectiveness of cotrimoxazole (CTX) compared with sulfadoxine-pyrimethamine (SP) intermittent-preventive-therapy (IPTp) for malaria in HIV-infected pregnant women is unknown. We examined effectiveness of CTX with or without SP-IPTp versus SP-IPTp at reducing malaria parasitemia and anemia.

Methods. From 2005 to 2009, we conducted a cross-sectional study of HIV-infected pregnant women at Thyolo Hospital, Malawi. Blood was tested for malaria parasitemia and anemia (hemoglobin<11g/dl). Data were collected on use of anti-malaria interventions and other risk factors. CTX prophylaxis policy for HIV-infected pregnant women was introduced in 2007, but implementation problems resulted in some women receiving both CTX and SP-IPTp.

Findings. We enrolled 1,142 women, of whom 1,121 had data on CTX and/or SP-IPTp intake. Of these, 49.7%, 29.8%, and 15.4% reported taking SP-IPTp only, CTX only and SP-IPTp plus CTX, respectively. Compared with women taking SP-IPTp, those taking SP-IPTp plus CTX and CTX were less likely to have malaria parasitemia (OR, [95%CI]: 0.09, [0.01-0.66] and 0.43, [0.19-0.97], respectively) or anemia (PR, [95% CI]: 0.67, [0.54-0.83] and 0.72, [0.61-0.83], respectively).

Conclusion. In HIV-infected pregnant women, daily CTX was associated with reduced malaria parasitemia and anemia compared with SP-IPTp. CTX plus SP-IPTp was associated with further reduction in malaria parasitemia but toxicity was not fully assessed.

Footnotes
• Potential conflicts of interest: none reported.
• Received April 6, 2010.
• Accepted November 8, 2010.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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