BackgroundPrenatal exposure to Plasmodium falciparum affects development of protective immunity and susceptibility to subsequent natural challenges with similar parasite antigens. However, the nature of these effects has not been fully elucidated. The aim of this study was to determine the effect of prenatal exposure to P. falciparum on susceptibility to natural malaria infection, with a focus on median time from birth to first clinical malaria episode and frequency of clinical malaria episodes in the first 2 years of life.MethodsA prospective birth cohort study was conducted in Rufiji district in Tanzania, between January 2013 and December 2015. Infants born to mothers with P. falciparum in the placenta at time of delivery were defined as exposed, and infants born to mothers without P. falciparum parasites in placenta were defined as unexposed. Placental infection was established by histological techniques. Out of 206 infants recruited, 41 were in utero exposed to P. falciparum and 165 infants were unexposed. All infants were monitored for onset of clinical malaria episodes in the first 2 years of life. The outcome measure was time from birth to first clinical malaria episode, defined by fever (≥37 °C) and microscopically determined parasitaemia. Median time to first clinical malaria episode between exposed and unexposed infants was assessed using Kaplan–Meier survival analysis and comparison was done by log rank. Association of clinical malaria episodes with prenatal exposure to P. falciparum was assessed by multivariate binary logistic regression. Comparative analysis of mean number of clinical malaria episodes between exposed and unexposed infants was done using independent sample t test.ResultsThe effect of prenatal exposure to P. falciparum infection on clinical malaria episodes was statistically significant (Odds Ratio of 4.79, 95 % CI 2.21–10.38, p < 0.01) when compared to other confounding factors. Median time from birth to first clinical malaria episode for exposed and unexposed infants was 32 weeks (95 % CI 30.88–33.12) and 37 weeks (95 % CI 35.25–38.75), respectively, and the difference was statistically significant (p = 0.003). The mean number of clinical malaria episodes in exposed and unexposed infants was 0.51 and 0.30 episodes/infant, respectively, and the difference was statistically significant (p = 0.038).ConclusionsPrenatal exposure to P. falciparum shortens time from birth to first clinical malaria episode and increases frequency of clinical malaria episodes in the first 2 years of life.

ObjectiveExisting information has shown that infants who are prenatally exposed to P. falciparum are susceptible to subsequent malaria infections. However, the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes has not been fully elucidated. This study is a component of a prospective cohort study for which initial results have been published. This component was designed to determine the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes in the first 24 months of life. A total of 215 infants were involved and monitored for clinical malaria episodes defined by fever (≥ 37 °C) and parasitaemia. The geometric mean parasite counts between exposed and unexposed infants were compared using independent samples t test. The effect of in utero exposure to P. falciparum on parasite density was assessed using binary logistic regression.ResultsThe geometric mean parasite count per µl of blood during clinical malaria episodes in exposed infants was 24,889 (95% CI 18,286–31,490) while in unexposed infants it was 14,035 (95% CI 12,111–15,960), P < 0.05. Prenatal exposure to P. falciparum was associated with hyperparasitaemia during clinical malaria episodes (OR 7.04, 95% CI 2.31–21.74), while other factors were not significantly associated (P > 0.05).

Background Infants born to mothers with placental malaria are prenatally exposed to Plasmodium falciparum antigens. However, the effect of that exposure to subsequent immune responses has not been fully elucidated. This study aimed at determining the effect of prenatal exposure to P. falciparum on Interleukin-10 and Interferon-γ responses during clinical malaria episodes in the first 24 months of life. Methods This prospective cohort study involved 215 infants aged 0-2 years born to mothers with or without placental malaria. Enzyme-linked immunosorbent assay (ELISA) was used to determine levels of IL-10 and IFN-γ in infants and detect IgM in cord blood. Data were analyzed using SPSS version 20. Findings Geometric mean for IFN-γ in exposed infants was 557.9 pg/ml (95% CI: 511.6-604.1) and in unexposed infants it was 634.4 pg/ml (95% CI: 618.2-668.5) (P=0.02). Mean IL-10 was 22.4 pg/ml (95% CI: 19.4-28.4) and 15.1 pg/ml (95%CI: 12.4-17.6), respectively (P=0.01). Conclusions Prenatal exposure to P. falciparum antigens significantly affects IL-10 and IFN-γ responses during clinical malaria episodes in the first two years of life.

Purpose: Africa has a very low rate of induction of labour with high maternal and perinatal morbidity and mortality. However fetal-maternal outcomes following induction of labour are not well documented in Tanzania. This study aimed to assess fetal-maternal outcomes following induction of labour among women delivered at Dar es Salaam regional referral hospitals in Tanzania. Design/methodology/Approach: A total of 301 expectant mothers were recruited in a prospective observational study conducted at all regional referral hospitals in Dar es Salaam, Tanzania. Data on fetal-maternal outcomes were collected using a pre-designed clinical sheet. Demographic data, obstetric history, methods as well as outcomes of labour induction were recorded. The continuous variables were summarized using the median and corresponding interquartile range. Categorical variables were summarized using frequency and proportions and the significance of differences were assessed using Chi-square at P<0.05. Results: The leading methods for induction of labour were Oxytocin (48.5%) and a combination of Folley’s catheter with Oxytocin (28.4%). Induction of labour significantly improved fetal outcomes at birth P<0.05. Induction of labour associated with improved Apgar scores in newborn babies. Failure of induction of labour was the largest contributor to the increased Caesarean Section rate observed in this study. Research limitation/Implication: This study has therefore explored the fetal-maternal outcomes following induction of labour in Tanzanian regional referral hospitals. Practical implication: Induction of labour improves and minimizes neonatal complications in referral regional hospitals in Dar es Salaam. Originality/Value: These findings fill a gap of information which was missing on the fetal-maternal outcomes following induction of labour among expectant mothers in Dar es Salaam regional referral hospitals.

The present study aimed to reveal the association between family incomes and status of malaria in 50 randomly selected families. Results show that there is an association between income poverty and malaria experiences (P < 0.05) and that 80% of the low-income families experienced malaria while only 20% of high-income families had experienced malaria (P < 0.05).