Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa

Abstract

Although randomized controlled trials of interventions to reduce malaria in pregnancy have demonstrated an increase in the birthweight of the newborn in primigravidae, the subsequent impact on infant mortality in all-parities has not been assessed. The aim of this paper was to model the possible impact of placental malarial infection on infant mortality through reduced birthweight. An extensive literature search was undertaken to define a series of parameters describing the associations between placental infection, birthweight and premature mortality in sub-Saharan Africa. It was shown that a baby is twice as likely to be born of low birthweight if the mother has an infected placenta at the time of delivery (all-parities: 23% vs 11%, primigravidae only: 32% vs 16%), and that the probability of premature mortality of African newborns in the first year of life is 3 times higher in babies of low birthweight than in those of normal birthweight (16% vs 4.6%). Assuming 25% of pregnant women in malaria-endemic areas of Africa harbour placental malarial infection, it is suggested that 5.7% of infant deaths in malarious areas could be an indirect cause of malaria in pregnancy. This would imply that, in 1997, malaria in pregnancy could have been responsible for around 3700 infant deaths under the diverse epidemiological conditions in Kenya. Placental infection with Plasmodium falciparum appears to have a more significant role in infant survival in Africa than has been previously assumed. This may explain the high reduction in infant mortality rates from interventions aimed at reducing transmission, over and above that expected from a decline in direct malaria-specific mortality alone.

Gender Differentials and Disease-Specific Cause of Infant Mortality: A Case Study in an Urban Hospital in Accra, Ghana

“…The IMR (32/1000) live births at in the capital city and at one of the most advanced hospitals in Ghana is an indication that the rural and hard to reach areas of the country will have higher IMRs. This is, therefore, consistent with the report of the GDHS of 2003 that variations within the country are more disturbing and the CIA IMR ranking of Ghana as the 52 nd in world 6,8 . Malaria, severe anemia, and neonatal sepsis were found to be the top killers of the 98 infants at the hospital which constituted 31%, 23%, and 20% respectively in 2007.…”

“…As a sub-Saharan country, Ghana faces huge problem of reducing infant mortality rates as lack of sturdy improvement in child survival and development in Ghana was reported in the Ghana Demographic and Health Survey (GDHS) 8 . The GDHS (2003) reported that infant mortality rates were 77, 66, 57, 64, per 1000 live births for the years 1988, 1993, 1998, 2003 respectively 8 .…”

“…The GDHS (2003) reported that infant mortality rates were 77, 66, 57, 64, per 1000 live births for the years 1988, 1993, 1998, 2003 respectively 8 . The CIA ranked Ghana as the 52nd in the world with infant mortality rate of 53.56 per 1000 live births in 2007 6,7 .…”

High Levels of Antibodies to Multiple Domains and Strains of VAR2CSA Correlate with the Absence of Placental Malaria in Cameroonian Women Living in an Area of High Plasmodium falciparum Transmission

“…P. falciparum infections during pregnancy have been associated with maternal anemia and poor pregnancy outcomes, specifically, low birth weight babies (4,6,19,27,29). Low birth weight is a major cause of neonatal and infant mortality in both developed and developing countries (25,36,55) and may be associated with long-term health consequences (28,30,36,43). Furthermore, babies born to mothers who have placental malaria are more likely to have clinical malaria earlier in life than babies born to placentalmalaria-negative (PM Ϫ ) mothers (11,27,49).…”

Intermittent Preventive Sulfadoxine-Pyrimethamine Treatment of Primigravidae Reduces Levels of Plasma Immunoglobulin G, Which Protects against Pregnancy-Associated Plasmodium falciparum Malaria

“…Pregnancy-associated malaria (PAM) is a major cause of low birth weight (LBW) and maternal anemia among primigravidae in areas of highly endemic parasite transmission (3,10,11,24). PAM is characterized by placental accumulation of Plasmodium falciparum-infected erythrocytes (IE) that can adhere to proteoglycans such as chondroitin sulfate A (CSA) in the placental intervillous space (7,18,25).…”