Malaria in Pregnancy in Endemic Regions of Colombia: High Frequency of Asymptomatic and Peri-Urban Infections in Pregnant Women with Malaria

Abstract

Background. Malaria in pregnancy (MiP) has been associated with adverse pregnancy outcomes. There is limited information on MiP in low transmission regions as Colombia. This study aimed to describe the epidemiology of MiP through active surveillance of infections by microscopy and polymerase chain reaction (PCR). Methods. A cross-sectional study was conducted between May 2016 and January 2017 in five municipalities (Apartadó, Turbo, El Bagre, Quibdó, and Tumaco) in Colombia. Pregnant women self-presenting at health centers for antenatal care visits, seeking medical care for suspected malaria, or delivery, were enrolled. Diagnosis of Plasmodium spp was made in peripheral and placental blood samples by microscopy and PCR. Results. A total of 787 pregnant women were enrolled; plasmodial infection was diagnosed by microscopy in 4.2% (95% CI 2.8-5.6; 33/787) or by nPCR in 5.3% (95% CI 3.8-6.9; 42/787) in peripheral blood. Most of the infections were caused by P. falciparum (78.5%), and 46% were afebrile (asymptomatic). Women in the first and second trimester of pregnancy were more likely to be infected (aOR=3.06, 95%CI=1.6−5.8). To live in the urban/peri-urban area (aOR=3.04, 95%CI=1.4−6.56), to have a history of malaria during last year (aOR=5.45, 95%IC=2.16−13.75), and the infrequent bed net usage (aOR=2.8, 95%CI=1.31−5.97) were associated with the infection. Pregnant infected women had a higher risk of anaemia (aOR=2.18, 95%CI=1.15−4.12) and fever (aOR=14.2, 95%CI=6.89−29.8). Conclusion. The screening for malaria during antenatal care in endemic areas of Colombia is highly recommended due to the potential adverse effects of Plasmodium spp. infection in pregnancy and as an important activity for the surveillance of asymptomatic infections in the control of malaria.

Global trend of Plasmodium malariae and Plasmodium ovale spp. malaria infections in the last two decades (2000–2020): a systematic review and meta-analysis

“…Forty-nine studies (43.36%) comprised both symptomatic and asymptomatic participants, whereas 26.55% and 30.09% included respectively asymptomatic and symptomatic participants only. Children under 15 years old were targeted in 10.62% of studies, mostly in AFR ( n = 11); pregnant women were investigated in 7.08% in the African Region ( n = 7) [ 18 – 24 ] and Region of the Americas (AMR) ( n = 1) [ 25 ], and one study (0.88%) was conducted among 4570 women of childbearing age in the Democratic Republic of the Congo (DRC) [ 26 ] (Additional file 3 : Table S3).

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Meta-analysis of the prevalence of malaria associated with pregnancy in Colombia 2000–2020

“…With PCR, the comparison of both species presented the following results: MAP registered an OR of 1.0 (95%CI = 0.7-1.5) and CM 0.7 (95%CI = 0.5-1.1) that indicated a similar prevalence of both species. Finally, among the factors associated with MAP, the area of residence (higher GM in rural areas) [10]; the number of previous pregnancies (more GM in women with a higher number of pregnancies) [12]; the weeks of gestation (lower gestational age in infected women) [10,12]; the number of malaria episodes in the current pregnancy [10,23], in the last year and among partners (higher among infected pregnant women) [10]; and lower birth weight were reported [12]. However, this evidence was not consistent among the studies (even between those carried out in the same endemic area), since other authors did not report statistical differences in MAP according to maternal age [10,15,16,22,24], gestational age [15,16,24], number of pregnancies [15,22], previous episodes of malaria [16,22], parity [16,23,24], weight and height of the newborn [15,16,22,24], neonatal anemia, or preterm delivery [15].…”

“…Finally, it is essential to note that the report of the factors associated with MAP was deficient. Some studies reported the association of MAP with the number of pregnancies [14], gestational age [10,12], previous malaria episodes [10,23], and birth weight [12]. However, these findings were not consistent between the studies, so their research should be circumscribed to more local spaces, which allow the identification of possible risk factors specific to each group.…”

“…In Colombia, research on MAP is incipient, the few available studies have reported an increased risk of anemia, severe malaria with complications such as liver dysfunction, acidosis, and severe thrombocytopenia; lower birth weight and no record of neonatal or fetal deaths [10][11][12]. Furthermore, there are few studies that determine the magnitude of the problem.…”

Frequency of placental malaria and its associated factors in northwestern Colombia, pooled analysis 2009–2020

“…Besidesa, in Colombia, there are few publications on PM, and they concentrate on histopathological and immunological issues [ 8 – 10 , 22 ]. Epidemiological studies on PM have reported frequencies between 0.3% and 12.8% with TBS (thick blood smear), and 2.7% to 57.3% with PCR (polymerase chain reaction); These studies have focused on the comparison of diagnostic tests, the detection of asymptomatic and submicroscopic infections (positive with PCR and negative with TBS) [ 8 , 16 , 23 – 25 ]. Knowledge about maternal and neonatal factors and the history of malaria potentially associated with PM has been less explored.…”