Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

Abstract

Introduction: Malaria in pregnancy ('MiP') poses risks to mother, foetus and newborn. Studies from Africa and Asia have reported high prevalence of 'MiP' and recommended further research to address 'MiP'. India has a significant burden of 'MiP' but most of the studies are a decade old. Hardly any studies exist in India that report on asymptomatic malaria in pregnant women. The current Indian policies for malaria control are silent on 'MiP'. A campaign was carried out by community health workers (CHWs) in 2019 to screen pregnant women across rural Chhattisgarh. Methods: This is a cross-sectional study. Malaria was tested in pregnant women by CHWs using bivalent rapid tests. Multi-stage sampling was used to cover 21,572 pregnant women screened across different geographical areas of rural Chhattisgarh. Cross-tabulation and multivariate regression were used to find out the relationship of 'MiP' with different symptoms and geographical areas. GIS maps were used to compare malaria in pregnant women against overall febrile population. Results: In rural Chhattisgarh, malaria was present in 0.81% of the pregnant women at the time of testing. 'MiP' prevalence varied across geographies, reaching 4.48% in the geographical division with highest burden. Febrile pregnant women had three times greater malaria-positivity than overall febrile population and both showed a similar geographical pattern. Discussion: Prevalence of 'MiP' was found to be less than earlier studies in the state. Though overall malaria in India has shown some decline, a policy response is needed for 'MiP' in high-burden areas. Fever, diarrhoea and jaundice remain relevant symptoms in 'MiP', but around one fourth of malaria-positive pregnant-women were afebrile, suggesting the need for strategies to address it. Conclusion: The current study based on a large sample provides fresh evidence on 'MiP' in India. It used CHWs as skilled providers for large-scale screening for malaria. In high-burden areas, intermittent screening and treatment (IST) of all pregnant women can be a useful strategy in order to address 'MiP'. Pregnant women can be considered as a pertinent sentinel population for malaria. The global and national policies need to evolve concrete strategies for addressing malaria in pregnancy.

Impact of Sub-patent Malaria During Pregnancy on Birth-Weight in Odisha, India: Time-to-Event Analysis of Prospective Longitudinal Follow-Up of a Survey

“…According to Rogerson and others (2018), RDT have been poor at detecting malaria in pregnant women, while PCRbased assay was highly efficient in detecting the low-density infection prevalent among pregnant women, [18]. Previous studies from India showed much lesser prevalence of MiP in high-endemic areas when compared to the current study [5,8,9]. The higher prevalence of MiP observed in the current study could be because both patent and subpatent infection were explored in the study, compared to the previous Indian studies, which measured only patent infection.…”

“…Although every individual living in malaria-endemic areas is at risk of infection, a pregnant woman's risk of infection is greater due to changes in her hormone levels and immune system [2][3][4]. Around 60% of pregnant women in the world live in malaria-endemic regions and the prevalence of Malaria in Pregnancy (MiP) ranges from 4 to 40% in Africa to 0.4 to 6.4% in Asia [5][6][7]. In India the prevalence has been reported to be 0.8-1.3% in Chhattisgarh, 1.8% in Jharkhand and 6.4% in Madhya Pradesh state [5,8,9].…”

“…Around 60% of pregnant women in the world live in malaria-endemic regions and the prevalence of Malaria in Pregnancy (MiP) ranges from 4 to 40% in Africa to 0.4 to 6.4% in Asia [5][6][7]. In India the prevalence has been reported to be 0.8-1.3% in Chhattisgarh, 1.8% in Jharkhand and 6.4% in Madhya Pradesh state [5,8,9]. MiP when caused by Plasmodium falciparum (P. falciparum), has devastating consequences for both the mother and baby, especially in terms of birthweight and infant mortality [10,11].…”

The effect and control of malaria in pregnancy and lactating women in the Asia-Pacific region

“…20,[24][25][26]34,35 There was marked regional heterogeneity in burden and species distribution in Lancet Glob Health 2023; 11: e1805- 18 India, where P vivax is dominant in some, but not all, areas (figure). 30 Estimates of infection using PCR were generally double those generated from light-microscopy studies, 22,27,33,39 but estimates of infection can be substantially higher when an RDT is a comparator. 14 In Bangladesh, where transmission was localised with little seasonality, most infections were asymptomatic and subpatent.…”

Improving the approach to assess impact of anaemia control programs during pregnancy in India: a critical analysis

“…Studies from India have reported varying prevalence of malaria in pregnancy (between 1 and 6%) [ 31 , 32 ]. What is important to note is that afebrile malaria constituted around one fourth of malaria positive cases in pregnancy in another study [ 33 ]. Reports from scattered studies from developing countries on smaller samples suggest that the prevalence of worm infestation in pregnancy ranges from 11% to more than 25% [ 34 – 36 ].…”