The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria

Abstract

We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

Neonatal Plasmodium vivax malaria: an overlooked entity

“…Although malaria is endemic in India, neonatal disease is considered rare because of the protection provided by the passive acquisition of maternal antibodies and fetal hemoglobin [2]. The nonspecific signs and symptoms of neonatal malaria are often confused with sepsis, which leads to delay in diagnosis and treatment [2][3][4]. We report a similar incident in which a 26-day-old male neonate was diagnosed as having malaria after a long and unsuccessful battery of tests for splenomegaly.…”

Clinical Presentation and Management of Neonatal Malaria: A Review

“…Being a low endemic region, the median age of presentation tends to be later (8 years) in contrast to the mean age at 26 months reported from Africa [32]. In recent year, workers from endemic areas reported the incidence of neonatal malaria to be 58.5% [4,33]. Studies examining the incidence of parasitemia in infant born in endemic region have shown rates varying from 0-33% [34,35].…”

“…So it becomes difficult to assign parasitaemia as a cause of ill health in these newborns. In addition one study suggests that septic neonates and those with suspected sepsis are likely to have parasitaemia [4].…”

“…Despite these well-documented indirect effects of malaria to the fetus and newborn, the direct burden of neonatal malaria infection in terms of prevalence and outcome is not well described in malaria endemic areas. Studies published so far have documented contradictory levels of this burden [4][5][6][7]. Most of these studies were conducted in large referral or teaching hospitals, and the results are difficult to generalize [4][5][6]8,9].…”

“…Studies published so far have documented contradictory levels of this burden [4][5][6][7]. Most of these studies were conducted in large referral or teaching hospitals, and the results are difficult to generalize [4][5][6]8,9]. Furthermore, many studies lack details of internal and external laboratory quality control procedures, parasite densities and examine a small sample size of neonates with malaria [6][7][8][9][10][11] and thus these limitations further complicate the interpretation and application of the findings.…”