Search

Introduction. Malaria during pregnancy is a major cause of morbidity and mortality in sub-Saharan Africa. Microcopy and rapid diagnostic test (RDT) recommended by the World Health Organization for clinical diagnosis have poor sensitivity to detect individuals with very low levels of parasitemia. Previous studies have shown that malaria in pregnancy is associated with mastitis and excessive uterine blood loss during delivery. However, information evaluating the performance of these tools in detecting malaria in pregnancy at the national level is limited. This study therefore evaluates the performance of microscopy, RDT, and nested polymerase chain reaction (nPCR) in the detection of pregnancy-associated malaria at delivery. Methods. A total of 227 participants constituting of 201 pregnant women without and 26 with HIV were recruited from five health facilities within the Kumba health district area. Mother venous and cord blood were collected at delivery to test for malaria using the thick-film microscopy, SD-bioline RDT, and 18SrRNA-nested PCR. Results. The percentage of malaria-positive cases detected by thick-film microcopy (TFM), RDT, and PCR in pregnant women with and without HIV was 7.69%, 53.85%, and 50% and 3.48%, 23.38%, and 49.25%, respectively. Plasmodium falciparum was detected in 1.99% cord blood samples of women without HIV by PCR. The positivity rate in at least two of the test methods (composite positive) was 42.31% for women with and 19.90% for women without HIV. The sensitivity of TFM and RDT when using PCR as a reference was 7.21% and 49.00%, respectively, in all samples. The specificity was 99.14% and 90.55% with kappa values of 0.064 and 0.461, respectively. When using the composite test as a reference, the sensitivity of TFM, RDT, and nPCR was 15.69%, 94.12%, and 100%, respectively. Specificity was 99.43%, 93.18%, and 65.34% with kappa values of 0.213, 0.821, and 0.458, respectively. Conclusion. This study shows that PCR is more sensitive in the detection of malaria parasite followed by SD-bioline RDT kit. However, in resource-limited settings where access to molecular diagnosis of malaria is a problem, RDT should be considered as the first option to microscopy in the diagnosis of malaria. [ABSTRACT FROM AUTHOR]

Malaria and HIV are geographically in the tropics and subtropics of the world, including sub-Saharan Africa. Understanding the overlapping effect of both infections, especially among pregnant women, is crucial in managing pregnant women during antenatal care visits, and postpartum babies. It was realized that the prevalence of malaria among HIV-positive pregnant women ranges between 31–61%, while for non-HIV infected pregnant women the prevalence still stands between 10 and 36%. Co-infection is between 0.52 and 56.3%. Even though the rate of mother-to-child transmission of HIV has dropped, MTCT of malaria still remains a problem. MTCT is associated with low birth-weight, anemia, and even immune dysregulation. The adoption of the Option B+ plan has proven to be effective in the fight against the MTCT of HIV. However, malaria in pregnancy still remains a problem. Concurrent administration of both antimalarial drugs and Cotrimozaxole to pregnant women is not recommended, because of the toxic effect of the interaction of both drugs. Nevertheless, studies looking at the effect of the current ART regimens on mothers and their children need to be carried out. Studies looking at exposed children over a longer period of time, to determine their susceptibility to malaria infection and also to monitor their immune response to malaria over time, are needed. [ABSTRACT FROM AUTHOR]

Background: Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden.Methods: This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan. Pyrethroid long-lasting insecticidal nets were the principal form of malaria vector control in all study areas; in Sudan this approach was supplemented by indoor residual spraying. Cohorts of children from randomly selected households in each cluster were recruited and followed up by community health workers to measure incidence of clinical malaria and prevalence of infection. Mosquitoes were assessed for susceptibility to pyrethroids using the standard WHO bioassay test. Country-specific results were combined using meta-analysis.Findings: Between June 2, 2012, and Nov 4, 2016, 40 000 children were enrolled and assessed for clinical incidence during 1·4 million follow-up visits. 80 000 mosquitoes were assessed for insecticide resistance. Long-lasting insecticidal net users had lower infection prevalence (adjusted odds ratio [OR] 0·63, 95% CI 0·51-0·78) and disease incidence (adjusted rate ratio [RR] 0·62, 0·41-0·94) than did non-users across a range of resistance levels. We found no evidence of an association between insecticide resistance and infection prevalence (adjusted OR 0·86, 0·70-1·06) or incidence (adjusted RR 0·89, 0·72-1·10). Users of nets, although significantly better protected than non-users, were nevertheless subject to high malaria infection risk (ranging from an average incidence in net users of 0·023, [95% CI 0·016-0·033] per person-year in India, to 0·80 [0·65-0·97] per person year in Kenya; and an average infection prevalence in net users of 0·8% [0·5-1·3] in India to an average infection prevalence of 50·8% [43·4-58·2] in Benin).Interpretation: Irrespective of resistance, populations in malaria endemic areas should continue to use long-lasting insecticidal nets to reduce their risk of infection. As nets provide only partial protection, the development of additional vector control tools should be prioritised to reduce the unacceptably high malaria burden.Funding: Bill & Melinda Gates Foundation, UK Medical Research Council, and UK Department for International Development. [ABSTRACT FROM AUTHOR]