Impact of maternal malaria Impact of maternal malaria during pregnancy on Infant during pregnancy on Infant Mortality Rate in an highly Mortality Rate in an highly

endemic areaendemic area

Ali-Akbar Haghdoost, London school of hygiene and tropical medicine

Neal Alexander, London school of hygiene and tropical medicine

Tom Smith, Swiss Tropical Institute Department of Public Health & Epidemiology

Royal Society of Tropical Medicine and Hygiene Manson House12th December 2002

Introduction1Introduction1 Pregnancy malaria and IMRPregnancy malaria and IMR

Why malaria during pregnancy is important?Why malaria during pregnancy is important?

Pregnant Women:

pregnancy immunity severity

Maternal immunity

Malaria during pregnancy

Baby

Introduction2Introduction2 Pregnancy malaria and IMRPregnancy malaria and IMR

Anaemia in woman

Placental infection

Severe disease and/or infection

decreasedecrease

Congenital malaria (rare)

LBW and anaemia

mortalitymortality

increaseincrease

Pregnancy malaria and IMRPregnancy malaria and IMRmethod1method1

highly endemic are in Northern Nigeria, highly endemic are in Northern Nigeria,

The garki project: more than 12,000 people The garki project: more than 12,000 people were followed in 23 surveywere followed in 23 survey

Mother’s and baby’s data were linked base Mother’s and baby’s data were linked base data collection time and birth dates and, data collection time and birth dates and, compound ID, 417 pairs out of 747 deliveriescompound ID, 417 pairs out of 747 deliveries

Rate ratio for infection during first and Rate ratio for infection during first and second half of pregnancy on IMR were second half of pregnancy on IMR were computed by Poisson regression modelcomputed by Poisson regression model

Pregnancy malaria and IMRPregnancy malaria and IMRresults1results1

Time of infectionTime of infection IMRIMR

First halfFirst half 0.690.69

Second halfSecond half 1.471.47

Any timeAny time 0.940.94

Offspring malaria rateOffspring malaria rate

0.730.73

1.521.52

1.01.0

Malaria during the first half of Malaria during the first half of pregnancy is a protective factor, pregnancy is a protective factor, however during the second half is a however during the second half is a risk factor for IM and also contracting risk factor for IM and also contracting infection after birthinfection after birth

Pregnancy malaria and IMRPregnancy malaria and IMRresults2results2

Malaria during Malaria during crude crude

RRRR PAF PAF

First halfFirst half 0.670.67 - -Second half Second half 1.471.47 0.120.12Any timeAny time 0.940.94 - -

Adjusted for baby’s Adjusted for baby’s malariamalaria

RRRR PAFPAF

0.760.76 - -1.741.74 0.160.161.151.15 0.060.06

Adjusted > crudeAdjusted > crudeWhy?Why?Might be due to maternal immunityMight be due to maternal immunityThe effect of malaria in the first and The effect of malaria in the first and second half of pregnancy is differentsecond half of pregnancy is different

results3results3 Pregnancy malaria and IMRPregnancy malaria and IMR

SPR and risk of infection in pregnant and non-SPR and risk of infection in pregnant and non-pregnant womenpregnant women

GroupGroup pregnantpregnant non-pregnantnon-pregnantSPRSPR 0.14 0.16Risk of infectionRisk of infection 18.5 34.7

WhyWhy pregnant women has less chance of infection?pregnant women has less chance of infection?

1.1.Higher immunityHigher immunity

2.2.Lower risk of exposureLower risk of exposure

Pregnancy malaria and IMRPregnancy malaria and IMRConclusion:Conclusion:

WHO recommendation:WHO recommendation:Prompt treatment for all demonstrable diseasePrompt treatment for all demonstrable disease

Prophylaxes for all pregnant womenProphylaxes for all pregnant women

Although it is correct, to make more Although it is correct, to make more precise plan we should think aboutprecise plan we should think aboutThe difference between infection and diseaseThe difference between infection and diseaseEndemisity of malariaEndemisity of malariaDrug resistanceDrug resistancePregnancy agePregnancy ageSocio-economic and nutritional status of peopleSocio-economic and nutritional status of people