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Estimated risk of placental infection and low birthweight attributable to Plasmodium falciparum malaria in Africa in 2010: a modelling study

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Walker, Patrick G T, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Garske, Tini, Menendez, Clara and Ghani, Azra C (2014) 'Estimated risk of placental infection and low birthweight attributable to Plasmodium falciparum malaria in Africa in 2010: a modelling study'. Lancet Global Health, Vol 2, Issue 8, e460-e467.

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Abstract

Background

Plasmodium falciparum infection during pregnancy leads to adverse outcomes including low birthweight; however, contemporary estimates of the potential burden of malaria in pregnancy in Africa (in the absence of interventions) are poor. We aimed to estimate the need to protect pregnant women from malaria across Africa.

Methods

Using a mathematical model applied to estimates of the geographical distribution of P falciparum across Africa in 2010, we estimated the number of pregnant women who would have been exposed to infection that year in the absence of pregnancy-specific intervention. We then used estimates of the parity-dependent acquisition of immunity to placental infection and associated risk of low birthweight to estimate the number of women who would have been affected.

Findings

We estimate that, without pregnancy-specific protection, 12·4 million pregnant women (44·9% of all 27·6 million livebirths in malaria endemic areas in Africa in 2010) would have been exposed to infection, with 11·4 million having placental infection (41·2% of all livebirths). This infection leads to an estimated 900 000 (95% credible interval [CrI] 530 000—1 240 000) low birthweight deliveries per year. Around the end of the first trimester, when the placenta becomes susceptible to infection, is a key period during which we estimate that 65·2% (95% CrI 60·9—70·0) of placental infections first occur.

Interpretation

Our calculations are the only contemporary estimates of the geographical distribution of placental infection and associated low birthweight. The risk of placental infection across Africa in unprotected women is high. Prevention of malaria before conception or very early in pregnancy is predicted to greatly reduce incidence of low birthweight, especially in primigravidae. The underlying lifetime risk of low birthweight changes slowly with decreasing transmission, drawing attention to the need to maintain protection as transmission falls.

Item Type: Article
Subjects: QX Parasitology > Protozoa > QX 135 Plasmodia
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WQ Obstetrics > Pregnancy Complications > WQ 256 Infectious diseases
WS Pediatrics > By Age Groups > WS 410 Premature infants. Diseases of premature infants
WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1016/S2214-109X(14)70256-6
Depositing User: Martin Chapman
Date Deposited: 27 Aug 2014 12:01
Last Modified: 31 May 2018 13:27
URI: http://archive.lstmed.ac.uk/id/eprint/4118

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