Epidemiology of malaria in pregnancy in central India

Abstract

Analysis of three years of data from a malaria clinic operated by the Indian Council of Medical Research (ICMR) in the Government Medical College Hospital in Jabalpur, central India, showed a high malaria prevalence among pregnant women, which was statistically highly significant (P < 0.0001) compared with the situation among nonpregnant women. Cerebral malaria was a common complication of severe Plasmodium falciparum infection, with a high mortality during pregnancy, requiring immediate attention. The study also showed that malaria infection was more frequent in primigravidae, falling progressively with increasing parity. Mean parasite densities were significantly higher in pregnant women compared with nonpregnant women for both P. falciparum (P < 0.001; df = 137) and P. vivax (P < 0.05; df = 72) infection. Pregnant women with falciparum or vivax malaria were significantly more anaemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less than that of 175 neonates from noninfected mothers. This difference in birth weight was statistically significant for both P. falciparum (P < 0.0001; df = 278) and P. vivax (P < 0.0001; df = 223) infection. Congenital malaria was not recorded. We conclude that pregnant women from this geographical area require systematic intervention owing to their high susceptibility to malaria during pregnancy and the puerperium.

PIP: A 3-year study on malarial epidemiology was conducted among 2127 pregnant women from 12 weeks' gestation up to 40 days after delivery at the Obstetrics and Gynecology Department of Government Medical College in Central India. The women either had fever or a history of fever, belonged to the lower socioeconomic groups, and worked in their homes and in the fields. Personal and reproductive histories as well as antimalarial drug intake during pregnancy were considered. Comparisons in rates of anemia and low birth weight were investigated between the two groups, which were composed, respectively, of nonpregnant women of reproductive age assessed for the prevalence of vivax/falciparum malaria and parasite density (the control group) and pregnant women from the study group who had fever, but no malarial infection. Blood smears from all neonates whose mothers were enrolled in the study were also prepared. Results showed statistically higher malaria prevalence in primigravidae, decreasing progressively with increasing parity. 33 pregnant women were infected with P. vivax, while 67% were infected with P. falciparum; 17 of these were cerebral malaria cases. Women with falciparum or vivax malaria were significantly more anemic than noninfected pregnant women or infected nonpregnant women. The average weight of 155 neonates from infected mothers was 350 g less than that of 174 neonates from noninfected mothers. These findings suggest that the high susceptibility of pregnant women to malaria requires systemic intervention.