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. 2013 Nov 1;208(9):1504-13.
doi: 10.1093/infdis/jit366. Epub 2013 Aug 1.

Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study

Kwaku Poku Asante  1 , Seth Owusu-Agyei, Matthew Cairns, Daniel Dodoo, Ellen Abrafi Boamah, Richard Gyasi, George Adjei, Ben Gyan, Akua Agyeman-Budu, Theophilus Dodoo, Emmanuel Mahama, Nicholas Amoako, David Kwame Dosoo, Kwadwo Koram, Brian Greenwood, Daniel Chandramohan
Affiliations

Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study

Kwaku Poku Asante et al. J Infect Dis. .

Abstract

Background: Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain.

Methods: We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology.

Results: The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants.

Conclusions: There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.

Keywords: Ghana; cohort study; infant malaria; malaria; malaria epidemiology; placental malaria.

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Figures

Figure 1.
Figure 1.
Study flow diagram for infants in the 2008–2011 Kintampo Birth Cohort Study. There were 102 infant deaths (primigravidae [PG] with placental malaria [PM] = 16; PG without PM = 6; multigravidae [MG] with PM = 33; MG without PM = 47), 100 migrations out of the study area, and 110 withdrawals of consent among the cohort of 1855 infants. Eighty-three percent (1543) of the total cohort completed 1 year of follow-up. The final follow-up rate was significantly lower among infants of PG compared those of MG (P = .03). Abbreviations: MG, multigravidae; PG, primigravidae.
Figure 2.
Figure 2.
Kaplan–Meier curves for the risk of the first or only episode of parasitemia (A) or clinical malaria (B) in infants by gravidity and placental malaria status. Abbreviations: MG, multigravidae; PG, primigravidae; PM− indicates no placental malaria; PM+ indicates placental malaria present.
Figure 3.
Figure 3.
Kaplan–Meier curves for the risk of the first or only episode of parasitemia (A for primigravidae [PG] and B for multigravidae [MG]) or first or only episode of clinical malaria (C for PG and D for MG) in infants by placental malaria status and wealth index. There was a clear association between the risk of first infant parasitemia or clinical malaria and wealth index among PG and MG. P value for log-rank test was <.01 for all survival graphs. Abbreviations: PM– indicates no placental malaria; PM+ indicates placental malaria present.
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