Tags

Type your tag names separated by a space and hit enter

Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study.
BMC Infect Dis. 2020 Oct 27; 20(1):796.BI

Abstract

BACKGROUND

Malaria infection during pregnancy has negative health consequences for both mothers and offspring. Sub-microscopic malaria infection during pregnancy is common in most African countries. We sought to identify factors associated with sub-microscopic placental malaria, and its association with adverse pregnancy outcomes among HIV-negative pregnant women in Dar es Salaam, Tanzania.

METHODS

We recruited a cohort of pregnant women during their first trimester and assessed for the occurrence of placental malaria and pregnancy outcomes. The follow-up was done monthly from recruitment until delivery. Histopathology placental malaria positive results were defined as the presence of malaria pigment or parasitized erythrocytes on the slide (histology-positive (HP)), and the sub-microscopic placental infection was defined as positive Plasmodium falciparum DNA by polymerase chain reaction (DNA PCR) amplification in a negative histopathology test. Adverse pregnancy outcomes investigated included low birth weight (birth weight below 2.5 kg), prematurity (live birth below 37 weeks), and small-for-gestational-age (SGA) (live born with a birth weight below 10th percentile for gestational age and sex). Weighted baseline category logit, log-binomial, and log-Poisson models were used to assess factors associated with placental malaria, and its association with adverse pregnancy outcomes.

RESULTS

Among 1115 women who had histopathology and DNA PCR performed, 93 (8%) had HP placental infection, and 136 (12%) had the sub-microscopic placental infection. The risk of sub-microscopic placental malaria was greater in women who did not use mosquito prevention methods such as bed nets, fumigation, or mosquito coils (odds ratio (OR) = 1.75; 95% confidence interval (CI): 1.05-2.92; P = 0.03) and in women who were anemic (OR = 1.59; 95% CI: 1.20-2.11; P = 0.001). Women who were underweight had reduced odds of sub-microscopic placental malaria infection (OR = 0.33; 95% CI: 0.17-0.62; P = 0.001). Women who were overweight/obese had 1.48 times higher the odds of HP placental malaria compared to normal weight (OR = 1.48; 95% CI: 1.03-2.11; P = 0.03). HP placental malaria infection was associated with an increased risk of SGA births (RR = 1.30, 95% CI: 0.98-1.72, P = 0.07). In contrast, the sub-microscopic infection was associated with a reduced risk of SGA births (RR = 0.61, 95% CI: 0.43-0.88, P = 0.01). Placental malaria was not associated with low birth weight or prematurity.

CONCLUSION

Malaria prevention methods and maternal nutrition status during early pregnancy were important predictors of sub-microscopic placental malaria. More research is needed to understand sub-microscopic placental malaria and the possible mechanisms mediating the association between placental malaria and SGA.

Authors+Show Affiliations

Department of Intervention and Clinical Trials, Ifakara Health Institute, P.O. Box 53, Ifakara, Morogoro, Tanzania. avedastus@gmail.com. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. avedastus@gmail.com.Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.Departments of Internal Medicine; and Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.Department of Intervention and Clinical Trials, Ifakara Health Institute, P.O. Box 53, Ifakara, Morogoro, Tanzania.Departments of Internal Medicine; and Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.Department of Intervention and Clinical Trials, Ifakara Health Institute, P.O. Box 53, Ifakara, Morogoro, Tanzania.Department of Global Health, Boston University School of Public Health, Boston, MA, USA. Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33109111

Citation

Kalinjuma, Aneth Vedastus, et al. "Factors Associated With Sub-microscopic Placental Malaria and Its Association With Adverse Pregnancy Outcomes Among HIV-negative Women in Dar Es Salaam, Tanzania: a Cohort Study." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 796.
Kalinjuma AV, Darling AM, Mugusi FM, et al. Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study. BMC Infect Dis. 2020;20(1):796.
Kalinjuma, A. V., Darling, A. M., Mugusi, F. M., Abioye, A. I., Okumu, F. O., Aboud, S., Masanja, H., Hamer, D. H., Hertzmark, E., & Fawzi, W. W. (2020). Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study. BMC Infectious Diseases, 20(1), 796. https://doi.org/10.1186/s12879-020-05521-6
Kalinjuma AV, et al. Factors Associated With Sub-microscopic Placental Malaria and Its Association With Adverse Pregnancy Outcomes Among HIV-negative Women in Dar Es Salaam, Tanzania: a Cohort Study. BMC Infect Dis. 2020 Oct 27;20(1):796. PubMed PMID: 33109111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with sub-microscopic placental malaria and its association with adverse pregnancy outcomes among HIV-negative women in Dar es Salaam, Tanzania: a cohort study. AU - Kalinjuma,Aneth Vedastus, AU - Darling,Anne Marie, AU - Mugusi,Ferdinand M, AU - Abioye,Ajibola Ibraheem, AU - Okumu,Fredros O, AU - Aboud,Said, AU - Masanja,Honorati, AU - Hamer,Davidson H, AU - Hertzmark,Ellen, AU - Fawzi,Wafaie W, Y1 - 2020/10/27/ PY - 2019/12/27/received PY - 2020/10/16/accepted PY - 2020/10/28/entrez PY - 2020/10/29/pubmed PY - 2020/10/29/medline KW - DNA PCR KW - Histopathology KW - Premature KW - Small for gestational age KW - Sub-microscopic parasitemia KW - low birth weight KW - placental malaria SP - 796 EP - 796 JF - BMC infectious diseases JO - BMC Infect Dis VL - 20 IS - 1 N2 - BACKGROUND: Malaria infection during pregnancy has negative health consequences for both mothers and offspring. Sub-microscopic malaria infection during pregnancy is common in most African countries. We sought to identify factors associated with sub-microscopic placental malaria, and its association with adverse pregnancy outcomes among HIV-negative pregnant women in Dar es Salaam, Tanzania. METHODS: We recruited a cohort of pregnant women during their first trimester and assessed for the occurrence of placental malaria and pregnancy outcomes. The follow-up was done monthly from recruitment until delivery. Histopathology placental malaria positive results were defined as the presence of malaria pigment or parasitized erythrocytes on the slide (histology-positive (HP)), and the sub-microscopic placental infection was defined as positive Plasmodium falciparum DNA by polymerase chain reaction (DNA PCR) amplification in a negative histopathology test. Adverse pregnancy outcomes investigated included low birth weight (birth weight below 2.5 kg), prematurity (live birth below 37 weeks), and small-for-gestational-age (SGA) (live born with a birth weight below 10th percentile for gestational age and sex). Weighted baseline category logit, log-binomial, and log-Poisson models were used to assess factors associated with placental malaria, and its association with adverse pregnancy outcomes. RESULTS: Among 1115 women who had histopathology and DNA PCR performed, 93 (8%) had HP placental infection, and 136 (12%) had the sub-microscopic placental infection. The risk of sub-microscopic placental malaria was greater in women who did not use mosquito prevention methods such as bed nets, fumigation, or mosquito coils (odds ratio (OR) = 1.75; 95% confidence interval (CI): 1.05-2.92; P = 0.03) and in women who were anemic (OR = 1.59; 95% CI: 1.20-2.11; P = 0.001). Women who were underweight had reduced odds of sub-microscopic placental malaria infection (OR = 0.33; 95% CI: 0.17-0.62; P = 0.001). Women who were overweight/obese had 1.48 times higher the odds of HP placental malaria compared to normal weight (OR = 1.48; 95% CI: 1.03-2.11; P = 0.03). HP placental malaria infection was associated with an increased risk of SGA births (RR = 1.30, 95% CI: 0.98-1.72, P = 0.07). In contrast, the sub-microscopic infection was associated with a reduced risk of SGA births (RR = 0.61, 95% CI: 0.43-0.88, P = 0.01). Placental malaria was not associated with low birth weight or prematurity. CONCLUSION: Malaria prevention methods and maternal nutrition status during early pregnancy were important predictors of sub-microscopic placental malaria. More research is needed to understand sub-microscopic placental malaria and the possible mechanisms mediating the association between placental malaria and SGA. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/33109111/Factors_associated_with_sub-microscopic_placental_malaria_and_its_association_with_adverse_pregnancy_outcomes_among_HIV-negative_women_in_Dar_es_Salaam,_Tanzania:_a_cohort_study L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05521-6 DB - PRIME DP - Unbound Medicine ER -