Risk Factors for Placental Malaria and Birth Weight Outcome among Pregnant Women Attending Mawenzi Regional Referral Hospital, Moshi North Eastern Tanzania

Objective:This study aimed to determine the Prevalence and Risk Factors for Placental Malaria and its associated effects on Pregnancy Outcome among Pregnant Women in Mawenzi Regional Referral Hospital in Kilimanjaro Region.Methodology:This was a hospital based cross-sectional study. We derived our study sample from previous survey of 700 pregnant women who attended labor ward at MRRH between 2018-2019 in which we obtained study subjects by random sampling. The study included 350 subjects. We extracted data from the dataset using data extraction sheet and was analyzed using IBM SPSS software version 24. Chi–square was performed and we accepted an error of 5% level P<0.05 was the cut off for statistical significance.Results:The prevalence of PM was 7.1% among the pregnant women in the study area. Primigravida had more cases of PM (11%) as compared to multigravida (2.7%). Pregnant women who had gestation age below 37 weeks attributed more cases of PM (9.6%) as compared to 6.7% of PM infections in pregnant women at gestation age of 37 weeks and above. Low birth-weight was estimated at 32% of all subjects who were identified with PM as compared to 6.2% of subjects without placental malaria and their difference was statistically significant (P<0.001). Gestational age of less than 37 weeks was associated with LBW with proportion of 21% among women with PM and it has strong statistical significance of P (<0.001). The use of bed nets was associated with PM among the non-user at 28% P (<0.001).Conclusion:PM is still a major public health problem in low malaria endemic areas and the groups at risk are women who are Primigravida, women not using bed nets and women who gives birth at gestation age of <37 weeks. We recommend more studies on PM in low endemic

Low Fetal Weight is Directly Caused by Sequestration of Parasites and Indirectly by IL-17 and IL-10 Imbalance in the Placenta of Pregnant Mice with Malaria

The sequestration of infected erythrocytes in the placenta can activate the syncytiotrophoblast to release cytokines that affect the micro-environment and influence the delivery of nutrients and oxygen to fetus. The high level of IL-10 has been reported in the intervillous space and could prevent the pathological effects. There is still no data of Th17 involvement in the pathogenesis of placental malaria. This study was conducted to reveal the influence of placental IL-17 and IL-10 levels on fetal weights in malaria placenta. Seventeen pregnant BALB/C mice were divided into control (8 pregnant mice) and treatment group (9 pregnant mice infected by Plasmodium berghei). Placental specimens stained with hematoxylin and eosin were examined to determine the level of cytoadherence by counting the infected erythrocytes in the intervillous space of placenta. Levels of IL-17 and IL-10 in the placenta were measured using ELISA. All fetuses were weighed by analytical balance. Statistical analysis using Structural Equation Modeling showed that cytoadherence caused an increased level of placental IL-17 and a decreased level of placental IL-10. Cytoadherence also caused low fetal weight. The increased level of placental IL-17 caused low fetal weight, and interestingly low fetal weight was caused by a decrease of placental IL-10. It can be concluded that low fetal weight in placental malaria is directly caused by sequestration of the parasites and indirectly by the local imbalance of IL-17 and IL-10 levels.

Placental Malaria and Its Associations with Pregnancy Outcome.

Background: Placental malaria constitutes a risk for both the pregnant women and their unborn child hence there is need to demonstrate the adverse associations between placental malaria and pregnancy outcome. Aim: To demonstrate the adverse maternal and fetal associations with placental malaria Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013. Result: Two hundred placentae were analyzed, 141(70.5%) were positive for malaria, Placental malaria was associated with lower maternal pcv (30.67±1.60 vs 32.51±2.82, p-value < 0.001), preterm delivery (OR=4.99, C.I=1.15 – 45.08, p- value=0.020), and low birth weight (OR = 4.71, C.I=1.08 – 42.71, p-value=0.027) but not associated with maternal anaemia (OR=2.27, C.I= 0.90-6.47, p-value=0.063) and perinatal deaths (OR=Infinity, C.I =0.38 – infinity, p-value = 0.143). Conclusion: Placental malaria was associated with low birth weight, lower pcv and preterm delivery but associated neither with maternal anaemia nor perinatal deaths.

Prevalence of Placental Malaria and Effects on Birth Weight of Neonate of Mothers Who Had Antenatal Care in Maiduguri Metropolitan City, Nigeria.

Background: Low birth weight (LBW) is an important risk factor for infant morbidity and mortality especially in malarial endemic countries. The study focused on the prevalence of placental malaria and neonatal LBW, as well as the relationship between placental malaria and neonatal LBW outcome in Maiduguri metropolitan city, Nigeria. Methods: A total of 110 mother-neonatal pairs were studied. Neonatal birth weights were measured using the bassinet weighing scale and placental tissues for the diagnosis of placental malaria were collected from mothers of these neonates. Student t test and Chi-square trend (χ2) with Yate’s correction were used to investigate quantitative and categorical variables, whereas, Univariate analytical model was used to estimate the relationship between placental malaria, maternal age, parity and neonatal LBW. Results: Forty-nine mothers (44.5%) had placental malaria and the association of maternal age group (27-31and32-36) years with placental malaria was significant (p=0.029). Of the 14(100%) neonates with LBW, 10(71.4%) had their mothers diagnosed with placental malaria. The relationship between placental malaria and LBW was however not significant (p=0.207). Also, the relationship between maternal age, parity and neonatal LBW outcome was not significant. Conclusions: Placental malaria constituted 44.5% and the disease was associated with maternal age bracket (27-31and32-36) years in this work. Although the relationship between placental malaria and neonatal LBW was not significant, most neonates with LBW in present study had their mothers diagnosed with placental malaria.

Prevalence and Risk Factors for Placental Malaria in Nnewi, South East Nigeria.

Background: Placental malaria is one of the complications of malaria in pregnancy and is associated with poor pregnancy outcome. Demonstration of its prevalence and risk factors will help in modifying the measures in the prevention of malaria in pregnancy and strengthens the effective pre-existing preventive measures in our community. More so, there is paucity of studies of placental malaria in our environment using histology which is the gold standard. Aim: To determine the prevalence and the risk factors for placental malaria. Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013. Materials and Methods: A cross section of pregnant women who delivered in the labour ward was recruited for the study. The following data were obtained from those who met the inclusion criteria: age, parity, gestational age, the booking status, educational level and husband’s occupation. The history of Intermittent preventive therapy (IPT), Insecticide treated net (ITN), HIV status, Blood group and Haemoglobin genotype were also obtained. Descriptive analysis of the results was done using the statistical package for social sciences (SPSS) version 16. Univariate analysis and logistic regression were used and the results expressed in Odd ratios (OR) and Confidence interval (C.I). P-value <0.05 was taken as significant level. Result: Out of 200 placentae analyzed, 141 were positive for malaria, giving a prevalence of 70.5%. The commonest form of parasitisation was chronic infection (68.09%) followed by past infection (19.14%) and acute infection (12.77%). Using univariate analysis, the potential risk factors were young age, primigrividity, unbooked status and non use of IPT, non use of ITN, low social class, HIV positivity and haemoglobin genotype AA. However when these were subjected to logistic regression, the independent risk factors identified were young age, primigrividity, unbooked status, non use of IPT and non use of ITN. Conclusion: This study highlighted high prevalence of placental malaria in our environment. The independent risk factors noted were young age, primigrividity, unbooked status, non use of IPT and non use of ITN.

Glicosaminoglicanos como posibles reguladores de inflamación durante la malaria placentaria / Glycosaminoglycans as potential regulators of inflammation during placental malaria

Los mecanismos fisiopatológicos de la malaria placentaria son hasta el momento poco comprendidos, y el daño placentario derivado de la infección por Plasmodium spp se ha relacionado con eventos adversos del embarazo que afectan directamente el desarrollo del feto. Las concentraciones placentarias de algunas citocinas como la IL-10, TNF-alfa y TGF-beta y glicosaminoglicanos como el CSA, HA y HS podrían estar participando de forma reguladora en los eventos inflamatorios placentarios durante la infección por Plasmodium spp.

The pathophysiological mechanisms of placental malaria are until now poorly understood and the placental damage resulting from infection by Plasmodium spp has been linked to adverse pregnancy events that directly affect fetal development. Placental concentrations of some cytokines such as IL-10, TNF-alpha and TGF-beta and glycosaminoglycans such as CSA, HA and HS could be involved in a regulatory role in placental inflammation during infection by Plasmodium spp.

Incidencia de las malarias gestacional, congénita y placentaria en Urabá (Antioquia, Colombia), 2005-2007 / Incidence of gestational, congenital and placental malaria in Urabá (Antioquia, Colombia), 2005-2007

Introducción: en Colombia se ignora la frecuencia de malarias gestacional (MG), congénita (MC) y placentaria (MP) y la mortalidad asociada a ellas, así como el cuadro clínico de la MG. Objetivos: calcular la prevalencia e incidencia de MG, MP y MC, la mortalidad por MG y MC, y describir y comparar entre mujeres con y sin MG, los síntomas, signos y las características de la MG. Metodología: estudio descriptivo con componente longitudinal (cohorte) y transversal, con gestantes de 15 a 44 años, sus placentas e hijos. Las gestantes se captaron en las consultas prenatales y salas de parto de tres municipios de Urabá (Antioquia, Colombia), entre 2005 y 2007. Resultados: se captaron 2117 gestantes: a) cohorte: n=1927 mujeres con mínimo dos exámenes de gota gruesa; b) grupo transversal: n=190 mujeres con solo un examen de gota gruesa (en consulta prenatal o en parto). Hubo 220 casos de MG. Según la gota gruesa para Plasmodium las frecuencias fueron: prevalencia MG: 10,39%; proporción de incidencia MG: 9,28%; tasa de incidencia de MG: 9,01 por 100 mujeres/semana; proporción MC: 2,7%; prevalencia de MP: 11,7%. P. vivax causó 76% de MG, P. falciparum 22%, ambas especies 2%. Los síntomas y signos hallados en las gestantes con MG concordaron con los referidos para gestantes y no gestantes. No hubo muertes entre las 220 gestantes que presentaron malaria ni entre los cinco niños que presentaron MC. Conclusiones: las frecuencias de MG, MC y MP indican que esas entidades son problemas de salud pública en la población de gestantes y neonatos de Urabá.

Introduction: gestational (GM), congenital (CM) and placental malaria (PM) and associated mortality frequency in Colombia remains unknown, as does GM’s clinical features. Objectives: estimating GM, PMand CM prevalence and incidence and mortality caused by GM and CM and describing GM’s symptoms and signs. Methodology: this was a descriptive study of pregnant women aged 15-44, their children and placentas; it had longitudinal (cohort) and cross-sectional components. The pregnant women were recruited during their prenatal visits and in the delivery rooms of three towns in Urabá (Antioquia, Colombia) from 2005-2007. Results: 2,117 pregnant women were evaluated: a) cohort: n=1,927 women with at least two reviews of thick smear; b) cross-sectional group: n=190 women having had just a thick smear examination (during prenatal consultation or childbirth). There were 220 cases of GM according to thick smear for Plasmodium (76% P. vivax, 22% P. falciparum, 2% mixed malaria). GM prevalence was 10.395, GM incidente 9.28%, 9.01 per 100 women per week GM incidence rate, 2.7% CM and 11.7% PM prevalence. The symptoms and signs found in pregnant women suffering from GM agreed with those for pregnant and non-pregnant women. There were no deaths amongst the 220 pregnant women who had malaria or amongst the five children who presented CM. Conclusions: GM, CM and PM frequencies indicated that these types of malaria are public health problems amongst pregnant women and infants in Uraba.