Burden of malaria during pregnancy in areas of stable and unstable transmission in Ethiopia during a nonepidemic year.
Little is known about the epidemiology of malaria during pregnancy in areas of unstable (epidemic-prone) transmission (UT) in sub-Saharan Africa. In cross-sectional studies, peripheral malaria parasitemia was identified in 10.4% of women attending antenatal care clinics at 1 stable transmission (ST) site and in 1.8% of women at 3 UT sites; parasitemia was associated with anemia in both ST (relative risk [RR], 2.0; P<.001) and UT (RR, 4.4; P<.001) sites. Placental parasitemia was identified more frequently during deliveries at ST sites (12/185; 6.5%) than at UT sites (21/833; 2.5%; P=.006). Placental parasitemia was associated with low birth weight at the ST site (RR, 3.2; P=.01) and prematurity at ST (RR, 2.7; P=.04) and UT (RR, 3.9; P=.01) sites and with a 7-fold increased risk of stillbirths at UT sites. The effectiveness and efficiency in Ethiopia of standard preventive strategies used in high-transmission regions (such as intermittent preventive treatment) may require further evaluation; approaches such as insecticide-treated bednets and epidemic preparedness may be needed to prevent adverse pregnancy outcomes.
Newman
Robert D
RD
Malaria Epidemiology, National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. ren5@cdc.gov
Hailemariam
Afework
A
Jimma
Daddi
D
Degifie
Abera
A
Kebede
Daniel
D
Rietveld
Aafje E C
AE
Nahlen
Bernard L
BL
Barnwell
John W
JW
Steketee
Richard W
RW
Parise
Monica E
ME
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000150:complications / Q000188:drug therapy; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000150:complications; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D016780:Malaria, Vivax / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D008297:Male; D007752:Obstetric Labor, Premature / Q000150:complications; D018512:Parasitemia / Q000150:complications; D010920:Placenta / Q000469:parasitology; D010963:Plasmodium falciparum / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D011256:Pregnancy Outcome
D000962:Antimalarials