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.
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
Robert D
RD
Newman
Afework
A
Hailemariam
Daddi
D
Jimma
Abera
A
Degifie
Daniel
D
Kebede
Aafje E C
AE
Rietveld
Bernard L
BL
Nahlen
John W
JW
Barnwell
Richard W
RW
Steketee
Monica E
ME
Parise
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