title: Clinical malaria in African pregnant women.
abstract: BACKGROUND
  There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints.
  
  
  METHODS
  A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia.
  
  
  RESULTS
  In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129) were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129) of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4%) presented, but their positive predictive values for malaria parasitaemia were low [28% (27-30), 29% (28-31), and 33% (31-35), respectively].
  
  
  CONCLUSIONS
  Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be unnecessarily receiving antimalarial drugs, often those with unknown safety profiles for pregnancy. Accessibility to malaria diagnostic tools needs to be improved for pregnant women and drugs with a safety profile in all gestational ages are urgently needed.
authors.affiliation: Barcelona Centre for International Health Research, Hospital Clinic, Institut d'Investigacions Biomedicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. abardaji@clinic.ub.es
authors.forename: Azucena
authors.initials: A
authors.lastname: Bardají
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigauque
authors.forename: Laia
authors.initials: L
authors.lastname: Bruni
authors.forename: Cleofé
authors.initials: C
authors.lastname: Romagosa
authors.forename: Sergi
authors.initials: S
authors.lastname: Sanz
authors.forename: Samuel
authors.initials: S
authors.lastname: Mabunda
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.forename: John
authors.initials: J
authors.lastname: Aponte
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
mesh_terms: D000328:Adult; D044383:Black People; D005260:Female; D005865:Gestational Age; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D009073:Mozambique / Q000453:epidemiology; D018512:Parasitemia / Q000517:prevention & control*; D010298:Parity; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology* / Q000517:prevention & control*; D037841:Pregnant People; D012307:Risk Factors; D012424:Rural Population; D012621:Seasons