title: Burden of malaria in pregnancy in Jharkhand State, India.
abstract: BACKGROUND
  Past studies in India included only symptomatic pregnant women and thus may have overestimated the proportion of women with malaria. Given the large population at risk, a cross sectional study was conducted in order to better define the burden of malaria in pregnancy in Jharkhand, a malaria-endemic state in central-east India.
  
  
  METHODS
  Cross-sectional surveys at antenatal clinics and delivery units were performed over a 12-month period at two district hospitals in urban and semi-urban areas, and a rural mission hospital. Malaria was diagnosed by Giemsa-stained blood smear and/or rapid diagnostic test using peripheral or placental blood.
  
  
  RESULTS
  2,386 pregnant women were enrolled at the antenatal clinics and 718 at the delivery units. 1.8% (43/2382) of the antenatal clinic cohort had a positive diagnostic test for malaria (53.5% Plasmodium falciparum, 37.2% Plasmodium vivax, and 9.3% mixed infections). Peripheral parasitaemia was more common in pregnant women attending antenatal clinics in rural sites (adjusted relative risk [aRR] 4.31, 95%CI 1.84-10.11) and in those who were younger than 20 years (aRR 2.68, 95%CI 1.03-6.98). Among delivery unit participants, 1.7% (12/717) had peripheral parasitaemia and 2.4% (17/712) had placental parasitaemia. Women attending delivery units were more likely to be parasitaemic if they were in their first or second pregnancy (aRR 3.17, 95%CI 1.32-7.61), had fever in the last week (aRR 5.34, 95%CI 2.89-9.90), or had rural residence (aRR 3.10, 95%CI 1.66-5.79). Malaria control measures including indoor residual spraying (IRS) and untreated bed nets were common, whereas insecticide-treated bed nets (ITN) and malaria chemoprophylaxis were rarely used.
  
  
  CONCLUSIONS
  The prevalence of malaria among pregnant women was relatively low. However, given the large at-risk population in this malaria-endemic region of India, there is a need to enhance ITN availability and use for prevention of malaria in pregnancy, and to improve case management of symptomatic pregnant women.
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. dhamer@bu.edu
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Mrigendra P
authors.initials: MP
authors.lastname: Singh
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Wylie
authors.forename: Kojo
authors.initials: K
authors.lastname: Yeboah-Antwi
authors.forename: Jordan
authors.initials: J
authors.lastname: Tuchman
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.forename: Venkatachalam
authors.initials: V
authors.lastname: Udhayakumar
authors.forename: Priti
authors.initials: P
authors.lastname: Gupta
authors.forename: Mohamad I
authors.initials: MI
authors.lastname: Brooks
authors.forename: Manmohan M
authors.initials: MM
authors.lastname: Shukla
authors.forename: Kiran
authors.initials: K
authors.lastname: Awasthy
authors.forename: Lora
authors.initials: L
authors.lastname: Sabin
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.forename: Aditya P
authors.initials: AP
authors.lastname: Dash
authors.forename: Neeru
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D000818:Animals; D001769:Blood / Q000469:parasitology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology*; D016780:Malaria, Vivax / Q000453:epidemiology*; D010963:Plasmodium falciparum / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D055815:Young Adult