Assessing the burden of pregnancy-associated malaria under changing transmission settings.
BACKGROUND
The clinical presentation of pregnancy-associated malaria, or PAM, depends crucially on the particular epidemiological settings. This can potentially lead to an underestimation of its overall burden on the female population, especially in regions prone to epidemic outbreaks and where malaria transmission is generally low.


METHODS
Here, by re-examining historical data, it is demonstrated how excess female mortality can be used to evaluate the burden of PAM. A simple mathematical model is then developed to highlight the contrasting signatures of PAM within the endemicity spectrum and to show how PAM is influenced by the intensity and stability of transmission.


RESULTS
Both the data and the model show that maternal malaria has a huge impact on the female population. This is particularly pronounced in low-transmission settings during epidemic outbreaks where excess female mortality/morbidity can by far exceed that of a similar endemic setting.


CONCLUSIONS
The results presented here call for active intervention measures not only in highly endemic regions but also, or in particular, in areas where malaria transmission is low and seasonal.
Department of Zoology, University of Oxford, Oxford OX1 3PS, UK. mario.recker@zoo.ox.ac.uk
Mario
M
Recker
Menno J
MJ
Bouma
Paul
P
Bamford
Sunetra
S
Gupta
Andy P
AP
Dobson
D017677:Age Distribution; D000818:Animals; D004196:Disease Outbreaks; D005260:Female; D049673:History, 20th Century; D006801:Humans; D007194:India / Q000453:epidemiology; D008288:Malaria / Q000150:complications* / Q000401:mortality / Q000469:parasitology / Q000635:transmission*; D008954:Models, Biological; D008962:Models, Theoretical; D009017:Morbidity; D009026:Mortality / Q000266:history; D018512:Parasitemia / Q000453:epidemiology / Q000469:parasitology; D010961:Plasmodium / Q000302:isolation & purification; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000401:mortality / Q000469:parasitology*; D036301:Qualitative Research