title: Quantification of the burden and consequences of pregnancy-associated malaria in the Democratic Republic of the Congo.
abstract: BACKGROUND
  Pregnancy-associated malaria (PAM) produces poor birth outcomes, but its prevalence is commonly estimated in convenience samples.
  
  
  METHODS
  We assessed the prevalence of malaria using real-time polymerase chain reaction (PCR) and estimated the consequences of infection on birth outcomes, using specimens from a nationally representative sample of 4570 women of childbearing age (WOCBA) responding to the 2007 Demographic and Health Survey in Democratic Republic of the Congo (DRC).
  
  
  RESULTS
  Overall, 31.2% (95% confidence interval [CI], 29.2-33.1) of WOCBA were parasitemic, which was significantly more common in pregnant (37.2% [31.0-43.5]) than nonpregnant women (30.4% [CI, 28.4-32.5], prevalence ratio [PR] 1.22 [1.02-1.47]). Plasmodium falciparum was highest among pregnant women (36.6% vs 28.8%, PR 1.27 [1.05-1.53]). By contrast, P malariae was less common in pregnant (0.6%) compared with nonpregnant women (2.7%, PR 0.23 [0.09-0.56]). Extrapolation of the prevalence estimate to the population at risk of malaria in DRC suggests 1.015 million births are affected by P falciparum infection annually, and that adherence to preventive measures could prevent up to 549 000 episodes of pregnancy-associated malaria and 47 000 low-birth-weight births.
  
  
  CONCLUSIONS
  Pregnancy-associated malaria and its consequences are highly prevalent in the DRC. Increasing the uptake of malaria preventive measures represents a significant opportunity to improve birth outcomes and neonatal health.
authors: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. taylo115@email.unc.edu
authors: Steve M
authors: SM
authors: Taylor
authors: Anna Maria
authors: AM
authors: van Eijk
authors: Carla C
authors: CC
authors: Hand
authors: Kashamuka
authors: K
authors: Mwandagalirwa
authors: Jane P
authors: JP
authors: Messina
authors: Antoinette K
authors: AK
authors: Tshefu
authors: Benjamin
authors: B
authors: Atua
authors: Michael
authors: M
authors: Emch
authors: Jérémie
authors: J
authors: Muwonga
authors: Steven R
authors: SR
authors: Meshnick
authors: Feiko O
authors: FO
authors: Ter Kuile
mesh_terms: D000740:Anemia / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use; D001724:Birth Weight; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D018512:Parasitemia / Q000453:epidemiology; D010963:Plasmodium falciparum; D010965:Plasmodium malariae; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology* / Q000517:prevention & control; D011256:Pregnancy Outcome; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use; D060888:Real-Time Polymerase Chain Reaction; D013413:Sulfadoxine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine