title: Malaria prevalence among pregnant women in two districts with differing endemicity in Chhattisgarh, India.
abstract: BACKGROUND
  In India, malaria is not uniformly distributed. Chhattisgarh is a highly malarious state where both Plasmodium falciparum and Plasmodium vivax are prevalent with a preponderance of P. falciparum. Malaria in pregnancy (MIP), especially when caused by P. falciparum, poses substantial risk to the mother and foetus by increasing the risk of foetal death, prematurity, low birth weight (LBW), and maternal anaemia. These risks vary between areas with stable and unstable transmission. The specific objectives of this study were to determine the prevalence of malaria, its association with maternal and birth outcomes, and use of anti-malarial preventive measures for development of evidence based interventions to reduce the burden of MIP.
  
  
  METHODS
  A cross-sectional study of pregnant women presenting to antenatal clinics (ANC) or delivery units (DU), or hospitalized for non-obstetric illness was conducted over 12 months in high (Bastar) and low (Rajnandgaon) transmission districts in Chhattisgarh state. Intensity of transmission was defined on the basis of slide positivity rates with a high proportion due to P. falciparum. In each district, a rural and an urban health facility was selected.
  
  
  RESULTS
  Prevalence of peripheral parasitaemia was low: 1.3% (35/2696) among women at ANCs and 1.9% at DUs (19/1025). Peripheral parasitaemia was significantly more common in Bastar (2.8%) than in Rajnandgaon (0.1%) (p < 0.0001). On multivariate analysis of ANC participants, residence in Bastar district (stable malaria transmission) was strongly associated with peripheral parasitaemia (adjusted OR [aOR] 43.4; 95% CI, 5.6-335.2). Additional covariates associated with parasitaemia were moderate anaemia (aOR 3.7; 95% CI 1.8-7.7), fever within the past week (aOR 3.2; 95% CI 1.2-8.6), and lack of formal education (aOR 4.6; 95% CI 2.0-10.7). Similarly, analysis of DU participants revealed that moderate anaemia (aOR 2.5; 95% CI 1.1-5.4) and fever within the past week (aOR 5.8; 95% CI 2.4-13.9) were strongly associated with peripheral and/or placental parasitaemia. Malaria-related admissions were more frequent among pregnant women in Bastar, the district with greater malaria prevalence (51% vs. 11%, p < 0.0001).
  
  
  CONCLUSIONS
  Given the overall low prevalence of malaria, a strategy of enhanced anti-vector measures coupled with intermittent screening and targeted treatment during pregnancy should be considered for preventing malaria-associated morbidity in central India.
authors.affiliation: Regional Medical Research Centre for Tribals, Jabalpur, Madhya Pradesh, India. neeru.singh@gmail.com
authors.forename: Neeru
authors.initials: N
authors.lastname: Singh
authors.forename: Mrigendra P
authors.initials: MP
authors.lastname: Singh
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Wylie
authors.forename: Mobassir
authors.initials: M
authors.lastname: Hussain
authors.forename: Yeboah A
authors.initials: YA
authors.lastname: Kojo
authors.forename: Chander
authors.initials: C
authors.lastname: Shekhar
authors.forename: Lora
authors.initials: L
authors.lastname: Sabin
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.forename: V
authors.initials: V
authors.lastname: Udhayakumar
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence