title: Prevalence of congenital malaria in high-risk Ghanaian newborns: a cross-sectional study.
abstract: BACKGROUND
  Congenital malaria is defined as malaria parasitaemia in the first week of life. The reported prevalence of congenital malaria in sub-Saharan Africa is variable (0 - 46%). Even though the clinical significance of congenital malaria parasitaemia is uncertain, anti-malarial drugs are empirically prescribed for sick newborns by frontline health care workers. Data on prevalence of congenital malaria in high-risk newborns will inform appropriate drug use and timely referral of sick newborns.
  
  
  METHODS
  Blood samples of untreated newborns less than 1 week of age at the time of referral to Korle Bu Teaching hospital in Accra, Ghana during the peak malaria seasons (April to July) of 2008 and 2010 were examined for malaria parasites by, i) Giemsa-stained thick and thin blood smears for parasite count and species identification, ii) histidine-rich protein- and lactic dehydrogenase-based rapid diagnosis tests, or iii) polymerase chain reaction amplification of the merozoite surface protein 2 gene, for identification of sub-microscopic parasitaemia. Other investigations were also done as clinically indicated.
  
  
  RESULTS
  In 2008, nine cases of Plasmodium falciparum parasitaemia were diagnosed by microscopy in 405 (2.2%) newborns. All the nine newborns had low parasite densities (≤ 50 per microlitre). In 2010, there was no case of parasitaemia by either microscopy or rapid diagnosis tests in 522 newborns; however, 56/467 (12%) cases of P. falciparum were detected by polymerase chain reaction.
  
  
  CONCLUSIONS
  Congenital malaria is an uncommon cause of clinical illness in high-risk untreated newborns referred to a tertiary hospital in the first week of life. Empirical anti-malarial drug treatment for sick newborns without laboratory confirmation of parasitaemia is imprudent. Early referral of sick newborns to hospitals with resources and skills for appropriate care is recommended.
authors: Department of Child Health, University of Ghana Medical School, PO Box 4236, Accra, Ghana. chikalaryea@gmail.com
authors: Christabel C
authors: CC
authors: Enweronu-Laryea
authors: George O
authors: GO
authors: Adjei
authors: Benjamin
authors: B
authors: Mensah
authors: Nancy
authors: N
authors: Duah
authors: Neils B
authors: NB
authors: Quashie
mesh_terms: D000953:Antigens, Protozoan / Q000097:blood; D001769:Blood / Q000469:parasitology; D003430:Cross-Sectional Studies; D016054:DNA, Protozoan / Q000097:blood; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007118:Immunoassay; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000151:congenital* / Q000453:epidemiology*; D008297:Male; D008853:Microscopy; D018512:Parasitemia / Q000151:congenital / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence
chemical_list: D000953:Antigens, Protozoan; D016054:DNA, Protozoan