title: Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study.
abstract: BACKGROUND
  Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain.
  
  
  METHODS
  We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology.
  
  
  RESULTS
  The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants.
  
  
  CONCLUSIONS
  There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Kintampo.
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Matthew
authors.initials: M
authors.lastname: Cairns
authors.forename: Daniel
authors.initials: D
authors.lastname: Dodoo
authors.forename: Ellen Abrafi
authors.initials: EA
authors.lastname: Boamah
authors.forename: Richard
authors.initials: R
authors.lastname: Gyasi
authors.forename: George
authors.initials: G
authors.lastname: Adjei
authors.forename: Ben
authors.initials: B
authors.lastname: Gyan
authors.forename: Akua
authors.initials: A
authors.lastname: Agyeman-Budu
authors.forename: Theophilus
authors.initials: T
authors.lastname: Dodoo
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mahama
authors.forename: Nicholas
authors.initials: N
authors.lastname: Amoako
authors.forename: David Kwame
authors.initials: DK
authors.lastname: Dosoo
authors.forename: Kwadwo
authors.initials: K
authors.lastname: Koram
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005869:Ghana; D020073:Gravidity; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D008431:Maternal-Fetal Exchange; D018512:Parasitemia / Q000453:epidemiology* / Q000635:transmission; D010920:Placenta / Q000469:parasitology*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012621:Seasons; D055815:Young Adult
keywords: Ghana; cohort study; infant malaria; malaria; malaria epidemiology; placental malaria
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