title: Placental malaria is rare among Zanzibari pregnant women who did not receive intermittent preventive treatment in pregnancy.
abstract: Zanzibar has transitioned from malaria control to the pre-elimination phase, and the continued need for intermittent preventive treatment during pregnancy (IPTp) has been questioned. We conducted a prospective observational study to estimate placental malaria positivity rate among women who did not receive IPTp with sulfadoxine-pyrimethamine. A convenience sample of pregnant women was enrolled from six clinics on the day of delivery from August of 2011 to September of 2012. Dried placental blood spot specimens were analyzed by polymerase chain reaction (PCR); 9 of 1,349 specimens (0.7%; precision estimate = 0.2-1.1%) were PCR-positive for Plasmodium falciparum. Placental infection was detected on both Pemba (N = 3) and Unguja (N = 6). Placental malaria positivity in Zanzibar was low, even in the absence of IPTp. It may be reasonable for the Ministry of Health to consider discontinuing IPTp, intensifying surveillance efforts, and promoting insecticide-treated nets and effective case management of malaria in pregnancy.
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.forename: Khadija
authors.initials: K
authors.lastname: Said
authors.forename: Mwinyi I
authors.initials: MI
authors.lastname: Msellem
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Chase
authors.forename: Natalie
authors.initials: N
authors.lastname: Hendler
authors.forename: Asma Ramadhan
authors.initials: AR
authors.lastname: Khamis
authors.forename: Elaine
authors.initials: E
authors.lastname: Roman
authors.forename: Chonge
authors.initials: C
authors.lastname: Kitojo
authors.forename: Alanna C
authors.initials: AC
authors.lastname: Schwartz
authors.forename: Julie
authors.initials: J
authors.lastname: Gutman
authors.forename: Peter D
authors.initials: PD
authors.lastname: McElroy
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D059788:Dried Blood Spot Testing; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology* / Q000473:pathology; D008875:Middle Aged; D010920:Placenta / Q000469:parasitology* / Q000473:pathology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine