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The link between malaria and perinatal mortality was explored by systematically reviewing 117 studies published between 1948 and 2002. The mean perinatal mortality rate was higher in malaria endemic countries (61.1/1,000, 95% confidence interval [CI] = 52.1–70.1) than in non-endemic countries (25.8/1,000, 95% CI = 21.1–30.6). Similarly, the fetal mortality rate was higher in endemic countries (40.1/1,000, 95% CI = 32.1–48.0) than in non-endemic countries (20.0/1,000, 95% CI = 13.2–26.8) countries. Considering that perinatal mortality is an important indicator of obstetric care quality and socioeconomic development, further analysis was restricted to countries with a human development index between 500 and 800. In this category, the perinatal mortality rate was also significantly higher in endemic countries (50.5/1,000, 95% CI = 35.5–65.5) than in non-endemic countries (30.0/1,000, 95% CI = 25.7–34.3). In some publications, the occurrence of placental malaria and stillbirth was available. Placental malaria was significantly associated with a higher risk for stillbirth, regardless of parity (odds ratio = 2.19, 95% CI = 1.49–3.22, P < 0.001). Despite the limitations involved in this kind of review, all information found indicates that in endemic countries, malaria is an important determinant of perinatal mortality. Preventive measures such as intermittent preventive treatment or insecticide-treated bed nets could substantially reduce perinatal mortality and fetal wastage.
Received January 5, 2004. Accepted for publication March 6, 2004.
Acknowledgments: We thank Professor Bernard Brabin for his useful comments during the preparation of the manuscript.
Financial support: This work received financial support from the European Commission Research Directorate (contract no: PREMA-EU 84 150).
Authors’ address: Jean-Pierre van Geertruyden, Florence Thomas, Annette Erhart, and Umberto D’Alessandro, Department of Parasitology, Prince Leopold Institute of Tropical Medicine Nationalestraat 155, B-2000 Antwerp, Belgium, Telephone: 32-3-247-6354, Fax: 32-3-247-6362, E-mail: udalessandro{at}itg.be.
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