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THE EFFECT OF MALARIA TRANSMISSION INTENSITY ON NEONATAL MORTALITY IN ENDEMIC AREAS

Estimates of the impact of Plasmodium falciparum infections during pregnancy on neonatal mortality have not taken into account how this varies with the level of malaria endemicity and thus do not indicate the possible effects of malaria control strategies that reduce transmission. We now review the relevant literature, and propose a mathematical model for the association between P. falciparum transmission and neonatal death. The excess risk of neonatal mortality in malaria-endemic areas appears to be insensitive to the intensity of P. falciparum transmission over a wide range of endemicity. Moderate reductions in the overall level of malaria transmission in endemic areas are therefore unlikely to significantly reduce neonatal mortality. The magnitude of the excess risk is very uncertain because existing estimates are heavily dependent on the questionable assumption that the effects are mediated by birth weight. Accurate prediction of the impact of malaria control measures targeted at pregnant women requires direct estimates of malaria-attributable neonatal mortality rates.

Received September 18, 2005. Accepted for publication February 6, 2006.

Acknowledgments: We thank the members of the Technical Advisory Group (Michael Alpers, Paul Coleman, David Evans, Brian Greenwood, Carol Levin, Kevin Marsh, F. Ellis McKenzie, Mark Miller, and Brian Sharp), the Project Management Team at the Program for Appropriate Technology in Health (PATH) Malaria Vaccine Initiative, and GlaxoSmithKline Biologicals S.A. for their assistance.

Financial support: The mathematical modeling study was supported by the PATH Malaria Vaccine Initiative and GlaxoSmithKline Biologicals S.A.

Disclaimer: Publication of this report and the contents hereof do not necessarily reflect the endorsement, opinion, or viewpoints of the PATH Malaria Vaccine Initiative or GlaxoSmithKline Biologicals S.A.

^* Address correspondence to Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, Postfach, 4002 Basel, Switzerland. E-mail: amanda.ross{at}unibas.chand, Thomas-A.Smith{at}unibas.ch

Authors’ address: Amanda Ross and Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, Postfach, 4002 Basel, Switzerland, Telephone: 41-61-284-8273, Fax: 41-61-284-8105, E-mails: amanda.ross{at}unibas.ch and Thomas-A.Smith{at}unibas.ch.

Reprint requests: Thomas Smith, Swiss Tropical Institute, Socinstrasse 57, Postfach, 4002 Basel, Switzerland.

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