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Prevalence and Predictors of Maternal Peripheral Malaria Parasitemia in Central Mozambique

Malaria infection during pregnancy (MiP) is heterogeneously distributed even in malaria-endemic countries. Program planners require data to facilitate identification of highest-priority populations for MiP control. Using data from two cross-sectional studies of 5,528 pregnant women in 8 neighboring sites in Mozambique, we described factors associated with maternal peripheral parasitemia by using logistic regression. Principal multivariate predictors of maternal peripheral parasitemia were gravidity (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.60–3.26 for primigravidae and OR = 1.61, 95% CI = 1.29–2.01 for secundigravidae compared with gravidity 3); age (OR = 0.96 per year, 95% CI = 0.94–0.99); study site (OR = 1.45, 95% CI = 1.34–1.56 to 5.32, 95% CI = 4.92–5.75) for comparison with the reference site; and no maternal education (OR = 1.38, 95% CI = 1.15–1.66) compared with any education. Other predictors (in subgroups) were bed net use (OR = 0.49, 95% CI = 0.48–0.50); preventive sulfadoxine-pyrimethamine doses (OR = 0.25, 95% CI = 0.24–0.25); and infection with human immunodeficiency virus (HIV) (OR = 1.49, 95% CI = 1.11–2.00). Programmatic priorities should respond to heterogeneous distribution of multiple risk factors, including prevalance of malaria and infection with HIV, and maternal socioeconomic status.

Received September 25, 2006. Accepted for publication April 12, 2007.

Acknowledgments: We are grateful to the following entities and individuals for technical support and/or assistance with study implementation: Direcção Provincial de Saúde, Província de Sofala; Direcção Provincial de Saúde, Província de Manica; Direcção Distrital de Saúde, Distrito de Gondola; Direcção Distrital de Saúde, Distrito de Nhamatanda; the National Malaria Control Program of Mozambique, the Malaria Branch of the Centers for Disease Control and Prevention (Atlanta, GA), Pedro João Corda, David Ehlert, Maria Felicidade Faria, Florência Floriano, Sheila Lukehart, Marquês Machaieie, Tom Martin, Josefa Sairosse, Benjamin Stubbs, and Fernanda Toalha.

Financial support: This study was supported by a cooperative agreement from the Centers for Disease Control and Prevention through the Association of Schools of Public Health (grant U36/CCU300430-20), and by the Bill and Melinda Gates Foundation.

^* Address correspondence to Paula E. Brentlinger, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195. E-mail: brentp2{at}u.washington.edu

Authors’ addresses: Paula E. Brentlinger, Kenneth Gimbel-Sherr, Mary Anne Mercer, and Stephen Gloyd, Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195, Telephone: 206-543-8382, Fax: 206-543-3964, E-mails: brentp2{at}u.washington.edu, ksherr{at}u.washington.edu, mamercer{at}u.washington.edu, and gloyd{at}u.washington.edu. Pablo Montoya and Ana Judith Blanco Rojas, Health Alliance International, Rua Mayor Serpa Pinto 294, 4° Andar, Sector da Repartição de Saúde da Comunidade, Beira, Mozambique, Telephone: 258-3-324-271, Fax: 258-3-325-882, E-mails: pablom{at}teledata.mz and anajublan{at}hotmail.com. Maria Ana Chadreque Correia, Health Alliance International, Rua Dr. Araújo de Lacerda 147 CP 266 Chimoio, Mozambique, Telephone: 258-51-23251, E-mail: ma.correia{at}teledata.mz. Martinho Dgedge, Training Department, Department of Human Resources, Ministry of Health, Av Eduardo Mondlane c/Salvador Allende, C.P. 264 Maputo, Mozambique, E-mail: mdgedge{at}dnsdee.misau.gov.mz. Francisco Saúte, National Malaria Control Program of Mozambique, Communicable Disease Division, Ministry of Health, Av Eduardo Mondlane c/Salvador Allende, C.P. 264 Maputo, Mozambique, Telephone: 258-82-326-527, Fax: 258-1-311-621, E-mail: fsaute{at}dnsdee.misau.gov.mz.

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