THE CONTRIBUTION OF MALARIA IN PREGNANCY TO PERINATAL MORTALITY

JEAN-PIERRE VAN GEERTRUYDEN Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Search for other papers by JEAN-PIERRE VAN GEERTRUYDEN in
Current site
Google Scholar
PubMed
Close
,
FLORENCE THOMAS Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Search for other papers by FLORENCE THOMAS in
Current site
Google Scholar
PubMed
Close
,
ANNETTE ERHART Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Search for other papers by ANNETTE ERHART in
Current site
Google Scholar
PubMed
Close
, and
UMBERTO D’ALESSANDRO Department of Parasitology, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium

Search for other papers by UMBERTO D’ALESSANDRO in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

Author Notes

  • 1

    WHO/FRH/MSM/96.7, 1996 Perinatal Mortality: A Listing of Available Information. Maternal Health and Safe Motherhood Program. Geneva: World Health Organization.

    • PubMed
    • Export Citation
  • 2

    Weiner R, Ronsmans C, Dorman E, Jilo H, Muhoro A, Shulman C, 2003. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya. Bull World Health Organ 81 :561–566.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Shulman CE, Dorman EK, 2003. Reducing childhood mortality in poor countries—Importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg 97 :30–35.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    McGregor IA, Wilson ME, Billewicz WZ, 1983. Malaria infection of the placenta in The Gambia, west Africa; its incidence and relationship to stillbirth, birthweight and placental weight. Trans R Soc Trop Med Hyg 77 :232–244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Brabin BJ, 1983. An analysis of malaria in pregnancy in Africa. Bull World Health Organ 61 :1005–1016.

  • 6

    Nosten F, McGready R, Simpson JA, Thwai KL, Balkan S, Cho T, 1999. Effects of Plasmodium vivax malaria in pregnancy. Lancet 354 :546–549.

  • 7

    Blacklock DB, Gordon RM, 1925. Malaria infection as it occurs in late pregnancy; its relationship to labour and early infancy. Ann Trop Med Parasitol 19 :327–365.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Bruce-Chwatt LJ, 1952. Malaria in African infants and children in southern Nigeria. Ann Trop Med Parasitol 46 :173–200.

  • 9

    Archibald HM, 1956. The influence of malaria infection of the placenta on the incidence of prematurity. Bull World Health Organ 15 :842–845.

  • 10

    Spitz AJW, 1959. Malaria infection of the placenta and its influence on the incidence of prematurity in eastern Nigeria. Bull World Health Organ 21 :242–244.

  • 11

    McLaren DS, Ward PG, 1962. Malaria infection of the placenta and foetal nutrition. East Afr Med J 39 :182–189.

  • 12

    Jelliffe EFP, 1968. Low birth weight and malarial infection of the placenta. Bull World Health Organ 38 :69–78.

  • 13

    Reinhardt MC, Ambroise-Thomas P, Cavallo-Serra R, Meylan C, Gautier R, 1978. Malaria at delivery in Abidjan. Helv Paediatr Acta 33 :65–84.

  • 14

    Connor DSH, 1958. Malaria and prematurity in the western region of Nigeria. BMJ 2 :877–878.

  • 15

    Newman RD, Parise ME, Slutsker L, Nahlen B, Steketee RW, 2003. Safety, efficacy and determinants of effectiveness of antimalarial drugs during pregnancy: implications for prevention programmes in Plasmodium falciparum-endemic sub-Saharan Africa. Trop Med Int Health 8 :488–506.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Kramer MS, 1987. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 65 :663–737.

  • 17

    McCormick M-C, 1985. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312 :82–90.

  • 18

    Murphy SC, Breman JG, 2001. Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy. Am J Trop Med Hyg 64 :57–67.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Steketee RW, Nahlen BL, Parise ME, Menendez C, 2001. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 64 :28–35.

  • 20

    Bruce-Chwatt LJ, 1983. Malaria and pregnancy. BMJ 286 :63–76.

  • 21

    Greenwood AM, Menendez C, Todd J, Greenwood BM, 1994. The distribution of birth weights in Gambian women who received malaria chemoprophylaxis during their first pregnancy and in control women. Trans R Soc Trop Med Hyg 88 :311–312.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Menendez C, Todd J, Alonso PL, Francis N, Lulat S, Ceesay S, 1994. The effects of iron supplementation during pregnancy, given by traditional birth attendants, on the prevalence of anaemia and malaria. Trans R Soc Trop Med Hyg 88 :590–593.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    UNDP, Rapport Mondial sur le Dévelopement Humain 2002, 2003. Electronic citation.

    • PubMed
    • Export Citation
  • 24

    Snow RW, Craig M, Deichmann U, Marsh K, 1999. Estimating mortality, morbidity and disability due to malaria among Africa’s non-pregnant population. Bull World Health Organ 77 :624–640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Nyirjesy P, Kavasya T, Axelrod P, Fischer PR, 1993. Malaria during pregnancy: neonatal morbidity and mortality and the efficacy of chloroquine chemoprophylaxis. Clin Infect Dis 16 :127–132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Cohn LD, Becker BJ, 2003. How meta-analysis increases statistical power. Psychol Methods 8 :243–253.

  • 27

    Higgins JP, Thompson SG, 2002. Quantifying heterogeneity in a meta-analysis. Stat Med 21 :1539–1558.

  • 28

    Tabutin D, Eliwo A, 1980. Socio-economic and cultural differentials in the mortality of sub-Saharan Africa. van de Walle E, Pison G, Sala-Diakanda M, eds. Mortality and Society in Sub-Saharan Africa. Oxford, United Kingdom: Clarendon Press, 35–61.

    • PubMed
    • Export Citation
  • 29

    D’Alessandro U, Langerock P, Bennett S, Francis N, Cham K, Greenwood BM, 1996. The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia. Trans R Soc Trop Med Hyg 90 :487–492.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Sachs J, 2003. Economic Analyses Indicate that the Burden of Malaria is Great. Economics of Malaria Executive Summary. Cambridge: Center for International Development, Harvard University and London: London School of Hygiene and Tropical Medicine.

    • PubMed
    • Export Citation
  • 31

    Barros F-C, Victora C-G, Vaughan J-P, Estanislau H-J, 1987. Perinatal mortality in southern Brazil: a population-based study of 7,392 births. Bull World Health Organ 65 :95–104.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Guildea ZE, Fone DL, Dunstan FD, Sibert JR, Cartlidge PH, 2001. Social deprivation and the causes of stillbirth and infant mortality. Arch Dis Child 84 :307–310.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Naidu J, Moodley M, Adhikari R, Ramsaroop N, Morar OO, Dunmoye S, 2001. Clinico-pathological study of causes of perinatal mortality in a developing country. J Obstet Gynaecol 21 :443–447.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Richardus JH, Graafmans WC, Verloove-Vanhoorick SP, Mack-enbach JP; The Euronatal Audit Panel; The Euronatal Working Group, 2003. Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit. BJOG 11 :97–102.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Menon R, 1972. Pregnancy and malaria. Med J Mal 27 :115–119.

  • 36

    van Hung L, 1951. Paludisme et grossesse à Saïgon. Rev Pal Med Trop 83 :75.

  • 37

    Nosten F, 1991. Malaria during pregnancy in an area of unstable endemicity. Trans R Soc Trop Med Hyg 85 :424–429.

  • 38

    Schwetz J, Peel E, 1934. Congenital malaria and placental infections amongst the Negroes of central Africa. Trans R Soc Trop Med Hyg 28 :167–174.

  • 39

    Peel E, van Hoof L, 1948. Le paludisme à la maternité indigène de Léopoldville. Ann Soc Belg Med Trop 28 :413–420.

  • 40

    Steketee RW, Wirima JJ, Slutsker L, Breman JG, Heymann DL, 1996. Comparability of treatment groups and risk factors for parasitemia at the first antenatal clinic visit in a study of malaria treatment and prevention in pregnancy in rural Malawi. Am J Trop Med Hyg 55 (Suppl 1):17–23.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Garner P, Gulmezoglu AM, 2003. Drugs for preventing malaria-related illness in pregnant women and death in the newborn. Cochrane Data System Rev 1: CD000169.

  • 42

    Anagnos D, Lanoie LO, Palmieri JR, 1986. Effects of placental malaria on mothers and neonates from Zaire. Z Parasitol 72 :57–64.

  • 43

    Geelhoed DW, Visser LE, Addae V, Asare K, Schagen van Leeuwen JH, van Roosmalen J, 2001. Malaria prophylaxis and the reduction of anemia at childbirth. Int J Gynaecol Obstet 74 :133–138.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Lefait JF, Seixas J, Tavora Tavira L, Alves F, Alves A, 1999. Infection palustre à la maternité de Bissau (Guinée-Bissau), parasitémie maternelle, placentaire et néonatale en début de saison des pluies. Med Afr Noire 46 :93–98.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Voorhoeve AM, Muller AS, W’oigo H, 1979. Machakos Project Studies: agents affecting health of mother and child in a rural area of Kenya. XVI. The outcome of pregnancy. Trop Geogr Med 31 :607–627.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Kulmala T, Vaahtera M, Ndekha M, Koivisto AM, Cullinan T, Salin ML, Ashorn P, 2000. The importance of preterm births for peri- and neonatal mortality in rural Malawi. Paediatr Perinat Epidemiol 14 :219–226.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    McDermott JM, Steketee R, Wirima J, 1996. Perinatal mortality in rural Malawi. Bull World Health Organ 74 :165–171.

  • 48

    Sule-Odu AO, Ogunledun A, Olatunji AO, 2002. Impact of asymptomatic maternal malaria parasitaemia at parturition on perinatal outcome. J Obstet Gynaecol 22 :25–28.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Lamikanra OT, 1993. A study of malaria parasitaemia in pregnant women, placentae, cord blood and newborn babies in Lagos, Nigeria. West Afr J Med 12 :213–217.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50

    Hodges M, Williams RA, 1998. Registered infant and under-five deaths in Freetown, Sierra Leone from 1987–1991 and a comparison with 1969–1979. West Afr J Med 17 :95–98.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Woodruff AW, Adamson EA, El Suni A, Maughan TS, Kaku M, Bundru N, 1983. Infants in Juba, southern Sudan: the first six months of life. Lancet 2 :262–264.

  • 52

    Jamieson DJ, Meikle SF, Hillis SD, Mtsuko D, Mawji S, Duerr A, 2000. An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania. JAMA 283 :397–402.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Matteelli A, Donato F, Shein A, 1996. Malarial infection and birthweight in urban Zanzibar, Tanzania. Ann Trop Med Parasitol 90 :125–134.

  • 54

    Walraven GE, Mkanje RJ, van Roosmalen J, van Dongen PW, Dolmans WM, 1994. Comparison of perinatal outcome in rural Tanzania as obtained from a prospective community-based survey and hospital data. Trop Geogr Med 46 :11–13.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Okoko BJ, Ota MO, Yamuah LK, Idiong D, Mkpanam SN, Avieka A, Banya WA, Osinusi K, 2002. Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mcgregor. J Health Popul Nutr 20 :4–11.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56

    Greenwood AM, Greenwood BM, Bradley AK, Williams K, Shenton FC, Tulloch S, Byass P, Oldfield FSJ, 1987. A prospective survey of the outcome of pregnancy in a rural area of the Gambia. Bull World Health Organ 65 :635–643.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57

    Ndyomugyenyi R, Magnussen P, 2001. Malaria morbidity, mortality and pregnancy outcome in areas with different levels of malaria transmission in Uganda: a hospital record- based study. Trans R Soc Trop Med Hyg 95 :463–468.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Kasumba IN, Nalunkuma AJ, Mujuzi G, Kitaka FS, Byaruhanga R, Okong P, Egwang TG, 2000. Low birthweight associated with maternal anaemia and Plasmodium falciparum infection during pregnancy, in a peri-urban/urban area of low endemicity in Uganda. Ann Trop Med Parasitol 94 :7–13.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59

    Kalenga MK, Mutach K, Nsungula K, Kabyla I, Odimba FK, 1992. Epidemiological considerations on the deliveries of stillbirths in the maternity unit of Gecamines Sendwe of Lubum-bashi (Zaire). Rev Fr Gynecol Obstet 87 :26–29.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60

    Singh N, Mehra RK, Srivastava N, 2001. Malaria during pregnancy and infancy, in an area of intense malaria transmission in central India. Ann Trop Med Parasitol 95 :19–29.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61

    McGready R, Cho T, Keo NK, Thwai KL, Villegas L, Looaree-suwan S, White NJ, Nosten F, 2001. Artemisinin antimalarials in pregnancy: a prospective treatment study of 539 episodes of multidrug-resistant Plasmodium falciparum.Clin Infect Dis 33 :2009–2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62

    Nosten F, Vincenti M, Simpson J, Yei P, Thwai KL, de Vries A, Chongsuphajaisiddhi T, White NJ, 1999. The effects of meflo-quine treatment in pregnancy. Clin Infect Dis 28 :808–815.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63

    Amoa AB, Klufio CA, Moro M, Kariwiga G, Mola G, 1998. A case-control study of stillbirths at the Port Moresby General Hospital. P N G Med J 41 :126–136.

  • 64

    Mola G, Permezel M, Amoa AB, Klufio CA, 1999. Anaemia and perinatal outcome in Port Moresby. Aust N Z J Obstet Gynaecol 39 :31–34.

  • 65

    Das LK, 2000. Malaria during pregnancy and its effects on foetus in a tribal area of Koraput District, Orissa. Indian J Malariol 37 :11–17.

  • 66

    Carles G, Bousquet F, Raynal P, Peneau C, Mignot V, Arbeille P, 1998. Pregnancy and malaria. Study of 143 cases in French Guyana. J Gynecol Obstet Biol Reprod (Paris) 27 :798–805.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67

    Luxemburger C, McGready R, Kham A, 2001. Effects of malaria during pregnancy on infant mortality in an area of low malaria transmission. Am J Epidemiol 154 :459–465.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68

    Philippe E, Gass R, Gendrel D, Zinsou RD, Walter P, Ivanoff B, Lasalle Y, Blot P, 1984. The placenta of premature and hypotrophic Gabonese infants. J Gynecol Obstet Biol Reprod (Paris) 13 :515–519.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 69

    Paksoy N, 1986. The incidence of placental malaria in Vanuatu in the south Pacific. Trans R Soc Trop Med Hyg 80 :174–175.

  • 70

    Taha T el-T, Gray RH, 1993. Malaria and perinatal mortality in central Sudan. Am J Epidemiol 138 :563–568.

  • 71

    Osman NB, Folgosa E, Gonzales C, Bergstrom S, 1995. Genital infections in the aetiology of late fetal death: an incident case-referent study. J Trop Pediatr 41 :258–266.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 72

    Newman RD, Hailemariam A, Jimma D, Degifie A, Kebede D, Rietveld AE, Nahlen BL, Barnwell JW, Steketee RW, Parise ME, 2003. Burden of malaria during pregnancy in areas of stable and unstable transmission in Ethiopia during a nonepidemic year. J Infect Dis 187 :1765–1772.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 217 187 10
Full Text Views 458 5 1
PDF Downloads 116 2 2
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save