Burden of Malaria during Pregnancy in Areas of Stable and Unstable Transmission in Ethiopia during a Nonepidemic Year

Newman, Robert D.
Hailemariam, Afework
Jimma, Daddi
Degifie, Abera
Kebede, Daniel
Rietveld, Aafje E. C.
Nahlen, Bernard L.
Barnwell, John W.
Steketee, Richard W.
Parise, Monica E.

¹Malaria Epidemiology
²Biology and Diagnostics Branches, Division of Parasitic Diseases, National Center for Infectious Diseases
³Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
⁴Malaria and Other Vector Borne Diseases Control Unit, Ethiopia Ministry of Health
⁵Oromia Regional Health Bureau, Addis Ababa, Ethiopia
⁶Roll Back Malaria, World Health Organization, Geneva, Switzerland

Presented in part: 50th annual meeting of the American Society for Tropical Medicine and Hygiene, Atlanta, 11-15 November 2001 (abstract 535); 51st Annual Epidemic Intelligence Service Conference, Centers for Disease Control and Prevention, Atlanta, 22-26 April 2002

Informed consent was obtained from all women in the local language (depending on study site) before enrollment. The human subjects guidelines of the Centers for Disease Control and Prevention and the Ethiopia Science and Technology Commission were strictly followed, and these institutions reviewed and approved the study procedures

Financial support: Centers for Disease Control and Prevention (U50/CCU012445); United States Agency for International Development (HFM-P-00-01-00022-00); World Health Organization (U50/CCU012445-06)

Reprints or correspondence: Dr. Robert D. Newman, Malaria Epidemiology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Mailstop F-22, Atlanta, GA 30341 ([email protected])

Received 25 September 2002; revised 30 May 2002; accepted 27 December 2002

Journal of Infectious Diseases 187(11):p 1765-1772, June 1, 2003. | DOI: 10.1086/374878

Little is known about the epidemiology of malaria during pregnancy in areas of unstable (epidemic-prone) transmission (UT) in sub-Saharan Africa. In cross-sectional studies, peripheral malaria parasitemia was identified in 10.4% of women attending antenatal care clinics at 1 stable transmission (ST) site and in 1.8% of women at 3 UT sites; parasitemia was associated with anemia in both ST (relative risk [RR], 2.0; P<.001) and UT (RR, 4.4; P<.001) sites. Placental parasitemia was identified more frequently during deliveries at ST sites (12/185; 6.5%) than at UT sites (21/833; 2.5%; P=.006). Placental parasitemia was associated with low birth weight at the ST site (RR, 3.2; P=.01) and prematurity at ST (RR, 2.7; P=.04) and UT (RR, 3.9; P=.01) sites and with a 7-fold increased risk of stillbirths at UT sites. The effectiveness and efficiency in Ethiopia of standard preventive strategies used in high-transmission regions (such as intermittent preventive treatment) may require further evaluation; approaches such as insecticide-treated bednets and epidemic preparedness may be needed to prevent adverse pregnancy outcomes