Congenital Malaria in newborns delivered to Malaria-Infected mothers in hilly region of northern India: Is it really deadly?

Background: Malaria is endemic in many states of India. Though there are reports of maternal and congenital malaria from endemic areas, however there remains paucity of data from hilly terrains. The present study evaluated the prevalence, clinical and microbiological spectrum of maternal and congenital malaria at a tertiary health care facility in Northern India over a period of 18 months. Methods: In this observational study, mothers along with their new borns were evaluated for malaria by maternal, placental and cord blood smear examination and rapid point-of-care diagnostic serological tests. Positive cases were confirmed by polymerase chain reaction. Mother-newborn duos were followed up till discharge from hospital. Results : A total of 843 mothers delivered during the study period and were screened along with their newborns and placentae. A total of Ten (1.18%) mothers had evidence of malarial parasitemia (Plasmodium vivax, n=7 and Pl. falciparum, n=3), however none of the placental and cord blood samples were positive for malaria. Overall, 127 (15.1%) neonates required admission in neonatal intensive care unit for various morbidities. Incidence of small for gestational age (SGA) was high (n=210; 24.9%). Multivariate logistic regression analysis demonstrated maternal malaria to be an independent contributor for SGA [Odds Ratio (95% Confidence Interval), 10.7 (2.06 - 49.72)]. However, only 2% variance of SGA could be explained by maternal malaria alone. Conclusions: We report an encouragingly lower incidence of maternal malaria in mothers attending for delivery and a ‘Zero’ incidence for placental and congenital malaria during the study period as compared to national data (upto 7.4% in non-immune mothers), although maternal malaria could be a causative factor for SGA.

Placental Plasmodium Parasitemia and Pregnancy Outcome In Asymptomatic Parturients at Term In A Tertiary Institution South East Nigeria

Background: Malaria in pregnancy is a major public health problem in sub-Saharan Africa and can result in placental malaria with its associated adverse pregnancy outcomes.Method: This was a case control study involving 190 consenting, asymptomatic, booked parturients, recruited consecutively at 36 week. The aim was to determine the effect of placental malaria on pregnancy outcome in asymptomatic women delivering at term. The participants were screened for malaria parasites using peripheral blood film. Based on their results, the participants were grouped into parasitemia positive cases (Group 1) and parasitemia negative controls (Group 2). Both groups were then followed up in the clinic till they presented in labour at term. In labour, participants’ peripheral venous blood sample were collected and used to determine intrapartum haematocrit and peripheral parasitemia. After delivery, cord blood and a section of the placenta were collected for investigation. Data analysis: Collected data were analysed using Statistical Product and service solutions (SPSS) software (version 20). Numerical variables were presented as mean and standard deviation (Mean SD), while categorical variables were presented as numbers and percentages. Chi-square test(X2) was used to compare qualitative variables. Odds ratio (OR) and Confidence interval(CI) were used to observe the odds of outcomes. A p-value 0.05 was considered statistically significant.Results: The prevalence of placental malaria and congenital malaria were 41.05% and 29.47% respectively. Birth weight, APGAR score, NICU admission or congenital malaria were not statistically significant between the two groups. The mean birth weight was 3.16 ± 0.5 kg while 17.89% had low birth weight. There was also no significant difference between the two groups in terms of the association of placental parasitaemia and maternal anaemia or dose of IPT taken. There was no significant association between placental parasitaemia and low parity. Multivariate logistic regression analysis of maternal anaemia and low birth weight showed significant placental parasitaemia in both cases (p = 0.004). Conclusion: Placental parasitaemia is a major complication of malaria in pregnancy and is associated with adverse feto-maternal effects. Early booking and uptake of intermittent preventive therapy with sulphadoxine-pyrimethamine may help reduce the adverse effects.

Case series on congenital malaria from a tertiary care hospital in North Eastern India

Malaria in early life is due to transfer of parasitized maternal red blood cell across placenta or direct transfer of parasite from placental syncytotrophoblast. Congenital malaria is defined as malaria acquired from mother in prenatal or perinatal period. Most of the cases in endemic area, passive transfer of high amount of maternal IgG antibody binds to malarial antigen and various components of parasites giving rise to various atypical clinical presentation. This case series will help neonatologist to think malaria in all non-specific symptoms of inconsolable cry, poor feeding, lethargy, even persistence of physiological jaundice. Very few reports of congenital malaria from India is reported in literature. Our series of five cases will address these few atypical symptoms.

BIOCHEMICAL AND HAEMATOLOGICAL CHANGES ASSOCIATED WITH TRANSPLACENTAL CONGENITAL MALARIA IN KOGI STATE, NORTH CENTRAL NIGERIA

Background: Transplacental congenital malaria is a vertical transplacental transmission of malaria parasites from the mother to the baby in utero or perinatally during labor. Cord blood that conveyed oxygen and nutrients from mother to fetus and return with carbon dioxide and other waste materials can transmit malaria pathogen. This study is aim to establish early diagnosis of transplacental congenital malaria using cord blood biochemical and haematological indices. Cord blood from 164 babies delivered at three hospitals in Kogi State between January and December, 2020 were microscopically investigated for malaria parasite. Biochemical and Haematological analyses were done using SYSMEX XP 300, Roche 9180 and VIS Spectrophotometer model 721. The data obtained were expressed as mean plus or minus standard deviation using SPSS 23. The indicator level of statistical significance was set at p<0.05. The results showed significant (p<0.05) decreased in values of WBC, platelet, sodium, potassium, urea, creatinine, RBC, PCV, haemoglobin and MCHC in malaria infected cord blood in comparison to malaria negative control group. Significant (P<0.05) increased activities of liver enzymes (AST, ALT, ALP), total protein, bicarbonate and chloride in malaria infected cord blood when compared with malaria negative group. However, no statistically significant difference in lymphocyte, MCV, MCH, neutrophil and mixed of both malaria infected and malaria negative cord blood. This study suggests that cord blood biochemical and haematological indices can be used to diagnose and manage transplacental congenital malaria in fetus and neonates. Keywords: Transplacental, Biochemical, Haematological and Congenital Malaria.

Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature Review

Congenital malaria is the presence of malaria parasites in a blood smear obtained from a neonate usually within 24 hours to 7 days of life. It has for long been regarded a rare condition. However, recent data indicate that congenital malaria complicates around 35.9% of live births globally, 0–37% in Sub-Saharan Africa and about 4–6.1% in Eastern Uganda. We present a 2-day-old neonate who presented with fever, irritability, and failure to breastfeed. Laboratory tests indicated that the neonate had a positive Giemsa-stained peripheral smear for Plasmodium falciparum, with a positive malaria rapid diagnostic test (MRDT) for P. falciparum malaria. The mother had a negative peripheral film for malaria and a negative MRDT. The neonate was managed with intravenous artesunate with improvement.

Are there variations in hotspots in clinical malaria in pregnancy and neonatal malaria? Evidence from Ghana

BackgroundMalaria in pregnancy (MIP) is a significant public health problem, and affects both mother and foetus. MIP has both direct and indirect effects. These direct effects attributed to malaria in pregnancy are clinical malaria in pregnancy and congenital malaria. Although there has been a steady decline of malaria in pregnancy (MIP); reducing from 9% in 2004 to 1.4% in 2016, the decline, does not seem equitable across the country. There was therefore a need to identify areas where clinical MIP and neonatal was high and target them for interventions (neonatal malaria was used because data for malaria was available only for the first 28 days). As a result, this study sought to use routine data to identify areas of high transmission (hotspots) for clinical malaria in pregnancy and neonatal malaria (extrapolating for congenital malaria hotspots).Methods Clinical MIP and neonatal malaria (suspected and confirmed) data were retrieved from the national routine database. Using expected pregnancy and all clinical malaria cases as the denominators of clinical malaria in pregnancy and clinical malaria respectively, the per 1000 cases of malaria in pregnancy and percentage neonatal malaria were calculated for both conditions. These two data sets were fed into ARC GIS software and hotspots spatially determined for both conditions from 2014 to 2016. ResultsVariations in hotspots were identified both chronologically and geospatially for clinical MIP and neonatal malaria respectively. Nevertheless, stable hotspots were found for clinical malaria in pregnancy for the three years and stable hotspots also identified for Neonatal malaria for two years. Congenital malaria was extrapolated from neonatal malaria data only for Bole District in the Northern Region of Ghana for 2015.Conclusions:Hotspots for malaria in pregnancy show marked variation year on year both for clinical malaria in pregnancy and neonatal malaria and vary geospatially. The differences in hotspots in clinical malaria in pregnancy and neonatal malaria also show that neonatal malaria cannot be attributed to congenital malaria and therefore is not the effect of malaria in pregnancy. However, stable hotspots for clinical malaria in pregnancy should be targeted for intervention.

Are There Variations in Hotspots in Clinical Malaria in Pregnancy and Neonatal Malaria? Evidence From Ghana

BackgroundMalaria in pregnancy (MIP) is a significant public health problem, and affects both mother and foetus. MIP has both direct and indirect effects. These direct effects attributed to malaria in pregnancy are clinical malaria in pregnancy and congenital malaria. Although there has been a steady decline of malaria in pregnancy (MIP); reducing from 9% in 2004 to 1.4% in 2016, the decline, does not seem equitable across the country. There was therefore a need to identify areas where clinical MIP and neonatal was high and target them for interventions (neonatal malaria was used because data for malaria was available only for the first 28 days). As a result, this study sought to use routine data to identify areas of high transmission (hotspots) for clinical malaria in pregnancy and neonatal malaria (extrapolating for congenital malaria hotspots).Methods Clinical MIP and neonatal malaria (suspected and confirmed) data were retrieved from the national routine database. Using expected pregnancy and all clinical malaria cases as the denominators of clinical malaria in pregnancy and clinical malaria respectively, the per 1000 cases of malaria in pregnancy and percentage neonatal malaria were calculated for both conditions. These two data sets were fed into ARC GIS software and hotspots spatially determined for both conditions from 2014 to 2016. ResultsVariations in hotspots were identified both chronologically and geospatially for clinical MIP and neonatal malaria respectively. Nevertheless, stable hotspots were found for clinical malaria in pregnancy for the three years and stable hotspots also identified for Neonatal malaria for two years. Congenital malaria was extrapolated from neonatal malaria data only for Bole District in the Northern Region of Ghana for 2015.Conclusions:Hotspots for malaria in pregnancy show marked variation year on year both for clinical malaria in pregnancy and neonatal malaria and vary geospatially. The differences in hotspots in clinical malaria in pregnancy and neonatal malaria also show that neonatal malaria cannot be attributed to congenital malaria and therefore is not the effect of malaria in pregnancy. However, stable hotspots for clinical malaria in pregnancy should be targeted for intervention.

Placental Malaria histological features and the burden of congenital malaria among HIV/ malaria co-infected mothers in Benin City, Edo State

Background: It is well documented that sub-Saharan Africa bears the highest burden of both malaria and HIV. Coinfection with both diseases is also well documented. Malaria parasites infecting the placenta lead to inflammation, intervillous fibrin deposition and infarction. This pathologic effect of malaria on the placental has led to the staging of placental malaria histology. These pathologic features may reflect different levels in the breach of the integrity of the placenta which may predispose to transmission of congenital malaria and possibly HIV. But few if any have examined the association of maternal placental malaria histology stages in HIV positive and negative mothers and the effects of these on their newborns (congenital malaria). Methods: Subjects were 162 newborns of HIV/malaria co-infected mothers and Controls were 162 newborns of HIV negative malaria infected mothers. Blood film for malaria parasites was done on cord blood and peripheral blood on days 1, 3 and 7 in the newborns. Maternal peripheral blood film for malaria parasite was done at delivery and placental tissue was obtained for confirmation of placental malaria by histology. Diagnosis of malaria in blood films was by light microscopy. Results: The placental malaria histology in HIV positive mothers were predominantly the chronic type (51.9%) and past type (54.6%) in HIV negative mothers respectively. Congenital malaria was significantly more in chronic types of placental malaria histology irrespective of maternal HIV status (p=0.017 in subjects and p= 0.000 in controls respectively) Conclusion: Babies born to mothers are at increased risk for congenital malaria if their placental malaria histology is of the chronic type compared to the other types (active and past) irrespective of maternal HIV status. This risk (chronic type) is highest in mothers with HIV; therefore, all babies born to HIV positive mothers should be screened for congenital malaria and managed as appropriate.