Congenital Plasmodium falciparum malaria in sub-Saharan Africa: a rarity or frequent occurrence?

It is still debatable whether congenital Plasmodium falciparum malaria is a rarity or a frequent occurrence in sub-Saharan Africa. The objective of this report is to review scientific information and findings from investigations conducted in sub-Saharan Africa on the occurrence of congenital malaria to highlight the need for development of appropriate public health policy on prevention, care, treatment, and support activities. Studies conducted in sub-Saharan Africa within the last two decades (1986 to 2006) that investigated congenital or transplacental malaria were identified using the Medline-Entrez Pubmed search and systematically reviewed. References from selected publications obtained from a Google search were also used to identify additional relevant literature for the review. Five of the studies reviewed indicated that congenital malaria is a rare event in sub-Saharan Africa with prevalence ranging from 0% to 0.7% although maternal malaria parasitemia rates of between 24.8 and 54.4% were obtained. Nine other studies noted that congenital malaria was not uncommon, with prevalence reaching up to 37%. These studies also noted high frequency of neonatal peripheral parasitemia ranging from 4.0 to 46.7%. Congenital malaria should be suspected and investigated in babies whose mothers are parasitemic, particularly if the babies are febrile.