Akua Kyerewaa Botwe1,2,3, Felix Boakye Oppong4, Stephaney Gyaase4, Seth Owusu-Agyei4,5, Muhammad Asghar6,7, Kwaku Poku Asante4, Anna Färnert4,7,8, Faith Osier9,10. 1. Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. akua.agyeman-budu@kintampo-hrc.org. 2. Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. akua.agyeman-budu@kintampo-hrc.org. 3. Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya. akua.agyeman-budu@kintampo-hrc.org. 4. Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. 5. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana. 6. Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. 7. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden. 8. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 9. Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya. 10. Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany.
Abstract
BACKGROUND: Understanding why some infants tolerate infections, remaining asymptomatic while others succumb to repeated symptomatic malaria is beneficial for studies of naturally acquired immunity and can guide control interventions. This study compared demographic, host and maternal factors associated with being either parasite negative or having asymptomatic infections versus developing symptomatic malaria in the first year of life. METHODS: A birth cohort (n = 1264) was monitored longitudinally over two years for malaria infections in Kintampo, Ghana. Symptomatic and asymptomatic infections were detected actively through monthly home visits, complemented by passive case detection. Light microscopy was used to detect parasitaemia. Based on data from a minimum of eight monthly visits within the first year of life, infants were classified into one of four groups: "parasite negative", "only-asymptomatic", "only-symptomatic" or "alternating" i.e., sometimes symptomatic and other times asymptomatic. The host and maternal characteristics and demographic factors in relation to these four groups were compared. RESULTS: The parasite negative group formed 36% of the cohort, whilst the only-symptomatic were 35%. The alternating group were 22% and the only-asymptomatic were 7% of the cohort. There were significant associations between residence, socio-economic status (SES), parity, IPTp doses, delivery place of infant and having or not having malaria parasites. Maternal factors such as early commencement and frequency of ante-natal care (ANC) were significantly higher in the parasite negative group compared to all others. ITN use in pregnancy increased the odds of infant having only asymptomatic infections ("protected against disease"). Placental malaria was more common in the groups of infants with symptomatic malaria. Urban residence was significantly higher in the parasite negative group, while birth in the malaria transmission season were significantly more common in the alternating and parasite negative groups. Risk factors for infants with symptomatic malaria included low SES, birth in private maternity homes, sickle cell normal variant, lower MUAC, reported intake of anti-malarials and increased morbidity before the first microscopic infection was detected. CONCLUSION: Strengthening ANC by encouraging early and regular attendance, the use of IPTp, maternal bed nets and improving the nourishment of infants help reduce the frequency of symptomatic malaria over the first year of life.
BACKGROUND: Understanding why some infants tolerate infections, remaining asymptomatic while others succumb to repeated symptomatic malaria is beneficial for studies of naturally acquired immunity and can guide control interventions. This study compared demographic, host and maternal factors associated with being either parasite negative or having asymptomatic infections versus developing symptomatic malaria in the first year of life. METHODS: A birth cohort (n = 1264) was monitored longitudinally over two years for malaria infections in Kintampo, Ghana. Symptomatic and asymptomatic infections were detected actively through monthly home visits, complemented by passive case detection. Light microscopy was used to detect parasitaemia. Based on data from a minimum of eight monthly visits within the first year of life, infants were classified into one of four groups: "parasite negative", "only-asymptomatic", "only-symptomatic" or "alternating" i.e., sometimes symptomatic and other times asymptomatic. The host and maternal characteristics and demographic factors in relation to these four groups were compared. RESULTS: The parasite negative group formed 36% of the cohort, whilst the only-symptomatic were 35%. The alternating group were 22% and the only-asymptomatic were 7% of the cohort. There were significant associations between residence, socio-economic status (SES), parity, IPTp doses, delivery place of infant and having or not having malaria parasites. Maternal factors such as early commencement and frequency of ante-natal care (ANC) were significantly higher in the parasite negative group compared to all others. ITN use in pregnancy increased the odds of infant having only asymptomatic infections ("protected against disease"). Placental malaria was more common in the groups of infants with symptomatic malaria. Urban residence was significantly higher in the parasite negative group, while birth in the malaria transmission season were significantly more common in the alternating and parasite negative groups. Risk factors for infants with symptomatic malaria included low SES, birth in private maternity homes, sickle cell normal variant, lower MUAC, reported intake of anti-malarials and increased morbidity before the first microscopic infection was detected. CONCLUSION: Strengthening ANC by encouraging early and regular attendance, the use of IPTp, maternal bed nets and improving the nourishment of infants help reduce the frequency of symptomatic malaria over the first year of life.
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Authors: Hamtandi Magloire Natama; Eduard Rovira-Vallbona; M Athanase Somé; Serge Henri Zango; Hermann Sorgho; Pieter Guetens; Maminata Coulibaly-Traoré; Innocent Valea; Petra F Mens; Henk D F H Schallig; Luc Kestens; Halidou Tinto; Anna Rosanas-Urgell Journal: Malar J Date: 2018-04-12 Impact factor: 2.979