Sequoia I Leuba1, Daniel Westreich1, Carl L Bose2, Kimberly A Powers1, Andy Olshan1, Steve M Taylor3, Antoinette Tshefu4, Adrien Lokangaka4, Waldemar A Carlo5, Elwyn Chomba6, Edward A Liechty7, Sherri L Bucher7, Fabian Esamai8, Saleem Jessani9, Sarah Saleem9, Robert L Goldenberg10, Janet Moore11, Tracy Nolen11, Jennifer Hemingway-Foday11, Elizabeth M McClure11, Marion Koso-Thomas12, Richard J Derman13, Matthew Hoffman14, Melissa Bauserman2. 1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Division of Infectious Diseases and Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina, USA. 4. Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. 5. University of Alabama at Birmingham, Birmingham, Alabama, USA. 6. University Teaching Hospital, Lusaka, Zambia. 7. Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana, USA. 8. Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya. 9. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 10. Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA. 11. Social, Statistical and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA. 12. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. 13. Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 14. Department of Obstetrics and Gynecology, Christiana Care, Newark, Delaware, USA.
Abstract
BACKGROUND: Malaria can have deleterious effects early in pregnancy, during placentation. However, malaria testing and treatment are rarely initiated until the second trimester, leaving pregnancies unprotected in the first trimester. To inform potential early intervention approaches, we sought to identify clinical and demographic predictors of first-trimester malaria. METHODS: We prospectively recruited women from sites in the Democratic Republic of the Congo (DRC), Kenya, and Zambia who participated in the ASPIRIN (Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas) trial. Nulliparous women were tested for first-trimester Plasmodium falciparum infection by quantitative polymerase chain reaction. We evaluated predictors using descriptive statistics. RESULTS: First-trimester malaria prevalence among 1513 nulliparous pregnant women was 6.3% (95% confidence interval [CI], 3.7%-8.8%] in the Zambian site, 37.8% (95% CI, 34.2%-41.5%) in the Kenyan site, and 62.9% (95% CI, 58.6%-67.2%) in the DRC site. First-trimester malaria was associated with shorter height and younger age in Kenyan women in site-stratified analyses, and with lower educational attainment in analyses combining all 3 sites. No other predictors were identified. CONCLUSIONS: First-trimester malaria prevalence varied by study site in sub-Saharan Africa. The absence of consistent predictors suggests that routine parasite screening in early pregnancy may be needed to mitigate first-trimester malaria in high-prevalence settings.
BACKGROUND: Malaria can have deleterious effects early in pregnancy, during placentation. However, malaria testing and treatment are rarely initiated until the second trimester, leaving pregnancies unprotected in the first trimester. To inform potential early intervention approaches, we sought to identify clinical and demographic predictors of first-trimester malaria. METHODS: We prospectively recruited women from sites in the Democratic Republic of the Congo (DRC), Kenya, and Zambia who participated in the ASPIRIN (Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas) trial. Nulliparous women were tested for first-trimester Plasmodium falciparum infection by quantitative polymerase chain reaction. We evaluated predictors using descriptive statistics. RESULTS: First-trimester malaria prevalence among 1513 nulliparous pregnant women was 6.3% (95% confidence interval [CI], 3.7%-8.8%] in the Zambian site, 37.8% (95% CI, 34.2%-41.5%) in the Kenyan site, and 62.9% (95% CI, 58.6%-67.2%) in the DRC site. First-trimester malaria was associated with shorter height and younger age in Kenyan women in site-stratified analyses, and with lower educational attainment in analyses combining all 3 sites. No other predictors were identified. CONCLUSIONS: First-trimester malaria prevalence varied by study site in sub-Saharan Africa. The absence of consistent predictors suggests that routine parasite screening in early pregnancy may be needed to mitigate first-trimester malaria in high-prevalence settings.
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