Asymptomatic malaria and anaemia among pregnant women during high and low malaria transmission seasons in Burkina Faso: household-based cross-sectional surveys in Burkina Faso, 2013 and 2017.

Publisher: BioMed Central Country of Publication: England NLM ID: 101139802 Publication Model: Electronic Cited Medium: Internet ISSN: 1475-2875 (Electronic) Linking ISSN: 14752875 NLM ISO Abbreviation: Malar J Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Anemia/*epidemiology ; Asymptomatic Infections/*epidemiology ; Malaria/*epidemiology ; Pregnancy Complications, Parasitic/*epidemiology; Adult ; Anemia/parasitology ; Burkina Faso/epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Malaria/parasitology ; Pregnancy ; Pregnancy Complications, Parasitic/parasitology ; Pregnant Women ; Prevalence ; Young Adult

Background: Malaria in endemic countries is often asymptomatic during pregnancy, but it has substantial consequences for both the mother and her unborn baby. During pregnancy, anaemia is an important consequence of malaria infection. In Burkina Faso, the intensity of malaria varies according to the season, albeit the prevalence of malaria and anaemia as well as their risk factors, during high and low malaria transmission seasons is underexplored at the household level.
Methods: Data of 1751 pregnant women from October 2013 to March 2014 and 1931 pregnant women from April 2017 to June 2017 were drawn from two cross-sectional household surveys conducted in 24 health districts of Burkina Faso. Pregnant women were tested for malaria in their household after consenting. Asymptomatic carriage was defined as a positive result from malaria rapid diagnostic tests in the absence of clinical symptoms of malaria. Anaemia was defined as haemoglobin level less than 11 g/dL in the first and third trimester and less than 10.5 g/dL in the second trimester of pregnancy.
Results: Prevalence of asymptomatic malaria in pregnancy was estimated at 23.9% (95% CI 20.2-28.0) during the high transmission season (October-November) in 2013. During the low transmission season, it was 12.7% (95% CI 10.9-14.7) between December and March in 2013-2014 and halved (6.4%; 95% CI 5.3-7.6) between April and June 2017. Anaemia prevalence was estimated at 59.4% (95% CI 54.8-63.8) during the high transmission season in 2013. During the low transmission season, it was 50.6% (95% CI 47.7-53.4) between December and March 2013-2014 and 65.0% (95% CI 62.8-67.2) between April and June, 2017.
Conclusion: This study revealed that the prevalence of malaria asymptomatic carriage and anaemia among pregnant women at the community level remain high throughout the year. Thus, more efforts are needed to increase prevention measures such as IPTp-SP coverage in order to reduce anaemia and contribute to preventing low birth weight and poor pregnancy outcomes.

Schantz-Dunn J, Nour NM. Malaria and pregnancy: a global health perspective. Rev Obstet Gynecol. 2009;2:186–92. (PMID: 198265762760896)
van Geertruyden J-P, Thomas F, Erhart A, D’Alessandro U. The contribution of malaria in pregnancy to perinatal mortality. Am J Trop Med Hyg. 2004;71:35–40. (PMID: 1533181710.4269/ajtmh.2004.71.3515331817)
Schwetz J, Peel E. Congenital malaria and placental infections amongst the Negroes of central Africa. Trans R Soc Trop Med Hyg. 1934;28:167–74. (PMID: 10.1016/S0035-9203(34)90139-5)
Madanitsa M, Kalilani L, Mwapasa V, van Eijk AM, Khairallah C, Ali D, et al. Scheduled intermittent screening with rapid diagnostic tests and treatment with dihydroartemisinin-piperaquine versus intermittent preventive therapy with sulfadoxine-pyrimethamine for malaria in pregnancy in Malawi: an open-label randomized controlled trial. PLoS Med. 2016;13:e1002124. (PMID: 27622558502127110.1371/journal.pmed.1002124)
Menendez C, Ordi J, Ismail MR, Ventura PJ, Aponte JJ, Kahigwa E, et al. The impact of placental malaria on gestational age and birth weight. J Infect Dis. 2000;181:1740–5. (PMID: 1082377610.1086/31544910823776)
Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001;64:28–35. (PMID: 1142517510.4269/ajtmh.2001.64.28)
Shulman CE, Marshall T, Dorman EK, Bulmer JN, Cutts F, Peshu N, et al. Malaria in pregnancy: adverse effects on haemoglobin levels and birthweight in primigravidae and multigravidae. Trop Med Int Health. 2001;6:770–8. (PMID: 1167912510.1046/j.1365-3156.2001.00786.x11679125)
Uneke CJ, Sunday-Adeoye I, Iyare FE, Ugwuja EI, Duhlinska DD. Impact of maternal Plasmodium falciparum malaria and haematological parameters on pregnancy and its outcome in southeastern Nigeria. J Vector Borne Dis. 2007;44:285–90. (PMID: 1809253818092538)
Natama HM, Ouedraogo DF, Sorgho H, Rovira-Vallbona E, Serra-Casas E, Somé MA, et al. Diagnosing congenital malaria in a high-transmission setting: clinical relevance and usefulness of P. falciparum HRP2-based testing. Sci Rep. 2017;7:2080. (PMID: 28522856543709310.1038/s41598-017-02173-6)
Berry I, Walker P, Tagbor H, Bojang K, Coulibaly SO, Kayentao K, et al. Seasonal dynamics of malaria in pregnancy in West Africa: evidence for carriage of infections acquired before pregnancy until first contact with antenatal care. Am J Trop Med Hyg. 2018;98:534–42. (PMID: 2921035110.4269/ajtmh.17-062029210351)
Sule-Odu AO, Ogunledun A, Olatunji AO. Impact of asymptomatic maternal malaria parasitaemia at parturition on perinatal outcome. J Obstet Gynaecol (Lahore). 2002;22:25–8. (PMID: 10.1080/01443610120101664)
Anorlu RI, Odum CU, Essien EE. Asymptomatic malaria parasitaemia in pregnant women at booking in a primary health care facility in a periurban community in Lagos. Nigeria Afr J Med Med Sci. 2001;30(Suppl):39–41. (PMID: 1451393714513937)
Matangila JR, Lufuluabo J, Ibalanky AL, Inocêncio da Luz RA, Lutumba P, Van Geertruyden J-P. Asymptomatic Plasmodium falciparum infection is associated with anaemia in pregnancy and can be more cost-effectively detected by rapid diagnostic test than by microscopy in Kinshasa, Democratic Republic of the Congo. Malar J. 2014;13:132. (PMID: 24690179397667410.1186/1475-2875-13-132)
Nwagha UI, Ugwu VO, Nwagha TU, Anyaehie BU. Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria. Trans R Soc Trop Med Hyg. 2009;103:16–20. (PMID: 1878380910.1016/j.trstmh.2008.07.01618783809)
WHO. Malaria surveillance, monitoring and evaluation: a reference manual. Geneva: World Health Organization; 2018. https://who.int/iris/handle/10665/272284.
Geiger C, Compaore G, Coulibaly B, Sie A, Dittmer M, Sanchez C, et al. Substantial increase in mutations in the genes pfdhfr and pfdhps puts sulphadoxine-pyrimethamine-based intermittent preventive treatment for malaria at risk in Burkina Faso. Trop Med Int Health. 2014;19:690–7. (PMID: 2467435510.1111/tmi.1230524674355)
Mockenhaupt FP, Bedu-Addo G, Eggelte TA, Hommerich L, Holmberg V, von Oertzen C, et al. Rapid increase in the prevalence of sulfadoxine-pyrimethamine resistance among Plasmodium falciparum isolated from pregnant women in Ghana. J Infect Dis. 2008;198:1545–9. (PMID: 1883430310.1086/59245518834303)
Rouamba T, Samadoulougou S, Tinto H, Alegana VA, Kirakoya F. Spatial and spatio-temporal epidemiology severe-malaria infection and its outcomes among pregnant women in Burkina Faso health-districts : hierarchical Bayesian space-time models applied to routinely-collected data from 2013 to 2018. Spat Spatiotemporal Epidemiol. 2020;33:100333. (PMID: 3237094110.1016/j.sste.2020.10033332370941)
Tagbor H, Bruce J, Agbo M, Greenwood B, Chandramohan D. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: a randomised controlled non-inferiority trial. PLoS ONE. 2010;5:e14425. (PMID: 21203389301099910.1371/journal.pone.0014425)
Roh ME, ter Kuile FO, Rerolle F, Glymour MM, Shiboski S, Gosling R, et al. Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis. Lancet Glob Health. 2020;8:e942–53. (PMID: 32562650730395710.1016/S2214-109X(20)30119-4)
Okell LC, Griffin JT, Roper C. Mapping sulphadoxine-pyrimethamine-resistant Plasmodium falciparum malaria in infected humans and in parasite populations in Africa. Sci Rep. 2017;7:7389. (PMID: 28785011554705510.1038/s41598-017-06708-9)
van Eijk AM, Larsen DA, Kayentao K, Koshy G, Slaughter DEC, Roper C, et al. Effect of Plasmodium falciparum sulfadoxine-pyrimethamine resistance on the effectiveness of intermittent preventive therapy for malaria in pregnancy in Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2019;19:546–56. (PMID: 3092281810.1016/S1473-3099(18)30732-130922818)
Kayentao K, Kodio M, Newman RD, Maiga H, Doumtabe D, Ongoiba A, et al. Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. J Infect Dis. 2005;191:109–16. (PMID: 1559301110.1086/42640015593011)
Yaméogo TM, Kyelem CG, Bamba S, Savadogo LB, Sombié I, Traoré AZ, et al. Chemin de soin des cas présomptifs de paludisme admis dans un hôpital de district au Burkina Faso. Med Sante Trop. 2014;24:301–6. (PMID: 2529588325295883)
Cisse M, Sangare I, Lougue G, Bamba S, Bayane D, Guiguemde RT. Prevalence and risk factors for Plasmodium falciparum malaria in pregnant women attending antenatal clinic in Bobo-Dioulasso (Burkina Faso). BMC Infect Dis. 2014;14:631. (PMID: 25408152424087110.1186/s12879-014-0631-z)
Ouédraogo CMR, Nébié G, Sawadogo L, Rouamba G, Ouédraogo A, Lankoandé J. Étude des facteurs favorisant la survenue du paludisme à Plasmodium falciparum chez les femmes enceintes dans le district sanitaire de Bogodogo à Ouagadougou, Burkina Faso. J Gynecol Obstet Biol Reprod. 2011;40:529–34. (PMID: 10.1016/j.jgyn.2011.03.005)
Tahita MC, Tinto H, Menten J, Ouedraogo JB, Guiguemde RT, Van Geertruyden JP, et al. Clinical signs and symptoms cannot reliably predict Plasmodium falciparum malaria infection in pregnant women living in an area of high seasonal transmission. Malar J. 2013;12:464. (PMID: 24373481387787810.1186/1475-2875-12-464)
Douamba Z, Bisseye C, Djigma FW, Compaoré TR, Bazie VJT, Pietra V, et al. Asymptomatic malaria correlates with anaemia in pregnant women at Ouagadougou, Burkina Faso. J Biomed Biotechnol. 2012;2012:198317. (PMID: 23226937351184910.1155/2012/198317)
Ruizendaal E, Schallig HDFH, Scott S, Traore-Coulibaly M, Bradley J, Lompo P, et al. Evaluation of malaria screening during pregnancy with rapid diagnostic tests performed by community health workers in Burkina Faso. Am J Trop Med Hyg. 2017;97:1190–7. (PMID: 28722627563760410.4269/ajtmh.17-0138)
Burkina Faso-Health results-based financing impact evaluation 2013. Household Baseline Survey. https://microdata.worldbank.org/index.php/catalog/2762 . Accessed 30 Sept 2020.
Kattenberg JH, Tahita CM, Versteeg IAJ, Tinto H, Traoré-Coulibaly M, D’Alessandro U, et al. Evaluation of antigen detection tests, microscopy, and polymerase chain reaction for diagnosis of malaria in peripheral blood in asymptomatic pregnant women in Nanoro, Burkina Faso. Am J Trop Med Hyg. 2012;87:251–6. (PMID: 22859362341455910.4269/ajtmh.2012.12-0125)
Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Women’s Health (Lond). 2015;11:891–900. (PMID: 10.2217/whe.15.35)
Coulibaly SO, Gies S, D’Alessandro U. Malaria burden among pregnant women living in the rural district of Boromo, Burkina Faso. Am J Trop Med Hyg. 2007;77:56–60. (PMID: 1816547510.4269/ajtmh.2007.77.5618165475)
Valea I, Tinto H, Drabo MK, Huybregts L, Sorgho H, Ouedraogo J-B, et al. An analysis of timing and frequency of malaria infection during pregnancy in relation to the risk of low birth weight, anaemia and perinatal mortality in Burkina Faso. Malar J. 2012;11:71. (PMID: 22433778333839610.1186/1475-2875-11-71)
Rouamba T, Samadoulougou S, Tinto H, Alegana VA, Kirakoya-Samadoulougou F. Bayesian Spatiotemporal modeling of routinely collected data to assess the effect of health programs in malaria incidence during pregnancy in Burkina Faso. Sci Rep. 2020;10:2618. (PMID: 32060297702168110.1038/s41598-020-58899-3)
Fox J, Monette G. Generalized collinearity diagnostics. JASA. 1992;87:178–83. (PMID: 10.1080/01621459.1992.10475190)
Brabin BJ. An analysis of malaria in pregnancy in Africa. Bull World Health Organ. 1983;61:1005–16. (PMID: 63704842536236)
Worrall E, Morel C, Yeung S, Borghi J, Webster J, Hill J, et al. The economics of malaria in pregnancy-a review of the evidence and research priorities. Lancet Infect Dis. 2007;7:156–68. (PMID: 1725108610.1016/S1473-3099(07)70027-0)
Scott S, Mens PF, Tinto H, Nahum A, Ruizendaal E, Pagnoni F, et al. Community-based scheduled screening and treatment of malaria in pregnancy for improved maternal and infant health in The Gambia, Burkina Faso and Benin : study protocol for a randomized controlled trial. Trials. 2014;15:340. (PMID: 25169073415660910.1186/1745-6215-15-340)
Nega D, Dana D, Tefera T, Eshetu T. Prevalence and predictors of asymptomatic malaria parasitemia among pregnant women in the rural surroundings of Arbaminch Town, South Ethiopia. PLoS ONE. 2015;10:e0123630. (PMID: 25849587438838910.1371/journal.pone.0123630)
Kassa GM, Muche AA, Berhe AK, Fekadu GA. Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis. BMC Hematol. 2017;17:17. (PMID: 29075500564615310.1186/s12878-017-0090-z)
Thompson JM, Eick SM, Dailey C, Dale AP, Mehta M, Nair A, et al. Relationship between pregnancy-associated malaria and adverse pregnancy outcomes: a systematic review and meta-analysis. J Trop Pediatr. 2020;66:327–38. (PMID: 3159871410.1093/tropej/fmz06831598714)
Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, et al. Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis. 2012;12:942–9. (PMID: 2299585210.1016/S1473-3099(12)70222-022995852)
Cosmic Consortium. Community-based malaria screening and treatment for pregnant women receiving standard intermittent preventive treatment with sulfadoxine-pyrimethamine: a multicenter (The Gambia, Burkina Faso, and Benin) cluster-randomized controlled trial. Clin Infect Dis. 2018;68:586–96. (PMID: 10.1093/cid/ciy522)
World Health Organization. Global Technical Strategy for Malaria 2016–2030. Geneva: Global Malaria Programme, World Health Organization; 2015. http://apps.who.int/iris/bitstream/handle/10665/176712/9789241564991_eng.pdf;jsessionid=66E6DA665C88369AF0BA3A99E8525283?sequence=1 .
Ministère de la santé/Direction de la Promotion de la Santé. Plan stratégique de promotion de la sante 2015–2019. Ouagadougou, Burkina Faso; 2014.
Jain D, Atmapoojya P, Colah R, Lodha P. Sickle cell disease and pregnancy. Mediterr J Hematol Infect Dis. 2019;11:e2019040. (PMID: 31308916661362410.4084/mjhid.2019.040)
Rogers DT, Molokie R. Sickle cell disease in pregnancy. Obstet Gynecol Clin North Am. 2010;37:223–37. (PMID: 2068555010.1016/j.ogc.2010.02.01520685550)
Dicko A, Mantel C, Thera MA, Doumbia S, Diallo M, Diakité M, et al. Risk factors for malaria infection and anemia for pregnant women in the Sahel area of Bandiagara. Mali Acta Trop. 2003;89:17–23. (PMID: 1463697810.1016/j.actatropica.2003.07.00114636978)
Ononge S, Campbell O, Mirembe F. Haemoglobin status and predictors of anaemia among pregnant women in Mpigi, Uganda. BMC Res Notes. 2014;7:712. (PMID: 25304187419867010.1186/1756-0500-7-712)
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW. Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2013;346:f3443. (PMID: 23794316368988710.1136/bmj.f3443)
Orish VN, Onyeabor OS, Boampong JN, Acquah S, Sanyaolu AO, Iriemenam NC. The effects of malaria and HIV co-infection on hemoglobin levels among pregnant women in Sekondi-Takoradi. Ghana Int J Gynecol Obstet. 2013;120:236–9. (PMID: 10.1016/j.ijgo.2012.09.021)
Brooker S, Hotez PJ, Bundy DAP. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis. 2008;2:e291. (PMID: 18820740255348110.1371/journal.pntd.0000291)
WHO. Daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012. http://www.who.int/nutrition/publications/micronutrients/guidelines/daily_ifa_supp_pregnant_women/en/ .
WHO. Malaria rapid diagnostic test performance: results of WHO product testing of malaria RDTs: round 8 (2016–2018). Geneva: World Health Organization; 2018.
Kattenberg JH, Tahita CM, Versteeg IAJ, Tinto H, Traoré-Coulibaly M, Schallig HDFH, et al. Antigen persistence of rapid diagnostic tests in pregnant women in Nanoro, Burkina Faso, and the implications for the diagnosis of malaria in pregnancy. Trop Med Int Health. 2012;17:550–7. (PMID: 2246949610.1111/j.1365-3156.2012.02975.x22469496)

Keywords: Asymptomatic carriage; Community; Haemoglobin; Health district; Plasmodium; Pregnant

Date Created: 20210502 Date Completed: 20210913 Latest Revision: 20210913

20240105

PMC8088076

10.1186/s12936-021-03703-4

33933072