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Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study

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Show simple item record Unger, H. W. en_US Rosanas-Urgell, A. en_US Robinson, L. J. en_US Ome-Kaius, M. en_US Jally, S. en_US Umbers, A. J. en_US Pomat, W. en_US Mueller, I. en_US Kattenberg, E. en_US Rogerson, S. J. en_US 2020-08-25T09:38:51Z 2020-08-25T09:38:51Z 2019 en_US
dc.identifier.issn 1475-2875 en_US
dc.identifier.doi en_US
dc.identifier.other en_US
dc.identifier.other 9 pp. en_US
dc.identifier.other 20 en_US
dc.identifier.other ITG-B2A; ITG-B9A; DBM; U-MALAR; JIF; DOI; PDF; PMC; Abstract; ITMPUB; DSPACE68 en_US
dc.description.abstract BACKGROUND: Infection during pregnancy with Plasmodium falciparum is associated with maternal anaemia and adverse birth outcomes including low birth weight (LBW). Studies using polymerase chain reaction (PCR) techniques indicate that at least half of all infections in maternal venous blood are missed by light microscopy or rapid diagnostic tests. The impact of these subpatent infections on maternal and birth outcomes remains unclear. METHODS: In a cohort of women co-enrolled in a clinical trial of intermittent treatment with sulfadoxine-pyrimethamine (SP) plus azithromycin for the prevention of LBW (< 2500 g) in Papua New Guinea (PNG), P. falciparum infection status at antenatal enrolment and delivery was assessed by routine light microscopy and real-time quantitative PCR. The impact of infection status at enrolment and delivery on adverse birth outcomes and maternal haemoglobin at delivery was assessed using logistic and linear regression models adjusting for potential confounders. Together with insecticide-treated bed nets, women had received up to 3 monthly intermittent preventive treatments with SP plus azithromycin or a single clearance treatment with SP plus chloroquine. RESULTS: A total of 9.8% (214/2190) of women had P. falciparum (mono-infection or mixed infection with Plasmodium vivax) detected in venous blood at antenatal enrolment at 14-26 weeks' gestation. 4.7% of women had microscopic, and 5.1% submicroscopic P. falciparum infection. At delivery (n = 1936), 1.5% and 2.0% of women had submicroscopic and microscopic P. falciparum detected in peripheral blood, respectively. Submicroscopic P. falciparum infections at enrolment or at delivery in peripheral or placental blood were not associated with maternal anaemia or adverse birth outcomes such as LBW. Microscopic P. falciparum infection at antenatal enrolment was associated with anaemia at delivery (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.09, 3.67; P = 0.025). Peripheral microscopic P. falciparum infection at delivery was associated with LBW (aOR 2.75, 95% CI 1.27; 5.94, P = 0.010) and preterm birth (aOR 6.58, 95% CI 2.46, 17.62; P < 0.001). CONCLUSIONS: A substantial proportion of P. falciparum infections in pregnant women in PNG were submicroscopic. Microscopic, but not submicroscopic, infections were associated with adverse outcomes in women receiving malaria preventive treatment and insecticide-treated bed nets. Current malaria prevention policies that combine insecticide-treated bed nets, intermittent preventive treatment and prompt treatment of symptomatic infections appear to be appropriate for the management of malaria in pregnancy in settings like PNG. en_US
dc.language English en_US
dc.relation.uri en_US
dc.subject Malaria en_US
dc.subject Protozoal diseases en_US
dc.subject Plasmodium falciparum en_US
dc.subject Anemia en_US
dc.subject Pregnancy en_US
dc.subject Outcomes en_US
dc.subject Papua New Guinea en_US
dc.subject Oceania en_US
dc.title Microscopic and submicroscopic Plasmodium falciparum infection, maternal anaemia and adverse pregnancy outcomes in Papua New Guinea: a cohort study en_US
dc.type Article-E en_US
dc.citation.issue 1 en_US
dc.citation.jtitle Malaria Journal en_US
dc.citation.volume 18 en_US
dc.citation.pages 302 en_US
dc.citation.abbreviation Malar J en_US

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