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

Abstract

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.

Clinical Presentation and Management of Neonatal Malaria: A Review

“…This may be explained on the basis that malaria parasite was transferred to the newborn followed by its clearance from maternal and placental blood [15,55,56]. In a study from South Africa, maternal malarial infection was associated with a low birth weight of baby [57]. However in a study from central India, no significant correlation was found between maternal malarial infection and its effect on either gestational weight or maturity [36].The plausible explanation of these contradictions could be explained on the basis of species of malaria parasite.…”

“…The need to build capacity in malaria microscopy in these areas is therefore crucial. In areas with limited resources, the capacity to diagnose malaria in newborn may be limited [60,61] and any issues with quality or accuracy of diagnostic technique may result in the diagnosis of malaria being missed [57]. Rapid diagnostic test may have significant diagnostic utility in neonatal malaria in which low parasetemia causes diagnostic difficulty through microscopy by non-experienced person.…”

Congenital malaria: an overview

“…It is pertinent to state that most cases of congenital malaria are misdiagnosed initially because of the lack of specific symptoms and a general lack of awareness of this uncommon disease (Reynolds et al, 2008). Because malaria is endemic in this region, it is often difficult to diagnose, and thus report, "classic" congenital malaria (Uneke, 2007b). One of the major factors constituting diagnostic problems is that it is much more difficult to differentiate congenital malaria from those acquired from mosquitoes following delivery (Balatbat et al, 1995).…”

“…Pregnant women residing in malaria endemic areas often experience a high frequency and density of parasitemia, resulting to high rates of maternal morbidity including fever and severe anaemia, with abortion and stillbirth, and with high rates of placental parasitisation (Brabin 1983;Steketee et al, 2001). Severe parasitization of the placenta by malaria parasites particularly P. falciparum and P. vivax which is known as placental malaria can result in transplacental transmission of the parasite to the foetus and consequently to congenital malaria (Brabin, 1983;Menendez & Mayor 2007;Uneke, 2007b).…”

Frequency and Sociodemographic Factors Associated with Congenital Malaria at the Borgou Regional University Teaching Hospital (CHUD-B) in Benin in 2015

“…Despite that high infant and child mortality associated with malaria in Sub-Saharan Africa, congenital malaria is still not properly understood there as regarding its frequency, severity and management [4]. In the West African sub-region, recent studies have reported high frequencies of congenital malaria: 24.4% in Burkina-Faso [5] and 46.7% in Nigeria [6] Two studies have established a higher susceptibility to infections in general and to severe malaria in particular during the first 30 months of life in infants with history of in utero exposure to Plasmodium [7] [8].…”