Diagnosis of Plasmoduim falciparum malaria in pregnancy in sub-Saharan Africa: the challenges and public health implications

Abstract

Plasmodium falciparum malaria in pregnancy is a major public health problem in sub-Saharan Africa and represents enormous diagnostic challenge. The objective of this report was to review scientific data from studies conducted in sub-Saharan Africa on the diagnosis of malaria in pregnancy within the last two decades (1987 to 2007), to highlight the challenges and the public health implications. Using the Medline Entrez-Pubmed search, relevant publications were identified for the review via combinations of key words such as Malaria, Pregnancy, and Sub-Saharan Africa, which yielded 777 entries as of September 2007. The results from the various studies were discordant, due to differences in the techniques of sample collection and analysis, based on the differences in the definition of clinical, peripheral, and placental malaria. Definitions were based on the presence of malaria parasite and/or pigments in blood smear from peripheral/placental blood, on histological placental findings, on the use of rapid diagnostic tests (RDTs) and polymerase chain reaction (PCR). Nonspecific clinical presentation of malaria, lack of efficient diagnostic facilities and trained personnel, and absence of regulatory standards for diagnostic tests, are some of the major diagnostic challenges. Increased allocation of resources to development and application of accurate diagnostics will improve malaria diagnosis in pregnancy.

Persistence of Plasmodium falciparum Parasites in Infected Pregnant Mozambican Women after Delivery

“…Placental sequestration of P. falciparum complicates detection and quantification of infections during pregnancy, as parasites may be present in the placenta yet not detectable in peripheral blood (44). Moreover, infections at densities below the limit of microscopic detection (submicroscopic infections) contribute to the underestimation of the actual burden of P. falciparum infection among pregnant women in areas where malaria is endemic (25,28,37).…”

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…More detailed information pertaining to the importance of various tissue protozoa (including Plasmodium spp.) in pregnancy was reported previously (43,63,70,72,73,161,192,195,203,342,432,482,499,564,565,600,616,624). For information regarding malaria in pregnancy, the WHO website is useful (see http://www .who.int/features/2003/04b/en/).…”

Molecular Detection of Malaria at Delivery Reveals a High Frequency of Submicroscopic Infections and Associated Placental Damage in Pregnant Women from Northwest Colombia

“…Similar discrepancies between PCR and microscopy are reported from other endemic population surveys. 13,14 However, the epidemiology and clinical significance of submicroscopic malaria infections during pregnancy are not well-understood. 13,[15][16][17][18][19][20] The present pilot study evaluated the frequency of submicroscopic plasmodial infections in parturient women in the Urabá-Altos Sinú -San Jorge-Bajo Cauca region of Colombia and their associations with clinical outcomes of pregnancy.…”