%0 Journal Article
%T Assessing the burden of pregnancy-associated malaria under changing transmission settings
%A Mario Recker
%A Menno J Bouma
%A Paul Bamford
%A Sunetra Gupta
%A Andy P Dobson
%J Malaria Journal
%D 2009
%I BioMed Central
%R 10.1186/1475-2875-8-245
%X Here, by re-examining historical data, it is demonstrated how excess female mortality can be used to evaluate the burden of PAM. A simple mathematical model is then developed to highlight the contrasting signatures of PAM within the endemicity spectrum and to show how PAM is influenced by the intensity and stability of transmission.Both the data and the model show that maternal malaria has a huge impact on the female population. This is particularly pronounced in low-transmission settings during epidemic outbreaks where excess female mortality/morbidity can by far exceed that of a similar endemic setting.The results presented here call for active intervention measures not only in highly endemic regions but also, or in particular, in areas where malaria transmission is low and seasonal.Malaria during pregnancy poses a significant threat to both the mother and unborn child. For the mother, it increases the risk of illness, severe anaemia and death; for the unborn child it increases the risk of intra-uterine growth retardation and low birth weight, spontaneous abortion and stillbirth (reviewed in [1]). Numerous epidemiological studies have highlighted the various aspects of malaria during pregnancy both in highly endemic regions (mostly from sub-Saharan Africa) and in regions where malaria transmission is low and sporadic (mainly from Asia) (see e.g. [1-4]), and it has become clear that the pathology of malaria during pregnancy and its evaluation are highly dependent on the particular epidemiological setting, due to differences in acquired immunity in women reaching child-bearing age.Acquired immunity to Plasmodium falciparum, the most virulent agent of human malaria, is a gradual process by which individuals build up a repertoire of protective immune responses over years of repeated exposure. Although sterilizing immunity might never be attained, people living in malaria endemic areas seem to acquire protection against clinical malaria after a certain period of exposu
%U http://www.malariajournal.com/content/8/1/245