Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed. Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia remain highly promising; though, specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures. Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems. 1. Introduction Malaria remains a significant burden in sub-Saharan Africa as it continues to be the leading cause of infant morbidity and mortality in Africa. It is believed that malaria contributes up to about 25% of infant mortality in Nigeria [1]. Furthermore, in areas of Africa with stable transmission, Plasmodium falciparum infection during pregnancy is estimated to cause as many as 10,000 maternal deaths each year, 8% to 14% of all low birth weight babies, and 3% to 8% of all infant deaths [2]. Thus, malaria burden, if not reduced, poses a threat to the attainment of the Millennium Development Goals 4 and 6. Congenital malaria is defined as malaria in a newborn or infant, transmitted from the mother [3]. Congenital malaria is generally defined as malaria acquired by the fetus or newborn directly from the mother, either in utero or during delivery [4]. It is also defined as the presence of malarial parasites in the peripheral smear of the newborn from twenty four hours to seven days of life [5]. Malaria is considered to be congenital in the neonate when asexual parasites are detected in the peripheral blood within the first week of life [6, 7]. Congenital malaria was thought to be rare in developing countries [8, 9]. This might be due to a number of reasons. Firstly, the protective effect of the foetal haemoglobin (HbF) in a newborn is expected to exert its influence during the immediate neonatal period [10, 11]. Secondly, local health facilities in resource-limited settings often lack the capacity to
References
[1]
National Population Commission [Nigeria] and ICF Macro, Nigeria Demographic and Health Survey 2008, National Population Commission and ICF Macro, Abuja, Nigeria, 2009.
[2]
Roll Back Malaria, Malaria in Pregnancy, http://www.rbm.who.int/cmc_upload/0/000/015/369/RBMInfosheet_4.htm.
[3]
Centers for Disease Control and Prevention, http://www.cdc.gov/malaria/glossary.html.
[4]
O. Coll, C. Menendez, F. Botet et al., “Treatment and prevention of malaria in pregnancy and Newborn,” Journal of Perinatal Medicine, vol. 36, pp. 15–29, 2008.
[5]
O. Basipinar, Z. Bayraktaroglu, T. Karsligil, A. Bavram, and Y. Coskun, “A rare cause of anemia and thrombocytopenia in a newborn: congenital malaria,” The Turkish Journal of Pediatrics, vol. 48, pp. 63–65, 2006.
[6]
C. Falade, O. Mokuolu, H. Okafor et al., “Epidemiology of congenital malaria in Nigeria: a multi-centre study,” Tropical Medicine and International Health, vol. 12, no. 11, pp. 1279–1287, 2007.
[7]
Ghana Health Service, “Guidelines for malaria in pregnancy,” http://www.ghanahealthservice.org/.
[8]
A. A. Orogadeav, C. Falade, H. U. Okafor, et al., “Clinical and laboratory features of congenital malaria in Nigeria,” Journal of Pediatric Infectious Diseases, vol. 3, pp. 181–187, 2008.
[9]
P. R. Fischer, “Congenital malaria: an African survey,” Clinical Pediatrics, vol. 36, no. 7, pp. 411–413, 1997.
[10]
H. L. Shear, L. Grinberg, J. Gilman et al., “Transgenic mice expressing human fetal globin are protected from malaria by a novel mechanism,” Blood, vol. 92, no. 7, pp. 2520–2526, 1998.
[11]
C. Shulman and E. Dorman, “Clinical features of malaria in pregnancy,” in Essential Malariology, D. A. Warrell and H. M. Gilles, Eds., p. 223, BookPower Formerly ELST, London, UK, 4th edition, 2002.
[12]
P. A. Phillips-Howard, K. A. Wannemuehler, F. O. Ter Kuile et al., “Diagnostic and prescribing practices in peripheral health facilities in rural western Kenya,” American Journal of Tropical Medicine and Hygiene, vol. 68, supplement 4, pp. 44–49, 2003.
[13]
B. Hailegiorgis, S. Girma, Z. Melaku et al., “Laboratory malaria diagnostic capacity in health facilities in five administrative zones of Oromia Regional State, Ethiopia,” Tropical Medicine and International Health, vol. 15, no. 12, pp. 1449–1457, 2010.
[14]
D. Ishengoma, Y. Derua, R. Rwegoshora et al., “The performance of health laboratories and the quality of malaria diagnosis in six districts of Tanzania,” Annals of Tropical Medicine and Parasitology, vol. 104, no. 2, pp. 123–135, 2010.
[15]
W. I. Olanrewaju, “Malaria in the neonate: report of 2 cases,” West African Journal of Medicine, vol. 18, no. 2, pp. 139–140, 1999.
[16]
C. R. Lesko, P. M. Arguin, and R. D. Newman, “Congenital malaria in the United States: a review of cases from 1966 to 2005,” Archives of Pediatrics and Adolescent Medicine, vol. 161, no. 11, pp. 1062–1067, 2007.
[17]
I. T. Runsewe-Abiodun, O. B. Ogunfowora, and B. M. Fetuga, “Neonatal malaria in Nigeria— a 2 year review,” BMC Pediatrics, vol. 6, article 19, 2006.
[18]
M. K. Mwaniki, A. W. Talbert, F. N. Mturi et al., “Congenital and neonatal malaria in a rural Kenyan district hospital: an eight-year analysis,” Malaria Journal, vol. 9, no. 1, article 313, 2010.
[19]
K. Pengsaa, “Congenital malaria in Thailand,” Annals of Tropical Paediatrics, vol. 27, no. 2, pp. 133–139, 2007.
[20]
G. Wagner, K. Koram, D. McGuinness, S. Bennett, F. Nkrumah, and E. Riley, “High incidence of asymptomatic malara infections in a birth cohort of children less than one year of age in Ghana, detected by multicopy gene polymerase chain reaction,” The American Journal of Tropical Medicine and Hygiene, vol. 59, no. 1, pp. 115–123, 1998.
[21]
F. Lesi, M. Mukhtar, E. Iroha, and M. Egri-Okwaji, “Clinical presentation of congenital malaria at the Lagos University Teaching Hospital,” The Nigerian Journal of Clinical Practice, vol. 13, no. 2, pp. 134–138, 2010.
[22]
R. W. Steketee, B. L. Nahlen, M. E. Parise, and C. Menendez, “The burden of malaria in pregnancy in malaria-endemic areas,” The American Journal of Tropical Medicine and Hygiene, vol. 64, supplement 1-2, pp. 28–35, 2001.
[23]
B. J. Brabin, “Congenital malaria— a recurrent problem,” Annals of Tropical Paediatrics, vol. 27, no. 2, pp. 95–98, 2007.
[24]
Maternal Mortality in 2005, World Health Organization, Geneva, Switzerland, 2007.
[25]
C. Menendez, “Malaria during pregnancy: a priority area of malaria research and control,” Parasitology Today, vol. 11, no. 5, pp. 178–183, 1995.
[26]
A. D. Ekanem, M. U. Anah, and J. J. Udo, “The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria,” Tropical Doctor, vol. 38, no. 2, pp. 73–76, 2008.
[27]
H. Guyatt and R. Snow, “Malaria in pregnancy as an indirect cause of infant mortality in sub-SaharanAfrica,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 95, no. 6, pp. 569–576, 2001.
[28]
World Health Organization, “A strategic framework for malaria prevention and control during pregnancy in the African region,” WHO Regional Office for Africa, Brazzaville, The Republic of the Congo, AFR/MAL/04/01, 2004.
[29]
F. Verhoeff, B. Brabin, L. Chimsuku, P. Kazembe, W. Russell, and R. Broadhead, “An evaluation of the effects of intermittent sulfadoxine-pyrimethamine treatment in pregnancy on parasite clearance and risk of low birthweight in rural Malawi,” Annals of Tropical Medicine and Parasitology, vol. 92, no. 2, pp. 141–150, 1998.
[30]
L. J. Schultz, R. W. Steketee, A. Macheso, P. Kazembe, L. Chitsulo, and J. J. Wirima, “The efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental Plasmodium falciparum infection among pregnant women in Malawi,” The American Journal of Tropical Medicine and Hygiene, vol. 51, no. 5, pp. 515–522, 1994.
[31]
M. E. Parise, J. G. Ayisi, B. L. Nahlen et al., “Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection,” The American Journal of Tropical Medicine and Hygiene, vol. 59, no. 5, pp. 813–822, 1998.
[32]
C. Shulman, E. Dorman, F. Cutts, et al., “Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial,” The Lancet, vol. 353, no. 9153, pp. 632–636, 1999.
[33]
K. Osungbade, S. Oginni, and A. Olumide, “Content of antenatal care services in secondary health care facilities in Nigeria: implication for quality of maternal health care,” International Journal for Quality in Health Care, vol. 20, no. 5, pp. 346–351, 2008.
[34]
K. O. Osungbade, V. N. Shaahu, O. C. Uchendu, et al., “Clinical audit of antenatal service provision in Nigeria,” Health Care for Women International, vol. 32, no. 5, pp. 441–452, 2011.
[35]
A. van Eijk, H. Bles, F. Odhiambo et al., “Use of antenatal services and delivery care among women in rural Western Kenya: a community based survey,” Reproductive Health, vol. 3, article 2, 2006.
[36]
B. Chigbu, S. Onwere, C. I. Kamanu, C. Aluka, O. Okoro, and E. Adibe, “Pregnancy outcome in booked and unbooked mothers in South Eastern Nigeria,” East African Medical Journal, vol. 86, no. 6, pp. 267–271, 2009.
[37]
A. T. Owolabi, A. O. Fatusi, O. Kuti, A. Adeyemi, S. O. Faturoti, and P. O. Obiajuwa, “Maternal complications and perinatal outcomes in booked and unbooked Nigerian mothers,” Singapore Medical Journal, vol. 49, no. 7, pp. 526–531, 2008.
[38]
Ghana Statistical Service, Ghana Health Service, and ICF Macro, Ghana Demographic and Health Survey 2008, GSS, GHS, and ICF Macro, Accra, Ghana, 2009.
[39]
S. Babalola and A. Fatusi, “Determinants of use of maternal health services in Nigeria—looking beyond individual and household factors,” BMC Pregnancy and Childbirth, vol. 9, article 1471, p. 43, 2009.
[40]
A. Sagay, C. Ekwempu, M. Kabiru, P. Daru, and A. Aisien, “Audit of antenatal services in primary healthcare centres in Jos, Nigeria,” Tropical Journal of Obstetrics & Gynaecology, vol. 22, no. 2, pp. 147–151.
[41]
C. Iyaniwura and Q. Yussuf, “Utilization of antenatal care and delivery services in Sagamu, South Western Nigeria,” African Journal of Reproductive Health, vol. 13, no. 3, pp. 111–122, 2009.
[42]
M. L. Telfer, J. T. Rowley, and G. E. Walraven, “Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia,” AfricanJournal of Reproductive Health, vol. 6, no. 1, pp. 74–83, 2002.
[43]
National Population Commission (Nigeria) and ORC Macro, Nigeria Demographic and Health Survey 2003, National Population Commission (Nigeria) and ORC Macro, Calverton, Md, USA, 2004.
[44]
C. Gamble, J. P. Ekwaru, and F. O. ter Kuile, “Insecticide-treated nets for preventing malaria in pregnancy,” Cochrane Database of Systematic Reviews, no. 2, p. CD003755, 2006.
[45]
A. Tami, J. Mbati, R. Nathan, H. Mponda, C. Lengeler, and J. Schellenberg, “Use and misuse of a discount voucher scheme as a subsidy for insecticide-treated nets for malaria control in southern Tanzania,” Health Policy and Planning, vol. 21, no. 1, pp. 1–9, 2005.
[46]
Kenya National Bureau of Statistics and ICF Macro, Kenya Demographic and Health Survey 2008–2009, KNBS and ICF Macro, Calverton, Md, USA, 2010.
[47]
Tanzania National Bureau of Statistics and ICF Macro, Tanzania Demographic and Health Survey 2009–2010, KNBS and ICF Macro, Calverton, Md, USA, 2010.
[48]
World Health Organization, World Malaria Report 2009, 2009.
[49]
P. Bloland, S. Kachur, and H. Williams, “Trends in antimalarial drug deployment in sub-Saharan Africa,” Journal of Experimental Biology, vol. 206, no. 21, pp. 3761–3769, 2003.
[50]
F. Moerman, C. Lengeler, J. Chimumbwa et al., “The contribution of the health-care service to a sound and sustainable malaria-control policy,” The Lancet Infectious Diseases, vol. 3, no. 2, pp. 99–102, 2003.
[51]
C. Wongsrichanalai, M. J. Barcus, S. Muth, A. Sutamihardja, and W. H. Wernsdorfer, “A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT),” The American Journal of Tropical Medicine and Hygiene, vol. 77, no. 6, pp. 119–127, 2007.
[52]
S. Shillcutt, C. Morel, C. Goodman et al., “Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy,” Bulletin of the World Health Organization, vol. 86, no. 2, pp. 101–110, 2008.
[53]
G. Bastiaens, E. Schaftenaar, A. Ndaro, et al., “Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change,” Malaria Journal, vol. 10, p. 76, 2011.
[54]
World Health Organization, “Making pregnancy safer: the critical role of the skilled attendant. A joint statement by WHO, ICM and FIGO,” Department of Reproductive Health and Research, WHO, 2004http://www.who.int/reproductive-health/publications/2004/skilled_attendant.pdf.
[55]
O. Oladapo, O. Daniel, and A. Olatunji, “Knowledge and use of the partograph among health care personnel at the peripheral maternity centres in Nigeria,” Journal of Obstetrics and Gynaecology, vol. 26, no. 6, pp. 538–541, 2006.
[56]
World Health Organization, Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice (Integrated Management of Pregnancy and Childbirth), World Health Organization, 2nd edition, 2006, http://www.who.int/making_pregnancy_safer/publications/PCPNC_2006_03b.pdf.
[57]
Z. Iliyasu, I. S. Abubakar, H. S. Galadanci, and M. H. Aliyu, “Birth preparedness, complication readiness and fathers' participation in maternity care in a northern Nigerian community,” African Journal of Reproductive Health, vol. 14, no. 1, pp. 21–32, 2010.
[58]
L. Martin, M. McNamara, A. Milot, T. Halle, and E. C. Hair, “The effects of father involvement during pregnancy on receipt of prenatal care and maternal smoking,” Maternal and Child Health Journal, vol. 11, no. 6, pp. 595–602, 2007.
[59]
U. M. Chukwuocha, I. N. Dozie, C. O. Onwuliri et al., “Perceptions on the use of insecticide treated nets in parts of the Imo River Basin, Nigeria: implications for preventing malaria in pregnancy,” African Journal of Reproductive Health, vol. 14, no. 1, pp. 117–128, 2010.
