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

Uneke, C. J.

doi:10.1007/s00436-007-0782-6

Cited by 53Malaria Research and ControlHemoglobinopathies and Related DisordersBird parasitology and diseases

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

Uneke, C. J.·2008·Parasitology Research

DOI 10.1007/s00436-007-0782-6

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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.

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Pregnancy poses a unique challenge for falciparum malaria diagnosis because parasites sequester in the placenta and circulating parasitaemia is very low and therefore undetectable by peripheral blood smear microscopy or rapid diagnostic test.
“Pregnancy poses a unique challenge for falciparum malaria diagnosis, as parasites sequester in the placenta and the circulating parasitaemia is very low and therefore undetectable by peripheral blood smear microscopy or rapid diagnostic test [7–10].”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [7]
Pregnant women may become asymptomatic reservoirs with low density infections and remain unidentified during routine passive surveillance because P. falciparum sequestration in the placenta hinders detection by RDT or microscopy.
“Pregnant women may become asymptomatic reservoirs with low density infections; remain unidentified during routine passive surveillance since P. falciparum sequestration in the placenta hinders their detection by RDT or microscopy”
From Intermittent preventive treatment with Sulphadoxine-Pyrimethamine (IPTp-SP) is associated with protection against sub-microscopic P. falciparum infection in pregnant women during the low transmission dry season in southwestern Cameroon: A Semi - longitudinal study (2022) · cites this paper as [7]
Sequestration of malaria parasites in the placenta presents an enormous diagnostic challenge, especially in sub-Saharan African countries.
“Sequestration of malaria parasites in the placenta, where selection of pregnancy-associated Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP-1) variant surface antigen occurs in P. falciparum malaria in pregnancy, presents an enormous diagnostic challenge, especially in sub-Saharan African countries [3,4].”
From Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan (2013) · cites this paper as [4]
A physiological adaptation to hypoxia results in syncytial knot formation, an alteration often reported during placental infection by Plasmodium.
“In consequence, a physiological adaptation to hypoxia results in syncytial knot formation, an alteration often reported during placental infection by Plasmodium[8].”
From Submicroscopic infection of placenta by Plasmodium produces Th1/Th2 cytokine imbalance, inflammation and hypoxia in women from north-west Colombia (2014) · cites this paper as [8]

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EDITORIAL BOARD Chairman
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Authors: Uneke, C. J.
Affiliations: Ebonyi State University (NG)
Corresponding author: Uneke, C. J.
ORCID: Uneke, C. J.
Venue: Parasitology Research
Publisher: Springer Science and Business Media LLC
Published: 2007-11-24
Volume: 102
Issue: 3
Pages: 333-342
ISSN: 0044-3255 (ISSN-L)
0932-0113
1432-1955
DOI: 10.1007/s00436-007-0782-6
OpenAlex: W2007654320
Cited by: 53
References: 80
Citations by year: 2025: 4 · 2024: 2 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 3 · 2015: 3 · 2014: 4 · 2013: 3 · 2012: 7
FWCI: 0.37
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Parasitology Research (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
Keywords: Plasmodium falciparum, malaria in pregnancy, malaria diagnosis, sub-Saharan Africa, placental malaria, rapid diagnostic tests, PCR, blood smear microscopy, diagnostic challenges, public health implications, diagnostic criteria
MeSH terms: Female, Humans, Pregnancy, Pregnancy Complications, Infectious, Public Health, Prevalence, Malaria, Falciparum, Africa South of the Sahara

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

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