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Prevalence of malaria infection in pregnant women compared with children for tracking malaria transmission in sub-Saharan Africa: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: In malarious areas, pregnant women are more likely to have detectable malaria than are their non-pregnant peers, and the excess risk of infection varies with gravidity. Pregnant women attending antenatal clinic for their first visit are a potential pragmatic sentinel group to track the intensity of malaria transmission; however, the relation between malaria prevalence in children, a standard measure to estimate malaria endemicity, and pregnant women has never been compared. METHODS: We obtained data on malaria prevalence in pregnancy from the Malaria in Pregnancy Library (January, 2015) and data for children (0-59 months) were obtained from recently published work on parasite prevalence in Africa and the Malaria in Pregnancy Library. We used random effects meta-analysis to obtain a pooled prevalence ratio (PPR) of malaria in children versus pregnant women (during pregnancy, not at delivery) and by gravidity, and we used meta-regression to assess factors affecting the prevalence ratio. FINDINGS: We used data from 18 sources that included 57 data points. There was a strong linear relation between the prevalence of malaria infection in pregnant women and children (r=0·87, p<0·0001). Prevalence was higher in children when compared with all gravidae (PPR=1·44, 95% CI 1·29-1·62; I(2)=80%, 57 studies), and against multigravidae (1·94, 1·68-2·24; I(2)=80%, 7 studies), and marginally higher against primigravidae (1·16, 1·05-1·29; I(2)=48%, 8 studies). PPR was higher in areas of higher transmission. INTERPRETATION: Malaria prevalence in pregnant women is strongly correlated with prevalence data in children obtained from household surveys, and could provide a pragmatic adjunct to survey strategies to track trends in malaria transmission in Africa. FUNDING: The Malaria in Pregnancy Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine, UK; US Centers for Disease Control and Prevention; and Wellcome Trust, UK.
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“literature suggests prevalence among children is representative of prevalence among pregnant women, especially among primigravidae and in areas of low transmission (<5%) [23].”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [23]
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“The rate of P. falciparum infection among 2 to 10 year olds, as generated by the Malaria Atlas Project (MAP), has been used as a proxy for malaria among pregnant women [23, 24].”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [23]
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Metadata
- Authors
- van Eijk, A. M., Hill, J., Noor, A. M., Snow, R. W., & ter Kuile, F. O.
- Affiliations
- Liverpool School of Tropical Medicine (GB)
- Kenya Medical Research Institute (KE)
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2015-10
- Volume
- 3
- Issue
- 10
- Pages
- e617-e628
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC4673091
- OpenAlex
- W2125571993
- Cited by
- 130
- References
- 50
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 13 · 2023: 14 · 2022: 16 · 2021: 16 · 2020: 15 · 2019: 11 · 2018: 6 · 2017: 13 · 2016: 4 · 2015: 1
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- US Centers for Disease Control and Prevention (CDC)
- Division of Parasitic Diseases and Malaria, CDC
- Liverpool School of Tropical Medicine
- Bill & Melinda Gates Foundation
- Wellcome Trust (079080, 103602, 095127)
- UK's Department for International Development
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Keywords
- malaria in pregnancy, malaria prevalence, children under five, malaria transmission intensity, gravidity, primigravida, multigravidae, antenatal care attendance, sentinel surveillance, sub-Saharan Africa, parasite prevalence
- MeSH terms
- Adolescent, Adult, Antimalarials, Child, Child, Preschool, Female, Humans, Malaria, Male, Middle Aged, Pregnancy, Regression Analysis, Pregnancy Complications, Parasitic, Prevalence, Africa South of the Sahara, Young Adult
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