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Submicroscopic Plasmodium falciparum infections in pregnancy in Ghana
Open accessAbstract
Malarial parasitaemia below the threshold of microscopy but detectable by polymerase chain reaction (PCR) assays is common in endemic regions. This study was conducted to examine prevalence, predictors, and effects of submicroscopic Plasmodium falciparum infections in pregnancy. In a cross-sectional study among 530 pregnant women in Ghana, plasmodial infections were assessed by microscopy and PCR assays. Concentrations of haemoglobin and C-reactive protein (CRP) were measured and antimalarial drugs (chloroquine, pyrimethamine) in urine were demonstrated by ELISA dipsticks. By microscopy, 32% of the women were found to harbour malaria parasites. This rate increased to 63% adding the results of the parasite-specific PCR. P. falciparum was present in all but one infection. With increasing gravidity, infection rates and parasite densities decreased and the proportions of submicroscopic parasitaemia among infected women grew. Correspondingly, anaemia, fever and evidence of inflammation (CRP > 0.6 mg/dl) were more frequent in primigravidae than in multigravidae. Antimalarial drugs were detected in 65% of the women and were associated with a reduced prevalence of P. falciparum infections and a raised proportion of submicroscopic parasitaemia. Both gravidity and antimalarial drug use were independent predictors of submicroscopic P. falciparum infections. These infections caused a slight reduction of Hb levels and considerably increased serum concentrations of CRP. Conventional microscopy underestimates the actual extent of malarial infections in pregnancy in endemic regions. Submicroscopic P. falciparum infections are frequent and may contribute to mild anaemia and inflammation in seemingly aparasitaemic pregnant women.
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“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 [31]
In the citing paper
“and the proportion of submicroscopic parasitaemia among infected women decreased with increasing gravidity [31].”
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 [31]
In the citing paper
“SMIs are also frequently detected in pregnant women in sub-Saharan Africa and were associated with adverse outcomes in several cross-sectional (21)(22)(23)(24) and longitudinal studies (25,26).”
From Clinical outcomes of submicroscopic infections and correlates of protection of VAR2CSA antibodies in a longitudinal study of pregnant women in Colombia (2018) · cites this paper as [23]
In the citing paper
“An earlier study also reported higher rates of submicroscopic infection with increasing parity [47], whereas other studies have reported similar rates of sub microscopic infections among women of different parities [16,38,40].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [47]
In the citing paper
“However, the association of maternal anemia to submicroscopic infection (defined by PCR, qPCR or HRP2 methods) is inconsistent, with some studies finding a relationship [16,47,53] while other studies did not [38,40,47].”
From Diagnosing malaria in pregnancy: An update (2012) · cites this paper as [47]
In the citing paper
“These studies have consistently shown that conventional microscopy vastly underestimates infection compared to PCR in both peripheral and placental blood samples. 12-22”
From What is the burden of submicroscopic malaria in pregnancy in central India? (2015) · cites this paper as [12]
In the citing paper
“Submicroscopic infections were linked with maternal anemia in some 17,18,20,23 but not all 12,13,15,21 studies.”
From What is the burden of submicroscopic malaria in pregnancy in central India? (2015) · cites this paper as [12]
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Metadata
- Authors
- Mockenhaupt, F. P., Rong, B., Till, H., Eggelte, T. A., Beck, S., Gyasi‐Sarpong, C., Thompson, W. N. A., & Bienzle, U.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Amsterdam UMC Location University of Amsterdam (NL)
- Venue
- Tropical Medicine & International Health
- Publisher
- Wiley
- Published
- 2000-03
- Volume
- 5
- Issue
- 3
- Pages
- 167-173
- ISSN
- 1360-2276 (ISSN-L)
- 1365-3156
- OpenAlex
- W2033480254
- Cited by
- 105
- References
- 26
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 8 · 2020: 1 · 2019: 7 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 9 · 2014: 6 · 2013: 2 · 2012: 9
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tropical Medicine & International Health (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Royal Society
- Royal Society of Tropical Medicine and Hygiene
- 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
- Plasmodium falciparum, submicroscopic malaria infection, malaria in pregnancy, gravidity, antimalarial drug use, chloroquine, pyrimethamine, C-reactive protein, anemia, malaria prevalence, Ghana
- MeSH terms
- Adult, Anemia, Animals, Antimalarials, Cross-Sectional Studies, Female, Fever, Ghana, Humans, Inflammation, Plasmodium falciparum, Pregnancy, Pregnancy Trimesters, Pregnancy Complications, Parasitic, Prevalence, Malaria, Falciparum, Parasitemia, Gravidity
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