Sub-microscopic infections and long-term recrudescence of Plasmodium falciparum in Mozambican pregnant women
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BACKGROUND: Control of malaria in pregnancy remains a public health challenge. Improvements in its correct diagnosis and the adequacy of protocols to evaluate anti-malarial drug efficacy in pregnancy, are essential to achieve this goal. METHODS: The presence of Plasmodium falciparum was assessed by real-time (RT) PCR in 284 blood samples from pregnant women with clinical complaints suggestive of malaria, attending the maternity clinic of a Mozambican rural hospital. Parasite recrudescences in 33 consecutive paired episodes during the same pregnancy were identified by msp1 and msp2 genotyping. RESULTS: Prevalence of parasitaemia by microscopy was 5.3% (15/284) and 23.2% (66/284) by RT-PCR. Sensitivity of microscopy, compared to RT-PCR detection, was 22.7%. Risk of maternal anaemia was higher in PCR-positive women than in PCR-negative women (odds ratio [OR] = 1.92, 95% confidence interval [CI] 1.09-3.36). Genotyping confirmed that recrudescence after malaria treatment occurred in 7 (21%) out of 33 pregnant women with consecutive episodes during the same pregnancy (time range between recrudescent episodes: 14 to 187 days). CONCLUSION: More accurate and sensitive diagnostic indicators of malaria infection in pregnancy are needed to improve malaria control. Longer follow-up periods than the standard in vivo drug efficacy protocol should be used to assess anti-malarial drug efficacy in pregnancy.
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Studies in Africa have consistently shown that conventional microscopy vastly underestimates infection compared to PCR in both peripheral and placental blood samples.
“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 [17]
Submicroscopic infections were linked with maternal anemia in some studies but not all.
“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 [17]
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References 41 · Cited by 105
- Authors
- Mayor, A., Serra-Casas, E., Bardají, A., Sanz, S., Puyol, L., Cisteró, P., Sigauque, B., Mandomando, I., Aponte, J. J., Alonso, P. L., & Menéndez, C.
- Affiliations
- Manhiça Health Research Centre (MZ)
- Universitat de Barcelona (ES)
- Corresponding author
- Mayor, Alfredo
- ORCID
- Venue
- Malaria Journal
- Published
- 2009-01-09
- Volume
- 8
- Issue
- 1
- Pages
- 9-9
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC2633011
- OpenAlex
- W2021840991
- Cited by
- 105
- References
- 41
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2022: 3 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 8 · 2016: 4 · 2015: 8 · 2014: 9 · 2013: 4 · 2012: 14
- FWCI
- 10.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Malaria Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Banco Bilbao Vizcaya Argentaria
- Instituto de Salud Carlos III (CP-04/00220)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Keywords
- Plasmodium falciparum, malaria in pregnancy, anemia in pregnancy, follow-up duration, Mozambique
- MeSH terms
- Adult, Animals, Antigens, Protozoan, Antimalarials, Chloroquine, Drug Combinations, Female, Genotype, Humans, Mozambique, Plasmodium falciparum, Pregnancy, Pyrimethamine, Recurrence, Sensitivity and Specificity, Sulfadoxine, Pregnancy Complications, Parasitic, Protozoan Proteins, Prevalence, Polymerase Chain Reaction, Malaria, Falciparum, Parasitemia, Merozoite Surface Protein 1
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