Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
Parasitology Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achidi EA, Salimonu LS (1997) Malaria parasitaemia and immunoglobulin levels in paired maternal-cord sera from south western Nigeria. Afr J Med Med Sci 26:167–170

    PubMed  CAS  Google Scholar 

  • Adam I, A-Elbasit IE, Salih I, Elbashir MI (2005) Submicroscopic Plasmodium falciparum infections during pregnancy, in an area of Sudan with a low intensity of malaria transmission. Ann Trop Med Parasitol 99:339–344

    Article  PubMed  CAS  Google Scholar 

  • Adegnika AA, Verweij JJ, Agnandji ST, Chai SK, Breitling LP, Ramharter M, Frolich M, Issifou S, Kremsner PG, Yazdanbakhsh M (2006) Microscopic and sub-microscopic Plasmodium falciparum infection, but not inflammation caused by infection, is associated with low birth weight. Am J Trop Med Hyg 75:798–803

    PubMed  CAS  Google Scholar 

  • Akum AE, Kuoh AJ, Minang JT, Achimbom BM, Ahmadou MJ, Troye-Blomberg M (2005) The effect of maternal, umbilical cord and placental malaria parasitaemia on the birthweight of newborns from South-western Cameroon. Acta Paediatr 94:917–923

    Article  PubMed  Google Scholar 

  • Allen S, Van de perre P, Serufilira A, Lepage P, Carael M, DeClercq A, Tice J, Black D, Nsengumuremyi F, Ziegler J (1991) Human immunodeficiency virus and malaria in a representative sample of childbearing women in Kigali, Rwanda. J Infect Dis 164:67–71

    PubMed  CAS  Google Scholar 

  • Armstrong-Schellenberg JRM, Smith T, Alonso PL, Hayes RJ (1994) What is clinical malaria? Finding case definition for field research in highly endemic areas. Parasitol Today 10:439–442

    Article  Google Scholar 

  • Ayoya MA, Spiekermann-Brouwer GM, Traore AK, Stoltzfus RJ, Garza C (2006) Determinants of anemia among pregnant women in Mali. Food Nutr Bull 27:3–11

    PubMed  Google Scholar 

  • Beeson JG, Rogerson SJ, Cooke BM, Reeder JC, Chai W, Lawson AM, Molyneux ME, Brown GV (2000) Adhesion of Plasmodium falciparum infected erythrocytes to hyaluronic acid in placental malaria. Nat Med 6:86–90

    Article  PubMed  CAS  Google Scholar 

  • Bell D, Wongsrichanalai C, Barnwell JW (2006) Ensuring quality and access for malaria diagnosis: how can it be achieved? Nat Rev Microbiol 9:S7–S20

    Article  CAS  Google Scholar 

  • Bouvier P, Breslow N, Doumbo O, Robert CF, Picquet M, Mauris A, Dolo A, Dembele HK, Delley V, Rougement A (1997) Seasonality, malaria, and impact of prophylaxis in a West African village II. Effect on birthweight. Am J Trop Med Hyg 56:384–389

    PubMed  CAS  Google Scholar 

  • Brabin BJ (1983) An analysis of malaria in pregnancy in Africa. Bull World Health Organ 61:1005–1016

    PubMed  CAS  Google Scholar 

  • Cot M, Le Hesran JY, Miailhes P, Roisin A, Fievet N, Barro D, Etya’ale D, Deloron P, Carnevale P, Breart G (1998) Effect of chloroquine prophylaxis during pregnancy on maternal haematocrit. Ann Trop Med Parasitol 92:37–43

    Article  PubMed  CAS  Google Scholar 

  • Cot M, Roisin A, Barro D, Yada A, Verhave JP, Carnevale P, Breart G (1992) Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: results of a randomized trial. Am J Trop Med Hyg 46:21–27

    PubMed  CAS  Google Scholar 

  • Cottrell G, Mary JY, Barro D, Cot M (2005) Is malarial placental infection related to peripheral infection at any time of pregnancy? Am J Trop Med Hyg 73:1112–1118

    PubMed  Google Scholar 

  • D’Alessandro U, Langerock P, Bennett S, Francis N, Cham K, Greenwood BM (1996) The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia. Trans R Soc Trop Med Hyg 90:487–492

    Article  PubMed  CAS  Google Scholar 

  • Duffy P, Fried M (2005) Malaria: new diagnostics for an old problem. Am J Trop Med Hyg 73:482–483

    PubMed  Google Scholar 

  • Egwunyenga AO, Ajayi JA, Nmorsi OP, Duhlinska-Popova DD (2001) Plasmodium/intestinal helminth co-infections among pregnant Nigerian women. Mem Inst Oswaldo Cruz 96:1055–1059

    Article  PubMed  CAS  Google Scholar 

  • Egwunyenga OA, Ajayi JA, Duhlinska-Popova DD (1995) Transplacental passage of Plasmodium falciparum and seroevaluation of newborns in northern Nigeria. J Commun Dis 27:77–83

    PubMed  CAS  Google Scholar 

  • Enato EF, Okhamafe AO, Okpere EE, Oseji FI (2007) Prevalence of malaria during pregnancy and antimalarial intervention in an urban secondary health care facility in Southern Nigeria. Med Princ Pract 16:240–243

    Article  PubMed  Google Scholar 

  • Farcas GA, Zhong KJ, Mazzulli T, Kain KC (2004) Evaluation of the RealArt Malaria LC real-time PCR assay for malaria diagnosis. J Clin Microbiol 42:636–638

    Article  PubMed  CAS  Google Scholar 

  • Fleming AF (1989) The aetiology of severe anaemia in pregnancy in Ndola, Zambia. Ann Trop Med Parasitol 83:37–49

    PubMed  CAS  Google Scholar 

  • Heymann DL, Steketee RW, Wirima JJ, McFarland DA, Khoromana CO, Campbell CC (1990) Antenatal chloroquine chemoprophylaxis in Malawi: chloroquine resistance, compliance, protective efficacy and cost. Trans R Soc Trop Med Hyg 84:496–498

    Article  PubMed  CAS  Google Scholar 

  • Kasumba IN, Nalunkuma AJ, Mujuzi G, Kitaka FS, Byaruhanga R, Okong P, Egwang TG (2000) Low birthweight associated with maternal anaemia and Plasmodium falciparum infection during pregnancy, in a peri-urban/urban area of low endemicity in Uganda. Ann Trop Med Parasitol 94:7–13

    Article  PubMed  CAS  Google Scholar 

  • Kilian AH, Metzger WG, Mutschelknauss EJ, Kabagambe G, Langi P, Korte R, von Sonnenburg F (2000) Reliability of malaria microscopy in epidemiological studies: results of quality control. Trop Med Int Health 5:3–8

    Article  PubMed  CAS  Google Scholar 

  • Leke RF, Djokam RR, Mbu R, Leke RJ, Fogako J, Megnekou R, Metenou S, Sama G, Zhou Y, Cadigan T, Parra M, Taylor DW (1999) Detection of the Plasmodium falciparum antigen histidine-rich protein 2 in blood of pregnant women: implications for diagnosing placental malaria. J Clin Microbiol 37:2992–2996

    PubMed  CAS  Google Scholar 

  • Malhotra I, Dent A, Mungai P, Muchiri E, King CL (2005) Real-time quantitative PCR for determining the burden of Plasmodium falciparum parasites during pregnancy and infancy. J Clin Microbiol 43:3630–3635

    Article  PubMed  CAS  Google Scholar 

  • Mankhambo L, Kanjala M, Rudman S, Lema VM, Rogerson SJ (2002) Evaluation of the OptiMAL rapid antigen test and species-specific PCR to detect placental Plasmodium falciparum infection at delivery. J Clin Microbiol 40:155–158

    Article  PubMed  CAS  Google Scholar 

  • Matteelli A, Donato F, Shein A, Muchi JA, Abass AK, Mariani M, Leopardi O, Maxwell CA, Carosi G (1996) Malarial infection and birthweight in urban Zanzibar, Tanzania. Ann Trop Med Parasitol 90:125–134

    PubMed  CAS  Google Scholar 

  • Matteelli A, Donato F, Shein A, Muchi JA, Leopardi O, Astori L, Carosi G (1994) Malaria and anaemia in pregnant women in urban Zanzibar, Tanzania. Ann Trop Med Parasitol 88:475–483

    PubMed  CAS  Google Scholar 

  • Mbanzulu PN, Leng JJ, Kaba S, Mputu L, Ngimbi NP, Makengo N, Ngbege (1988) Malaria and pregnancy. Epidemiological situation in Kinshasa (Zaïre). Rev Fr Gynecol Obstet 83:99–103

    PubMed  CAS  Google Scholar 

  • Meeusen EN, Bischof RJ, Lee CS (2001) Comparative T-cell responses during pregnancy in large animals and humans. Am J Rep Immunol 46:169–179

    Article  CAS  Google Scholar 

  • Menendez C, Todd J, Alonso PL, Lulat S, Francis N, Greenwood BM (1994) Malaria chemoprophylaxis, infection of the placenta and birthweight in Gambian primigravidae. J Trop Med Hyg 97:244–248

    PubMed  CAS  Google Scholar 

  • Mockenhaupt FP, Bedu-Addo G, von Gaertner C, Boye R, Fricke K, Hannibal I, Karakaya F, Schaller M, Ulmen U, Acquah PA, Dietz E, Eggelte TA, Bienzle U (2006) Detection and clinical manifestation of placental malaria in southern Ghana. Malar J 5:119

    Article  PubMed  Google Scholar 

  • Mockenhaupt FP, Rong B, Till H, Eggelte TA, Beck S, Gyasi-Sarpong C, Thompson WN, Bienzle U (2000) Submicroscopic Plasmodium falciparum infections in pregnancy in Ghana. Trop Med Int Health 5:167–173

    Article  PubMed  CAS  Google Scholar 

  • Mockenhaupt FP, Ulmen U, von Gaertner C, Bedu-Addo G, Bienzle U (2002) Diagnosis of placental malaria. J Clin Microbiol 40:306–308

    Article  PubMed  Google Scholar 

  • Moody A (2002) Rapid diagnostic tests for malaria parasites. Clin Microbiol Rev 15:66–78

    Article  PubMed  CAS  Google Scholar 

  • Moormann AM, Sullivan AD, Rochford RA, Chensue SW, Bock PJ, Nyirenda T, Meshnick SR (1999) Malaria and pregnancy: placental cytokine expression and its relationship to intrauterine growth retardation. J Infect Dis 180:1987–1993

    Article  PubMed  CAS  Google Scholar 

  • Morgan HG (1994) Placental malaria and low birthweight neonates in urban Sierra Leone. Ann Trop Med Parasitol 88:575–80

    PubMed  CAS  Google Scholar 

  • Mutabingwa TK, Malle LN, de Geus A, Oosting J (1993) Malaria chemosuppression in pregnancy. II: Its effect on maternal haemoglobin levels, placental malaria and low birth weight. Trop Geogr Med 45:49–55

    PubMed  CAS  Google Scholar 

  • N’Dao CT, N’Diaye JL, Gaye A, Le Hesran JY (2006) Placental malaria and pregnancy outcome in a peri urban area in Senegal [Article in French]. Rev Epidemiol Sante Publique 54:149–156

    PubMed  CAS  Google Scholar 

  • Ndyomugyenyi R, Magnussen P (1999) Anaemia in pregnancy: Plasmodium falciparum infection is an important cause in primigravidae in Hoima district, western Uganda. Ann Trop Med Parasitol 93:457–465

    Article  PubMed  CAS  Google Scholar 

  • Okoko BJ, Ota MO, Yamuah LK et al (2002) Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian McGregor. J Hlth Pop Nutr 20:4–11

    Google Scholar 

  • Okwa OO (2003) The status of malaria among pregnant women: a study in Lagos, Nigeria. Afr J Reprod Health 7:77–83

    Article  PubMed  Google Scholar 

  • Onyenekwe CC, Arinola OG, Meludu SC, Salimonu LS, Adewale IF, Obisesan AK (2004) Malaria parasitaemia and Plasmodium falciparum specific-IgG in maternal peripheral, placental and cord circulation. J Vect Borne Dis 41:72–75

    CAS  Google Scholar 

  • Osman NB, Challis K, Cotiro M, Nordahl G, Bergstrom S (2000) Maternal and fetal characteristics in an obstetric cohort in Mozambique. Afr J Reprod Health 4:110–119

    Article  PubMed  CAS  Google Scholar 

  • Parise ME, Ayisi JG, Nahlen BL, Schultz LJ, Roberts JM, Misore A, Muga R, Oloo AJ, Steketee RW (1998) 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. Am J Trop Med Hyg 59:813–822

    PubMed  CAS  Google Scholar 

  • Peeling RW, Smith PG, Bossuyt PMM (2006) A guide for diagnostic evaluations. Nat Rev Microbiol 9:S2–S6

    Article  CAS  Google Scholar 

  • Peters RP, Zijlstra EE, Schijffelen MJ, Walsh AL, Joaki G, Kumwenda JJ, Kublin JG, Molyneux ME, Lewis DK (2004) A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management. Trop Med Int Health 9:928–934

    Article  PubMed  Google Scholar 

  • Ransohoff DF, Feinstein AR (1978) Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 299:926–930

    Article  PubMed  CAS  Google Scholar 

  • Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ (2004) Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329:1212

    Article  PubMed  Google Scholar 

  • Rogerson SJ, Chaluluka E, Manjala M, Mkundika P, Mhango C, Molyneux ME (2000) Intermittent sulphadoxine-pyrimethamine in pregnancy: effectiveness against malaria morbidity in Blantyre, Malawi, 1997–1999. Trans R Soc Trop Med Hyg 94:549–553

    Article  PubMed  CAS  Google Scholar 

  • Rogerson SJ, Mkundika P, Kanjala MK (2003) Diagnosis of Plasmodium falciparum malaria at delivery: comparison of blood film preparation methods and of blood films with histology. J Clin Microbiol 41:1370–1374

    Article  PubMed  Google Scholar 

  • Sartelet H, Milko-Sartelet I, Garraud O, Picot S (1997) Plasmodium falciparum persists in the placenta after three days’ treatment with quinine. Trans R Soc Trop Med Hyg 91:431

    Article  PubMed  CAS  Google Scholar 

  • Shulman CE, Dorman EK (2003) Reducing childhood mortality in poor countries—importance and prevention of malaria in pregnancy. Trans R Soc Trop Med Hyg 97:30–35

    Article  PubMed  Google Scholar 

  • Shulman CE, Graham WJ, Jilo H, Lowe BS, New L, Obiero J, Snow RW, Marsh K (1996) Malaria is an important cause of anaemia in primigravidae: evidence from a district hospital in coastal Kenya. Trans R Soc Trop Med Hyg 90:535–539

    Article  PubMed  CAS  Google Scholar 

  • Singer LM, Newman RD, Diarra A, Moran AC, Huber CS, Stennies G, Sirima SB, Konate A, Yameogo M, Sawadogo R, Barnwell JW, Parise ME (2004) Evaluation of a malaria rapid diagnostic test for assessing the burden of malaria during pregnancy. Am J Trop Med Hyg 70:481–485

    PubMed  Google Scholar 

  • Singh N, Mishra AK, Shukla MM, Chand SK, Bharti PK (2005) Diagnostic and prognostic utility of an inexpensive rapid on site malaria diagnostic test (ParaHIT f)among ethnic tribal population in areas of high, low and no transmission in central India. BMC Infect Dis 5:50

    Article  PubMed  Google Scholar 

  • Steketee RW, Nahlen BL, Parise ME, Menendez C (2001) The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg 64:28–35

    PubMed  CAS  Google Scholar 

  • Sullivan AD, Nyirenda T, Cullinan T, Taylor T, Harlow SD, James SA, Meshnick SR (1999) Malaria infection during pregnancy: intrauterine growth retardation and preterm delivery in Malawi. J Infect Dis 179:1580–1583

    Article  PubMed  CAS  Google Scholar 

  • Tako EA, Zhou A, Lohoue J, Leke R, Taylor DW, Leke RF (2005) Risk factors for placental malaria and its effect on pregnancy outcome in Yaoundé, Cameroon. Am J Trop Med Hyg 72:236–242

    PubMed  Google Scholar 

  • Uneke CJ, Duhlinska DD, Igbinedion EB (2007) Plasmodium falciparum malaria, human immunodeficiency virus infection, and anaemia during pregnancy in Eastern Nigeria: The Public Health Implication. Infect Dis Clin Pract 15:239–244

    Article  Google Scholar 

  • van Eijk AM, Ayisi JG, ter Kuile FO, Misore AO, Otieno JA, Rosen DH, Kager PA, Steketee RW, Nahlen BL (2002) Risk factors for malaria in pregnancy in an urban and peri-urban population in western Kenya. Trans R Soc Trop Med Hyg 96:586–592

    Article  PubMed  Google Scholar 

  • van Eijk AM, Ayisi JG, ter Kuile FO, Misore AO, Otieno JA, Rosen DH, Kager PA, Steketee RW, Nahlen BL (2003) HIV increases the risk of malaria in women of all gravidities in Kisumu, Kenya. AIDS. 17:595–603

    Article  PubMed  Google Scholar 

  • van Geertruyden JP, Thomas F, Erhart A, D'Alessandro U (2004) The contribution of malaria in pregnancy to perinatal mortality. Am J Trop Med Hyg 71:35–40

    PubMed  Google Scholar 

  • VanderJagt TA, Ikeh EI, Ujah IO, Belmonte J, Glew RH, VanderJagt DJ (2005) Comparison of the OptiMAL rapid test and microscopy for detection of malaria in pregnant women in Nigeria. Trop Med Int Health 10:39–41

    Article  PubMed  CAS  Google Scholar 

  • Van Geertruyden JP, Ntakirutimana D, Erhart A, Rwagacondo C, Kabano A, D'Alessandro U (2005) Malaria infection among pregnant women attending antenatal clinics in six Rwandan districts. Trop Med Int Health 10:681–688

    Article  PubMed  Google Scholar 

  • World Health Organization (2000) Expert Committee on Malaria. WHO technical report series 892, i–v. World Health Organization, Geneva

    Google Scholar 

  • World Health Organization (2000b) Malaria Diagnosis New Perspectives. Report of a Joint WHO/USAID Informal Consultation. World Health Organization, Geneva

    Google Scholar 

  • World Health Organization (2000c) Severe falciparum malaria. Trans R Soc Trop Med Hyg 94(supplement 1): S1–S90

    Article  Google Scholar 

  • World Health Organization (2003) The African malaria report 2003. World Health Organization, Geneva

    Google Scholar 

  • Zinsou RD, Engongah-Beka T, Richard-Lenoble D, Philippe E, Awassi A, Kombila M (1987) Malaria and pregnancy. Comparative study of Central Africa and Western Africa. J Gynecol Obstet Biol Reprod (Paris) 16:485–488

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, PMB 053, Abakaliki, Nigeria

    C. J. Uneke

Authors
  1. C. J. Uneke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. J. Uneke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uneke, C.J. Diagnosis of Plasmoduim falciparum malaria in pregnancy in sub-Saharan Africa: the challenges and public health implications. Parasitol Res 102, 333–342 (2008). https://doi.org/10.1007/s00436-007-0782-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00436-007-0782-6

Keywords

Search

Navigation