Royal Society of Tropical Medicine and Hygiene Manson House Impact of maternal malaria during pregnancy on Infant Mortality Rate in an highly endemic area Ali-Akbar Haghdoost, London school of hygiene and tropical medicine Neal Alexander, London school of hygiene and tropical medicine Tom Smith, Swiss Tropical Institute Department of Public Health & Epidemiology Royal Society of Tropical Medicine and Hygiene Manson House 12th December 2002

Pregnant Women: Introduction1 Pregnancy malaria and IMR Why malaria during pregnancy is important? Pregnant Women: pregnancy immunity severity

Congenital malaria (rare) Severe disease and/or infection Introduction2 Pregnancy malaria and IMR Baby Anaemia in woman Congenital malaria (rare) LBW and anaemia mortality increase Malaria during pregnancy Placental infection Maternal immunity Severe disease and/or infection decrease

method1 Pregnancy malaria and IMR highly endemic are in Northern Nigeria, The garki project: more than 12,000 people were followed in 23 survey Mother’s and baby’s data were linked base data collection time and birth dates and, compound ID, 417 pairs out of 747 deliveries Rate ratio for infection during first and second half of pregnancy on IMR were computed by Poisson regression model

results1 Time of infection IMR First half 0.69 0.73 Second half 1.47 Pregnancy malaria and IMR Time of infection IMR First half 0.69 Second half 1.47 Any time 0.94 Offspring malaria rate 0.73 1.52 1.0 Malaria during the first half of pregnancy is a protective factor, however during the second half is a risk factor for IM and also contracting infection after birth

results2 Pregnancy malaria and IMR First half 0.67 - 1.74 0.16 Malaria during crude RR PAF First half 0.67 - Second half 1.47 0.12 Any time 0.94 - Adjusted for baby’s malaria RR PAF 0.76 - 1.74 0.16 1.15 0.06 Adjusted > crude Why? Might be due to maternal immunity The effect of malaria in the first and second half of pregnancy is different

SPR and risk of infection in pregnant and non-pregnant women results3 Pregnancy malaria and IMR SPR and risk of infection in pregnant and non-pregnant women Group pregnant non-pregnant SPR 0.14 0.16 Risk of infection 18.5 34.7 Why pregnant women has less chance of infection? Higher immunity Lower risk of exposure

Conclusion: Pregnancy malaria and IMR WHO recommendation: Prompt treatment for all demonstrable disease Prophylaxes for all pregnant women Although it is correct, to make more precise plan we should think about The difference between infection and disease Endemisity of malaria Drug resistance Pregnancy age Socio-economic and nutritional status of people