Congenital and Neonatal Malaria in Unit of Reanimation and Neonatology of CHU Gabriel Toure Dicko-Traore F.¹, Sylla M.¹,, Dara A.², Dama S.², Traore K.¹, Togo P.¹, Traore S.¹, Sissoko Sibiry ², Poudiougo B.², Keita M.¹, Doumbo O.² And Djimde AA². 1-Service de Pédiatrie, CHU Gabriel Toure, Bamako, Mali 2-Malaria Research and Training Center, Bamako, Mali

Background Cause of neonatal deaths is not known Infection suspected Pediatricians use their clinical judgment to treat

Introduction(1) Malaria = first cause of mortality & morbidity in Mali (EDS IV) Malaria = 50% of HGT Pediatrics admissions (Campbell et al., 2004) Most pregnant women are exposed to repeated malaria infection

Introduction(2) Most report of congenital malaria are case in non-endemic countries (Thompson, 1977; Laosombat, 1981) Recent reports suggest that congenital malaria is not as rare among newborns in Sub-Saharan Africa (Ficher 1997;Akindele, 2003) Whether malaria accounts for mortality or morbidity in neonates in Mali is not known.

Objective To determine the rate of congenital and acquired malaria in inpatient neonates at a tertiary paediatric hospital of Mali.

Methods (1) Unit of Reanimation and Neonatology of Hopital Gabriel Toure October 2006 and April 2008 Cross-sectional study in infants aged 0-28 days and their mothers Inclusion criteria –AG >= 37 SA –admitted for inpatient care to the Unit of Reanimation and Neonatology –Parental informed consent granted

Methods (2) Procedures –informed parental consent –Venous blood collected for malaria diagnosis by OptiMal-IT test, microscopy and PCR. –If infant is enrolled, mother is approached for enrollment

Rapid Diagnostic test : 15mn

PCR Diagnosis: 3H 120bp

Methods (3)

Descriptive results 146 mothers 300 infants

Mother’s social status Mean age : years ±6.93

Prevalence of parasitemia in mothers Positive% Microscopy0/1460 OptiMal IT*1/ PCR9/ P. Falciparum : 7/9 P. ovale : 2/9

Chemoprophylaxis

Characteristics of infants SexMale : 63.0% Female : 37.0% Mean weight g Mean age2.63 days

Prevalence of parasitemia in infants (1) Positive% Microscopy0/3000 OptiMal IT*3/3001 PCR0/3000

Prevalence of parasitemia in infants (2) Infants are believed to be protected from malaria (Bruce-Chwatt LJ,1952; Snow RW, 1998) Prevalence up to 33% in endemic areas (Ankindele,1993) Clinically atypical malaria occurring in infants and pre-term babies have been reported (Hewson M, 2003)

Clinical diagnosis

Conclusion Despite several years of Sulfadoxine- pyrimethamin IPTp policy, 40% women still used chloroquine Data suggest that malaria is not a significant contributor to neonatal morbidity and mortality in this setting

Futur studies Neonatal malaria in preterms Explore prevalence in older infants months Investigate mechanisms of infant protection from malaria

Acknowledgements MRTC –Pr. O. Doumbo –Abdoulaye Djimdé –Saly Konate –Souleymane Dama –Sibiry Traore –Antoine Dara –Aldiouma Guindo –A. Barry CHU Gabriel Touré –Pr. M. M. Keita –Pr Mariam Sylla –Kalirou Traore –Pierre Togo –Seydou Traore Study babies and their parents National Institute of Allergy and Infectious Diseases (NIAID)