1. 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

2. Why malaria during pregnancy is important? Pregnant Women: pregnancy immunityseverity

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

4.  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

5. Time of infectionIMR First half0.69 Second half1.47 Any time0.94 Offspring malaria rate 0.731.521.0 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

6. Malaria during crude RR PAF First half0.67 - Second half 1.470.12 Any time0.94 - Adjusted for baby’s malaria Adjusted for baby’s malaria RRPAF 0.76 - 1.740.16 1.150.06 Adjusted > crude Why? Might be due to maternal immunity The effect of malaria in the first and second half of pregnancy is different

7. SPR and risk of infection in pregnant and non- pregnant women Grouppregnantnon-pregnant SPR SPR 0.140.16 Risk of infection Risk of infection 18.534.7 Whypregnant women has less chance of infection? Why pregnant women has less chance of infection? 1.Higher immunity 2.Lower risk of exposure

8. 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