1. 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

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

3. 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

4. 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

5. 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
Second half 1.47
Any time
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

6. results2 Pregnancy malaria and IMR First half 0.67 - 1.74 0.16
Malaria during crude
RR PAF
First half
Second half
Any time
Adjusted for baby’s malaria
RR PAF
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
results3
Pregnancy malaria and IMR
SPR and risk of infection in pregnant and non-pregnant women
Group pregnant non-pregnant
SPR
Risk of infection
Why pregnant women has less chance of infection?
Higher immunity
Lower risk of exposure

8. 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