Research
Burden of malaria in pregnancy in Jharkhand State, India
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* Corresponding author: Davidson H Hamer dhamer@bu.edu
1 Center for Global Health and Development, Boston University School of Public Health, Boston, MA 02118, USA
2 Department of International Health, Boston University School of Public Health, Boston, MA, USA
3 Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
4 National Institute for Malaria Research Field Station, Jabalpur, Madhya Pradesh, India
5 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
6 Center for Leadership and Management, Management Sciences for Health, Cambridge, MA 02139, USA
7 Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, USA
8 National Institute for Malaria Research, Delhi, India
9 Regional Medical Research Centre for Tribals (Indian Council for Medical Research), Jabalpur, India
Malaria Journal 2009, 8:210 doi:10.1186/1475-2875-8-210
Published: 3 September 2009Abstract
Background
Past studies in India included only symptomatic pregnant women and thus may have overestimated the proportion of women with malaria. Given the large population at risk, a cross sectional study was conducted in order to better define the burden of malaria in pregnancy in Jharkhand, a malaria-endemic state in central-east India.
Methods
Cross-sectional surveys at antenatal clinics and delivery units were performed over a 12-month period at two district hospitals in urban and semi-urban areas, and a rural mission hospital. Malaria was diagnosed by Giemsa-stained blood smear and/or rapid diagnostic test using peripheral or placental blood.
Results
2,386 pregnant women were enrolled at the antenatal clinics and 718 at the delivery units. 1.8% (43/2382) of the antenatal clinic cohort had a positive diagnostic test for malaria (53.5% Plasmodium falciparum, 37.2% Plasmodium vivax, and 9.3% mixed infections). Peripheral parasitaemia was more common in pregnant women attending antenatal clinics in rural sites (adjusted relative risk [aRR] 4.31, 95%CI 1.84-10.11) and in those who were younger than 20 years (aRR 2.68, 95%CI 1.03-6.98). Among delivery unit participants, 1.7% (12/717) had peripheral parasitaemia and 2.4% (17/712) had placental parasitaemia. Women attending delivery units were more likely to be parasitaemic if they were in their first or second pregnancy (aRR 3.17, 95%CI 1.32-7.61), had fever in the last week (aRR 5.34, 95%CI 2.89-9.90), or had rural residence (aRR 3.10, 95%CI 1.66-5.79). Malaria control measures including indoor residual spraying (IRS) and untreated bed nets were common, whereas insecticide-treated bed nets (ITN) and malaria chemoprophylaxis were rarely used.
Conclusion
The prevalence of malaria among pregnant women was relatively low. However, given the large at-risk population in this malaria-endemic region of India, there is a need to enhance ITN availability and use for prevention of malaria in pregnancy, and to improve case management of symptomatic pregnant women.