Research
Assessing the burden of pregnancy-associated malaria under changing transmission settings
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* Corresponding author: Mario Recker mario.recker@zoo.ox.ac.uk
1 Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK
3 Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA
Malaria Journal 2009, 8:245 doi:10.1186/1475-2875-8-245
Published: 28 October 2009Abstract
Background
The clinical presentation of pregnancy-associated malaria, or PAM, depends crucially on the particular epidemiological settings. This can potentially lead to an underestimation of its overall burden on the female population, especially in regions prone to epidemic outbreaks and where malaria transmission is generally low.
Methods
Here, by re-examining historical data, it is demonstrated how excess female mortality can be used to evaluate the burden of PAM. A simple mathematical model is then developed to highlight the contrasting signatures of PAM within the endemicity spectrum and to show how PAM is influenced by the intensity and stability of transmission.
Results
Both the data and the model show that maternal malaria has a huge impact on the female population. This is particularly pronounced in low-transmission settings during epidemic outbreaks where excess female mortality/morbidity can by far exceed that of a similar endemic setting.
Conclusion
The results presented here call for active intervention measures not only in highly endemic regions but also, or in particular, in areas where malaria transmission is low and seasonal.