Malaria in pregnancy as an indirect cause of infant mortality in sub-Saharan Africa

被引:111
作者
Guyatt, HL
Snow, RW
机构
[1] Kenya Govt Med Res Ctr, Wellcome Trust Collaborat Programme, Nairobi, Kenya
[2] Univ Oxford, John Radcliffe Hosp, Ctr Trop Med, Oxford OX3 9DU, England
基金
英国惠康基金;
关键词
malaria; infants; low birthweight; pregnancy; placental infection; infant mortality; neonatal mortality; literature search; sub-Saharan Africa; Kenya;
D O I
10.1016/S0035-9203(01)90082-3
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Although randomized controlled trials of interventions to reduce malaria in pregnancy have demonstrated an increase in the birthweight of the newborn in primigravidae, the subsequent impact on infant mortality in all-parities has not been assessed. The aim of this paper was to model the possible impact of placental malarial infection on infant mortality through reduced birthweight. An extensive literature search was undertaken to define a series of parameters describing the associations between placental infection, birthweight and premature mortality in sub-Saharan Africa. It was shown that a baby is twice as likely to be born of low birthweight if the mother has an infected placenta at the time of delivery (all-parities: 23% vs 11 %, primigravidae only: 32% vs 16%), and that the probability of premature mortality of African newborns in the first year of life is 3 times higher in babies of low birthweight than in those of normal birthweight (16% vs 4.6%). Assuming 25% of pregnant women in malaria-endemic areas of Africa harbour placental malarial infection, it is suggested that 5.7% of infant deaths in malarious areas could be an indirect cause of malaria in pregnancy. This would imply that, in 1997, malaria in pregnancy could have been responsible for around 3700 infant deaths under the diverse epidemiological conditions in Kenya. Placental infection with Plasmodium falciparum appears to have a more significant role in infant survival in Africa than has been previously assumed. This may explain the high reduction in infant mortality rates from interventions aimed at reducing transmission, over and above that expected from a decline in direct malaria-specific mortality alone.
引用
收藏
页码:569 / 576
页数:8
相关论文
共 67 条
[1]  
Alihonou E., 1991, Medecine d'Afrique Noire, V38, P745
[2]   THE EFFECT OF INSECTICIDE-TREATED BED NETS ON MORTALITY OF GAMBIAN CHILDREN [J].
ALONSO, PL ;
LINDSAY, SW ;
ARMSTRONG, JRM ;
CONTEH, M ;
HILL, AG ;
DAVID, PH ;
FEGAN, G ;
DEFRANCISCO, A ;
HALL, AJ ;
SHENTON, FC ;
CHAM, K ;
GREENWOOD, BM .
LANCET, 1991, 337 (8756) :1499-1502
[3]  
[Anonymous], BR J OBSTET GYNAECOL
[4]  
[Anonymous], 1972, Malaria and Pregnancy
[5]  
[Anonymous], RISKS SEVERITY MALAR
[6]  
ARCHIBALD H. MUNRO, 1956, BULL WORLD HEALTH ORGAN, V15, P842
[7]   INFLUENCE OF MATERNAL MALARIA ON NEWBORN INFANTS [J].
ARCHIBALD, HM .
BRITISH MEDICAL JOURNAL, 1958, 2 (DEC20) :1512-1514
[8]   EFFECTS OF SEX, BIRTH-WEIGHT, BIRTH-ORDER AND MATERNAL AGE ON INFANT-MORTALITY IN A NIGERIAN COMMUNITY [J].
AYENI, O ;
ODUNTAN, SO .
ANNALS OF HUMAN BIOLOGY, 1978, 5 (04) :353-358
[9]  
BACHSCHMID I, 1991, B SOC PATHOL EXOT, V84, P257
[10]   MATERNO-FETAL TRANSMISSION OF PREGNANCY MALARIA - AN IMMUNOPARASITOLOGICAL STUDY ON 202 PARTURIENTS IN MAPUTO [J].
BERGSTROM, S ;
FERNANDES, A ;
SCHWALBACH, J ;
PEREZ, O ;
MIYAR, R .
GYNECOLOGIC AND OBSTETRIC INVESTIGATION, 1993, 35 (02) :103-107