Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study.
Asante, Kwaku Poku;
Owusu-Agyei, Seth;
Cairns, Matthew;
Dodoo, Daniel;
Boamah, Ellen Abrafi;
Gyasi, Richard;
Adjei, George;
Gyan, Ben;
Agyeman-Budu, Akua;
Dodoo, Theophilus;
+6 more...Mahama, Emmanuel;
Amoako, Nicholas;
Dosoo, David Kwame;
Koram, Kwadwo;
Greenwood, Brian;
Chandramohan, Daniel;
(2013)
Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study.
The Journal of infectious diseases, 208 (9).
pp. 1504-1513.
ISSN 0022-1899
DOI: https://doi.org/10.1093/infdis/jit366
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BACKGROUND: Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain. METHODS: We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology. RESULTS: The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants. CONCLUSIONS: There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.