Document Detail


Malaria prevention during pregnancy in unstable transmission areas: the highlands of Madagascar.
MedLine Citation:
PMID:  12100438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Malaria transmission in Madagascar is highly variable from one region to the next, and the consequences of the disease on pregnant women and their foetuses are not fully documented. In midwestern Madagascar, the high-transmission lowlands in the west of the country meet the central plateaux, where malaria is unstable because of the high altitude and annual indoor spraying of DDT since 1993. We studied five of the region's main maternity clinics. We began by interviewing sample groups of women of childbearing age living within the vicinity of each clinic. This enabled us to determine the extent to which they had accessed and made use of available maternal health services during pregnancy and delivery, and, hence, to estimate the feasibility of boosting the prophylaxis. We then spent a whole year (from June 1996 to May 1997) observing deliveries at the five clinics in order to gauge the prevalence of placental infection and its consequences on birthweight in various transmission situations. Although only between 2 and 15% of the women said that they had taken prophylaxis during their previous pregnancy, the vast majority had benefited from preventive care: 97% had attended an antenatal visit on at least one occasion and 84% had had the assistance of medical or paramedical staff during delivery, even when their homes were situated relatively far away from the clinic (76%). In total, we observed 1637 deliveries with a mean placental malaria prevalence rate of 8.1%. Individual prevalence rates, however, were found to differ significantly between the maternity clinics situated in the east (minimum 2.1%) and west (maximum 26.2%) of the region. There were also marked variations in line with the seasonal fluctuations in entomological transmission. On the whole, a greater percentage of low birthweights (LBWs) was recorded at the lowland clinics than at the highland ones (17.1% vs. 9.7%), possibly because of the higher malaria infection rate in low altitude areas. On the other hand, the relative risk of LBW linked to placental infection was far greater in the highlands [4.9 (3.3-7.3)] than in the lowlands [1.9 (1.2-3.0)]. Although the rate of placental malaria among women inhabiting the country's central plateaux may be low, it means that transmission--and, hence, the risk of LBW because of placental infection--still persists in spite of the indoor DDT spraying programme. For maximum efficacy, we recommend a combination of vector control (extended to lower altitude areas outside the current OPID zone) and preventive care--i.e. individual chemoprophylaxis--for all highland women during pregnancy.
Authors:
M Cot; L Brutus; V Pinell; H Ramaroson; A Raveloson; D Rabeson; A L Rakotonjanabelo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Tropical medicine & international health : TM & IH     Volume:  7     ISSN:  1360-2276     ISO Abbreviation:  Trop. Med. Int. Health     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-08     Completed Date:  2002-08-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9610576     Medline TA:  Trop Med Int Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  565-72     Citation Subset:  IM    
Affiliation:
Institut de Recherche pour le Développement, Programme Paludisme, Antananarivo, Madagascar. michel.cot@tnn.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Altitude*
Birth Weight
Comorbidity
Environmental Monitoring
Female
Geography
Humans
Infant, Low Birth Weight
Infant, Newborn
Interviews as Topic
Logistic Models
Madagascar / epidemiology
Malaria / epidemiology,  prevention & control*,  transmission*
Placenta / parasitology
Pregnancy
Pregnancy Complications, Parasitic / epidemiology,  prevention & control*
Prenatal Care / statistics & numerical data
Prevalence
Preventive Medicine
Risk

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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