Nutritional Advice El MondoObjectives:
In Sub-Saharan Africa (SSA), where malaria transmission is stable, malaria infection in pregnancy adversely affects pregnant women, fetuses and newborns and is often asymptomatic. So far, a plethora of primary studies have been carried out on asymptomatic malaria infection in pregnant women in Sub-Saharan Africa. Nevertheless, no meta-analysis estimated the burden of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa. Therefore, this review article (meta-analysis) has been conducted.
What is the burden of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa?
Study design:
This review article included 35 eligible studies. All included studies were conducted in 14 different countries; the largest number of included studies (n = 16, 45.7%) was conducted in Nigeria, while 3 in Ethiopia, 2 in DR Congo, 2 in Burkina Faso, 2 in Tanzania, 1 in Ghana, 1 in Kenya, 1 in Malawi, 1 in Madagascar, 1 in Liberia, 1 in Uganda, 1 in Zambia, 1 in Mozambique, 1 in Gabon and 1 in Cameroon.
The largest number of included studies (n = 20) used microscopy to diagnose asymptomatic malaria, while the remaining 9, 4 and 2 used molecular methods, microscopy and rapid diagnostic test and rapid diagnostic test, respectively.
The sample size of eligible studies ranges from 50 to 2,459.
All included studies were conducted between 2002 and 2020, with 9, 7 and 18 of the included studies were conducted between 2002 and 2010, 2011-2014 and 2015-2020, respectively.
The risk of bias assessment of included studies showed that 17 and 18 of them had a low and moderate risk of bias, respectively.
Both Egger’s regression test (p = 0.287) and Begg’s correlation test (p = 0.966) showed the absence of publication bias.
Results and conclusions:
The investigators found the overall prevalence estimate of asymptomatic Plasmodium infection prevalence was 26.1% [95% CI = 21% to 31.2%, I2 = 99.0%].
The result of sensitivity analysis demonstrated that the overall estimate of asymptomatic malaria infection prevalence was robust and it was not influenced by a single study.
The investigators found according to species-specific pooled prevalence estimate, Plasmodium falciparum was dominant species [22.1%, 95% CI = 17.1% to 27.2%, I2 = 98.6%], followed by Plasmodium vivax, Plasmodium malariae and Plasmodium ovale [3%, 95% CI = 0% to 5%, I2 = 88.3%, 0.8%, 95% CI = 0.3% to 0.13%, I2 = 60.5% and 0.2%, 95% CI = -0.01% to 0.5%, I2 = 31.5%], respectively.
The investigators found result of meta-regression analysis pointed out that the overall prevalence of asymptomatic malaria infection did not showed a statistically significant rise between the years 2002 and 2020 [coef. = -0.0221807, p = 0.200].
Also, the overall estimate of asymptomatic malaria infection was not impacted by an increase in sample size [coef. = -0.0000877, p = 0.55].
The investigators found asymptomatic malaria-infected pregnant women were 2.28 times more likely anemic [OR = 2.28, 95% CI = 1.66 to 3.13, I2 = 56.3%] than in non-infected pregnant women.
The investigators found asymptomatic malaria infection was 1.54 times higher [OR = 1.54, 95% CI = 1.28 to 1.85, I2 = 11.5%] in primigravida women compared to multigravida women (women who have been pregnant more than once).
The investigators concluded in Sub-Saharan Africa (SSA), asymptomatic malaria infection in pregnant women is prevalent and it is associated with an increased likelihood of anemia compared to non-infected pregnant women. Thus, screening of asymptomatic pregnant women for malaria and anemia should be included as part of antenatal care.
Original title:
A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: A challenge for malaria elimination efforts by Yimam Y, Nateghpour M, […], Afshar MJA.
Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016273/
Additional information of El Mondo:
Find more information/studies on RCTs/cohort/significantly/review article, malaria and food fortification/malnutrition right here.