Demographic Surveillance to Monitor Impact of Malaria on Pregnant Women in Ouelessebougou, Mali

Placental malaria (PM) leads to poor outcomes for pregnant women and their babies, and is caused by Plasmodium falciparum sequestration in the intervillous spaces of the placenta and ensuing inflammation. Severe maternal anemia, low birth weight (LBW) delivery and fetal loss are common sequelae. Malaria-related LBW alone is estimated to cause 62,000-363,000 infant deaths in Africa each year. To reduce poor pregnancy outcomes associated with malaria infection, WHO recommends monthly anti-malarial treatment with sulfadoxine pyrimethamine (SP) during the second and third trimester and the use of insecticide-treated bed nets. However, in East and Southern Africa, SP has lost its efficacy due to the spread of drug-resistant parasites. Therefore, an effective vaccine for PM is needed. Although the ideal vaccine will be given to adolescent girls prior to becoming pregnant, at this early stage of pregnancy malaria vaccine development, it is unknown if a boosting dose may be needed during pregnancy.

Before testing new interventions to improve pregnancy outcomes, it is important to obtain baseline information on pregnancy outcomes in the target population. In our recent longitudinal study of 1,885 pregnant women in Mali, in which women were closely followed during pregnancy (including malaria prevention and treatment), 2.9%, 2.4% and 6% of pregnancies ended in miscarriage, stillbirth, and preterm delivery, respectively.

The primary goal of the study is to assess pregnancy outcomes in women in the community with access to the WHO recommended standard of care. In the first part of the study, all women presenting for an antenatal visit at Ouelessebougou health centers will be recruited into the study. In the second part of the study, non-pregnant women will be enrolled and followed to capture data on pregnancy outcomes including early pregnancy losses. Pregnancy outcome information will be collected after the birth of the child or after pregnancy termination (i.e. miscarriage/stillbirth). Primary and secondary endpoints will be analyzed using appropriate statistical methods, including possible confounders, to determine the prevalence and factors associated with poor pregnancy outcomes.