SEASONALITY, MALARIA, AND IMPACT OF PROPHYLAXIS IN A WEST-AFRICAN VILLAGE .1. EFFECT ON ANEMIA IN PREGNANCY

The importance of malaria as a cause of anemia in pregnancy in endemic areas remains controversial. The prevalence of anemia in pregnant wom en following the dry (May) and the rainy (November) seasons was compar ed in two successive years in Bougoula village (region of Sikasso, Mal i). Phase I (1992) was observational and included 172 pregnant women a nd 208 controls. In Phase II (1993, 174 pregnant women and 206 control s), malaria prophylaxis with proguanil (200 mg/day) and chloroquine (3 00 mg/week) was offered to pregnant women. A strong seasonal variation in the prevalence of moderate to severe anemia in pregnant (hematocri t < 30%) occurred in Phase I (dry season = 8.7%, rainy season = 41.2%) . This variation was present only in women of parity lower than five, and paralleled variation in parasitemia. In Phase II, the seasonal var iation of anemia was suppressed in women under malaria prophylaxis (pr esence of antimalarial metabolites in urine), and the overall prevalen ce of moderate to severe anemia in prevalence of moderate to severe an emia in pregnancy decreased by 55.5% (22.8-74.3%). We conclude that ma laria is the major cause of anemia in pregnancy in this region. A high priority should be given to prevention of malaria in pregnancy.