Malaria in pregnancy and its consequences for the infant in rural Malawi

Maternal malaria and anaemia, pregnancy and infant outcomes are reviewed am ong a cohort of mothers and their babies living in Chikwawa district, south ern Malawi. Overall, 4104 women were screened at first antenatal visit and 1523 at delivery. Factors independently associated with moderately severe a naemia (MSA; < 8 g haemoglobin/dl) in primigravidae were malaria (relative risk = 1.9; 95% confidence interval = 1.6-2.3) and iron deficiency (relativ e risk = 4.2; 95% confidence interval = 3.5-5.0). Only iron deficiency was associated with MSA in multigravidae. After controlling for antimalarial us e, parasitaemia was observed in 56.3% of the HIV-infected primigravidae and 36.5% of the non-infected (P = 0.04). The corresponding figures for multig ravidae were 23.8% and 11.0%, respectively (P = 0.002). Over 33% of the inf ants born alive to primigravidae were of low birthweight (LBW; < 2500 g), a nd 23.3% of all newborns had foetal anaemia (< 12.5 g haemoglobin/dl cord b lood). LBW was significantly associated in primigravidae with pre-term deli very, placental malaria and frequency of treatment with sulfadoxine-pyrimet hamine (SP), and in multigravidae with pre-term delivery, adolescence, shor t stature and MSA. LBW was significantly reduced with a second SP treatment in primigravidae, and with iron-folate supplementation in multigravidae. M ean haemoglobin concentrations were significantly lower in the infant who h ad been LBW babies than in the others, and significantly associated with pa rity, peripheral parasitaemia at delivery and placental malaria. At 1 year post-delivery, life status was known for 364 (80.7%) of the 451 infants enr olled in the follow-up study. Independent risk factors far post-neonatal mo rtality were maternal HIV infection, LBW, and iron deficiency at delivery. This study identifies priorities for improving the health of pregnant women and their babies in this rural area of Malawi.