Malaria during pregnancy and infancy, in an area of intense malaria transmission in central India

The clinico-epidemiological pattern of malarial infection in a cohort of pr egnant women and infants was analysed during a malaria epidemic (1997-1998) . The subjects were all members of tribal communities in an isolated and al most inaccessible area of central India. Overall, 151 (55%) of the 274 pregnant women investigated were found to hav e malarial infections at some time during the study, with Plasmodium falcip arum predominating (88% of infections). All of the women investigated, whet her primigravidae (42% found infected), secundigravidae (68%) or multigravi dae (54%), were at great risk of developing severe malaria. When trimesters were compared, the highest prevalence of P. falciparum infection was recor ded in the second (59% infected), irrespective of parity. Of the women foun d infected with P. falciparum, 3% had abortions, 4% stillbirths and 2% had babies who died while neonates. The small number of P. vivax infections obs erved prevented similar analyses for this species of parasite. Malarial infection was also seen in 218 (41%) of the 535 infants investigat ed. The values for age-specific prevalences revealed that > 30% of the infa nts examined at 2 months of age were then found to have P. vivax and/or P. falciparum parasitaemias. At 1 year of age, overall malaria prevalence was 50%, with P. vivax representing 25% of the infections and P. falciparum the rest. Subsequent follow-up revealed that three of the infants investigated , each of a hom had had P. falciparum infections previously, died before th eir first birthdays. Re-infections (or treatment failures) were found to be common, both in the infants and the pregnant women. Pregnant women and infants from the study a rea clearly require systematic intervention to reduce their malaria-attribu table morbidity.