The epidemiology and burden of Plasmodium falciparum-related anemia among pregnant women in sub-Saharan Africa

The paucity of precise information on the burden of malaria among pregnant women has hampered effective lobbying for the inclusion of preventative str ategies against malaria in Safe Motherhood Initiatives. This article review s the evidence on the coincidental risks of malaria and anemia in Africa an d attempts to estimate the probable burden of malaria-related severe anemia in this susceptible group. Twenty-six studies on hemoglobin levels in all- parity pregnant women throughout this region could be matched with a malari a parasite ratio in children < 15 yr old (a measure of the intensity of tra nsmission). In areas with no malaria, the mean hemoglobin levels were marke dly higher than those found in areas with stable malaria transmission, thou gh changes with increasing intensity of transmission were unclear. Eighteen studies from areas with stable malaria transmission in sub-Saharan Africa suggested that the median prevalence of severe anemia in all-parity pregnan t women is approximately 8.2%. Assuming that 26% of these cases are due to malaria, it is suggested that as many as 400,000 pregnant women may have de veloped severe anemia as a result of infection with malaria in sub-Saharan Africa in 1995.