Placental Malaria

Prevalence of Placental Malaria Infection among Women Delivering at Tororo Hospital

PIs:  Deborah Cohan, MD, Pius Okong MBChB, Dip Obs, MMed, PhD, Veronica Ades, MD, MPH

Co-investigators: Lynette Tumwine, Diane Havlir, Grant Dorsey, Phil Rosenthal, Tamara Clark, Emmanuel Arinaitwe

Funded by:  UCSF-CFAR

This was an NIH funded prospective cohort study at the Tororo District Hospital Labor Ward.

This study aims to estimate the prevalence and predictive factors of placental malaria infection and compare four methods for determining placental malaria found in HIV-infected and HIV-uninfected women delivering at Tororo District Hospital. The three specific aims for this study are: 1) to estimate the prevalence of placental malaria in HIV infected and uninfected women; 2) to evaluate factors associated with placental malaria in HIV infected and uninfected women [such as antiretroviral (ARV) regimen, bed net use, use of septrin or intermittent preventative therapy (IPT)]; and 3) to compare 4 methods (placenta blood smear, PCR from filter paper dried placenta blood, HRP2 RDT and histology) in diagnosing placental malaria and evaluate each method’s association with low birth weight (LBW).

A Programmatic Evaluation of Sulfadoxine-Pyrimethamine for Prevention of Placental Malaria in Uganda

PIs: Moses Kamya, MD, PhD (MU), Veronica Ades, MD, MPH (UCSF), Scott Filler, MD, DTM&H (CDC)

Co-investigators: Grant Dorsey, MD, PhD (UCSF), Emmanuel Arinaitwe, MD, MPH (UMSP), Susie Nasr, MD (CDC)

This was a CDC-funded evaluation to determine the effectiveness of SP IPTp in Tororo, Uganda by measuring the association between prenatal SP use and the risk of placental malaria at the Tororo District Hospital Labor Ward.

SP continues to be used for intermittent preventive treatment during pregnancy (IPTp), but its effectiveness for this purpose in the setting of high resistance of SP for treatment is not known. It is important to evaluate SP effectiveness in pregnant women in Uganda. If SP IPTp continues to have the positive effects, this will provide strong evidence to the National Malaria Control Program (NMCP) to continue the program. If SP IPTp is not efficacious, the NCMP will consider stopping the program or find an alternative drug to be used as IPTp.

Objectives:

1) To determine the effectiveness of SP IPTp in Tororo, Uganda by measuring the association between prenatal SP use and the risk of placental malaria.

To determine birth outcomes of women given SP IPTp, an evaluation was done among women at delivery. Eligible consenting women who deliver at TGH were enrolled at the time of delivery. Finger prick blood specimens, placental specimens, and infant birth weight were collected. Participant ANC cards and records were examined to obtain information on SP IPTp doses. Outcomes of interest include maternal peripheral parasitemia, maternal anemia, placental parasitemia, placental histology, and infant birth weight.