Congenital and Neonatal Malaria in Unit of Reanimation and Neonatology of

CHU Gabriel Toure

Dicko-Traore F.¹, Sylla M.¹,, Dara A.², Dama S.², Traore K.¹, Togo P.¹, Traore S.¹, Sissoko Sibiry ², Poudiougo B.², Keita M.¹,

Doumbo O.² And Djimde AA².

1-Service de Pédiatrie, CHU Gabriel Toure, Bamako, Mali 2-Malaria Research and Training Center, Bamako, Mali

Background

• Cause of neonatal deaths is not known

• Infection suspected

• Pediatricians use their clinical judgment to treat

Introduction(1)

• Malaria = first cause of mortality & morbidity in Mali (EDS IV)

• Malaria = 50% of HGT Pediatrics admissions (Campbell et al., 2004)

• Most pregnant women are exposed to repeated malaria infection

Introduction(2)

• Most report of congenital malaria are case in non-endemic countries (Thompson, 1977; Laosombat, 1981)

• Recent reports suggest that congenital malaria is not as rare among newborns in Sub-Saharan Africa (Ficher 1997;Akindele, 2003)

• Whether malaria accounts for mortality or morbidity in neonates in Mali is not known.

Objective

To determine the rate of congenital and acquired malaria in inpatient neonates at a tertiary paediatric hospital of Mali.

Methods (1)

• Unit of Reanimation and Neonatology of Hopital Gabriel Toure

• October 2006 and April 2008

• Cross-sectional study in infants aged 0-28 days and their mothers

• Inclusion criteria– AG >= 37 SA – admitted for inpatient care to the Unit of

Reanimation and Neonatology – Parental informed consent granted

Methods (2)

• Procedures

– informed parental consent – Venous blood collected for malaria

diagnosis by OptiMal-IT test, microscopy and PCR.

– If infant is enrolled, mother is approached for enrollment

Rapid Diagnostic test : 15mn

PCR Diagnosis: 3H

120bp

1 2 3 4

Shematic of study designScreening

Informed ConsentBlood Draw

Malaria Positive Malaria Negative

Hospital Standard Patient Management Quinine Therapy

Hospital Standard Patient Management

Discharge

Methods (3)

Descriptive results

• 146 mothers

• 300 infants

Mother’s social status

Working women 20%

Housewives80%

Mean age : 25.26 years ±6.93

Prevalence of parasitemia in mothers

Positive %

Microscopy 0/146 0

OptiMal IT* 1/146 0.7

PCR 9/146 6.8

P. Falciparum : 7/9 P. ovale : 2/9

Chemoprophylaxis

49%

38,40%

9,52%

IPTp Chloroquine No chemoprophylaxis

Characteristics of infants

Sex Male : 63.0%Female : 37.0%

Mean weight 2881.93 g

Mean age 2.63 days

Prevalence of parasitemia in infants (1)

Positive %

Microscopy 0/300 0

OptiMal IT* 3/300 1

PCR 0/300 0

Prevalence of parasitemia in infants (2)

• Infants are believed to be protected from malaria (Bruce-Chwatt LJ,1952; Snow RW, 1998)

• Prevalence up to 33% in endemic areas (Ankindele,1993)

• Clinically atypical malaria occurring in infants and pre-term babies have been reported (Hewson M, 2003)

Clinical diagnosis

0102030405060708090

100

Pre

vale

nce

(%

)

Sepsis Hypoxia Preterm

Clinical diagnosis

Conclusion

• Despite several years of Sulfadoxine-pyrimethamin IPTp policy, 40% women still used chloroquine

• Data suggest that malaria is not a significant contributor to neonatal morbidity and mortality in this setting

Futur studies

• Neonatal malaria in preterms

• Explore prevalence in older infants 1 - 6 months

• Investigate mechanisms of infant protection from malaria

Acknowledgements

• MRTC– Pr. O. Doumbo– Abdoulaye Djimdé– Saly Konate– Souleymane Dama– Sibiry Traore– Antoine Dara– Aldiouma Guindo– A. Barry

• CHU Gabriel Touré– Pr. M. M. Keita– Pr Mariam Sylla– Kalirou Traore– Pierre Togo– Seydou Traore

• Study babies and their parents• National Institute of Allergy and Infectious Diseases (NIAID)