Congenital and Neonatal Malaria in Unit of Reanimation and Neonatology of CHU Gabriel Toure
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Transcript of Congenital and Neonatal Malaria in Unit of Reanimation and Neonatology of CHU Gabriel Toure
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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
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Background
• Cause of neonatal deaths is not known
• Infection suspected
• Pediatricians use their clinical judgment to treat
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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
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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.
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Objective
To determine the rate of congenital and acquired malaria in inpatient neonates at a tertiary paediatric hospital of Mali.
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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
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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
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Rapid Diagnostic test : 15mn
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PCR Diagnosis: 3H
120bp
1 2 3 4
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Shematic of study designScreening
Informed ConsentBlood Draw
Malaria Positive Malaria Negative
Hospital Standard Patient Management Quinine Therapy
Hospital Standard Patient Management
Discharge
Methods (3)
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Descriptive results
• 146 mothers
• 300 infants
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Mother’s social status
Working women 20%
Housewives80%
Mean age : 25.26 years ±6.93
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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
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Chemoprophylaxis
49%
38,40%
9,52%
IPTp Chloroquine No chemoprophylaxis
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Characteristics of infants
Sex Male : 63.0%Female : 37.0%
Mean weight 2881.93 g
Mean age 2.63 days
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Prevalence of parasitemia in infants (1)
Positive %
Microscopy 0/300 0
OptiMal IT* 3/300 1
PCR 0/300 0
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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)
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Clinical diagnosis
0102030405060708090
100
Pre
vale
nce
(%
)
Sepsis Hypoxia Preterm
Clinical diagnosis
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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
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Futur studies
• Neonatal malaria in preterms
• Explore prevalence in older infants 1 - 6 months
• Investigate mechanisms of infant protection from malaria
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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)