Welcome

The Malaria in Pregnancy (MiP) Library is a regularly updated, comprehensive bibliographic database of published and unpublished literature relating to malaria in pregnancy, including a trial registry of planned and ongoing trials. The MiP library is a product of the Malaria in Pregnancy Consortium and is available free of charge.

To start your search click on the “Search” Tab on the top of the page. For information on how to search, click on “How to use” Tab.

For more information on the MiP Library and inclusion criteria click the “About” Tab.

Article highlights from the update in January 2020

Article highlights from the update in December 2020-January 2021:

 

In January 2021, 207 new entries were added to the MiP library. New entries include peer reviewed journal articles, PhD and MSc theses, reports, and conference abstracts. Here we highlight new articles that may be of particular interest.

Reviews. For people who would appreciate an overview of the deleterious effects of malaria in pregnancy on the developing fetus, there is a comprehensive review by Saito et al. (2020) including the beneficial effects of treatment and prevention. To better understand the contribution of malaria to gestational hypertension in Africa, Mruma et al. (2020) published a systematic review and meta-analysis. They identified four good quality case-control studies; the association between malaria and gestational hypertension had an odds ratio of 2.67 (95% CI 1.58-4.53, I2 0%, N=1218 women).

Economics and feasibility. Three studies present cost-effectiveness analyses with regards to prevention or diagnosis of malaria in pregnancy. Fernandes et al. (2020) compared the cost-effectiveness of intermittent preventive treatment (IPTp) with dihydroartemisin-piperaquine (DP) versus sulfadoxine-pyrimethamine (SP) and concluded that among HIV-negative pregnant women with high uptake of long-lasting insecticidal nets, IPTp-DP would be cost-effective in areas with high malaria transmission and high sulfadoxine-pyrimethamine resistance. They recommend further research in areas with different underlying levels of SP resistance. In Indonesia, IPTp with DP was compared with single screening and treatment (Paintain et al. 2020); although IPTp with DP offered a cost-effective alternative to single screening and treatment in the context of the moderate malaria transmission setting of Papua, the higher cost of IPTp was driven by monthly administration, and acceptability and feasibility considerations would be needed to inform decision making. Restrepo-Posada et al. 2020 report that the use of rapid diagnostic tests for timely diagnosis and treatment of malaria in pregnancy instead of blood smears would be a highly cost-effective strategy in Colombia. A study on feasibility of intermittent screening and treatment with DP in Kenya concluded that the systems effectiveness of ANC clinics to deliver ISTp-DP under routine conditions, in particular the administration of DP, was relatively poor in comparison to IPTp-SP (Hill et al. 2020). However, a Tanzanian study noted that in areas of moderate or high transmission single screen and treat would identify many infected asymptomatic women (Kitojo et al. 2020).

Pharmacokinetics. A study using data from Kenyan and Indonesian women concluded that monthly, presumptive administration of DP has the potential to offer optimal prevention of malaria during pregnancy (Chotsiri et al 2020). A study from Uganda noted that piperaquine clearance is faster among pregnant (compared to non-pregnant women), among HIV-infected pregnant women using efavirenz (compared to HIV-negative pregnant women) , and among pregnant women with a low body mass index, and that regimens may need to be adapted for each group (Hughes et al. 2020).

VAR2CSA. In this update there are several articles about VAR2CSA, variant surface antigens binding to chondroitin sulfate A in the placenta, and important for the immunology of malaria in pregnancy. For an update on VAR2CSA-based placental malaria vaccine development, you can read the review by Doritchamou et al. (2021). Ma et al. (2021) presented a study on the structure of VAR2CSA and its binding to CSA and how the binding can be of importance for malaria in pregnancy and cancer treatment, whereas Bewley et al. (2020) focussed on the structural architecture of VAR2CSA. Wiebe & Yanow (2020) explored if naturally acquired antibodies to variant surface antigens can protect pregnant women from malarial anaemia. Results from 17 studies were not uniform, with some showing protection, and no association in others.

Co-infections. A large study in rural Burkina Faso among antenatal attendees reported a prevalence of malaria, curable STIs and coinfections of 24.5%, 4.0% and 1.2% respectively (Zango et al. 2020). A Kenyan study of the interaction between Kaposi sarcoma-associated herpes virus (KSHV) and malaria in pregnancy (N=199) reported a KSHV seroprevalence of 88%. Seventy KSHV-positive HIV-negative women were followed at delivery: malaria in pregnancy did not appear to affect transfer of KSHV antibodies across the placenta (Sabourin et al. 2020). Case-reports from India put the spotlight on the possibility of co-infection with malaria and COVID-19 in pregnancy (Mahajan et al. 2020).


Epidemiology. In a study in Niger, congenital malaria was diagnosed in 26.5% of 249 newborns, with symptomatic disease present in 14.1% (Tahirou et al. 2020). A secondary analysis of a trial in Uganda showed that severe past placental malaria was associated with a higher malaria incidence in male (aIRR 2.17, 95% CI 1.45–3.25, p < 0.001), but not in female, infants (aIRR 0.74, 95% CI 0.46–1.20, p = 0.22, Kakuru et al. 2020). A cohort study in Tanzania (N=1,115) examined submicroscopic placental malaria (prevalence 12%) and noted that malaria prevention methods and maternal nutrition status during early pregnancy were important predictors of submicroscopic placental malaria; however, unlike histological placental malaria, submicroscopic placental malaria was a protective factor for small-for-gestational age infants (Kalinjuma et al. 2020). In a preconception cohort of 273 women followed until delivery in Benin, factors associated with the number of P. falciparum infections after the 1st trimester included microscopic and submicroscopic infections in the first trimester and a low number of SP doses (0-1 vs. 2+, adjusted incidence rate ratio 1.50, 95% CI 1.11-2.03). However, no association was seen between IPTp doses and number of submicroscopic P. falciparum infections among women without microscopic P. falciparum after the first trimester (adjusted incidence rate ratio 1.2, N=157 Hounkonnou et al. 2020).

Prevention. IPTp coverage is still not optimal: in a four-country study (Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria), coverage for 3+ doses was higher than 30% in two districts in Mozambique but not in the other countries (Pons-Duran et al. 2020). In Eastern Uganda, SP3+ coverage was 14.7%, with higher coverage of net use (86.4%) (Wafula et al. 2021). Among 380 first-time ANC attendees in Nigeria, 41.8% thought IPTp could be harmful for their pregnancy (Balami et al. 2020). Coverage of SP3+ was 42.4% at 36 weeks gestational age in Ghana, with a protective effectiveness for malaria of 0.42 (odds ratio, 95% CI 0.32-0.56) among 1146 participants (Agyeman et al. 2020). An ethnographic study of healthcare managers on IPTp delivery in two regions in Ghana reported managers had addressed the effects of frequent stock-outs and delayed reimbursement by the national health insurance scheme to the program, by shifting clients to co-payments, rationing and referring clients to buy drugs from private pharmacies, thereby reducing their ability to enforce directly observed therapy and number of ANC visits for those who can’t afford payments (Aberese-Eko et al. 2020). Dissatisfaction with interpersonal relationships with health workers were mentioned as an additional barrier to accessing malarial prevention among 284 pregnant women in Nigeria (Obagha et al. 2020). Although community-directed distribution was satisfactory for clients in a study in Nigeria (N=229) with 71.6% reaching 3+ doses (Okedo-Alex et al. 2020), this type of distribution can have problems of its own such as trust issues (Enguita-Fernandez 2020). Among 297 pregnant women in Nigeria, ITN use was high (78%), and those who purchased LLINs were 3 times more likely to have used it (OR: 3.13, 95% CI 1.62–6.04) compared to those that got free LLINs (Ibegu et al. 2020). Al Khaja & Sequeira (2021) reviewed national guidelines for malaria in pregnancy in 35 countries and noted that several national guidelines require update revisions to harmonize with international guidelines and emergent trends in managing falciparum malaria in pregnancy. Webster et al. (2020) retrospectively examined the national policy adoption process for revised IPTp-SP dosing (from 2 to 3+ dosing), and prospectively examined attitudes toward adoption of artemisinin-combination therapies for treatment in the first trimester in four countries (Mali, Malawi, Kenya and The Gambia). Adoption of the revised IPTp-SP policy was perceived to be based on strong evidence, support from WHO, consensus from stakeholders. Poor tolerability of quinine was highlighted as a strong reason for a potential change in treatment policy. However, the evidence on safety of ACTs in the first trimester was considered weak. An announcement by WHO and local evidence could allay these fears.