Prevention Latin America

Women volunteer at a seed nursery near their village in a deforested region of the Guatemalan Highlands. Many seedlings are Guama, a fast growing species that helps provide shade for their corn crops in the  mountains surrounding their communities, and helps augment depleted fuel wood supplies.Project title: Estimating the burden and impact of malaria in pregnancy in Latin America

Project Coordinator(s): Meghna Desai and Julie Gutman (USA), Clara Menendez (Spain)

Project Collaborators:

Fundação de Medicina Tropical do Amazonas (FMTAM), Manaus, Brazil

Instituto de Inmunologia, Cali (CIV), Colombia

Universidad del Valle de Guatemala (CES-UVG), Guatemala City, Guatemala

Based on available knowledge of malaria in pregnancy (MiP) in areas with high and stable malaria transmission in sub-Saharan Africa, WHO developed guidelines for safe, effective interventions for pregnant women for this region. These include a combination of intermittent preventive treatment (IPTp), insecticide-treated mosquito nets, and prompt case management of febrile illness. No such recommendations are available for areas with much lower stable and unstable malaria transmission levels and/or higher risk of P. vivax infection such as the Latin American region, as there are little or no specific data on the burden of malaria during pregnancy or the impact and applicability of preventive interventions. This severely limits the development of optimal evidence-based policies and programmatic recommendations for this region.

We will be conducting a facility-based cohort observational study in pregnant women in three malaria endemic countries in Latin America: Guatemala, Colombia and Brazil. The study aims to describe the epidemiological and clinical features of vivax and falciparum malaria in pregnancy in areas of low malaria endemicity and/or predominantly P. vivax endemic areas. In addition, we will determine if there are pregnancy-specific P. vivax and P. falciparum immune responses and characterize the genotypes and phenotypes of the parasites in the placenta.

Data on the prevalence and incidence of malaria infection during pregnancy will be essential to guide control policies. In most Latin American countries, prevention of the infection in pregnancy relies on weekly prophylaxis with chloroquine (CQ), a strategy that has been fraught with poor patient and health worker compliance, and consequently proved not to be useful in sub-Saharan Africa. If the incidence and prevalence of malaria infection in Latin America is low, current preventive strategies could be replaced with more cost-effective approaches such as intermittent screening and treatment in pregnancy (ISTp). In ISTp, pregnant women are screened for malaria parasitemia at each antenatal visit with either rapid diagnostic tests (RDTs) or blood smears. Treatment for malaria would be provided only if the test is positive. This would limit unnecessary exposure of pregnant women (and their foetuses) to antimalarial drugs, and thus avoid potential risks. Therefore, the findings from the current study assessing the burden of disease will help to inform strategic approaches to prevention of MiP, as well as document the clinical impact of these infections in the region.