Academic journal article Bulletin of the World Health Organization

Epidemiology of Malaria in Pregnancy in Central India

Academic journal article Bulletin of the World Health Organization

Epidemiology of Malaria in Pregnancy in Central India

Article excerpt

Voir page 571 le resume en francais. En la pagina 572 figura un resumen en espanol.

Introduction

It is generally agreed that the prevalence of malaria is higher among pregnant women than other groups (1), and that this can lead to abortion, intrauterine fetal death, premature delivery and even maternal death (2). The greater part of our knowledge about malaria in pregnancy is derived from studies carried out in tropical Africa, which show differences in the clinical epidemiological pattern of malaria in pregnancy from one endemic setting to another (3). Systematic studies from malaria-endemic regions in India are lacking except for those carried out in Chandigarh (4, 5) and Surat, Gujarat (6), two areas that differ in climate, intensity of malaria transmission, use of malaria control measures, and sociocultural attitudes towards the disease. In the absence of such a study in central India, we examined the relationship between malaria infection and pregnancy in Jabalpur -- information which would help to develop control strategies. This endemic region is of special interest because the population is exposed to malaria from both Plasmodium vivax and P. falciparum.

Materials and methods

Study area

Jabalpur district (area, 10 160 [km.sup.2]) in central India (Madhya Pradesh), has a mixed rural, tribal, and urban population (total, ca. 2.2 million). The district is mostly rocky with an undulating terrain and has no proper drainage and irrigation facilities. The study was carried out in the Government Medical College, which is surrounded by typical urban slums; the river Narmada, about 5 km away, supports the breeding of three primary vector species -- Anopheles culicifacies, A. fluviatilis and A. stephensi. The Medical College is the largest medical facility in the district and serves as both a hospital for local people and a referral hospital for the adjoining six districts. Both P. vivax and P. falciparum malaria are common in the area (7), and there is a definite seasonal trend (8). Cases are mainly due to P. vivax in the dry hot season (March-June) and to P. falciparum during the monsoon and postmonsoon period. Resistance of P. falciparum to chloroquine is common (9, 10).

Antenatal clinic

The obstetrics and gynaecology department of the Medical College has a busy antenatal clinic, which an average of 500 women attend every month. Pregnant women usually first attend the antenatal clinic in the fourth or fifth month of gestation and make three or four visits before delivery. At enrolment, a clinical and obstetric history is recorded for each woman by the medical officer, followed by a full examination, including measuring the woman's weight, temperature, pulse, blood pressure, fundal height, fetal heart rate, and determining the presence of oedema or anaemia. An estimate of gestational age is also recorded, based on the fundal height and fetal size. The majority of women attend the antenatal clinic for a routine check-up, but those with fever or a history of fever at some time during the pregnancy are referred to the malaria clinic in the Malaria Research Centre (Indian Council of Medical Research). Fever cases among those attending other departments in the hospital with minor complaints, or while visiting patients or accompanying patients to the hospital, are also referred to the malaria clinic.

There were over 4000 deliveries in 1992 at the Medical College and the number has been increasing steadily. Women attending the antenatal clinic are given one month's supply of iron(II) sulfate tablets (60 mg daily) and folic acid tablets (5 mg daily). Deliveries are usually conducted by nurses and the birth weights are recorded within 24 hours by one of the clinic staff. Over 85% of the obstetric admissions to the hospital lived within a few miles of the hospital; about 5% were women from surrounding villages who arrived only when labour was imminent, and about 10% were referred from nearby districts. …

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