RESUMEN
Background: Plasmodium falciparum infection in pregnant women in sub-Saharan Africa is often asymptomatic. As these forms of malaria are often submicroscopic and difficult to diagnose by conventional methods (microscopy and/or rapid diagnostic test), diagnosis requires the use of molecular techniques such as polymerase chain reaction (PCR). This study analyses the prevalence of subclinical malaria and its association with adverse maternal and neonatal outcomes, a topic that has been scarcely evaluated in the literature. Methods: A cross-sectional study was conducted using semi-nested multiplex PCR to assess the presence of P. falciparum in placental and peripheral blood of 232 parturient pregnant women at the Hospital Provincial de Tete, Mozambique between March 2017 and May 2019. Multivariate regressions were performed to assess the associations of maternal subclinical malaria with several maternal and neonatal outcomes after controlling for the presence of preeclampsia/eclampsia (PE/E) and HIV infection, as well as for other maternal and pregnancy characteristics. Results: In total, 17.2% (n = 40) of the women studied had positive PCR for P. falciparum (7 in placental blood only, 3 in peripheral blood only). We found a significant association between subclinical malaria and a higher peripartum mortality risk, which persisted after controlling for maternal comorbidity and maternal and pregnancy characteristics (adjusted odds ratio: 3.50 [1.11-10.97]). In addition, PE/E and HIV infections were also significantly associated with several adverse maternal and neonatal outcomes. Conclusion: This study demonstrated the association of subclinical malaria, as well as of PE/E and HIV, in pregnant women with adverse maternal and neonatal outcomes. Therefore, molecular methods may be sensitive tools to identify asymptomatic infections that can reduce the impact on peripartum mortality and their contribution to sustained transmission of the parasite in endemic countries.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Infecciones por VIH/epidemiología , Malaria Falciparum/tratamiento farmacológico , Malaria/epidemiología , Placenta , Embarazo , Mortalidad Infantil , Mortalidad , Periodo Periparto , MozambiqueRESUMEN
The archipelago of the Canary Islands is one of the so-called ultra-peripheral territories of the European Union due to its geographical location away from the continent. Although the level of socioeconomic development and lifestyle of this region is comparable to that of any other of the European Union, it is just 100 km off the coast of Morocco, in the African continent. The population of the Canaries has been extensively studied with respect to their levels of POPs, and it has been described that their levels are relatively high compared to other European regions. It has been speculated with that the proximity to Africa may be associated with this level of contamination, but so far this theory has not been verified. This paper describes for the first time the levels of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in a sample of the population of Morocco (n = 131), which were compared with those of a similar sample of the population of permanent residents in the Canary Islands (n = 100) in order to check this hypothesis. Our results showed that Moroccans have higher median values of OCPs than the residents in the Canaries (∑ OCP = 150.2 ng/g lw vs. 83.4 ng/g lw, p = 0.0001). Regarding the PCBs, although recent studies have reported that new environmental sources of PCBs exist in several African countries (including Morocco), the plasma levels of most congeners were significantly higher in Canarians than in Moroccans, especially for the dioxin-like PCBs (median = 7.3 ng/g lw vs. 0.0 ng/g lw, p = 0.0001). The detailed analysis of our results suggests that the levels of these pollutants in the Canarian people are more influenced by their lifestyle and the previous use of these chemicals in the archipelago than by its geographical vicinity with Morocco.