Malaria Prevalence among Young Infants in Different Transmission Settings, Africa - Volume 21, Number 7—July 2015 - Emerging Infectious Disease journal - CDC
Figure 1. Study sites (arrows) in a study of malaria prevalence among young infants in The Gambia, Benin, and Guinea. Inset shows locations of the 3 countries in western Africa.
Volume 21, Number 7—July 2015
Malaria Prevalence among Young Infants in Different Transmission Settings, Africa
Infants are thought to be protected against malaria during the first 6 months of life, largely due to the transfer of maternal antibodies (1) and the presence of fetal hemoglobin (2). Thus, young infants have received little attention in terms of malaria research and treatment guidelines, and this age group has systematically been excluded from clinical trials. As a consequence, young infants are frequently given off-label antimalarial treatments at dosing schedules recommended for older infants and children (3). The lack of attention to case management in this age group is a cause of concern and should be addressed, particularly when considering the widespread use of artemisinin-based combination therapies (ACTs) (4) and ongoing antimalarial drug development.
The true prevalence of malaria in young infants is not well characterized, yet defining the prevalence is critical, especially in light of ongoing epidemiologic shifts in populations at risk for malaria (5). Data on the prevalence and clinical outcomes of malaria in young infants are limited and contradictory: some studies show minimal risk (6–8), and others report that the risk for malaria increases in the first months of life, according to the intensity of transmission (9). A few reports indicate that the prevalence of disease is higher than previously thought and that, after birth, the period of protection against malaria is shorter than the widely quoted 6 months (10,11). However, variations in study designs and challenges related to small sample sizes, lack of details regarding quality control, and varied procedures for sample selection make it difficult to interpret findings from earlier studies (3). A better understanding of the risk for malaria in early infancy is needed to develop antimalarial drugs and inform policy decisions for this age group (4). To improve our knowledge of malaria in young infants, we used standardized methods and more sensitive diagnostics to better characterize the prevalence of malaria among children<6 months of age in different epidemiologic settings.
Mr. Ceesay is a higher scientific officer and research coordinator at the Medical Research Unit, The Gambia. His research interests have focused mainly on the epidemiology of malaria in The Gambia and, more recently, on determining the risk for malaria in early infancy and in different transmission settings.
We acknowledge the contribution of the field teams in all 3 countries, and we thank the participants and their families.
This study was funded by Medicines for Malaria Venture and Novartis Pharma AG.
- McGregor IA. Epidemiology, malaria and pregnancy. Am J Trop Med Hyg. 1984;33:517–25 .
- Pasvol G, Weatherall DJ, Wilson RJ. Effects of foetal haemoglobin on susceptibility of red cells to Plasmodium falciparum. Nature. 1977;270:171–3.
- D'Alessandro U, Ubben D, Hamed K, Ceesay SJ, Okebe J, Taal M, Malaria in infants aged less than six months—is it an area of unmet medical need?Malar J. 2012;11:400.
- Larru B, Molyneux E, Ter Kuile FO, Taylor T, Molyneux M, Terlouw DJ. Malaria in infants below six months of age: retrospective surveillance of hospital admission records in Blantyre, Malawi. Malar J. 2009;8:310.
- Cotter C, Sturrock HJ, Hsiang MS, Liu J, Phillips AA, Hwang J, The changing epidemiology of malaria elimination: new strategies for new challenges.Lancet. 2013;382:900–11.
- Klein Klouwenberg PM, Oyakhirome S, Schwarz NG, Glaser B, Issifou S, Kiessling G, Malaria and asymptomatic parasitaemia in Gabonese infants under the age of 3 months. Acta Trop. 2005;95:81–5.
- Alao MJ, Gbadoe AD, Meremikwu M, Tshefu A, Tiono AB, Cousin M, Plasmodium falciparum malaria in infants under 5 kg: retrospective surveillance of hospital records in five sub-Saharan African countries. J Trop Pediatr. 2013;59:154–9.
- Snow RW, Craig MH, Deichmann U, le Sueur D. A preliminary continental risk map for malaria mortality among African children. Parasitol Today.1999;15:99–104.
- Brabin B. An analysis of malaria parasite rates in infants: 40 years after Macdonald. Trop Dis Bull. 1990;87:1–21.
- Nweneka CV, Eneh AU. Malaria parasitaemia in neonates in Port Harcourt, Nigeria. J Trop Pediatr. 2004;50:114–6.
- Afolabi BM, Salako LA, Mafe AG, Ovwigho UB, Rabiu KA, Sanyaolu NO, Malaria in the first 6 months of life in urban African infants with anemia. Am J Trop Med Hyg. 2001;65:822–7 .
- Snounou G, Singh B. Nested PCR analysis of Plasmodium parasites. Methods Mol Med. 2002;72:189–203 .
- Corran PH, Cook J, Lynch C, Leendertse H, Manjurano A, Griffin J, Dried blood spots as a source of anti-malarial antibodies for epidemiological studies. Malar J. 2008;7:195.
- Drakeley CJ, Corran PH, Coleman PG, Tongren JE, McDonald SL, Carneiro I, Estimating medium- and long-term trends in malaria transmission by using serological markers of malaria exposure. Proc Natl Acad Sci U S A. 2005;102:5108–13.
- Stewart L, Gosling R, Griffin J, Gesase S, Campo J, Hashim R, Rapid assessment of malaria transmission using age-specific sero-conversion rates.PLoS ONE. 2009;4:e6083.
- Lindsay S, Ansell J, Selman C, Cox V, Hamilton K, Walraven G. Effect of pregnancy on exposure to malaria mosquitoes. Lancet. 2000;355:1972.
- Verhulst NO, Qiu YT, Beijleveld H, Maliepaard C, Knights D, Schulz S, Composition of human skin microbiota affects attractiveness to malaria mosquitoes. PLoS ONE. 2011;6:e28991.
- Mwaniki MK, Talbert AW, Mturi FN, Berkley JA, Kager P, Marsh K, Congenital and neonatal malaria in a rural Kenyan district hospital: an eight-year analysis. Malar J. 2010;9:313.
- Nankabirwa V, Tylleskar T, Nankunda J, Engebretsen IM, Sommerfelt H, Tumwine JK. Malaria parasitaemia among infants and its association with breastfeeding peer counselling and vitamin A supplementation: a secondary analysis of a cluster randomized trial. PLoS ONE. 2011;6:e21862.
- Pedro R, Akech S, Fegan G, Maitland K. Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya.Malar J. 2010;9:307.
- King CL, Malhotra I, Wamachi A, Kioko J, Mungai P, Wahab SA, Acquired immune responses to Plasmodium falciparum merozoite surface protein-1 in the human fetus. J Immunol. 2002;168:356–64.
- Dinko B, Oguike MC, Larbi JA, Bousema T, Sutherland CJ. Persistent detection of Plasmodium falciparum, P. malariae, P. ovale curtisi and P. ovale wallikeri after ACT treatment of asymptomatic Ghanaian school-children. Int J Parasitol Drugs Drug Resist. 2013;3:45–50.
- Biggar RJ, Collins WE, Campbell CC. The serological response to primary malaria infection in urban Ghanaian infants. Am J Trop Med Hyg.1980;29:720–4 .
- Sehgal VM, Siddjiqui WA, Alpers MP. A seroepidemiological study to evaluate the role of passive maternal immunity to malaria in infants. Trans R Soc Trop Med Hyg. 1989;83(Suppl):105–6.
- Ibhanesebhor SE. Clinical characteristics of neonatal malaria. J Trop Pediatr. 1995;41:330–3.
- Hashemzadeh A, Heydarian F. Congenital malaria in a neonate [cited 2014 Jul 28]. http://www.ams.ac.ir/AIM/0583/0017.pdf
- World Health Organization. Guidelines for the treatment of malaria. Second edition [cited 2014 Aug 1].http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html
- Murray CK, Gasser RA Jr, Magill AJ, Miller RS. Update on rapid diagnostic testing for malaria. Clin Microbiol Rev. 2008;21:97–110.
- Maltha J, Gillet P, Jacobs J. Malaria rapid diagnostic tests in endemic settings. Clin Microbiol Infect. 2013;19:399–407.
- Malaria diagnosis: memorandum from a WHO meeting. Bull World Health Organ. 1988;66:575–94 .
- Milne LM, Kyi MS, Chiodini PL, Warhurst DC. Accuracy of routine laboratory diagnosis of malaria in the United Kingdom. J Clin Pathol.1994;47:740–2.
- Olupot-Olupot P, Urban BC, Jemutai J, Nteziyaremye J, Fanjo HM, Karanja H, Endotoxaemia is common in children with Plasmodium falciparummalaria. BMC Infect Dis. 2013;13:117.
- Rowley CF. Developments in CD4 and viral load monitoring in resource-limited settings. Clin Infect Dis. 2014;58:407–12.
Suggested citation for this article: Ceesay SJ, Koivogui L, Nahum A, Taal MA, Okebe J, Affara M, et al. Malaria prevalence among young infants in different transmission settings, Africa. Emerg Infect Dis. 2015 Jul [date cited]. http://dx.doi.org/10.3201/eid2107.142036