Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study

J Infect Dis. 2013 Nov 1;208(9):1504-13. doi: 10.1093/infdis/jit366. Epub 2013 Aug 1.


Background: Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain.

Methods: We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology.

Results: The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants.

Conclusions: There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.

Keywords: Ghana; cohort study; infant malaria; malaria; malaria epidemiology; placental malaria.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Ghana
  • Gravidity
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Malaria / epidemiology*
  • Malaria / transmission
  • Male
  • Maternal-Fetal Exchange
  • Parasitemia / epidemiology*
  • Parasitemia / transmission
  • Placenta / parasitology*
  • Pregnancy
  • Pregnancy Complications, Parasitic / epidemiology*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk
  • Seasons
  • Young Adult