Predictors of Plasmodium falciparum Infection in the First Trimester Among Nulliparous Women From Kenya, Zambia, and the Democratic Republic of the Congo.

Journal Article (Clinical Trial;Journal Article;Multicenter Study)

BACKGROUND: Malaria can have deleterious effects early in pregnancy, during placentation. However, malaria testing and treatment are rarely initiated until the second trimester, leaving pregnancies unprotected in the first trimester. To inform potential early intervention approaches, we sought to identify clinical and demographic predictors of first-trimester malaria. METHODS: We prospectively recruited women from sites in the Democratic Republic of the Congo (DRC), Kenya, and Zambia who participated in the ASPIRIN (Aspirin Supplementation for Pregnancy Indicated risk Reduction In Nulliparas) trial. Nulliparous women were tested for first-trimester Plasmodium falciparum infection by quantitative polymerase chain reaction. We evaluated predictors using descriptive statistics. RESULTS: First-trimester malaria prevalence among 1513 nulliparous pregnant women was 6.3% (95% confidence interval [CI], 3.7%-8.8%] in the Zambian site, 37.8% (95% CI, 34.2%-41.5%) in the Kenyan site, and 62.9% (95% CI, 58.6%-67.2%) in the DRC site. First-trimester malaria was associated with shorter height and younger age in Kenyan women in site-stratified analyses, and with lower educational attainment in analyses combining all 3 sites. No other predictors were identified. CONCLUSIONS: First-trimester malaria prevalence varied by study site in sub-Saharan Africa. The absence of consistent predictors suggests that routine parasite screening in early pregnancy may be needed to mitigate first-trimester malaria in high-prevalence settings.

Full Text

Duke Authors

Cited Authors

  • Leuba, SI; Westreich, D; Bose, CL; Powers, KA; Olshan, A; Taylor, SM; Tshefu, A; Lokangaka, A; Carlo, WA; Chomba, E; Liechty, EA; Bucher, SL; Esamai, F; Jessani, S; Saleem, S; Goldenberg, RL; Moore, J; Nolen, T; Hemingway-Foday, J; McClure, EM; Koso-Thomas, M; Derman, RJ; Hoffman, M; Bauserman, M

Published Date

  • June 1, 2022

Published In

Volume / Issue

  • 225 / 11

Start / End Page

  • 2002 - 2010

PubMed ID

  • 34888658

Pubmed Central ID

  • PMC9159331

Electronic International Standard Serial Number (EISSN)

  • 1537-6613

Digital Object Identifier (DOI)

  • 10.1093/infdis/jiab588


  • eng

Conference Location

  • United States