Prevalence and impact of Malaria infection on pregnancy and prenatal outcomes in the Blue Nile state of Sudan

Malaria is a global public health concern. It is prevalent in the Blue Nile state of Sudan, where the incidence rate exceeds 34%, according to a 2015 survey. P.falciparum is the dominant infecting species in sub-Saharan Africa; it particularly affects pregnant women, for it tends to sequester in the intervillous space (IVS) of placenta, resulting in placental malaria which can subsequently lead to congenital malaria. Congenital malaria (CM) is defined as the presence of malaria parasites in the peripheral blood of new born infants, in the first week of life. There is quite a lot of controversy associated with the frequency of occurrence of congenital malaria as the mechanism/s of how the parasites crosses the placenta barrier is not yet fully understood.
The main aim of this study was to determine the prevalence of placental malaria and congenital malaria and their effects on the pregnancy outcomes in the Blue Nile state of Sudan. The subsequent aim of this study was to explore the possible mechanism/s by which the malaria parasite crosses the placental barrier. The role of tight junction proteins in the placenta with regards to the crossing of the parasites through the placental barrier will be investigated.
A cross-sectional study has been conducted with 336 pregnant women. The mean (SD) maternal age was (25.13 ± 4.43), who have given birth in the main maternity wards at Complex Centre, Damazin, Roseris hospitals, respectively, between the years 2012–2014 in Sudan. The socio-demographic and the obstetric information of the mothers have also been collected. The peripheral blood smears of pregnant women at delivery have been used for haemoglobin (Hb gm/dl) measurement and the detection of the malaria parasite; the placental blood and tissues, cord blood, and peripheral blood smears of the new born babies have been collected and examined for malaria parasites infection by microscopic using Giemsa staining and polymerase chain reaction (PCR) techniques. The placental tissue classification of malaria infection has been done by Haematoxylin & Eosin (H&E) staining and double staining microscopically by Giemsa and Prussian blue respectively. Placental tissues have been examined for two tight junction markers’ Zonulaoccludens-1 andClaudin-4 using immunohistochemistry method.
Results showed that PCR technique was more sensitive than Giemsa staining technique in detecting the presence of parasite in the blood samples tested. Results also showed that all cases of malaria infection, that has been detected in the baby’s peripheral blood has been found to be positive in the corresponding cord blood.