Prevention Latin America

Estimating the burden and impact of malaria in pregnancy in Latin America.

Project Coordinator(s):        Meghna Desai and Julie Gutman (USA), Clara Menendez (Spain)

Project Collaborators:          Fundação de Medicina Tropical do Amazonas (FMTAM),

                                                 Manaus, Brazil Instituto de Inmunologia, Cali (CIV), Colombia


No recommendations are available for areas with lower stable and unstable malaria transmission levels and/or higher risk of P. vivax infection such as the Latin American region, as there are little or no specific data on the burden of malaria during pregnancy or the impact and applicability of preventive interventions. This was an observational study in pregnant women in three endemic Latin American countries.

We will be conducting a facility-based cohort observational study in pregnant women in three malaria endemic countries in Latin America: Guatemala, Colombia and Brazil. The study aims to describe the epidemiological and clinical features of vivax and falciparum malaria in pregnancy in areas of low malaria endemicity and/or predominantly P. vivax endemic areas. In addition, we will determine if there are pregnancy-specific P. vivax and P. falciparum immune responses and characterize the genotypes and phenotypes of the parasites in the placenta.

Data on the prevalence and incidence of malaria infection during pregnancy will be essential to guide control policies. In most Latin American countries, prevention of the infection in pregnancy relies on weekly prophylaxis with chloroquine (CQ), a strategy that has been fraught with poor patient and health worker compliance, and consequently proved not to be useful in sub-Saharan Africa. If the incidence and prevalence of malaria infection in Latin America is low, current preventive strategies could be replaced with more cost-effective approaches such as intermittent screening and treatment in pregnancy (ISTp). In ISTp, pregnant women are screened for malaria parasitemia at each antenatal visit with either rapid diagnostic tests (RDTs) or blood smears. Treatment for malaria would be provided only if the test is positive. This would limit unnecessary exposure of pregnant women (and their foetuses) to antimalarial drugs, and thus avoid potential risks. Therefore, the findings from the current study assessing the burden of disease will help to inform strategic approaches to prevention of MiP, as well as document the clinical impact of these infections in the region.