Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon
Abstract Background Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality...
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-021-03981-y |
| _version_ | 1818851427576971264 |
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| author | Julio Abel Seijas-Chávez Melissa S. Nolan Mary K. Lynn Maria José Francalino da Rocha Muana da Costa Araújo Fernando Luiz Affonso Fonseca Gabriel Zorello Laporta |
| author_facet | Julio Abel Seijas-Chávez Melissa S. Nolan Mary K. Lynn Maria José Francalino da Rocha Muana da Costa Araújo Fernando Luiz Affonso Fonseca Gabriel Zorello Laporta |
| author_sort | Julio Abel Seijas-Chávez |
| collection | DOAJ |
| description | Abstract Background Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality of Cruzeiro do Sul, Acre state, Brazilian Amazon. The research questions are: what are the causal effects of low birth weight on low Apgar at 5-min and of perinatal anaemia on stillbirth? Methods From November 2018 to October 2019, pregnant women of ≥ 22 weeks or puerperal mothers, who delivered at the referral maternity hospital (Juruá Women and Children’s Hospital), were recruited to participate in a malaria surveillance study. Clinical information was obtained from a questionnaire and abstracted from medical reports. Haemoglobin level and presence of malarial parasites were tested by haematology counter and light microscopy, respectively. Low Apgar at 5-min and stillbirth were the outcomes analysed in function of clinical data and epidemiologic risk factors for maternal malaria infection using both a model of additive and independent effects and a causal model with control of confounders and use of mediation. Results In total, 202 (7.2%; N = 2807) women had malaria during pregnancy. Nearly half of malaria infections during pregnancy (n = 94) were P. falciparum. A total of 27 women (1.03%; N = 2632) had perinatal malaria (19 P. vivax and 8 P. falciparum). Perinatal anaemia was demonstrated in 1144 women (41.2%; N = 2779) and low birth weight occurred in 212 newborns (3.1%; N = 2807). A total of 75 newborns (2.7%; N = 2807) had low (< 7) Apgar scores at 5-min., and stillbirth occurred in 23 instances (30.7%; n = 75). Low birth weight resulted in 7.1 higher odds of low Apgar at 5-min (OR = 7.05, 95% CI 3.86–12.88, p < 0.001) modulated by living in rural conditions, malaria during pregnancy, perinatal malaria, and perinatal anaemia. Stillbirth was associated with perinatal anaemia (OR = 2.56, 95% CI 1.02–6.42, p = 0.0444) modulated by living in rural conditions, falciparum malaria during pregnancy, perinatal malaria, and perinatal fever. Conclusions While Brazil continues its path towards malaria elimination, the population still faces major structural problems, including substandard living conditions. Here malaria infections on pregnant women were observed having indirect effects on fetal outcomes, contributing to low Apgar at 5-min and stillbirth. Finally, the utility of employing multiple statistical analysis methods to validate consistent trends is vital to ensure optimal public health intervention designs. |
| first_indexed | 2024-12-19T07:04:51Z |
| format | Article |
| id | doaj.art-8798c4f496c6471ea969f98adfc2353a |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-19T07:04:51Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj.art-8798c4f496c6471ea969f98adfc2353a2022-12-21T20:31:19ZengBMCMalaria Journal1475-28752021-11-0120111410.1186/s12936-021-03981-yCausal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian AmazonJulio Abel Seijas-Chávez0Melissa S. Nolan1Mary K. Lynn2Maria José Francalino da Rocha3Muana da Costa Araújo4Fernando Luiz Affonso Fonseca5Gabriel Zorello Laporta6Centro Universitário FMABC, Fundação ABCLaboratory of Vector-Borne and Parasitic Diseases, Arnold School of Public Health, University of South CarolinaLaboratory of Vector-Borne and Parasitic Diseases, Arnold School of Public Health, University of South CarolinaUniversidade Federal do Acre (UFAC) – Forest CampusVigilância Entomológica da Secretaria Municipal de SaúdeCentro Universitário FMABC, Fundação ABCCentro Universitário FMABC, Fundação ABCAbstract Background Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality of Cruzeiro do Sul, Acre state, Brazilian Amazon. The research questions are: what are the causal effects of low birth weight on low Apgar at 5-min and of perinatal anaemia on stillbirth? Methods From November 2018 to October 2019, pregnant women of ≥ 22 weeks or puerperal mothers, who delivered at the referral maternity hospital (Juruá Women and Children’s Hospital), were recruited to participate in a malaria surveillance study. Clinical information was obtained from a questionnaire and abstracted from medical reports. Haemoglobin level and presence of malarial parasites were tested by haematology counter and light microscopy, respectively. Low Apgar at 5-min and stillbirth were the outcomes analysed in function of clinical data and epidemiologic risk factors for maternal malaria infection using both a model of additive and independent effects and a causal model with control of confounders and use of mediation. Results In total, 202 (7.2%; N = 2807) women had malaria during pregnancy. Nearly half of malaria infections during pregnancy (n = 94) were P. falciparum. A total of 27 women (1.03%; N = 2632) had perinatal malaria (19 P. vivax and 8 P. falciparum). Perinatal anaemia was demonstrated in 1144 women (41.2%; N = 2779) and low birth weight occurred in 212 newborns (3.1%; N = 2807). A total of 75 newborns (2.7%; N = 2807) had low (< 7) Apgar scores at 5-min., and stillbirth occurred in 23 instances (30.7%; n = 75). Low birth weight resulted in 7.1 higher odds of low Apgar at 5-min (OR = 7.05, 95% CI 3.86–12.88, p < 0.001) modulated by living in rural conditions, malaria during pregnancy, perinatal malaria, and perinatal anaemia. Stillbirth was associated with perinatal anaemia (OR = 2.56, 95% CI 1.02–6.42, p = 0.0444) modulated by living in rural conditions, falciparum malaria during pregnancy, perinatal malaria, and perinatal fever. Conclusions While Brazil continues its path towards malaria elimination, the population still faces major structural problems, including substandard living conditions. Here malaria infections on pregnant women were observed having indirect effects on fetal outcomes, contributing to low Apgar at 5-min and stillbirth. Finally, the utility of employing multiple statistical analysis methods to validate consistent trends is vital to ensure optimal public health intervention designs.https://doi.org/10.1186/s12936-021-03981-yInfectious Pregnancy ComplicationsMaternal–Fetal MedicineMaternal HealthNewbornsPlasmodium falciparum MalariaVivax Malaria |
| spellingShingle | Julio Abel Seijas-Chávez Melissa S. Nolan Mary K. Lynn Maria José Francalino da Rocha Muana da Costa Araújo Fernando Luiz Affonso Fonseca Gabriel Zorello Laporta Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon Malaria Journal Infectious Pregnancy Complications Maternal–Fetal Medicine Maternal Health Newborns Plasmodium falciparum Malaria Vivax Malaria |
| title | Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon |
| title_full | Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon |
| title_fullStr | Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon |
| title_full_unstemmed | Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon |
| title_short | Causal effects on low Apgar at 5-min and stillbirth in a malaria maternal–fetal health outcome investigation: a large perinatal surveillance study in the Brazilian Amazon |
| title_sort | causal effects on low apgar at 5 min and stillbirth in a malaria maternal fetal health outcome investigation a large perinatal surveillance study in the brazilian amazon |
| topic | Infectious Pregnancy Complications Maternal–Fetal Medicine Maternal Health Newborns Plasmodium falciparum Malaria Vivax Malaria |
| url | https://doi.org/10.1186/s12936-021-03981-y |
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