Background
Methods
Study sites
Sample size calculations
Study population
Data collection
Laboratory investigations
Training
Peripheral blood samples
Placental blood samples
Neonatal blood samples
Malaria diagnosis
HIV diagnosis
Definitions
Statistical analysis
Ethics statement
Results
Study population
IPT-SP dose | P Value | |||||
---|---|---|---|---|---|---|
Total | 0 | 1 | 2 | ≥3 | ||
(N = 2 044) | (n = 333) | (n = 694) | (n = 821) | (n = 196) | ||
Age (years)
| ||||||
Median (IQR) |
24 (20-30)
| 25 (20-29) | 24 (20-30) | 25 (20-30) | 24 (20-30) | 0.819 |
< 20 |
427 (20.9)
| 69 (20.7) | 155 (22.3) | 163 (19.8) | 40 (20.4) | 0.365 |
20-24 |
598 (29.2)
| 92 (27.5) | 201 (29.0) | 245 (29.8) | 60 (30.6) | |
25-29 |
492 (24.1)
| 96 (28.8) | 146 (21.0) | 204 (24.9) | 46 (23.5) | |
≥30 |
527 (25.8)
| 76 (22.8) | 192 (27.7) | 209 (25.5) | 50 (25.5) | |
Gravidity
| ||||||
Median (IQR) |
2 (1-4)
| 3 (2-4) | 3 (1-4) | 2 (1-4) | 2 (1-4) | 0.120 |
1 |
533 (26.1)
| 79 (23.8) | 175 (25.2) | 223 (27.2) | 56 (28.6) | 0.135 |
2 |
492 (24.1)
| 78 (23.4) | 167 (24.1) | 190 (23.1) | 57 (29.1) | |
≥3 |
1 019 (49.8)
| 176 (52.8) | 352 (50.7) | 408 (49.7) | 83 (42.3) | |
Number of ANC visit
| < 0.001 | |||||
Median (IQR) |
3 (2-4)
| 2 (1-3) | 2 (1-3) | 3 (2-4) | 4 (3-5) | < 0.001 |
0 |
46 (2.2)
| 41 (12.3) | 1 (0.1) | 4 (0.5) | 0 (0.0) | |
1-3 |
1 332 (65.2)
| 236 (70.9) | 570 (83.1) | 457 (55.7) | 69 (35.2) | |
≥4 |
666 (32.6)
| 56 (16.8) | 123 (17.7) | 360 (43.8) | 127 (64.8) | |
Birth weight (grams)*
| ||||||
Median (IQR) |
3000 (2700-3300)
| 3000 (2600-3250) | 3000 (2650-3250) | 3000 (2700-3300) | 3000 (2700-3350) | 0.942 |
< 2500 |
207 (10.6)
| 35 (11.3) | 79 (12.1) | 80 (10.1) | 13 (6.8) | 0.190 |
< 2000 |
35 (1.8)
| 5 (1.6) | 13 (2.0) | 15 (1.9) | 2 (1.0) | 0.840 |
Mothers'HIV status
| ||||||
HIV positive |
110 (5.4)
| 14 (4.2) | 42 (6.1) | 43 (5.2) | 11 (5.6) | 0.090 |
HIV negative |
1 914 (93.6)
| 311 (93.4) | 647 (93.2) | 771 (93.9) | 185 (94.4) | |
Not collected |
20 (1.0)
| 8 (2.4) | 5 (0.7) | 7 (0.8) | 0 (0.0) | |
Malaria prophylaxis
| ||||||
Chloroquine |
11 (0.5)
| 11 (3.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | < 0.001 |
ITNs |
980 (47.9)
| 98 (29.4) | 301 (43.4) | 532 (64.8) | 49 (25.0) | < 0.001 |
Others (insecticide) |
272 (13.3)
| 67 (20.1) | 93 (13.4) | 73 (8.9) | 39 (19.9) | < 0.001 |
Location
| < 0.001 | |||||
Koumassi |
285 (13.9)
| 111 (33.3) | 104 (15.0) | 60 (7.3) | 10 (5.1) | |
Yopougon |
400 (19.6)
| 82 (24.6) | 189 (27.2) | 113 (13.8) | 16 (8.1) | |
Grand-Lahou |
428 (20.9)
| 35 (10.5) | 129 (18.6) | 138 (26.8) | 126 (64.3) | |
Sassandra |
207 (10.1)
| 27 (8.1) | 67 (9.7) | 70 (8.5) | 43 (21.9) | |
San-Pedro |
354 (17.3)
| 27 (8.1) | 89 (12.8) | 237 (28.9) | 1 (0.5) | |
Bouaké |
370 (18.1)
| 51 (15.3) | 116 (16.7) | 203 (24.7) | 0 (0.0) |
IPT-SP coverage
Maternal malaria parasitaemia
IPT-SP dose | ||||||
---|---|---|---|---|---|---|
Total (N = 2 044) | 0 (n = 333) | 1 (n = 694) | 2 (n = 821) | ≥3 (n = 196) | P value | |
Mothers
| ||||||
Peripheral cord blood positive
| ||||||
Rapid Malaria test (ACON®) |
21 (1.0)
| 6 (1.8) | 8 (1.2) | 6 (0.7) | 1 (0.5) | 0.358 |
95% Confidence interval |
[0.64-1.57]
| [0.66 - 3.88] | [0.50-2.26] | [0.27-1.58] | [0.00-2.81] | |
Blood smears |
19 (0.9)
| 6 (1.8) | 7 (1.0) | 6 (0.7) | 0 (0.0) | 0.564 |
95% Confidence interval |
[0.56-1.44]
| [0.66 - 3.88] | [0.41-2.07] | [0.27-1.58] | [0.00-1.86] | |
Placental blood positives
| ||||||
Rapid Malaria test (ACON®) |
109 (5.3)
| 39 (11.7) | 34 (4.9) | 27 (3.3) | 9 (4.6) | < 0.001 |
95% Confidence interval |
[4.40-6.40]
| [8.46-15.66] | [3.42-6.78] | [2.18-4.75] | [2.12-8.54] | |
Blood smears |
99 (4.8)
| 39 (11.7) | 31 (4.5) | 23 (2.8) | 6 (3.1) | 0.026 |
95% Confidence interval |
[3.95 - 5.86]
| [8.46-15.66] | [3.05-6.28] | [1.78 - 4.17] | [1.13-6.54] | |
Neonates
| ||||||
Number of available specimens* |
85
| 35 | 26 | 19 | 5 | |
Peripheral blood positives |
4 (4.7)
| 2 (5.7) | 1 (3.8) | 1 (5.3) | 0 (0.0) | 1.00 |
95 % Confidence interval |
[1.30-11.61]
| [0.70-19.16] | [0.10-19.64] | [0.13-26.03] | [0.00-52.18] |
Placental malaria | Univariate analysis | Multivariate analysis (N = 2 044) | ||||||
---|---|---|---|---|---|---|---|---|
(+) (n = 99) | (-) (n = 1 945) | OR | 95% CI | P value | AOR | 95% CI | P value | |
Age (years)
| ||||||||
< 20 | 30 (30.3) | 397 (20.4) | 1 | - | - | 1 | - | - |
20-24 | 35 (35.3) | 563 (29.0) | 0.82 | [0.50-1.36] | 0.448 | 1.39 | [0.78-2.47] | 0.261 |
25-29 | 17 (17.2) | 475 (24.4) | 0.47 | [0.26-0.87] | 0.016 | 1.10 | [0.49-2.48] | 0.812 |
≥30 | 17 (17.2) | 510 (26.2) | 0.44 | [0.24-0.81] | 0.008 | 1.29 | [0.53-3.13] | 0.574 |
Gravidity
| ||||||||
1 | 45 (45.5) | 488 (25.1) | 2.67 | [1.69-4.22] | < 0.001 | 2.96 | [1.45-6.04] | 0.003 |
2 | 20 (20.2) | 472 (24.3) | 1.23 | [0.70-2.15] | 0.475 | 1.18 | [0.59-2.33] | 0.637 |
≥3 | 34 (34.3) | 985 (50.6) | 1 | - | - | 1 | - | - |
Location
| ||||||||
Koumassi | 9 (9.1) | 276 (14.2) | 1 | - | - | 1 | - | - |
Yopougon | 13 (13.1) | 387 (19.9) | 1.03 | [0.43-2.44] | 0.946 | 1.43 | [0.59-3.47] | 0.427 |
Grand Lahou | 25 (25.2) | 403 (20.7) | 1.90 | [1.87-4.14] | 0.105 | 3.01 | [1.31-6.92] | 0.009 |
Sassandra | 28 (28.3) | 179 (9.2) | 4.80 | [2.21-10.40] | < 0.001 | 8.54 | [3.76-19.41] | < 0.001 |
San Pedro | 8 (8.1) | 346 (17.8) | 0.71 | [0.27-1.86] | 0.485 | 1.99 | [0.70-5.65] | 0.198 |
Bouaké | 16 (16.2) | 354 (18.2) | 1.39 | [0.60-3.18] | 0.442 | 2.31 | [0.98-5.47] | 0.056 |
Mothers' HIV status
| ||||||||
HIV positive | 3 (3.0) | 107 (5.5) | 0.11 | [0.02-0.55] | 0.01 | 0.25 | [0.04-1.42] | 0.119 |
HIV negative | 92 (92.9) | 1 822 (93.7) | 0.20 | [0.07-0.62] | 0.01 | 0.39 | [0.11-1.38] | 0.144 |
Not collected | 4 (4.1) | 16 (0.8) | 1 | - | - | 1 | - | - |
Use of IPT-SP
| ||||||||
Yes (≥2 doses) | 29 (29.3) | 988 (50.8) | 0.22 | [0.13-0.36] | < 0.001 | 0.18 | [0.10-0.32] | < 0.001 |
Yes (1 dose) | 31 (31.3) | 663 (34.1) | 0.35 | [0.21-0.58] | < 0.001 | 0.32 | [0.19-0.55] | < 0.001 |
No | 39 (39.4) | 294 (15.1) | 1 | - | - | 1 | - | - |
ITNs
| ||||||||
Yes | 23 (23.2) | 957 (49.2) | 0.31 | [0.19-0.50] | < 0.001 | 0.47 | [0.27-0.82] | 0.008 |
No | 76 (76.8) | 988 (50.8) | 1 | - | - | 1 | - | - |
Congenital malaria parasitaemia
Low birth weight
Low birth weight (grams) | Univariate analysis | Multivariate analysis (N = 1938) | Multivariate analysis (N = 1938) | |||||||
---|---|---|---|---|---|---|---|---|---|---|
< 2500 (n = 207) | OR | 95% CI | P value | AOR | 95% CI | P value | AOR | 95% CI | P value | |
Age (years)
| ||||||||||
< 20 (n = 407) | 76 (18.7) | 1 | - | - | 1 | - | - | 1 | - | - |
20-24 (n = 575) | 49 (8.5) | 0.40 | [0.28-0.60] | < 0.001 | 0.55 | [0.36-0.85] | 0.006 | 0.58 | [0.38-0.89] | 0.012 |
25-29 (n = 469) | 44 (9.4) | 0.45 | [0.30-0.67] | < 0.001 | 0.79 | [0.47-1.34] | 0.392 | 0.83 | [0.49-1.40] | 0.486 |
> = 30 (n = 494) | 38 (7.7) | 0.36 | [0.24-0.55] | < 0.001 | 0.67 | [0.37-1.22] | 0.192 | 0.71 | [0.39-1.29] | 0.265 |
Gravidity
| ||||||||||
1 (n = 509) | 89 (17.5) | 2.55 | [1.83-3.55] | < 0.001 | 2.09 | [1.27-3.43] | 0.004 | 2.30 | [1.40-3.79] | 0.001 |
2 (n = 471) | 44 (9.3) | 1.24 | [0.84-1.83] | 0.279 | 1.21 | [0.77-1.92] | 0.407 | 1.25 | [0.79-1.98] | 0.332 |
> = 3 (n = 965) | 74 (7.7) | 1 | - | - | 1 | - | - | 1 | - | - |
Location
| ||||||||||
Koumassi (n = 268) | 21 (7.8) | 1 | - | - | 1 | - | - | 1 | - | - |
Yopougon (n = 388) | 50 (12.9) | 1.74 | [1.02-2.97] | 0.043 | 1.80 | [1.03-3.06] | 0.037 | 1.81 | [1.05-3.14] | 0.033 |
Grand Lahou (n = 394) | 38 (9.6) | 1.25 | [0.72-2.19] | 0.423 | 1.14 | [0.64-2.02] | 0.649 | 1.32 | [0.73-2.39] | 0.348 |
Sassandra (n = 187) | 23 (12.3) | 1.65 | [0.88-3.08] | 0.116 | 1.46 | [0.77-2.77] | 0.244 | 1.79 | [0.94-3.41] | 0.077 |
San Pedro (n = 347) | 42 (12.1) | 1.62 | [0.93-2.81] | 0.086 | 1.58 | [0.90-2.77] | 0.109 | 1.79 | [1.00-3.22] | 0.049 |
Bouaké (n = 361) | 33 (9.1) | 1.18 | [0.67-2.10] | 0.564 | 1.10 | [0.61-1.97] | 0.754 | 1.21 | [0.66-2.19] | 0.534 |
Mothers' HIV status
| ||||||||||
HIV positive (n = 103) | 11 (10.7) | 0.66 | [0.13-3.36] | 0.615 | 0.95 | [0.18-5.06] | 0.949 | 0.86 | [0.16-4.64] | 0.858 |
HIV negative (n = 1829) | 194 (10.6) | 0.65 | [0.14-2.10] | 0.581 | 0.80 | [0.17-3.81] | 0.781 | 0.74 | [0.15-3.57] | 0.709 |
Not collected (n = 13) | 2 (15.4) | 1 | - | - | 1 | - | - | 1 | - | - |
Malaria status
| ||||||||||
Positive (n = 90) | 20 (22.2) | 2.55 | [1.52-4.28] | < 0.001 | 2.28 | [1.32-3.93] | 0.003 | - | - | - |
Negative (n = 1855) | 187 (10.1) | 1 | - | - | 1 | - | - | - | - | - |
Sexe
| ||||||||||
Male (n = 986) | 102 (10.3) | 1 | - | - | 1 | - | - | 1 | - | - |
Female (n = 952) | 103 (10.8) | 1.05 | [0.79-1.40] | 0.734 | 1.02 | [0.76-1.38] | 0.872 | 1.0 | [0.75-1.35] | 0.985 |
Not mentionned (n = 7) | 2 (28.6) | - | - | - | - | - | - | - | - | - |
Use of IPT-SP
| ||||||||||
No (n = 310) | 35 (11.3) | 1 | - | - | - | - | - | 1 | - | - |
1 dose (n = 652) | 79 (12.1) | 1.08 | [0.71-1.65] | 0.711 | - | - | - | 0.98 | [0.63-1.53] | 0.935 |
> = 2 doses (n = 983) | 93 (9.5) | 0.82 | [0.54-1.24] | 0.348 | - | - | - | 0.71 | [0.46-1.12] | 0.146 |