Medicine (RMH) - Theses

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Subject: malaria × Author: FENG, GAOQIAN ×

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    Epidemiological and immunological studies of treatment for pregnancy associated malaria
    FENG, GAOQIAN ( 2010)
    Pregnant women are highly susceptible to malaria, and malaria in pregnancy causes a number of adverse outcomes such as maternal anaemia and delivery of low birth weight babies. Thus pregnant women are specifically targeted in malaria prevention efforts with control measures including IPTp and bed nets. Pregnant women are uniquely susceptible to malaria because Plasmodium falciparum infected erythrocytes can adhere to the placenta. This is mediated by the variant surface antigen (VSA) family Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1). Accumulation of infected erythrocytes in the placenta may subsequently result in acquisition of immunity targeting this protein especially among multigravid women. Longitudinal data collected over 9 years from Malawian pregnant women demonstrated decreased prevalence of peripheral and placental malaria, maternal anaemia and LBW. In the same time frame coverage with IPTp SP and bed nets increased. SP IPT doses were associated with protection against placental parasitaemia, maternal anaemia and LBW from 1997-2001, but not from 2002-2006. Bed net use was associated with protection from peripheral or placental parasitemia and LBW throughout the study, but not with anaemia. These results indicated decreased maternal malaria infection correlated with improved pregnancy outcomes. Increased bed net coverage explains more of this change than SP use. SP resistance may be compromising its effectiveness. In chapter 4 of this thesis, I explored the protective effect of immunity against pregnant associated malaria variant surface antigens (VSA-PAM) using sera from a group of Malawian pregnant women who undertook anti-malarial treatment. My results showed that the level of immunity against VSA-PAM was associated with improved anti-malarial treatment outcomes and decreased maternal anaemia at delivery. The finding presented in this thesis validated further studies investigating the role of antibodies against VSA-PAM in protecting against placental malaria infection. The decreased protective effect of SP-IPTp also urged the importance of replacing SP from the first line anti-malarial treatment drugs.