A.Tiono, Centre National de Recherche et de Formation sur le Paludisme - Investigating the Human Malaria Reservoir of Transmission during Pregnancy

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Malaria affects millions of individuals annually and is most harmful to children and pregnant women. However, in recent years there has been considerable success in controlling malaria reducing the levels of both infections and deaths. This has been achieved by high levels of use mosquito nets and the availability of effective drugs. This success has prompted many countries to think about eliminating malaria altogether. Eliminating malaria will require additional and different approaches in that it will be necessary to identify people who transmit the infection to mosquitoes. These may be different to those who are sick. A number of studies have shown that there are individuals with low levels of malaria parasites who are asymptomatic and a few studies show that these low level infections can be transmitted to mosquitoes. So, at the moment there is surprisingly little data on who might transmit the parasites to mosquitoes. This is important to know because it will help design approaches to control malaria that will be more effective both in terms of the speed they work and the cost to carry them out. For example, if we know who the main people or groups of people are then it would be easier to target them with specifically.One group of individuals that realistically might infect mosquitoes more are pregnant women. Malaria is particularly harmful to pregnant women as the placenta provides a new environment for parasites to develop and grow in. It is because of this that pregnant women have higher chances of infection and when they are infected have higher numbers of parasites than non-pregnant women or men of the same age. Women in their first or second infections in pregnancy are most at risk. Anywhere between 1 and 5% of the population ae pregnant at one time and thus this is a substantial proportion of potentially infected and infectious individuals.In this study we aim to calculate how much pregnant women contribute to malaria transmission. To do this we will describe the levels of stages of the malaria parasite that can infect mosquitoes in pregnant women compared with other members of the population. We will also see if these parasites are found in specialised locations in pregnant women. We will also check if pregnant women are bitten more by mosquitoes and infect mosquitoes more than non pregnant women and other members. Finally, we will combine these data in a series of simulations to work out what the best approaches to preventing transmission in pregnant women so that we can advise malaria control programmes if a focus on pregnant women is necessary and if so how this should be done.