Burden of Malaria in Pregnancy in India

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DESCRIPTION (provided by applicant): Malaria is one of the gravest threats to the health of pregnant women and their unborn babies. Malaria in pregnancy (MIP) is associated with an increased risk of fetal death, prematurity, intrauterine growth retardation (IUGR), low birth weight (LBW), and maternal anemia. In recent years, malaria has reemerged as a public health problem in India, with 1.5-2 million documented cases reported annually by India's National Malaria Control Programme, though these figures probably substantially underestimate the true burden of disease. The development and implementation of effective policies for the prevention and control of MIP in India has been hampered by a lack of detailed information on malaria-associated morbidity during pregnancy and the impact of malaria on birth outcomes. To address these issues, we are proposing a study to be conducted in two districts of Chhattisgarh state, India, one with stable malaria transmission and one with unstable transmission. We aim to establish the impact of MIP on maternal anemia, birth outcomes (LBW, IUGR, and stillbirths), and the relative contributions of Plasmodium falciparum and P. vivaxto malaria-associated morbidity. In addition, we will assess the current availability of MIP interventions, such as chloroquine prophylaxis and insecticide treated bednets, and patient/clinic level factors that influence the utilization of such interventions. This project will be a collaborative effort between scientists at Boston University's Center for International Health and Development, the National Malaria Research Center in Jabalbur, India, and the Malaria Branch of the Centers for Disease Control and Prevention in Atlanta. This project will serve to strenghten the collaborative relationship of these institutions while enhancing the capacity of Indian researchers to design, implement, and analyze data from applied research studies. The information generated by the study will also be instrumental in the development of new programs for preventing and mitigating the impact of MIP in India.