A review and meta-analysis of studies published in the May 16 theme issue of Global Health in JAMA reveals a significant burden of malaria and STIs/RTIs amongst pregnant women who attend antenatal facilities in sub-Saharan Africa. The findings were discovered after a review of studies reporting estimates of the prevalence of sexually transmitted infections/reproductive tract infections (STIs/RTIs) and malaria over the past 2 decades.

The article’s background information states:

“There are 880,000 stillbirths and 1.2 million neonatal deaths each year in sub-Saharan Africa. Low birth weight (< 2.5 kg [5.5 lbs.]), attributable to intrauterine growth retardation, preterm delivery, or both, is the leading risk factor for neonatal mortality. Intrauterine infection is implicated in stillbirth and is associated with 25 percent to 40 percent of preterm births. Sexually transmitted infections and reproductive tract infections and malaria are associated with adverse birth outcomes, but both may be mitigated with preventive or presumptive treatment or by repeated screening and treatment throughout the antenatal period. The extent to which either approach may be beneficial depends on the underlying prevalence of STIs/RTIs and malaria in pregnancy.”

R. Matthew Chico, M.P.H., from the London School of Hygiene and Tropical Medicine and his team performed a systematic review and meta-analysis to provide estimates for the dual prevalence of STIs/RTIs and malaria in pregnant women in sub-Saharan Africa. Their search criteria included reports on malaria, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, or bacterial vaginosis amongst pregnant women who attended antenatal care facilities in sub-Saharan Africa.

From 1990 to 2011, the team found a total of 171 eligible studies including 340,904 women. The combined prevalence estimates of Eastern & Southern Africa and of West & Central Africa was:

DiseaseEastern & Southern AfricaWest & Central Africa
PercentagePositive diagnosesPercentagePositive diagnoses
N gonorrhoeae3.7%6262.7%73
C trachomatis6.9%3506.1%357
T vaginalis29.1%5,50217.8%822
Bacterial vaginosis50.8%4,28037.6%1,208
Peripheral malaria32.0%11,68838.2%12,242
Placental malaria25.8%1,38839.9%4,658

The researchers conclude:

“The dual prevalence of malaria and STIs/RTIs is evident among pregnant women who attend antenatal facilities in sub-Saharan Africa. As malaria control and elimination efforts are brought to scale, the relative contribution of STIs/RTIs to adverse birth outcomes most likely will increase proportionately. Coinfection prevalence estimates for malaria and STIs/RTIs need to be established and routinely reported. Rigorous studies using molecular diagnostic methods are needed to characterize more accurately the prevalence of these infections and their clinical consequences.

Clinical trials are needed to compare birth outcomes, operational feasibility/acceptability, and cost-effectiveness of intermittent preventive treatment during pregnancy (IPTp) with azithromycin-based combination therapy against an approach of integrated screening and treatment for malaria and STIs/RTIs.”

Written By Petra Rattue