Presentation Abstract

Session: Clinical Tropical Medicine I
Abstract Number: 950
Title: A systematic review and meta-analysis of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: Opportunities for antenatal intervention
Presentation Start: 11/13/2012 3:00:00 PM
Authors: R. Matthew Chico, Philippe Mayaud, Cono Ariti, David Mabey, Carine Ronsmans, Daniel Chandramohan
London School of Hygiene and Tropical Medicine, London, United Kingdom
Context: Malaria and sexually transmitted infections/reproductive tract infections (STIs/RTIs) in pregnancy are direct and indirect causes of stillbirth, prematurity, low birth weight, and maternal and neonatal morbidity and mortality. Novel use of diagnostic tools and/or drugs may improve birth outcomes with the impact depending on the prevalence of malaria and STI/RTI. Data Sources:
PubMed, MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry, and reference lists were searched for studies reporting malaria, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, or bacterial vaginosis among pregnant women attending antenatal care facilities in sub-Saharan Africa. Study Selection: Included studies were conducted in 1990-2011 with open enrollment. Studies from South Africa, where malaria is no longer endemic, were excluded. Data Extraction: Point prevalence estimates were corrected for diagnostic precision. A random-effects model meta-analysis was then applied to produce pooled prevalence estimates. Results: A total of 171 studies met inclusion criteria, providing 307 point prevalence estimates for malaria or STIs/RTIs. The pooled prevalence estimates (95% confidence intervals; n=positive diagnoses) among studies in 1990-2011 in East and Southern Africa were as follows: syphilis 4.5% (3.9,5.1; n=8,346), N. gonorrhoeae 3.7% (2.8, 4.6; n=626), C. trachomatis 6.9% (5.1, 8.6; n=350), T. vaginalis 29.1% (20.9, 37.2; n=5,502), bacterial vaginosis 50.8% (43.3, 58.4; n=4,280), peripheral malaria 32.0% (25.9, 38.0; n=11,688) and placental malaria 25.8% (19.7, 31.9; n=1,388). West and Central Africa prevalence estimates were as follows: syphilis 3.5% (1.8, 5.2; n=851), N. gonorrhoeae 2.7% (1.7, 3.7; n=73), C. trachomatis 6.1% (4.0, 8.3; n=357), T. vaginalis 17.8% (12.4, 23.1; n=822), bacterial vaginosis 37.6% (18.0, 57.2; n=1,208), peripheral malaria 38.2% (32.3, 44.1; n=12,242) and placental malaria 39.9% (34.2, 45.7; n=4,658). Conclusion: The dual prevalence of malaria and STIs/RTIs in pregnancy among women who attend antenatal care facilities in sub-Saharan Africa is considerable, with the combined prevalence of curable STIs/RTIs being equal to, if not greater than, malaria.

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