Clinical Tropical Medicine I
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
11/13/2012 3:00:00 PM
R. Matthew Chico
, Philippe Mayaud
, Cono Ariti
, David Mabey
, Carine Ronsmans
, Daniel Chandramohan
London School of Hygiene and Tropical Medicine, London, United Kingdom
: 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.
PubMed, MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry, and reference lists were searched for studies reporting malaria, syphilis,
, or bacterial vaginosis among pregnant women attending antenatal care facilities in sub-Saharan Africa.
: Included studies were conducted in 1990-2011 with open enrollment. Studies from South Africa, where malaria is no longer endemic, were excluded.
: Point prevalence estimates were corrected for diagnostic precision. A random-effects model meta-analysis was then applied to produce pooled prevalence estimates.
: 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),
3.7% (2.8, 4.6; n=626),
6.9% (5.1, 8.6; n=350),
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),
2.7% (1.7, 3.7; n=73),
6.1% (4.0, 8.3; n=357),
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).
: 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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