Congenital malaria

My favourite lecture is the one on jaundice – a pet topic of mine. I was challenged today on my statement that congenital malaria can cause jaundice. Actually the challenge was whether the malaria parasites can cross the placenta. Grace – with a lot more experience of congenital malaria than me – came to my rescue. In Cameroon, she is now doing peripheral blood smears for babies born to mothers known to have malaria during delivery and is finding more cases than expected in the neonates being treated for sepsis. This evening, I looked it up.

Here are a few bullet points from the above paper which comes from just east of where I am sitting as I write:

  • placental malaria significantly increases the risk of perinatal morbidity and mortality including low birth weight, intrauterine growth restriction, preterm labour and intrauterine fetal death
  • malaria in pregnancy is estimated to account for 100,000 neonatal deaths annually
  • maternal malaria can be prevented during pregnancy with intermittent presumptive treatment with sulfadoxine–pyrimethamine, and can reduce neonatal mortality by up to 61%
  • maternal immunity to malaria may confer protection to the fetus through transmission of immunoglobulin G antibodies (IgG) against malaria
  • the presence of fetal haemoglobin (HbF) in the neonate prevents high parasitaemia
  • to maximize the chances of early detection of congenital malaria, neonates born to mothers with malaria in the last 7 days before delivery should be investigated with a blood film for malaria parasites irrespective of the clinical picture and weekly thereafter for the first month
  • the clinical features of neonatal and congenital malaria overlap with sepsis syndromes. Other symptoms can include anaemia, jaundice, diarrhoea, vomiting, lethargy, convulsions, irritability, tachypnoea, respiratory distress, hepatosplenomegaly
  • for infants weighing less than 5kg with uncomplicated P. falciparum, the World Health Organization (WHO) recommends treatment with ACT at the same mg/ kg body weight dose as for children weighing 5 kg.

I’ll report back to the learners tomorrow. They do not look for malaria here in babies born to mothers with active malaria but the paper suggests that may be testing is indicated. We all learnt something today.


Malaria is endemic in Liberia and prevalence is high at the moment as the rainy season draws to a close.  One of our 2 local instructors succumbed to it this morning during the 1st lecture of the day.  Fortunately she was sitting next to one of the observing doctors when she collapsed so was admitted straight from our teaching room.  She has been discharged now on oral treatment but is not going to be up to teaching tomorrow either which is sad for her as she was quite excited to be involved in the course.

Julia’s unmade bed (a la Tracy Emin)

This is a picture of my pop-up mosquito net which I love sleeping under.  It makes me feel like I’m sleeping in a 4-poster bed!  Unfortunately not many pregnant women like sleeping under the nets they are provided with by the antenatal clinic and there is only a 55% uptake of these and malaria prophylaxis which is offered to all pregnant women in Liberia.  It reminds me of when I was in Malawi many years ago watching people fish with beautiful blue fine mesh nets – mosquito nets distributed to them free.

Malaria remains the leading cause of morbidity and mortality in Liberia, with 38% of outpatient attendance and 42% of inpatient deaths attributable to malaria ( However, malaria prevalence in children aged under 5 years has been significantly reduced from 66% to 32% since 2005 and this will be largely due to distribution of free nets to households with children aged under 5 years, pregnant women and lactating mothers.  So, despite some Liberian women’s reticence and some Malawian fishermen’s initiative, free mosquito nets do save lives.