Predictors and Optimal Diagnostics of Placental Malaria in Tororo, Uganda
Malaria during pregnancy commonly leads to placental malaria, with adherence of parasite-infected erythrocytes in the placenta, and high risk of adverse maternal and fetal outcomes. Risk factors for placental malaria are not well understood. Moreover, there is an urgent need to identify optimal methods of diagnosing placental malaria. The objectives are (1) To identify predictors of placental malaria among HIV-infected and -uninfected women in rural Uganda; (2) To assess correlations between four methods of diagnosing placental malaria and low birth weight (LBW) among HIV-infected and -uninfected women. This will be a cross-sectional study of 200 HIV-infected and 600 HIV-uninfected pregnant women enrolled at the time of delivery at Tororo District Hospital in Tororo, Uganda. Following delivery, study staff will obtain placental blood and biopsies to detect malaria by smear, PCR of placental blood, histidine-rich protein 2 rapid diagnostic test (HRP2 RDT) of placental blood and placental biopsy. Participants will undergo a short questionnaire eliciting duration of antiretroviral use, use of insecticide-treated nets and use of antifolate prophylaxis. Staff will also obtain infant birth weight. The primary outcome will be placental malaria, defined by histopathology. Secondary outcomes will include positive placental blood PCR, RDT, and smear. The primary outcome for aim 2 will be LBW (less than 2500 grams). Tororo District Hospital delivers approximately 300 HIV-infected and 1500 HIV-uninfected women per year. Last year, we conducted a pilot study of 150 HIV-infected and 356 HIV-uninfected pregnant women. Based on these preliminary data, we estimate the prevalence of placental malaria defined by histopathology to be 20% in this population. The data obtained in this study will aid further research in placental malaria by identifying possible avenues of investigation for prophylactic intervention, as well as establishing a laboratory diagnostic standard for placental malaria.