Research by the USP (University of São Paulo) mapped the incidence of malaria in pregnant women in Brazil. The scope of the study makes the work unprecedented considering that it was analyzed over a long period from 2004 to 2018 and included more than 60,000 women, based on data from Sivep-Malária (Malaria Epidemiological Surveillance System), the Ministry of Health. Among the results found is the observation that the disease is more common in pregnant women in communities in the states of Amazonas, Acre, Rondônia and Pará.
“These are the hotspots for the disease, the regions that are most critical, where the incidence of the disease is more evident. The study shows where major interventions by the healthcare system and public policies would be needed,” explains Cláudio Romero Farias Marinho, professor at the Laboratory of Experimental Immunoparasitology at the Institute of Biomedical Sciences, who coordinated the work. The research was supported by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo) and published in the journal Lancet Regional Health – Americas.
The group coordinated by Marinho has been studying gestational malaria for 10 years. “Pregnant women and children up to the age of five are the main risk groups for developing a serious disease, severe malaria. These two groups have the highest mortality rates in the world,” he stressed. The disease is caused by protozoa of the genus Plasmodium and transmitted by the Anopheles mosquito. Infected pregnant women are at increased risk of severe anemia, premature delivery, miscarriage, and stillbirth. The fetus may also be affected and show microcephaly, or growth retardation.
The work also shows that there was a reduction to about half of the cases over the period analysed. “With all the problems we have, Brazil has a very serious malaria control program. The disease must be reported and this system is fed almost daily. It’s a very efficient monitoring system,” he assessed. In addition, he emphasizes that all treatments are free. “That’s super important because it prevents drug resistance, we make sure the person is really treated right.”
treatment
Despite this, the study also found that treating these patients with the prescription of a contraindicated drug, primaquine, may be inappropriate. However, Marinho warns that since it is a database, it is necessary to confirm this information as the information recorded may contain errors. “This is an important alert point, but it is up to the authorities to check and verify this, to have greater control and to verify the accuracy of this information,” the researcher reflected.
Under the coordination of Marinho, the survey was conducted by ICB-USP postdoc Jamille Dombrowski in collaboration with researchers from the Faculty of Public Health. Based on this epidemiological analysis, the focus of the group is now on the early detection of a complication of the disease, placental malaria. In these cases, the parasite can be in the placenta and the pregnant woman without any symptoms. Dombrowski is therefore working on a project that aims to identify biomarkers in order to introduce this analysis into routine prenatal care.