Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Disclosures: The authors report no relevant financial disclosures.
October 01, 2020
2 min read

Malaria associated with increased prevalence of anemia during pregnancy

Disclosures: The authors report no relevant financial disclosures.
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A study conducted in seven sub-Saharan African countries demonstrated an association between malaria and an increased prevalence of anemia among pregnant women, according to findings published in BMC Pregnancy and Childbirth.

Paddy Ssentongo, MD, MPH, a research assistant professor at Penn State University, and colleagues used nationally representative, cross-sectional demographic and health surveys conducted between 2012 and 2017 in Burundi, the Democratic Republic of the Congo, The Gambia, Ghana, Mali, Senegal and Togo to assess the association of malaria with anemia among pregnant women aged 15 to 49 years, as well as to determine the joint relation between malaria and HIV on anemia.

Paddy Ssentongo

“Pregnant women in sub-Saharan Africa suffer a double burden of malaria and HIV infections, and these infections interact with each other to cause anemia,” Ssentongo told Healio. “If not treated, the risk of the mother and the unborn baby dying is high. Multipronged strategies to prevent and treat malaria in HIV pregnant women are critical to ensure the survival of the mothers and their unborn babies.”

The study included 947 pregnant women and assessed the prevalence of malaria only, HIV only and malaria-HIV coinfections.

The prevalence of malaria only was 31% (95% CI, 28.5%-34.5%), of HIV only was 1.3% (95% CI, 0.77%-2.4%) and of malaria-HIV coinfection was 0.52% (95% CI, 0.02%-1.3%). Overall, the prevalence of anemia was 48.3% of pregnant women (95% CI, 45.1%-51.5%). Anemia prevalence in pregnant women who had only malaria was 56% (95% CI, 50.1%-61.7%), with HIV only was 62.5% (95% CI, 25.9%-89.8%) and with malaria-HIV coinfection was 60% (95% CI, 17%-92.7%). Pregnant women without either infection had an anemia prevalence of 44.6% (95% CI, 40.7%-48.6%).

“Clinicians should always investigate for anemia in pregnant women with HIV or malaria,” Ssentongo said. “More importantly, advise pregnant women in sub-Saharan Africa to seek care regularly from the antenatal care services to be screened for malaria.”

According to the study, in fully adjusted models, malaria was associated with a 27% higher prevalence of anemia (95% CI, –5.01 to –1.79) compared with uninfected pregnant women.

“Clinicians should use preventive strategies for anemia in pregnancy due to malaria and HIV, which include the use of trimethoprim-sulfamethoxazole (cotrimoxazole), intermittent preventive treatment with sulfadoxine-pyrimethamine, in addition to antiretroviral therapy, which both lower the odds of coinfection,” Ssentongo said.

Ssentongo said that malaria during pregnancy causes acute anemia through the direct destruction of red blood cells, the accumulation of both infected and uninfected red blood cells in the spleen, and a decreased count of red blood cell formulation in the bone marrow.

“In addition, malaria-infected red blood cells accumulate in the placenta, attached by the small knobs on their surface,” he said.

The authors reported that the prevalence of malaria-HIV coinfection was too low in the study group to determine a meaningful analysis of the association with anemia.