Malaria in pregnancy is a major underlying cause of neonatal morbidity in endemic regions [1–3]. The burden of malaria in pregnancy is highest in sub-Saharan Africa where 1:4 pregnant women have evidence of placental infection at the time of delivery [4–6]. Pregnancy associated malaria has been implicated as a cause of stillbirths, premature births, intrauterine growth restriction and consequently low birth weight (LBW) in affected newborns. However, its effect as a cause of clinical disease in the newborn especially in the first week of life, when most newborn illnesses and deaths occur, is uncertain.
Congenital malaria, defined as malaria parasitaemia in the first week of life can be acquired transplacentally or during the time of birth. The prevalence in sub-Saharan Africa has been reported to vary from 0 – 46% ; however, more recent multicentre longitudinal studies have reported lower rates of 4 – 6% [8, 9]. Clinical malaria is rare in newborns from endemic areas with high incidence of malaria in pregnancy. This rare occurrence has been attributed to the transplacental transfer of maternally derived antibodies to malaria, and the inhibitory effect of foetal haemoglobin on malaria parasite development [10–12].
The prevalence of congenital malaria in a community based prospective study in infants in southern Ghana in 1998 was 13.6% by polymerase chain reaction (PCR) and 2.5% by microscopy . In that study the risk of infection was three times higher during the rainy season (April – July) as compared to the dry season. Recently, two cases of symptomatic congenital malaria were reported in Ghanaian newborns [14, 15].
Clinical malaria in the newborn usually manifests after the first week of life (but has been reported on day 1) with symptoms such as fever, poor feeding, lethargy, anaemia, hepatosplenomegaly, jaundice, irritability, and drowsiness. These clinical features are similar to the manifestations of neonatal sepsis and other neonatal conditions that more commonly cause morbidity and mortality in the newborn period [8, 16, 17]. Many malaria endemic sub-Saharan African countries lack quality laboratory equipment and skilled frontline health care workers in primary health care facilities. As such, diagnosing neonatal problems is a major challenge and empirical treatment for malaria is often prescribed when newborns first present with the above symptoms. Sick newborns are referred to hospital few days later when malaria treatment does not resolve symptoms. This practice results in delayed referral of sick newborns for appropriate care and contributes to the high neonatal mortality and long-term morbidity in survivors in the sub-region.
Malaria is endemic in Ghana and World Health Organization (WHO) guidelines for empirical treatment of malaria in suspected cases is widely adhered to . This practice is extended to sick newborns by primary care health workers contrary to existing guidelines on the Integrated Management of Childhood Illnesses. Though many underlying reasons may account for this practice in sick newborns, the lack of sufficient local data on congenital malaria may be a contributory factor. This study presents the prevalence of malaria parasitaemia in non-treated high-risk newborns referred to a teaching hospital in the first week of life.