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Malaria in pregnancy in the Brazilian Amazon
Amazon Rainforest - Acre State / Brazil
This project was developed in the Juruá River Valley from December 2012 to October 2014 by researchers Jamille Dombrowski, Ricardo Ataide and Rodrigo Medeiros.
Malaria is a severe parasitic disease that, when occurs during pregnancy, it is one of the main cause of maternal-fetal mortality leading also to anemia, abortion, preterm birth, intrauterine growth restriction and low birth weight. Infections by Plasmodium (P.) falciparum are known to be detrimentally involved in poor pregnancy outcomes, effects that were also described during P. vivax infections. Despite its significant prevalence and possible association to severe complications during pregnancy, the impact of malaria in pregnant women and their children are not clearly understood.
This study was performed in the micro-region from Juruá (Juruá Valley) in the state of Acre, located in the Brazilian Amazon in the extreme southwest portion of the North region. It occupies an area of 164,221.36 km2, and it is limited in the north by the state of Amazonas, in the east by the state of Rondônia, and in the southwest by Bolivia and Peru. It is administratively composed of 22 cities. The studied region is formed by five cities (Cruzeiro do Sul, Rodrigues Alves, Mâncio Lima, Porto Walter, and Marechal Thaumaturgo) and with an estimated population of 200,000 inhabitants.
Mixed infection indicates that Plasmodium vivax and Plasmodium falciparum infections occurred at the same time or at different times during pregnancy.
The headquarters of the study was in Cruzeiro do Sul, as it is the principal city in the region, and which is considered the second larger city in the state of Acre, 648 km away from the capital city, Rio Branco. The total population estimated in the city is 88,376 inhabitants, with a demographic density of 8.9 inhabitants/km2. Together with Porto Velho and Manaus, the three towns are responsible for 21.9% of the malaria cases notified in Brazil. It is a high transmission risk city, with an annual parasitic incidence of 147,5 cases per 1,000 inhabitants, with the prevalence of P. vivax infection. In Cruzeiro do Sul, it is located the Hospital da Mulher e da Criança do Juruá (HMCJ), a public reference maternity hospital for every city located in the Juruá region.
1. REIS A.S. et al. "Inflammasome activation and IL-1 signaling during placental malaria induce poor pregnancy outcomes". Science Advances 04 Mar 2020, Vol. 6, no. 10, eaax6346. Doi: https://doi.org/10.1126/sciadv.aax6346
2. DOMBROWSKI, J.G. et al. “Association of malaria infection during pregnancy with head circumference of newborns in the Brazilian Amazon”. JAMA Network Open, 2(5):e193300, 2019. Doi: https://doi.org/10.1001/jamanetworkopen.2019.3300
3. DOMBROWSKI, J.G. et al. Malaria during pregnancy and newborn outcome in an unstable transmission area in Brazil: a population-based record linkage study.PLoS One. 21;13(6):e0199415, 2018. Doi: https://doi.org/10.1371/journal.pone.0199415
4. ATAIDE, R. et al. “Malaria in Pregnancy Interacts with and Alters the Angiogenic Profiles of the Placenta”. PLoS Neglected Tropical Diseases, v. 9, p. e0003824, 2015. Doi: https://doi.org/10.1371/journal.pntd.0003824
5. SOUZA, R.M. et al. “Placental Histopathological Changes Associated with Plasmodium vivax Infection during Pregnancy”. PLoS Neglected Tropical Diseases, v. 7, p. e2071, 2013. Doi: https://doi.org/10.1371/journal.pntd.0002071
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