Neonatal malaria in a mesoendemic malaria area of Northern Nigeria

Background: Though neonatal infections are most common reason for admissions in the newborn in Nigeria, Neonatal Malaria, which was thought to be uncommon, is becoming increasingly reported in areas of malaria hyperendemicity. These reports have described not only malaria parasitaemia in these babies, but also some symptoms attributable to malaria. There are no known documented clinical studies in areas of malaria mesoendemicity, which also have high prevalence of neonatal infections. Method: As a preliminary investigation to document the incidence of neonatal malaria in a mesoendemic area, as well as identify possible risk factors for its occurrence, a prospective study was carried out in the special care baby unit of ABU Teaching Hospital, Kaduna Nigeria, over a one year period (December 2001- November 2002). As part of the investigations for evaluation of sick neonates admitted into the unit, thick and thin blood films stained with Giemsa stain were examined for malaria parasite using standard techniques. Specie identification and quantification were carried out. Results: Of the 206 children tested, there was positive malaria parasitaemia in 17 (8.25%). Only P. falciparum malaria was identified. There were no mixed infections. Parasite density varied between 1,000 –20,000 asexual forms/mL. Analysis revealed a strong association between neonatal malaria and maternal genital infections (OR 4.51, p= 0.006). There is some association between neonatal malaria and both primigravidity (OR 3.01, p=0.035) and maternal fever developed within 2 weeks to parturition (OR 2.78, p=0.04). Fever was the most strongly associated clinical feature (OR 8.12, p=0.0002) at presentation. Conclusion: The study has confirmed the presence of neonatal malaria in this environment. There is need for detailed characterization of the aetiological agents of maternal genital infections with which neonatal malaria is strongly associated and investigate the placenta integrity in relation to such infections. Fever in the neonate should be taken as a strong pointer to the possibility of neonatal malaria. Key Words: Malaria, neonatal, mesoendemic Annals of African Medicine Vol.3(4) 2004: 170-17