J Pediatr Infect Dis 2008; 03(03): 181-187
DOI: 10.1055/s-0035-1556988
Original Article
Georg Thieme Verlag KG Stuttgart – New York

Clinical and laboratory features of congenital malaria in Nigeria

Adeola A. Orogade
a  Department of Pediatrics, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
Catherine O. Falade
b  Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
Henrietta U. Okafor
c  Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
Olugbenga A. Mokuolu
d  Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
Aisha I. Mamman
e  Department of Hematology, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
Tagbo A. Ogbonu
c  Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
Oluwatoyin O. Ogunkunle
f  Department of Pediatrics, University College Hospital, Ibadan, Nigeria
Kolade S. Ernest
d  Department of Pediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
Michael V. Callahan
g  Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
David H. Hamer
h  Center for International Health and Development, Boston University School of Public Health, Boston, MA, USA
i  Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
› Author Affiliations

Subject Editor:
Further Information

Publication History

07 November 2007

14 May 2008

Publication Date:
28 July 2015 (online)


Since congenital malaria had previously been thought to be rare, blood film examination for malaria parasites is still sometimes not routinely performed in ill neonates in malaria-endemic regions. Because of increasing published reports of congenital malaria in Nigeria, there is a need to characterize the clinical and laboratory manifestations associated with malaria parasitemia within the first few hours of life. In a 12-month (April 2003-March 2004), multicenter study in Nigeria, thin and thick blood smears made from maternal (finger prick), placental aspirates, cord blood and neonate (heel prick taken within 4 hours of life) were Giemsa-stained and examined by light microscopy for asexual stages of Plasmodium. Parasitemic neonates were closely monitored for clinical and laboratory features of symptomatic malaria. Plasmodium falciparum was found in 5.1% (95/1875) of neonatal heel pricks; mean parasite density was low (mean = 48/μL, range 8–200/μL). Antepartum maternal and placental parasitemia were the most important risk factors for congenital parasitemia (P < 0.001 and P < 0.001). Prolonged labor and prolonged rupture of membranes were also significant factors in the symptomatic neonates. Sixty-one percent (58/95) of parasitemic babies were asymptomatic, while 38.9% (37/95) of them exhibited signs of possible infection. The presence of any symptom was significantly related to parasitemia (P < 0.001). Among the symptomatic parasitemic babies the most common symptoms were, fever (temperature >37.5°;) within the first 24 hours of life (100%) and refusal to suck (10.8%). Anemia at birth (hematocrit <42%) was found in 15.7% (15/95) of parasitemic babies as compared to 9.2% in the non-parasitemic ones. (P = 0.03, OR = 1.84). The mean hematocrit of parasitemic neonates within 4 hours of life was 49.5 ± 6.4 as compared to 52.6 ± 8.2 in non-parasitemic babies (P = 0.001). Furthermore, the mean hematocrit was 44.0 ± 5.5% in the symptomatic parasitemic babies. All symptomatic babies were treated with oral chloroquine with a cure rate of 89.1%. Treatment failures subsequently received oral sulfadoxine-pyrimethamine with good outcome. The febrile newborn should be evaluated for malaria especially if there is a history of prolonged labor or in the presence of maternal malaria infection. Efforts should be intensified to reduce the burden of maternal, placental malaria and therefore congenital malaria.