Risk Factors for Placental Malaria, Sulfadoxine-pyrimethamine Doses, and Birth Outcomes in a Rural to Urban Prospective Cohort Study on the Bandiagara Escarpment and Bamako, Mali, 2011-2019

Placental malaria is associated with maternal illness and anemia, low birth weight, and preterm birth. Mali has one of the highest malaria case incidence rates globally, according to World Health Organization (WHO) reports on malaria. Using a rural to urban longitudinal cohort of women who initially resided on the Bandiagara Escarpment at study enrollment, this observational study addressed the following questions:

Was risk for placental malaria higher in Bamako (urban) or on the Bandiagara Escarpment (rural)?
What were the maternal risk factors for placental malaria in this cohort?
What was the association between number of intermittent preventative treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) doses, placental malaria, and birth outcomes?
What factors predicted how many doses women received?

Placental samples (N = 317) and accompanying demographic data were collected from 249 women living on the Bandiagara Escarpment or in the District of Bamako during the years 2011 to 2019. Samples were evaluated by histology to assess placental malaria infection stage and parasite density. Generalized estimating equations (GEE) for logistic regression were used to model the risk factors for placental malaria infection (yes/no) and to assess the characteristics of women who had no doses or fewer doses of SP versus 3 or more doses of SP during pregnancy. Lastly, GEE was used to model birth outcomes as continuous dependent variables (birth weight, birth length, and placenta weight).