Severe malaria in pregnant women hospitalized between 2010-2014 in the Department of Antioquia (Colombia)

Abstract

Introduction: Malaria during pregnancy negatively impacts maternal and neonatal health, with a high risk of clinical complications and mortality. Maternal anemia and low birth weight have been specially characterized in regions of high malarial endemicity. The clinical spectrum in low endemic areas is little known. Objective: To characterize clinically and epidemiologically the episodes of malaria during pregnancy in women hospitalized in the department of Antioquia (Colombia), 2010-2014. Materials and methods: Descriptive, cross-sectional, retrospective study, using clinical records of pregnant women with malaria caused by P. falciparum and P. vivax. The WHO diagnostic criteria for severe malaria and those from the Colombian guideline for malaria care were applied. Results: 111 cases were analyzed; 13.5% of them were classified as severe malaria according to WHO criteria; when the Colombian criteria were applied criteria the proportion of cases of severe malaria increased to 23.4%. The complications identified included hepatic dysfunction, anemia, acidosis and severe thrombocytopenia; no difference was observed in the frequency of complications by plasmodium species. Signs of danger were presented in 39.4% of the cases; pallor and jaundice were the most frequent; 40.5% showed signs of danger for pregnancy, such as persistent headache, abdominal pain and vaginal bleeding. Conclusions: Severe malaria manifests with precociously recognizable danger signs. It is a high frequency event in pregnant women, without difference by Plasmodium species. Hospital underreporting was identified in 88% of severe cases and lack of laboratory tests for a more complete diagnosis. A protocol is required for the clinical diagnosis of pregnant women with malaria.