Objective
The objectives of the proposal are to assess in women experiencing malaria in pregnancy if there is an influence of material anaemia on birthweight that is independent of malaria and to determine the difference in malaria prevalence, infant morbidity and growth between infants born with and without fetal anaemia. The proposal allows the opportunity for collaboration between doctors at the New Medical School in Malawi, and malaria field scientists in Liverpool, England and Leiden, The Netherlands. The project is linked with the Liverpool-Malawi Severe Malaria Project.
Two study designs will be employed. A preliminary case-control study will be undertaken to quantify the contribution of anaemia and iron status to low birthweight and to investigate the association between maternal anaemia and iron status with fetal anaemia. 400 cases and controls will be studied. Subsequently a cohort study design is employed with follow-up of 200 newborn babies for twelve months. This study will test the hypothesis that birth haemoglobin relates to malaria and morbidity risk in infants. Further studies will be done on malaria drug resistance in vivo in infants and on the nature of severe anaemia in infants admitted to hospital. These studies will address unanswered questions concerning the prevalence of anaemia in infants in a highly malarious area; the relationship between fetal anaemia and clinical risk in infancy, and the relationship between maternal anaemia and iron status and lowbirthweight risk. The project provides the opportunity for training to Ph. D level of a Malawian doctor and a European Dutch counterpart. The project is considered high priority because of the magnitude of drug resistant malaria and the high prevalence of anaemia requiring blood transfusion in malarious areas of developing countries. It should enable appropriate intervention strategies to be identified for women in pregnancy and infants.