Malaria in pregnancy Prevention, diagnosis, and adverse consequences of infection in early childhood

Malaria during pregnancy remains a major public health concern in the Democratic Republic of the Congo (DRC). Its diagnosis is challenging due to low peripheral parasitemia. To mitigate its impact on both mothers and newborns, preventive measures such as insecticide-treated nets (ITNs) and intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) are recommended. However, their uptake remains suboptimal, and increasing parasite resistance to SP threatens the effectiveness of IPTp-SP. This thesis explores various aspects of malaria in pregnancy, including its diagnosis, treatment, and consequences for newborns and early childhood. A clinical trial and ancillary studies were conducted among pregnant women and their offspring. Findings indicate that an ultra-sensitive rapid diagnostic test (uRDT) exhibited slightly higher sensitivity than conventional tests and outperformed routine microscopy. Despite the benefits of ITNs and IPTp-SP for maternal health, their utilization remains insufficient. A novel preventive approach, intermittent screening with uRDT followed by treatment with pyronaridine-artesunate, was found to be non-inferior to IPTp-SP and should serve as an alternative where SP is not used. Congenital malaria was rare, detected in 2.4% of newborns, but should be considered when no other cause of neonatal fever is identified. Lastly, maternal malaria was associated with cognitive development impairments in infants without affecting motor skills during the first 12 months of life. These findings underscore the importance of strengthening preventive strategies and highlight the need to explore alternative therapeutic approaches to improve maternal and child health in the DRC.