@article{fdi:010086725,
  title = {{B}urden of malaria in pregnancy among adolescent girls compared to adult women in 5 sub-{S}aharan {A}frican countries : a secondary individual participant data meta-analysis of 2 clinical trials},
  author = {{P}ons-{D}uran, {C}. and {M}ombo-{N}goma, {G}. and {M}acete, {E}. and {D}esai, {M}. and {K}akolwa, {M}. {A}. and {Z}oleko-{M}anego, {R}. and {O}uedragou, {S}. and {B}riand, {V}al{\'e}rie and {V}ala, {A}. and {K}abanywanyi, {A}. {M}. and {O}uma, {P}. and {M}assougbodji, {A}. and {S}evene, {E}. and {C}ot, {M}ichel and {A}ponte, {J}. {J}. and {M}ayor, {A}. and {S}lutsker, {L}. and {R}amharter, {M}. and {M}enendez, {C}. and {G}onzalez, {R}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {M}alaria is among the top causes of death in adolescent girls (10 to 19 years) globally. {A}dolescent motherhood is associated with increased risk of adverse maternal and neonatal outcomes. {T}he interaction of malaria, adolescence, and pregnancy is especially relevant in malaria endemic areas, where rates of adolescent pregnancy are high. {H}owever, data on burden of malaria among adolescent girls are limited. {T}his study aimed at investigating whether adolescent girls were at a greater risk of experiencing malaria-related outcomes in pregnancy-parasitaemia and clinical disease-than adult women. {M}ethods and findings {A}n individual secondary participant-level meta-analysis was conducted using data from 5,804 pregnant women participating in 2 malaria prevention clinical trials in {B}enin, {G}abon, {K}enya, {M}ozambique, and {T}anzania between 2009 and 2014. {O}f the sample, 1,201 participants were adolescent girls with a mean age of 17.5 years (standard deviation ({SD}) 1.3) and 886 (73.8%) of them primigravidae. {A}mong the 4,603 adult women with mean age of 27.0 years ({SD} 5.4), 595 (12.9%) were primigravidae. {M}ean gestational age at enrolment was 20.2 weeks ({SD} 5.2) and 1,069 (18.4%) participants were {HIV}-infected. {W}omen were followed monthly until the postpartum visit (1 month to 6 weeks after delivery). {T}his study considered outcomes including clinical episodes during pregnancy, peripheral parasitaemia at delivery, and placental malaria. {A} 2-stage meta-analysis approach was followed by pooling single multivariable regression results into standard {D}er{S}imonian-{L}aird random-effects models. {A}dolescent girls were more likely than adult women to present with clinical malaria during pregnancy (incidence risk ratio ({IRR}) 1.70, 95% confidence interval ({CI}) 1.20; 2.39, p-value = 0.003, {I}-2 = 0.0%, {N}= 4,092), peripheral parasitaemia at delivery (odds ratio ({OR}) 2.28, 95% {CI} 1.46; 3.55, p-value < 0.001, {I}-2 = 0.0%, {N}= 3,977), and placental infection ({OR} 1.97, 95% {CI} 1.31; 2.98, p-value = 0.001, {I}-2= 1.4%, {N}= 4,797). {S}imilar associations were observed among the subgroup of {HIV}-uninfected participants: {IRR} 1.72 (95% {CI} 1.22; 2.45, p-value = 0.002, {I}-2 = 0.0%, {N}= 3,531) for clinical malaria episodes, {OR} 2.39 (95% {CI} 1.49; 3.86, p-value < 0.001, {I}-2 = 0.0%, {N}= 3,053) for peripheral parasitaemia, and {OR} 1.88 (95% {CI} 1.06 to 3.33, p-value = 0.03, {I}-2 = 34.9%, {N}= 3,847) for placental malaria. {A}mong {HIV}-infected subgroups statistically significant associations were not observed. {S}imilar associations were found in the subgroup analysis by gravidity. {T}he small sample size and outcome prevalence in specific countries limited the inclusion of some countries in the meta-analysis. {F}urthermore, peripheral parasitaemia and placental malaria presented a considerable level of missing data-12.6% and 18.2% of participants had missing data on those outcomes, respectively. {G}iven the original scope of the clinical trials, asymptomatic malaria infection was only assessed at the end of pregnancy through peripheral and placental parasitaemia. {C}onclusions {I}n this study, we observed that adolescent girls in sub-{S}aharan {A}frica ({SSA}) are more prone to experience clinical malaria episodes during pregnancy and have peripheral malaria and placental infection at delivery than adult women. {M}oreover, to the best of our knowledge, for the first time this study disaggregates figures and stratifies analyses by {HIV} infection. {S}imilar associations were found for both {HIV}-infected and uninfected women, although those for {HIV}-infected participants were not statistically significant. {O}ur finding suggests that adolescent girls may benefit from targeted malaria prevention strategies even before they become pregnant.},
  keywords = {{AFRIQUE} {SUBSAHARIENNE} ; {BENIN} ; {GABON} ; {KENYA} ; {MOZAMBIQUE} ; {TANZANIE}},
  booktitle = {},
  journal = {{PL}o{S} {M}edicine},
  volume = {19},
  numero = {9},
  pages = {e1004084 [20 p.]},
  ISSN = {1549-1277},
  year = {2022},
  DOI = {10.1371/journal.pmed.1004084},
  URL = {https://www.documentation.ird.fr/hor/fdi:010086725},
}