The effect of maternal, umbilical cord and placental malaria parasitaemia on the birthweight of newborns from South-western Cameroon ACHIDI E. AKUM 1 , ANCHANG J. KUOH 1 , JACOB T. MINANG 1,2 , BOYO M. ACHIMBOM 1 , MOKUBE J. AHMADOU 3 & MARITA TROYE-BLOMBERG 2 1 Faculty of Health Sciences, University of Buea, Buea, Cameroon, 2 Department of Immunology, University of Stockholm, Stockholm, Sweden, and 3 Bota District Hospital, Limbe, Cameroon Abstract Aim: The impact of maternal, umbilical cord and placental malaria parasitaemia on the incidence of low birthweight was investigated in pregnant women reporting for delivery at the Mutengene Maternity Centre, Fako Division, South West Province, Cameroon. Methods: The malaria parasitaemia status of 770 umbilical cords, parturient women and placental impression smears were determined by light microscopy using blood samples collected between June 1999 and September 2001. The birthweights (BW) of the newborns were recorded soon after delivery. Results: The results show that malaria parasites were present in the blood samples of 57 out of 730 (7.8%), 233/711 (32.8%) and 248/735 (33.7%) cord, maternal and placental biopsies respectively. Low birthweight (LBW) was recorded in 72 (9.6%) newborns, and the incidence was higher in primiparae. Newborns of mothers who had malaria parasites in their peripheral blood (12.4%) had a higher incidence (p=0.014) of LBW when compared with malaria parasite-free mothers (6.8%). Similarly, neonates born from malaria-positive placentas (13.5%) had a significantly higher incidence of LBW (p=0.006) than those from parasite-negative placentas (6.8%). Furthermore, newborns of malaria parasite-positive mothers, umbilical cords, placentas and primiparae had lower mean birthweight than malaria-negative mothers, placentas, umbilical cords and multiparae. Conclusion: We suggest that parity and maternal and placental malaria parasitaemia at delivery have an important negative impact on birthweight, especially in first pregnancies. This observation emphasizes the need for appropriate aggressive intervention strategies such as the use of insecticide-treated bed nets or intermittent preventive treatment to control malaria in pregnancy in the study area. Key Words: Birth weight, malaria, pregnancy, placenta, Plasmodium falciparum Introduction Malaria in pregnancy has serious health consequences, in particular, maternal anaemia, maternal or fetal death, prematurity, intrauterine growth retardation and low birthweight [1,2]. During pregnancy, espe- cially in first pregnancies, women are more susceptible to Plasmodium falciparum infection and experience a higher frequency and density of parasitaemia than non- pregnant women [3,4]. The mechanism underlying this susceptibility is not fully understood. It has been suggested that despite the acquired antimalarial immunity of these pregnant women, the uteroplacental vascular space apparently provides a site for parasite sequestration and development [5,6]. This parasite replication presumably reduces nutrient transport across the placenta and allows for passage of para- sitized red blood cells to the fetus that may compromise fetal growth and infant survival. There is accumulating evidence that anaemia, particularly severe anaemia, increases the risk of low birthweight [7,8] and also contributes to maternal and perinatal mortality [9]. Low birthweight (LBW, 52500 g) is the single most important determinant of neonatal mortality, an important cause of fetal and neonatal morbidity, and one of the most important determinants of the infant’s chances of survival and healthy growth and development [10]. Women of Correspondence: Achidi Eric Akum, Faculty of Health Sciences, University of Buea, PO Box 63 Buea, Cameroon. Tel: +237 3323101/7739498. Fax: +237 3322272. E-mail: achidi_e@yahoo.com (Received 27 January 2004; revised 1 June 2004 and 1 December 2004; accepted 9 December 2004) Acta Pædiatrica, 2005; 94: 917–923 ISSN 0803-5253 print/ISSN 1651-2227 online # 2005 Taylor & Francis Group Ltd DOI: 10.1080/08035250510028605