Plasmodium falciparum malaria is a major health problem for pregnant women since it increases maternal mortality and poor pregnancy outcomes. In addition, infants whose mothers have malaria during pregnancy are at an increased risk of developing severe malaria, anemia, asthma and dying during the first year of life than those whose mothers remain malaria-free.

The long-term goal of this project is to improve the health of women and children living in sub-Saharan Africa. Accordingly, scientists at the University of Yaounde, Cameroon and University of Hawaii propose to answer key questions about the current recommended strategy for prevention of malaria during pregnancy, namely intermittent preventive treatment using sulfadoxine-pyrimethamine (IPT-SP). Studies are conducted in the city of Yaounde where transmission is ~1 infectious bite per month and in rural villages where individuals receive ~0.7 infectious bites per night. The studies are the first to evaluate IPT-SP in pregnant women living in Central/West Africa and in an area where transmission of malaria is low. Also, they are the first to determine if IPT-SP reduces the level of protective immunity infants have at birth and how this influences malaria episodes and antibody responses in infants during the first year of life. This program will evaluate the strengths and weaknesses of methods currently recommended by the World Health Organization for prevention of malaria in pregnant women living in developing countries. New information from this study should lead to improved health care for African mothers and their children.

Training of Cameroonian Scientists in Research of Malaria (training program)

The introduction of malaria control measures including insecticide-treated bed nets, rapid diagnostic tests, and intermittent preventative treatment (IPT) have reduced the prevalence of malaria in a number of African countries, yet malaria remains highly endemic in central Africa where public health resources are poor. At highest risk of severe infections are pregnant women and young children. More than ever, well-trained African scientists are needed to monitor the changing landscape as the malaria picture rapidly changes. Scientists in Cameroon are actively engaged in research on malaria, but additional expertise and faculty are needed to identify malaria-related problems as they arise and design strategies to solve them. Therefore, the purpose of this program is to assist young Cameroonian scientists acquire the skills necessary for conducting research on malaria, with a focus on malaria in pregnant women and infants.

Through continuous NIH grant support and a training grant from the Maternal and Child Health Research Training Program (MCHRT), a group of 5 full- time faculty members, 6 well-trained technicians, and 40 students are conducting research at the Cameroon Biotechnology Center (BTC), University of Yaoundi 1. Previous trainees wish to return after completing their post-doctoral and residency programs in the United States. This program allows the malaria group at the BTC to acquire the critical mass and expertise it needs to develop a long-term sustainable research program on malaria. The program includes training of 3 PhD-level and 4 MS-level students, mentoring of returning clinicians in OB/GYN and infectious diseases, and training of local physicians in ultrasound. Areas of training include 1) use of anti-malarial drugs, 2) immunology of the placenta, with emphasis on flow cytometry, 3) co-infections between malaria and other diseases, 4) use of ultrasound for monitoring fetal development, and 5) vector biology.

This research is supported by grants to Dr. Diane Taylor from the National Institute of Allergy and Infectious Diseases (R01AI071160), the Fogarty International Center (D43TW009074), National Institutes of Health.