Neonatal and congenital malaria (NCM): a case series in the Tigray region, northern Ethiopia

BACKROUND

Congenital malaria (CM) is the direct infection of a neonate with malaria parasites from their mother before or during birth. Neonatal malaria (NM) is acquired through mosquito bites after birth during the neonatal period. Both congenital and neonatal malaria (NCM) are potentially life-threatening conditions. There is limited recognition and experience with NCM in the Tigray region of Ethiopia. This case series aims to raise clinicians' awareness of NCM screening, treatment, and prevention, particularly in endemic areas.

METHODS

This case series was conducted in the neonatal intensive care unit of Miani General Hospital, Tigray region, northern Ethiopia, from January to May 2024. Neonates with persistent and/or high-grade fever and those with a delayed response to first-line antibiotics were selectively screened for malaria using thin and thick blood smears. Neonates with positive results for malaria species were included; others were excluded.

CASE PRESENTATIONS

Six cases are described: four congenital and two neonatal malaria cases. The neonates' ages at admission ranged from 1 to 16 days. All six neonates were presented by their caregivers with the primary complaint of fever. Blood smears revealed ring stages of Plasmodium falciparum in four neonates, Plasmodium vivax in one neonate, and a mixed infection of P. falciparum and P. vivax in another. All six neonates received antimalarial medication and first-line antibiotics. While five neonates recovered; one died.

CONCLUSION

Neonatal and congenital malaria should be considered in any newborn presenting with clinical features of neonatal sepsis from a malaria-endemic area. Therefore, routine malaria prevention strategies and screening tests should be implemented for neonates in malaria-endemic areas.