Impact of antimalarial resistance and COVID-19 pandemic on malaria care among pregnant women in Northern Uganda (ERASE): protocol of a prospective observational study

Francesco Vladimiro Segala, Francesco Di Gennaro, Jerry Ictho, Mariangela L'Episcopia, Emmanuel Onapa, Claudia Marotta, Elda De Vita, James Amone, Valentina Iacobelli, Joseph Ogwang, Giovanni Dall'Oglio, Benedict Ngole, Rita Murri, Lameck Olal, Massimo Fantoni, Samuel Okori, Giovanni Putoto, Carlo Severini, Peter Lochoro, Annalisa Saracino, Francesco Vladimiro Segala, Francesco Di Gennaro, Jerry Ictho, Mariangela L'Episcopia, Emmanuel Onapa, Claudia Marotta, Elda De Vita, James Amone, Valentina Iacobelli, Joseph Ogwang, Giovanni Dall'Oglio, Benedict Ngole, Rita Murri, Lameck Olal, Massimo Fantoni, Samuel Okori, Giovanni Putoto, Carlo Severini, Peter Lochoro, Annalisa Saracino

Abstract

Background: Uganda accounts for 5% of all malaria cases and deaths reported globally and, in endemic countries, pregnancy is a risk factor for both acquisition of P. falciparum infection and development of severe malaria. In recent years, malaria control has been threatened by COVID-19 pandemic and by the emergence, in Northern Uganda, of both resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine.

Methods: In this facility-based, prospective, observational study, pregnant women will be recruited at antenatal-care visits and followed-up until delivery. Collected data will explore the incidence of asymptomatic parasitemia and malaria-related outcomes, as well as the attitudes towards malaria prevention, administration of intermittent preventive treatment, healthcare seeking behavior and use of insecticide-treated nets. A subpopulation of women diagnosed with malaria will be recruited and their blood samples will be analyzed for detection of genetic markers of resistance to artemisinin derivatives and sulfadoxine-pyrimethamine. Also, to investigate the impact of COVID-19 on malaria care among pregnant women, a retrospective, interrupted-time series will be conducted on at the study sites for the period January 2018 to December 2021.

Discussion: The present study will explore the impact of COVID-19 pandemic on incidence of malaria and malaria-related adverse outcomes, along with the prevalence of resistance to artemisinin derivatives and to sulfadoxine-pyrimethamine. To our knowledge, this is the first study aiming to explore the combined effect of these factors on a cohort of pregnant women.

Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26th April, 2022.

Clinicaltrials: gov Identifier: NCT05348746.

Keywords: Antimalarial resistance; Artemisinin derivatives; COVID-19; Malaria in pregnancy; Sulfadoxine-pyrimethamine.

Conflict of interest statement

The authors declare that they do not have any competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Conceptual framework showing the possible impact of COVID-19 and antimalarial resistance on malaria care among pregnant women. Dashed line (green): antimalarial resistance; Dotted line (blue): COVID-19; Continuous line (yellow): both COVID-19 and antimalarial resistance

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