Investigating the pathways to adverse pregnancy outcomes among women infected with malaria infection and/or sexually transmitted/reproductive tract -

- in infections during pregnancy in Sub-Saharan Africa. (title cont)

Malaria and sexually transmitted infections/reproductive tract infections (STI/RTI) during pregnancy increase risk of adverse birth outcomes including; stillbirth, small for gestational age, and low birth weight. Prevalence of these infections among women attending antenatal care (ANC) in sub-Saharan Africa is unacceptably high with many women co-infected with a combination of these curable infections. Recent evidence from Zambia shows that at their first antenatal care appointment, 37.0% of women had malaria and a curable STI/RTI co-infection, 25.4% had STIs/RTIs only, 19.5% had malaria only, and 18.1% had no known infection.

For the management of malaria in pregnancy (MiP), World Health Organisation (WHO) recommends intermittent preventative treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) administered at ANC visits. Syphilis screening and treatment is recommended for pregnant women at their first ANC visit. For other curable STI/RTIs, WHO suggests using syndrome-based algorithms to guide diagnosis and treatment, however, the vast majority of infections in women are asymptomatic and therefore not diagnosed or treated.

As overall malaria has been brought under control and prevalence has decreased, the importance of STI/RTI during pregnancy has increased in relative terms. The occurrence and importance of co-infections combined with the threat of parasite resistance to SP provides the impetus for research to investigate alternative drugs and strategies which not only treat and prevent MiP effectively, but also address STI/RTI co-infections. An important step in the path towards tailoring integrated interventions is an understanding of the global distribution and occurance of MiP and curable STI/RTIs, seperatly and in combination as well as intergrated prevention and control stratergies.

This PhD will apply quantitative skills including statistics, data analytics and informatics, and mathematical modelling, to data from a variety of sources; clinical trial data, including an ongoing clinical trial of interventions for malaria in pregnancy and STI/RTI in Zambia, ASPIRE trial (Aim for Safe Pregnancy by reducing common Infections), demographic health data, and survey data). Gaps in current research shall be addressed including; providing estimates of the current global burden of malaria in pregnancy (the last estimates were for 2010), estimates of the prevalence of co-infection with malaria and a curable STI/RTI in pregnancy, investigating the reliability of using rapid diagnostic tests (RDTs) at antenatal care in Zambia for two of the most common curable STI/RTIs, and providing recommendations for the diagnosis of malaria and curable STI/RTI infections among pregnant women attending antenatal care.