Doctor: Amanda Garrison

Title: Parasitic infections during pregnancy and their consequences on child development in Benin

Supervisor: Florence Bodeau-Livinec

Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité

Date of thesis defense: 24/09/2021

Jury: Marie-Aline Charles, Michael Ramharter, Jaqueline Wendland, Jean-François Faucher.

Thesis summary:

Soil-transmitted helminth and malaria infection impact up to 50% of pregnant women in Sub-Saharan Africa. However, its impacts on child neurocognitive and behavioral development remain widely unknown. This thesis studied the impacts of soil-transmitted helminth infection in pregnancy (SHIP) and Plasmodium falciparum malaria in pregnancy (MIP) on child development in a mother-child cohort from Benin. Pregnant women were enrolled in a clinical trial in their second trimester where SHIP was diagnosed using Kato-Katz and MIP was diagnosed by thick blood smear tests and quantitative polymerase chain reaction (qPCR). Offspring were assessed for development at one year using the Mullen Scales of Early Learning and at six years using the Kaufman Assessment Battery in Children 2nd Edition (KABC-II). Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. 122 (25%) women were infected with malaria at least once during pregnancy and 121 (31%) were infected with placental malaria at delivery. Higher SDQ internalizing scores were associated with helminth infection at the 2nd ANV/delivery [1.07 Confidence Interval (CI)(0.15, 2.00)] and at least once during pregnancy [0.79 CI(0.12, 1.46)]. Impaired gross motor scores at one year were associated with MIP at least once [-2.55 CI(-5.15, 0.05)], and placental malaria by qPCR [-4.95 CI (-7.65, -2.24)]. Malaria and high parasite density at the 2nd ANV were associated with lower KABC-II Non-Verbal Index scores [-2.57 CI(-4.86, -0.28)] and [-1.91 CI(-3.51, -0.32)], respectively. This thesis provides evidence of long-term neurocognitive consequences of parasitic infection in pregnancy in a prospective cohort.

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