Maternal health and Rhodesiense human African trypanosomiasis: Case series from Malawi

This study aimed to explore maternal and fetal outcomes associated with rhodesiense Human African Trypanosomiasis (rHAT) during pregnancy in Rumphi and Nkhotakota districts, Malawi. A retrospective review of medical records was conducted, complemented by interviews with affected individuals. Data sources included surveillance reports, maternal health files, and inpatient notes.

Out of 409 records reviewed, three pregnancy-associated rHAT cases were identified. The first involved a 27-year-old woman in her fourth pregnancy who developed progressive symptoms at six months’ gestation. She was initially misdiagnosed and delivered a stillborn baby; rHAT was diagnosed a day later. The second case was a 24-year-old woman in her third pregnancy, diagnosed at eight weeks’ gestation after presenting with fever and body aches. She delivered a live baby who later experienced recurrent illnesses and poor growth in early childhood. The third case was a 20-year-old first-time mother who presented in the third trimester with vomiting, weakness, frequent urination, and anemia. She received fexinidazole treatment and delivered a live baby who experienced recurrent illness during infancy.

The findings indicate that rHAT during pregnancy poses serious risks, including stillbirth and adverse early childhood health. Diagnostic delays, non-specific symptoms, and poor clinical documentation reveal gaps in healthcare access and surveillance for vulnerable populations. Strengthening antenatal screening, improving data management, and expanding access to diagnostics for pregnant women are essential to protecting maternal and child health in rHAT-endemic regions.