Abstract

This study explored maternal and fetal outcomes associated with Rhodesiense Human African Trypanosomiasis (rHAT) during pregnancy in Rumphi and Nkhotakota districts, Malawi. A retrospective review of 409 medical records was conducted, complemented by interviews with affected individuals. Data sources included surveillance reports, maternal health files, and inpatient notes.

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 confirmed a day after the delivery. The second case was a 24-year-old woman in her third
pregnancy, diagnosed with rHAT at eight weeks after presenting with fever and body aches. She later delivered a live baby who experienced recurrent illnesses and poor growth in early childhood. The third case involved a 20-year-old first-time mother who presented during the third trimester with vomiting, weakness, frequent urination, and anemia. She received Fexinidazole treatment and delivered a live baby who experienced recurrent illness in early infancy.

These cases illustrate the serious risks posed by rHAT during pregnancy, including stillbirth and adverse early childhood health outcomes. Delayed diagnosis, non-specific symptom presentation, and inadequate clinical documentation highlight critical gaps in healthcare access and surveillance for vulnerable populations. The findings underscore the need to strengthen antenatal screening programs, improve health data management, and expand access to diagnostics to better protect maternal and child health in rHAT-endemic regions.