Malarial Infection and Curable Sexually Transmitted and Reproductive Tract Infections Among Pregnant Women in a Rural District of Zambia

Abstract

Abstract. Malarial infection and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are important causes of adverse birth outcomes. Reducing the burden of these infections in pregnancy requires interventions that can be easily integrated into the antenatal care (ANC) package. However, efforts to integrate the control of malarial infection and curable STIs/RTIs in pregnancy have been hampered by a lack of evidence related to their coinfection. Thus, we investigated the prevalence of coinfection among pregnant women of rural Zambia. A prospective cohort study was conducted in Nchelenge District, Zambia, involving 1,086 first ANC attendees. We screened participants for peripheral malarial infection and curable STIs/RTIs (syphilis, Chlamydia, gonorrhea, trichomoniasis, and bacterial vaginosis), and collected relevant sociodemographic data at booking. Factors associated with malarial and STI/RTI coinfection were explored using univariate and multivariate regression models. Among participants with complete results (N = 1,071), 38.7% (95% confidence interval [CI] = 35.7-41.6) were coinfected with malaria parasites and at least one STI/RTI; 18.9% (95% CI = 16.5-21.2) were infected with malaria parasites only; 26.0% (95% CI = 23.5-28.8) were infected with at least one STI/RTI but no malaria parasites, and 16.4% (95% CI = 14.1-18.6) had no infection. Human immunodeficiency virus (HIV)-infected women had a higher risk of being coinfected than HIV-uninfected women (odds ratio [OR] = 3.59 [95% CI = 1.73-7.48], P < 0.001). The prevalence of malarial and STI/RTI coinfection was high in this population. An integrated approach to control malarial infection and STIs/RTIs is needed to reduce this dual burden in pregnancy.

Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study

“…The high prevalence of BV (37.3%; 95%CI 33.9-40.9) in this HIV uninfected pregnant population in South Africa is consistent with other sub-Saharan African pregnant populations (Zimbabwe 32.6%, Zambia 48.3%) [20,21] and other South African studies of nonpregnant women at risk for HIV acquisition [22][23][24]. Our study is the first large cohort study of 750 HIV uninfected pregnant women of all ages attending primary health care clinics in a high HIV burden subdistrict of KwaZulu-Natal.…”

Prevalence And Associated Risk Factors Of Bacterial Vaginosis Among Pregnant Women In Africa: A Systematic Review

“…The prevalence of BV among pregnant women in this region was the highest as cumulative, which gives 38.7% (Table 1), whereas individually, these studies were much lower than that of eastern and western studies. Of the four studies reported from this region, the highest prevalence of BV was reported from Zambia among the rst ANC attendees in Nchelenge District with a prevalence of 48.3% [31]. But, an across-sectional study conducted in South Africa among HIV positive and negative pregnant women shows a low prevalence of BV (17.7%) [32].…”

“…However, few studies from the eastern part of Africa also reported a very low prevalence of BV from studies reported especially from Uganda [9] and Ethiopia [25]. High prevalence of BV was reported not only from the eastern region but also from the western region (highest prevalence's from Nigeria (56.6% and 60%) [10,20] and Cameroon (45.8%) [29]) and southern regions of Africa with the highest prevalence reported from Zambia 48.3% [31].…”

“…In Ethiopia, a study conducted in Felegehiwot referral hospital, on Common causes of vaginal infections and antibiotic susceptibility of aerobic bacterial isolates in women of reproductive age(pregnant and nonpregnant), reported that BV was higher among non-pregnant women (11/195, 5.6%) than pregnant women(1/214, 0.5%) and signi cant association was seen in the age group of 40-49 years [25]. [29,37] Marital status 2 [21,29] Multiple LTSP 2 [20,26] Gestational age 1 [32] Residence 1 [25] Number of pregnancy 1 [30] History of abortion 2 [21,26] Preterm delivery 1 [14] Low birth weight 1 [14] premature rupture of membranes 1 [14] Previous BV/STI 3 [13,20,21] Douching 1 [13] Vaginal discharge 2 [29,30] Contraceptive use 1 [23] HIV 6 [11,17,27,32,36,38] [31] .…”

Devising a strategy for prevention of malaria in pregnant women in the Asia Pacific

“…11 Dihydroartemisininpiperaquine alone-as SST, IST, or IPT-is unlikely to provide similar dual-protection, although this might be inconsequential in Indonesia if co-infection is less common than in Africa. 12 However, pregnant women in Papua New Guinea probably shoulder a dual-burden of infection, 13,14 similar to their African counterparts. 15 Nonetheless, the evidence presented by Ahmed and colleagues is important and shows that IPT with dihydroartemisinin-piperaquine might help to shape a WHO strategy that protects pregnant women in the Asia-Pacific region against P falciparum and P vivax infections.…”