Risk Factors for Helminth, Malaria, and HIV Infection in Pregnancy in Entebbe, Uganda

Abstract

BackgroundInfections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.ObjectivesTo describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy.MethodsThe trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression.ResultsThere was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus) showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities.ConclusionsInterventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection.

Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

“…However, we did not collect data on other risk factors for inadequate GWG such as level of physical activity, anemia, number of antenatal visits, and previous poor pregnancy outcome for those pregnant for the second time which could occur in Uganda. In addition, this study did not take into account other infections, such as malaria and helminths, which are prevalent in Uganda and have been associated with inadequate GWG [31, 32] neither did we collect data on whether the women received counseling on optimal GWG.…”

Malaria and soil-transmitted intestinal helminth co-infection and its effect on anemia: a meta-analysis

“…Among pregnant women, the pooled analysis of seven studies 9,34,[37][38][39]40,45 showed a significant positive association between malaria and hookworms (summary OR 1.36; 95% CI: 1.17-1.59; I 2 : 0%). However, there was no significant association between malaria and A. lumbricoides, T. trichiura or any other STH ( Figure 2).…”

“…Of the 30 studies, 12 assessed all three species of STH (A. lumbricoides, T. trichiura and hookworm) [8][9][10]26,28,32,[37][38][39][40][41]44 one assessed two species (A. lumbricoides and hookworm) 48 and two assessed two species (A. lumbricoides and T. trichiura).…”

Maternal Helminth Infections

“…Infection during pregnancy therefore is frequent and prevalence rates are reported to vary from 10 to 70 % in endemic areas where co-infection with multiple worm species is not an uncommon event [1][2][3][4]. In general, poor maternal health as a result of insufficient nutrition or anemia in particular is a major contributor to increased maternal and infant mortality and low birth weight and it is as well an important public health problem in developing countries [5].…”