Abstract
Background. Helminth and malaria coinfections are common in the tropics. We investigated the hypothesis that prenatal exposure to these parasites might influence susceptibility to malaria in childhood.Methods. In a birth cohort of 2345 mother–child pairs in Uganda, maternal helminth and malaria infection status was determined during pregnancy, and childhood malaria episodes were recorded from birth to age 5 years. We examined associations between maternal infections and malaria in the offspring.Results. Common maternal infections were hookworm (45%), Mansonella perstans (21%), Schistosoma mansoni (18%), and Plasmodium falciparum (11%). At age 5 years, 69% of the children were still under follow-up. The incidence of malaria was 34 episodes per 100 child-years, and the mean prevalence of asymptomatic malaria at annual visits was 5.4%. Maternal hookworm and M. perstans infections were associated with an increased rate of childhood clinical malaria (adjusted hazard ratio [aHR], 1.24, 95% confidence interval [CI], 1.10–1.41; aHR, 1.20, 95% CI, 1.05–1.38, respectively). S. mansoni infection had no consistent association with childhood malaria.Conclusions. This is the first report of an association between helminth infections in pregnancy and malaria in the offspring and indicates that helminth infections in pregnancy may increase the burden of childhood malaria morbidity.
Highlights
Helminth and malaria coinfections are common in the tropics
Maternal hookworm and M. perstans infections were associated with an increased rate of childhood clinical malaria
S. mansoni infection had no consistent association with childhood malaria
Summary
In a birth cohort of 2345 mother–child pairs in Uganda, maternal helminth and malaria infection status was determined during pregnancy, and childhood malaria episodes were recorded from birth to age 5 years. We examined associations between maternal infections and malaria in the offspring. The aim was to examine the association between maternal helminth and malaria infections in pregnancy and malaria in the offspring. Primary outcome was incidence of childhood clinical malaria from birth to age 5 years, and secondary outcome was prevalence of asymptomatic P. falciparum parasitemia as determined at annual visits to age 5 years. Childhood clinical malaria was defined as a history of recent fever or axillary temperature of ≥37.5°C and any parasitemia. Asymptomatic P. falciparum parasitemia was defined as a positive malaria slide in the absence of fever on the sampling day.
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