Abstract
Geohelminthiasis and malaria coinfections in pregnancy are common in sub-Saharan Africa. The consequences of the disease combination on maternal health and birth outcomes are poorly understood. For a better understanding of this coinfection in expectant mothers, a cross-sectional study was carried out to evaluate the effect of the coinfection on maternal health and birth outcomes in expectant mothers in Bungoma County, Kenya. To collect data on malaria and maternal haematological parameters, blood samples were obtained from 750 participants aged 18-49 years and analyzed. Haemoglobin and eosinophils levels were determined by coulter counter while malaria parasitemia levels and red blood cell morphology were assessed by preparing and observing blood smears under the microscope. Fresh stool samples were collected and processed for identification and quantification of geohelminths species using Kato-Katz. Harada Mori technique was used to increase chances of detecting hookworms and Strongyloides infections. Neonate's health was evaluated based on the appearance, pulse, grimace, activity, and respiration (APGAR) scale. Parasites identified were Plasmodium falciparum, P. malariae, P. ovale, Ascaris lumbricoides, Necator americanus, Enterobius vermicularis, and Schistosoma mansoni. The prevalence of geohelminths, malaria parasites, and coinfection was 24.7%, 21.6%, and 6.8%, respectively. Those coinfected with geohelminths and malaria parasites were four times likely to have anaemia (OR 4.137; 95% CI 2.088-8.195; P=0.001) compared with those infected with geohelminths or malaria parasites alone (OR 0.505; 95% CI 0.360-0.709; P=0.001 and OR 0.274; 95%CI 0.187-0.402 P=0.001, respectively). The odds of having preterm deliveries (OR 6.896; 95% CI 1.755-27.101; P=0.006) and still births (OR 3.701; 95% CI 1.008-13.579 P< 0.048) were greater in those coinfected than in those infected with either geohelminths or malaria parasites. Geohelminths and malaria coinfections were prevalent among study participants; consequently the risk of maternal anaemia, preterm deliveries, and still births were high. Routine screening and prompt treatment during antenatal visits should be encouraged to mitigate the adverse consequences associated with the coinfections.
Highlights
Parasitic infections such as malaria and geohelminthiasis are life-threatening as well as the leading cause of mortality in developing countries in risky groups, such as children under five years and pregnant women [1]
Expectant mothers are more vulnerable to infections because, during pregnancy, there is a transient depression of cell-mediated immunity that allows foetal allograft retention which on the other hand interferes with resistance to various infectious diseases [2]
These results are in agreement with a study in Ghana which revealed that coinfection between geohelminthiasis and malaria substantially increased the risk of anaemia in pregnancy [11]
Summary
Parasitic infections such as malaria and geohelminthiasis are life-threatening as well as the leading cause of mortality in developing countries in risky groups, such as children under five years and pregnant women [1]. Immunological factors influence rates of coinfection because helminths modulate host immune responses both to themselves and to concurrent infections. That is why pregnant women, immunologically compromised, are highly susceptible to parasitic infections such as malaria and soiltransmitted helminthiasis [3]. A number of inconsistencies regarding the relationship between geohelminthiasis and malaria coinfection in pregnancy abound in literature. In a study undertaken in Nigeria, it was demonstrated that over 45% of Plasmodium-infected pregnant women harbored various geohelminths [6]. A contrary study finding indicated no association between geohelminths and malaria parasites in pregnancy [7]
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