Prevalence of malaria and anaemia among HIV infected pregnant women receiving co-trimoxazole prophylaxis in Tanzania: a cross sectional study in Kinondoni Municipality.

Vicent P Manyanga,Billy Ngasala,Omary Minzi

doi:10.1186/2050-6511-15-24

Vicent P Manyanga, Billy Ngasala + Show 1 more

Open Access

https://doi.org/10.1186/2050-6511-15-24

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Abstract

BackgroundHIV-infected pregnant women are particularly more susceptible to the deleterious effects of malaria infection particularly anaemia. In order to prevent opportunistic infections and malaria, a policy of daily co-trimoxazole prophylaxis without the standard Suphadoxine-Pyrimethamine intermittent preventive treatment (SP-IPT) was introduced to all HIV infected pregnant women in the year 2011. However, there is limited information about the effectiveness of this policy.MethodsThis was a cross sectional study conducted among HIV-infected pregnant women receiving co-trimoxazole prophylaxis in eight public health facilities in Kinondoni Municipality from February to April 2013. Blood was tested for malaria infection and anaemia (haemoglobin <11 g/dl). Data were collected on the adherence to co-trimoxazole prophylaxis and other risk factors for malaria infection and anaemia. Pearson chi-square test, Fischer’s exact test and multivariate logistic regression were used in the statistical analysis.ResultsThis study enrolled 420 HIV infected pregnant women. The prevalence of malaria infection was 4.5%, while that of anaemia was 54%. The proportion of subjects with poor adherence to co-trimoxazole was 50.5%. As compared to HIV infected pregnant women with good adherence to co-trimoxazole prophylaxis, the poor adherents were more likely to have a malaria infection (Adjusted Odds Ratio, AOR = 6.81, 95% CI = 1.35-34.43, P = 0.02) or anaemia (AOR = 1.75, 95% CI = 1.03-2.98, P = 0.039). Other risk factors associated with anaemia were advanced WHO clinical stages, current malaria infection and history of episodes of malaria illness during the index pregnancy.ConclusionThe prevalence of malaria was low; however, a significant proportion of subjects had anaemia. Good adherence to co-trimoxazole prophylaxis was associated with reduction of both malaria infection and anaemia among HIV infected pregnant women.

Highlights

Human immunodeficiency virus (HIV)-infected pregnant women are more susceptible to the deleterious effects of malaria infection anaemia
Pregnant women with poor adherence to cotrimoxazole prophylaxis were 6.8 times more likely to have a malaria infection as compared to those with good adherence (AOR = 6.81, 95% 95% confidence interval (CI) =1.35-34.43 and P = 0.02)
This study has shown a low prevalence of malaria infection among HIV infected pregnant women using the daily co-trimoxazole prophylaxis; a significant proportion of subjects had anaemia

Summary

Introduction

HIV-infected pregnant women are more susceptible to the deleterious effects of malaria infection anaemia. There is limited information about the effectiveness of daily co-trimoxazole for preventing malaria and its deleterious effects anaemia among HIV infected pregnant women. This study was carried out in a malaria endemic area characterized by malaria transmission throughout the year [7] In this area, peripheral parasitaemia among pregnant women can be absent or below the detection limit of the microscopic method [8,9]. Peripheral parasitaemia among pregnant women can be absent or below the detection limit of the microscopic method [8,9] To overcome this challenge, we used selected malaria rapid diagnostic tests (MRDT) targeting antigens called histidine rich protein 2 (HRP-2). These antigens are released by red blood cells infected by the malaria parasites; they can be detected in the peripheral circulation even when the parasites are sequestered within the placenta [9,10]

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