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.
Highlights
One third of the world’s population is infected with helminths and, in recent years, helminth control has been the focus of renewed interest on account of the concomitant direct disease burden [1,2]
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
Risk factors for helminth infection depend on the route of transmission and lifecycle of the helminth, but are usually related to hygiene, sanitation and, for some species, environmental conditions required for the intermediate hosts or for a free-living soil-dwelling stage
Summary
One third of the world’s population is infected with helminths and, in recent years, helminth control has been the focus of renewed interest on account of the concomitant direct disease burden [1,2]. Risk factors for helminth infection depend on the route of transmission and lifecycle of the helminth, but are usually related to hygiene, sanitation and, for some species, environmental conditions required for the intermediate hosts or for a free-living soil-dwelling stage. The degree to which immunity may be developed to helminths depends very much on the species, leading to varied age distributions, but long-term chronic infection over several years has been observed for many species [4]. The varied environmental conditions required lead to varied geographic distributions of helminths both within and between countries and regions, and influenced by climate factors and proximity to water bodies [4,5]. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes
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