Abstract
Background Coinfections are becoming common risk factors that may contribute to the increased burden of morbidity in pregnancy. The aim of this study was to assess the seroprevalence of coinfections of malaria, hepatitis B (HBV), human immunodeficiency virus (HIV), and syphilis among pregnant women attending antenatal clinics (ANC) in the Tamale Metropolis. Methods By means of rapid diagnostic tests (RDTs), pregnant women attending the Tamale Teaching Hospital (TTH) were screened for malaria, HBV infection, HIV infection, and syphilis from March 2013 to February 2015. Haemoglobin (Hb) values, sickling, and glucose-6-phosphate dehydrogenase deficiency (G6PDd) statuses were also assessed using full blood count (FBC), sodium metabisulphite, and methaemoglobin reduction tests, respectively. Logistic regression analysis was performed to estimate the risks/odds ratios (ORs) for the coinfections and other variables (age, gravidity, and time of the first ANC visit) with 95% confidence intervals (CIs) and set p values for accepting any differences at <0.05. Results Within the two-year study period, data were collected from 3,127 pregnant women. The mean age (SD) of the pregnant women was 28.5 (±5.0) years. Of the total number, seroprevalence was high for malaria (11.6%) and HBV infection (4.2%) and low for HIV infection (1.0%) and syphilis (0.4%) monoinfections. Mal/HBV coinfection was higher (0.7%) when compared with Mal/HIV (0.1%), Mal/syphilis (0.0%), HBV/HIV (0.0%), HBV/syphilis (0.1%), and HIV/syphilis (0.0%) coinfections. The mean Hb (g/dl) for the women with the four monoinfections was significantly different from one another (p=0.009). Pregnant women with malaria infection were about 2 times more likely to be coinfected with HBV even after adjusting for potential confounders (adjusted odds ratio (AOR) = 1.66, 95% CI = 1.04–2.65, p=0.031). Those in their third trimester and visiting the ANC for the first time were significantly less likely to be infected with HBV (AOR = 0.45, 95% CI = 0.28–0.73, p=0.001), with malaria/HBV coinfection (AOR = 0.09, 95% CI = 0.01–0.68, p=0.020), and with any coinfection (AOR = 0.19, 95% CI = 0.06–0.63, p=0.007). Conclusion A comparatively high seroprevalence of malaria and its coinfection with HBV in pregnant women was observed in this study. Considering the effects that both malaria and HBV have on the liver, it would be expedient to conduct further studies to assess liver function among malaria/HBV-infected individuals, while interventions to prevent coinfections among pregnant women are intensified.
Highlights
Coinfections are becoming common risk factors that may contribute to the increased burden of morbidity in pregnancy. e aim of this study was to assess the seroprevalence of coinfections of malaria, hepatitis B (HBV), human immunodeficiency virus (HIV), and syphilis among pregnant women attending antenatal clinics (ANC) in the Tamale Metropolis
Individuals coinfected with Plasmodium sp. and Hepatitis B virus HBsAg (HBV) present with lower parasitaemia and higher viremia [16]. is is because malaria infection is associated with strong Cluster of differentiation 4 glucose-6-phosphate dehydrogenase deficiency (G6PDd) (CD4)+ cell activation and upregulation of proinflammatory cytokines, which provides an ideal microenvironment for the spread of the HIV-1 among the CD4+ cells and for rapid viral replication [17]
With respect to haematological characteristics, the mean Hb was 11.0 ± 1.4 g/dL, whilst 182 (5.8%) and 191 (6.1%) of the pregnant women had sickle cell trait and glucose-6phosphate dehydrogenase (G6PD) deficiency, respectively. e most prevalent infection was malaria (362, 11.6%), followed by HBV (132, 4.2%). irty-one (31, 1.0%) of them were found to be infected with HIV, while 13 (0.4%) had syphilis infection
Summary
Coinfections are becoming common risk factors that may contribute to the increased burden of morbidity in pregnancy. e aim of this study was to assess the seroprevalence of coinfections of malaria, hepatitis B (HBV), human immunodeficiency virus (HIV), and syphilis among pregnant women attending antenatal clinics (ANC) in the Tamale Metropolis. While monoinfections have shown to be significant risk factors for poor pregnancy outcomes (e.g., low birth weight, anaemia, early foetal loss, stillbirth, and prematurity) among pregnant women [1, 2], studies that evaluated the impact of coinfections on the health of pregnant women [3,4,5] have come out with some relevant findings, albeit limited by relatively smaller sample sizes Most of these studies have focused on soil-transmitted helminth (STH) and malaria [4, 6], TB [5], and human immunodeficiency virus (HIV) [7]. Malaria/HIV coinfection has been shown to have the following effects: low Hb [18,19,20], low CD4 count in the first trimester [21], and low birth weight, fever, and urinary tract infection [20] among others
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