Malaria and hookworm infections in relation to haemoglobin and serum ferritin levels in pregnancy in Masindi district, western Uganda

ArticleinTransactions of the Royal Society of Tropical Medicine and Hygiene 102(2):130-6 · February 2008with17 Reads
DOI: 10.1016/j.trstmh.2007.09.015 · Source: PubMed
This study examined the predictors of haemoglobin (Hb) concentration and serum ferritin (SF) levels in pregnant women in an area of stable malaria transmission and high prevalence of intestinal helminth infections. In total, 834 women attending antenatal care for the first time were examined. Blood slides for malaria parasites were prepared for 802, of which 154 were primigravidae (PG) and 648 were multigravidae (MG). Malaria parasitaemia rate was 42.6% (66) in PG and 33.3% (216) in MG (P=0.04). The geometric mean parasite density was 1695.8 (95% CI 1005.0-2386.5) in PG and 922.7 (95% CI 626.7-1382.6) in MG (P=0.02). Anaemia (Hb<100g/l) was found in 18.0% (94) of aparasitaemic women compared to 28.5% (80) among parasitaemic women (P<0.001). The prevalence of anaemia was 15.1% (42) in women without hookworm infection compared to 23.3% (129) among infected women (P=0.006). Malaria parasitaemia, hookworm infection, C-reactive protein, gravidity and gestational age were associated with Hb status. Malaria parasitaemia, Ascaris lumbricodes and Trichuris trichiura infections and age were associated with SF. Malaria, hookworm infections and iron deficiency were associated with anaemia in the study population.
    • "This association is intensity-dependent with moderate to heavy infections required for anaemia212223. In SSA, anaemia attributable to hookworm has been shown to be 18% in preschool children [21] , 5%-25% in school-aged indi- viduals [22, 23], and 28% in pregnant women [24]. The associations of anaemia with S. mansoni and hookworm infections have been studied in the same population under two contexts: efficacy of anthelminthic treatment and polyparasitism . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The association of anaemia with intestinal schistosomiasis and hookworm infections are poorly explored in populations that are not limited to children or pregnant women. Methods: We sampled 1,832 individuals aged 5-90 years from 30 communities in Mayuge District, Uganda. Demographic, village, and parasitological data were collected. Infection risk factors were compared in ordinal logistic regressions. Anaemia and infection intensities were analyzed in multilevel models, and population attributable fractions were estimated. Findings: Household and village-level predictors of Schistosoma mansoni and hookworm were opposite in direction or significant for single infections. S. mansoni was found primarily in children, whereas hookworm was prevalent amongst the elderly. Anaemia was more prevalent in individuals with S. mansoni and increased by 2.86 fold (p-value<0.001) with heavy S. mansoni infection intensity. Individuals with heavy hookworm were 1.65 times (p-value = 0.008) more likely to have anaemia than uninfected participants. Amongst individuals with heavy S. mansoni infection intensity, 32.0% (p-value<0.001) of anaemia could be attributed to S. mansoni. For people with heavy hookworm infections, 23.7% (p-value = 0.002) of anaemia could be attributed to hookworm. A greater fraction of anaemia (24.9%, p-value = 0.002) was attributable to heavy hookworm infections in adults (excluding pregnant women) as opposed to heavy hookworm infections in school-aged children and pregnant women (20.2%, p-value = 0.001). Conclusion: Community-based surveys captured anaemia in children and adults affected by S. mansoni and hookworm infections. For areas endemic with schistosomiasis or hookworm infections, WHO guidelines should include adults for treatment in helminth control programmes.
    Full-text · Article · Oct 2015
    • "This reduction could be due to the fact that the changes to the ANC protocol initiated by the Ghana Health Service in 2005 were not fully implemented in 2006 as they were by 2011 when this study was conducted. The finding from this study partly corroborates that of another study conducted in Uganda that reported an association between malaria and helminths with adverse birth outcomes [8]. In this study, only helminths that cause blood loss were associated with adverse birth outcomes. "
    [Show abstract] [Hide abstract] ABSTRACT: Aim: In 2005, the Ghana Health Service mandated malaria and helminths chemoprophylaxis during antenatal care visits. The aim of this study was to investigate the prevalence of malaria and helminth infections and their relationship with adverse birth outcomes (low birth weight, stillbirth, and preterm) following the implementation of these treatments. Study Design: A quantitative cross-sectional study. Method: The study was conducted on 630 women presenting for delivery in the Komfo Anokye Teaching Hospital and the Manhyia District Hospital from July to November 2011. Socio-demographic information and medical and obstetric history were collected. Laboratory analyses for the presence of malaria and helminths were performed. Association of malaria and helminths with birth outcomes was assessed using logistic regression to obtain odds ratios (ORs) and 95% confidence intervals. Results: The prevalence of malaria, helminths and adverse birth outcomes was 9.0%, 5.0% and 22.2%, respectively. Compared with women who received malaria prophylaxis, women without malaria prophylaxis were two times more likely to have malaria infection (aOR = 2.1; 95% CI = 1.06-4.17). Women who were not screened for helminths were twice as likely to be infected with helminths (aOR = 2.4; 95% CI = 1.15-5.12) than women who were screened for helminths. For women infected with hookworm or Schistosoma mansoni, the odds of having an adverse birth outcome (aOR = 3.9; 95% CI = 1.09-14.20) and stillbirth (aOR = 7.7; 95% CI = 1.21-36.38) were greater than for women who were not infected. Conclusion: The prevalence of malaria, helminths and adverse birth outcomes was lower than previously reported 9.0% vs. 36.3, 5.0% vs. 25.7 and 22.2% vs. 44.6, respectively. Helminth but not malaria infection was found to be significantly associated with adverse birth outcomes.
    Full-text · Article · Mar 2014
    • "Included studies were from a broad range of geographic locations and published between 1970 and 2012. Studies were categorized as those assessing the association between iron supplementation and malaria risk in pregnancy33343536373839, iron deficiency and malaria risk in pregnancy [34,4041424344454647484950, iron biomarkers and malaria risk in pregnancy4041424346,47,505152535455565758596061, or iron treatment and malaria risk in pregnancy [62,63]. These included two randomized controlled trials [36,37] and one subgroup analysis [33] from the main trial [37], two prospective cohort studies [38,62], one before-after study [39] , one retrospective cohort study [63], six case-control studies []. "
    [Show abstract] [Hide abstract] ABSTRACT: Malaria prevention and iron supplementation are associated with improved maternal and infant outcomes. However, evidence from studies in children suggests iron may adversely modify the risk of malaria. We reviewed the evidence in pregnancy of the association between malaria and markers of iron status, iron supplementation or parenteral treatment. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Global Health Library, and the Malaria in Pregnancy library to identify studies that investigated the association between iron status, iron treatment or supplementation during pregnancy and malaria. Thirty one studies contributed to the analysis; 3 experimental and 28 observational studies. Iron supplementation was not associated with an increased risk of P. falciparum malaria during pregnancy or delivery in Africa (summary Relative Risk = 0.89, 95% Confidence Interval (CI) 0.66-1.20, I(2) = 78.8%, 5 studies). One study in Asia reported an increased risk of P. vivax within 30 days of iron supplementation (e.g. adjusted Hazard Ratio = 1.75, 95% CI 1.14-2.70 for 1-15 days), but not after 60 days. Iron deficiency (based on ferritin and C-reactive protein) was associated with lower odds for malaria infection (summary Odds Ratio = 0.35, 0.24-0.51, I(2) = 59.2%, 5 studies). With the exception of the acute phase protein ferritin, biomarkers of iron deficiency were generally not associated with malaria infection. Iron supplementation was associated with a temporal increase in P vivax, but not with an increased risk of P. falciparum; however, data are insufficient to rule out the potential for an increased risk of P. falciparum. Iron deficiency was associated with a decreased malaria risk in pregnancy only when measured with ferritin. Until there is more evidence, it is prudent to provide iron in combination with malaria prevention during pregnancy.
    Full-text · Article · Feb 2014
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