Effect of Malaria and Geohelminth Infection on Birth Outcomes in Kumasi, Ghana

Ntui N Asundep, Pauline E Jolly, April P Carson, Cornelius A Turpin, Kui Zhang, Nana O Wilson, Jonathan K Stiles, Berhanu Tameru, Ntui N Asundep, Pauline E Jolly, April P Carson, Cornelius A Turpin, Kui Zhang, Nana O Wilson, Jonathan K Stiles, Berhanu Tameru

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.

Keywords: Geohelminths; Kumasi; malaria; pregnancy outcomes.

Conflict of interest statement

Competing Interests: Authors have declared that no competing interests exist.

References

    1. Egwunyenga AO, Ajayi JA, Nmorsi OP, Duhlinska-Popova DD. Plasmodium/intestinal helminth co-infections among pregnant Nigerian women. Mem Inst Oswaldo Cruz. 2001;96:1055–1059.
    1. Achidi EA, Kuoh AJ, Minang JT, Ngum B, Achimbom BM, Motaze SC, et al. Malaria infection in pregnancy and its effects on haemoglobin levels in women from a malaria endemic area of Fako Division, South West Province, Cameroon. J Obstet Gynaecol. 2005;25:235–240.
    1. Steketee RW. Pregnancy, nutrition and parasitic diseases. J Nutr. 2003;133(5Suppl 2):1661S–1667S.
    1. Dreyfuss ML, Stoltzfus RJ, Shrestha JB, Pradhan EK, LeClerq SC, Khatry SK, et al. Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal. J Nutr. 2000;130(10):2527–2536.
    1. Ronald LA, Kenny SL, Klinkenberg E, Akoto AO, Boakye I, Barnish G, et al. Malaria and anaemia among children in two communities of Kumasi, Ghana: a cross-sectional survey. Malar J. 2006;5:105.
    1. Yatich NJ, Funkhouser E, Ehiri JE, Agbenyega T, Stiles JK, Rayner JC, et al. Malaria, intestinal helminths and other risk factors for stillbirth in Ghana. Infect Dis Obstet Gynecol. 2010:350763.
    1. Tako EA, Zhou A, Lohoue J, Leke R, Taylor DW, Leke RF. Risk factors for placental malaria and its effect on pregnancy outcome in Yaounde, Cameroon. Am J Trop Med Hyg. 2005;72:236–242.
    1. Ndyomugyenyi R, Kabatereine N, Olsen A, Magnussen P. Malaria and hookworm infections in relation to haemoglobin and serum ferritin levels in pregnancy in Masindi district, western Uganda. Trans R Soc Trop Med Hyg. 2008;102:130–136.
    1. Bethony J, Brooker S, Albonico M, Geiger SM, Loukas A, Diemert D, et al. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet. 2006;367(9521):1521–1532.
    1. Nurdia DS, Sumarni S, Suyoko, Hakim M, Winkvist A. Impact of intestinal helminth infection on anemia and iron status during pregnancy: a community based study in Indonesia. Southeast Asian J Trop Med Public Health. 2001;32(1):14–22.
    1. Le Hesran JY, Akiana J, Ndiaye el HM, Dia M, Senghor P, Konate L. Severe malaria attack is associated with high prevalence of Ascaris lumbricoides infection among children in rural Senegal. Trans R Soc Trop Med Hyg. 2004;98:397–399.
    1. Shapiro AE, Tukahebwa EM, Kasten J, Clarke SE, Magnussen P, Olsen A, et al. Epidemiology of helminth infections and their relationship to clinical malaria in southwest Uganda. Trans R Soc Trop Med Hyg. 2005;99:18–24.
    1. Wilson NO, Bythwood T, Solomon W, Jolly P, Yatich N, Jiang Y, et al. Elevated levels of IL-10 and G-CSF associated with asymptomatic malaria in pregnant women. Infect Dis Obstet Gynecol. 2010
    1. Jones CY, Tang AM, Forrester JE, Huang J, Hendricks KM, Knox TA, et al. Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living cohort. Journal of acquired immune deficiency syndromes. 2006;43(4):475–482.
    1. Mitchell NJ, Kumi J, Johnson NM, Dotse E, Marroquin-Cardona A, Wang JS, et al. Reduction in the urinary aflatoxin M1 biomarker as an early indicator of the efficacy of dietary interventions to reduce exposure to aflatoxins. Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals. 2013;18(5):391–398.
    1. Programme GM, editor. WHO. Intermittent preventive treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) 2012. pp. 1–2.
    1. Ghana Ministry of Health, editor. Ghana Health Service. Malaria in Pregnancy: Training manual for health providers. 2005. pp. 1–92.
    1. Yatich NJ, Jolly PE, Funkhouser E, Agbenyega T, Rayner JC, Ehiri JE, et al. The effect of malaria and intestinal helminth coinfection on birth outcomes in Kumasi, Ghana. Am J Trop Med Hyg. 2010;82(1):28–34.
    1. Ghana Health Service. Ghana Demographic and Health Survey. Calverton Maryland, USA: Measure DHS Macro International Inc; 2008. pp. 1–41.
    1. Asundep NN, Jolly PE, Carson A, Turpin CA, Zhang K, Tameru B. Antenatal Care Attendance, a Surrogate for Pregnancy Outcome? The Case of Kumasi, Ghana. Matern Child Health J. 2013
    1. World Health Organization W. Bench aids for the diagnosis of intestinal parasites. Geneva: WHO; 1994.
    1. WHO. Basic Laboratory Methods in Medical Parasitology. Geneva: 1991.
    1. Noedl H, Yingyuen K, Laoboonchai A, Fukuda M, Sirichaisinthop J, Miller RS. Sensitivity and specificity of an antigen detection ELISA for malaria diagnosis. Am J Trop Med Hyg. 2006;75(6):1205–1208.
    1. WHO. Vitamin and Mineral NutritionInformation System. Geneva: World Health Organization; 2011. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity; pp. 1–6. vol. WHO/NMH/NHD/MNM/11.1.
    1. Stokes ME, Davis CS, Koch GG. Categorical Data Analysis using The SAS System. 2nd. Cary,NC: SAS Institute and Wiley; 2003.
    1. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–936.
    1. Brooker S, Hotez PJ, Bundy DA. Hookworm-related anaemia among pregnant women: a systematic review. PLoS Negl Trop Dis. 2008;2(9):e291.
    1. Ouedraogo S, Koura G, Accrombessi MM, Bodeau-Livinec F, Massougbodji A, Cot M. Maternal Anemia at First Antenatal Visit: Prevalence and Risk Factors in a Malaria-Endemic Area in Benin. Am J Trop Med Hyg. 2012
    1. Tolentino K, Friedman JF. An update on anemia in less developed countries. Am J Trop Med Hyg. 2007;77(1):44–51.
    1. Shuaib FMB, Jolly PE, Ehiri JE, Jiang Y, Ellis WO, Stiles JK, et al. Association between Anemia and Aflatoxin B-1 Biomarker Levels among Pregnant Women in Kumasi, Ghana. American Journal of Tropical Medicine and Hygiene. 2010;83(5):1077–1083.
    1. Gyorkos TW, Larocque R, Casapia M, Gotuzzo E. Lack of risk of adverse birth outcomes after deworming in pregnant women. Pediatr Infect Dis J. 2006;25:791–794.
    1. WHO Techincal Report Series. Geneva: WHO; 2002. Prevention and control of Schistosomiasis and Soil-transmitted helminthiasis: Report of a WHO Expert Committee; pp. 1–57.
    1. Basra A, Mombo-Ngoma G, Melser MC, Diop DA, Wurbel H, Mackanga JR, et al. Efficacy of mefloquine intermittent preventive treatment in pregnancy against Schistosoma haematobium infection in Gabon: a nested randomized controlled assessor-blinded clinical trial. Clin Infect Dis. 2013;56(6):e68–75.

Source: PubMed

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