Abstract

The daily increasing incidence of malaria and human immunodeficiency virus (HIV) co-infection and associated poor maternal and obstetrical outcomes among pregnant women in the malarious zone of Anambra east, southeast Nigeria, and the paucity of laboratory-based data on the deadly duo, necessitated this study on the prevalence of the co-infection in a case-cohort study of 450 women (15 to 45 years) from whom placental and peripheral blood samples were collected. Screening for HIV antibodies was by the DETERMINE and GENIE–II, confirmed at 95% confidence interval. Pregnancy screening was by human chorionic gonadotropin (HCG) one step pregnancy test strip. Placental malaria was determine by Pooled-biopsy; peripheral malaria, from maternal venous blood. Giemsa stain of thin and thick blood smears were assayed; results were confirmed by dipstick rapid test. Anaemia estimation was by packed cell volume. Population attributable fraction-associated co-infection was 62% (P-value, 0.019). Acute malaria (+++) was highest among dually infected multigravidas (53%) (P-value, 0.0672), and multiple infections highest in second trimester (mean parasite density, 3,471.1 ± 101.0 parasites/µl), with preponderance in the 25 to 29 age bracket (4,720.51 ± 110.3 parasites/µl). Gravidity-associated co-infection was prevalent among the multigravidas, with mean parasite density of 19,224.1 ± 136.0 parasites/µl. Placental malaria was a significant risk factor for mortality and morbidity (P < 0.01), and maternal anaemia which is the single most important adverse pregnancy outcome. Significance of abortion, pre-term delivery and low infant birth weights as serious adverse maternal outcomes were further established in the study.

Key words: Human immunodeficiency virus (HIV), placental malaria, gravidity-associated malaria, pregnancy outcomes.