Malaria and Intestinal Helminth Co-infection Among Pregnant Women in Ghana

Problem or question: In pregnant females in Ghana, the research demonstrates comparatively elevated levels of malaria, intestinal helminths, and co-infection. In a sample of over 700 pregnant females in Ghana, the research also evaluated the prevalence of malaria and intestinal helminth co-infection and recognized risk factors for co-infection. The research results show an incidence of malaria infection, intestinal helminth infection(s), and co-infection of 36.3%, 25.7%, and 16.6%, respectively.

Methodology used

Study site and population. The study was conducted in Kumasi, the capital of the Ashanti region of Ghana. The Ashanti region has a strong perennial malaria transmission, with the major parasite being P. falciparum.

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Ethical considerations. Prior to its application, the research protocol was endorsed by the Birmingham University's Institutional Review Board and the Human Research, Publications and Ethics Committee, Medical Science School, and Kwame Nkrumah University of Science and Technology, Kumasi.

Data collection. This was a cross-sectional study of women presenting for delivery at two hospitals in Kumasi, the Komfo Anokye Teaching Hospital (KATH) and the Manhyia Polyclinic. All women who had a singleton, uncomplicated pregnancy was invited to participate. Women were also identified from their admission records.

A qualified interviewer administered a questionnaire after obtaining informed permission. The questionnaire included data on population features (age, education, socio-economic status, residence and toilet facilities), obstetric history of present and past pregnancies (breastfeeding, ectopic pregnancy, premature delivery and LBW), diseases and treatments during present pregnancies.

Questionnaire content was obtained from a Roll Back Malaria Monitoring and Evaluation Reference group model questionnaire (malaria indicator study, women's questionnaire). Obstetric data from antenatal care (ANC) charts for women was acquired. ANC graphs given data on pregnancy at first ANC visits, number of visits to antenatal care, gestational age.

Tetanus immunization, malaria prophylaxis, anthelmintic medication, diseases and pregnancy therapy as evaluated by palpation or ultrasound at first ANC visit. Venipuncture has gathered a single blood sample in EDTA to determine malaria antigen. To determine intestinal helminths, stool samples were collected.

Laboratory procedures: The Malaria Antigen Celisa assay (Cellabs, Brookvale, Australia) was used to determine plasma malaria antigen. Malaria Antigen Celisa is a P. falciparum malaria-specific monoclonal antibody-based assay. The assay detects a merozoite antigen that circulates in the blood for up to 14 days after infection and detects P. falciparum infection with parasitemia as low as 0.001 percent, with ~98 percent awareness and more than 96 percent specificity.

Hookworms, Ascaris lumbricoides and Trichuris trichiura were determined using the thick smear technique of Kato-Katz (WHO 1991), while Strongyloides stercoralis samples were processed using the Baermann method. Within 12 hours of collection, stool samples were processed and microscopically examined within 1 hour of preparing to prevent missing hookworm ova.

Statistical Technique

Analysis of data was carried out using version 9.1 of SAS software (SAS Institute, Cary, NC). Differences in socio-demographic and obstetric features were evaluated using single and co-infection status tests. Since either there were no variations or very minimal distinctions between females with a single disease (only malaria or helminth) and females without infection, all of the analyzes outlined below relate to co-infection compared to no infection.

In order to recognize prospective multicollinearity between independent variables, correlation analyzes were conducted. We used various logistical regression to determine risk factors for co-infection. Variables that were statistically important on bivariate analysis at P 0.05 and those known to be associated with malaria and helminth infections based on prior research have been entered into the models using the step-by-step method.

Separate models have been run for primigravid and multigravid females, as factors such as the interval of pregnancy apply only to one group. For each variable entered in the model, we calculated odds ratios (ORs) and 95% confidence intervals (CIs). The research was eligible for a total of 785 females, and all agreed. P. falciparum Celisa and intestinal helminth outcomes were achieved for 746 (95.0 percent), however, and analyzes were performed on these 746 females.

Conclusion

Overall, women's average age was 26.8 years (range: 15–48 years); 22.1% had no formal schooling, and 23.6% had less than 100,000 Ghanaian cedis per week. Overall P. falciparum incidence was 36.3 percent (N= 271) of 746 females, only 19.7 percent (N= 147) tested positive for P. falciparum, only 9.1 percent (N= 68) tested positive for helminths, and only 16.6 percent (N= 124) tested positive for helminths.

Women with any intestinal helminth disease were nearly five times as probable as females with no worm infection to be infected with P. falciparum (OR= 4.8, 95 percent CI= 3.4–40). Also, females infected with A. lumbricoides and hookworms were as probable as uninfected females to be infected with P. falciparum.

Young age was considerably associated with either malaria or intestinal helminth infections during childbirth (20 years) and low earning Young age was heavily correlated with enhanced danger of co-infection during childbirth (OR= 6.2). There was also an enhanced danger of co-infection among single females and primigravid females.

Young age during pregnancy, low earnings and single age were each correlated with enhanced likelihood of co-infection among both primi- and multigravid females, but the power of the associations differed significantly between the two groups. Primigravid females had an enhanced malaria danger of 60% (OR= 1.6, 95% CI= 1.1–2.7).

References

• Yatich, N., Rayner, J., Turpin, A., Jolly, P., Ellis, W., Stiles, J., Agbenyega, T., Ehiri, J., Funkhouser, E., Williams, J. and Yi, J. (2009).
• Malaria and Intestinal Helminth Co-infection Among Pregnant Women in Ghana: Prevalence and Risk Factors. The American Journal of Tropical Medicine and Hygiene, 80(6), pp.896-901.

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