PREVALENCE AND PREDICTORS OF PLACENTAL MALARIA IN HIV-POSITIVE WOMEN IN ENUGU, SOUTH-EASTERN NIGERIA

Abstract

Background: Placental malaria is associated with certain adverse effects to both
mother and foetus/newborn. HIV-infected pregnant women have significant
alterations in both cellular and humoral immunity that increase their risks to placental
malaria infection.
Objective: To determine the prevalence and predictors of placental malaria amongst
HIV positive women.
Methodology: This was a prospective longitudinal study of two sample groups (A and
B) of eligible pregnant women recruited at booking at the antenatal clinic of the
University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Group A comprised
102 HIV positive women while group B (control group) consist of 102 HIV negative
women. Both groups slept under insecticide treated nets (ITNs) and received
intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) according
to the WHO protocol on malaria prevention in pregnancy. They were followed up till
delivery during which peripheral blood sample was collected from each participant at
presentation in labour for packed cell volume (PCV) estimation. Thick blood films
were made from the placental blood of each participant upon delivery to access for the
presence/degree of malaria parasite in the placenta. Statistical analysis was both
descriptive and inferential using the statistical package for social sciences (SPSS)
version 18.0 for windows. P value of < 0.05 was considered to be statistically
significant.
Results: The mean age of the participants was 26.2 ± 4.8 (range: 16 – 42). The overall
prevalence of placental malaria was 52.0%. The prevalence was significantly higher in
HIV positive women than in HIV negative women [68.6% (n = 70) vs. 35.3% (n =
36); χ2 = 22.70; P < 0.001]. Moderate and severe degrees of placental malaria were
significantly higher in HIV positive women than in HIV negative women (P < 0.05).
The overall mean packed cell volume (PCV) of the study participants, and the
prevalence of anaemia (PCV < 33%) were 32.1 ± 3.6, and 55.4% respectively. The
mean PCV of HIV positive women was significantly lower than that of the HIV
negative women [31.1 ± 3.6 vs. 33.2 ± 3.6; t = 4.08; P < 0.001] . The prevalence of
anaemia was significantly higher amongst HIV positive women than HIV negative
women [66.7% (n = 68) vs. 44.1% (n = 45); χ2 =9.60; p = 0.002] . Only the
employment status of the women was significantly associated with the development of
positive placental malaria in HIV positive women after adjusting for other variables in
the multi-variate logistic regression analysis (P = 0.04; OR = 0.38; 95% CI = 0.15
0.94).
Conclusion: The prevalence of placental malaria and maternal anaemia is very high
amongst HIV positive women in Enugu, Nigeria. Unemployment status is associated
with higher prevalence of placental malaria. Scaling up the employment opportunities
of HIV positive women may help reduce the prevalence of placental malaria in our
population.

PREVALENCE AND PREDICTORS OF PLACENTAL MALARIA IN HIV-POSITIVE WOMEN IN ENUGU, SOUTH-EASTERN NIGERIA