PREVALENCE, DETERMINANTS AND PATTERN OF PLACENTAL MALARIA IN HIV POSITIVE AND HIV NEGATIVE PARTURIENTS AT TERM AND NEONATAL OUTCOME

Abstract

BACKGROUND: The burden of malaria is severe in Africa, affecting mainly pregnant women
and their unborn children. This burden is worsened by co-infection with HIV, thus making the
Millennium Development Goal 6 (MDG 6) of combating HIV/AIDS, malaria and other diseases in
Africa to be off track. When combined malaria and HIV account for 9% of the total burden of
diseases in sub-Saharan Africa, and a total of over 4 million deaths globally, of which more than
80% occur in tropical Africa. A recent study in Nigeria also estimated that malaria and HIV
account for 27% of hospital based mortality. Despite these frightening statistics, studies on malaria
and HIV/AIDS are usually separate with minimal focus on pregnant women and their new born
child, both of whom happen to be the most severely affected by the two diseases. Although
placenta histology is regarded as the gold standard for diagnosis of malaria in pregnancy, only few
studies are available in the sub-region using this method. Moreover since the placenta is not
available until delivery there is need to determine which common method of malaria diagnosis has
the closest accuracy to that of placental histology.
OBJECTIVE: The main objective of this study was to determine the prevalence, determinants and
pattern of placental malaria in HIV positive and HIV negative parturients at term and the effect on
neonatal outcome.
METHODS/DESIGNS: This study was a comparative cross sectional study of 90 HIV positive
and 90 HIV negative parturients at term. At delivery whole blood was collected from both mother
and baby to determine malaria parasitaemia and PCV, while blood was also taken from the
placental sinusoid to determine malaria parasitaemia. Full thickness biopsies of the placenta were
also sent for histopathological analysis. A semi-structured researcher administered questionnaire
was also used to collect data from the participants and from the case notes. The birth weight of the
babies was also noted. The data obtained were processed and analyzed using Statistical Package for
Social Sciences, (SPSS) version 19.
RESULTS: The prevalence rate of placental malaria based on histological diagnosis was 11.1%
and 21.1% in HIV positive and HIV negative parturients at term respectively, while the prevalence
of congenital malaria was 0% and 15.6% respectively in their neonates. The determinants of
placental malaria in the total population were number of doses of IPT p-value 0.008 and history of
malaria treatment in pregnancy p-value < 0.001. The mean neonatal PCV was 44.8±1.9% in HIV
group compared with 51.4±5.8% in the HIV negative group p-value <0.001, while the mean birth
weight was also lower in the HIV positive group 3.0±0.4kg compared to 3.3±0.4kg p-value 0.005.
Congenital malaria was related to the mean dose of IPT in pregnancy and was not found in
neonates whose mothers had a mean dose 2.44 ±0.8 doses of IPT. Malaria microscopy in this study
was negative for malaria parasite in all samples while maternal blood RDT had a sensitivity of
37.9% and specificity of 99.3% when compared to placental histology. The sensitivity of placental
blood RDT was 89.7% with 100% specificity when compared with placental histology.
CONCLUSION: This study has shown that in an urban centre where the use of HAART and IPT
are consistent in HIV positive women, the prevalence of placental malaria and congenital malaria
is lower in HIV positive woman than HIV negative women. Usage of more than two doses of IPT
is also associated with reduced rate of placental malaria and congenital malaria. Use of three or
more doses of IPT is therefore recommended to reduce prevalence of placental malaria while
further studies are needed to completely understand the relationship between malaria and HIV in
asymptomatic HIV positive women on HAART.

PREVALENCE, DETERMINANTS AND PATTERN OF PLACENTAL MALARIA IN HIV POSITIVE AND HIV NEGATIVE PARTURIENTS AT TERM AND NEONATAL OUTCOME