The Effect of Malaria and Intestinal Helminth Coinfection on Birth Outcomes in Kumasi, Ghana

Nelly J. Yatich Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Pauline E. Jolly Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Ellen Funkhouser Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Tsiri Agbenyega Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Julian C. Rayner Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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John E. Ehiri Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Archer Turpin Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Jonathan K. Stiles Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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William O. Ellis Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Yi Jiang Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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Jonathan H. Williams Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama; Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia; Department of Biochemistry/Pro-Vice Chancellor, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Agriculture and Environmental Sciences, University of Georgia, Griffin, Georgia

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This study was conducted to investigate the effect of Plasmodium falciparum and intestinal helminth coinfection on maternal anemia and birth outcomes. A cross-sectional study of 746 women who delivered in two hospitals in Kumasi was conducted. Data were collected using an investigator-administered questionnaire and from patients' medical records. Blood was collected for determination of P. falciparum and hemoglobin levels. Adverse pregnancy outcomes were high (44.6%). Coinfection (versus no infection) was associated with 3-fold increase in low birth weight. For women with anemia, coinfection was 2.6 times and 3.5 times as likely to result in preterm deliveries and small for gestational age infants. The odds of having anemia was increased almost 3-fold by coinfection. Coinfection (versus helminth only) resulted in increased risks of anemia, low birth weight, and small for gestational age infants. This study demonstrates that women with malaria and intestinal helminth coinfection are at particular risk of adverse birth outcomes.

Author Notes

*Address correspondence to Pauline E. Jolly, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, RPHB 217, Birmingham, AL 35294. E-mail: jollyp@uab.edu

Financial support: This research was supported by United States Agency for International Development grant LAG-G-00-96-90013-00 for the Peanut Collaborative Support Research Program and the University of Alabama at Birmingham Framework Program for Global Health, grant R25TW007501, Fogarty International Center, National Institutes of Health.

Authors' addresses: Nelly J. Yatich, Pauline E. Jolly, and Yi Jiang, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, E-mails: yatich@uab.edu, jollyp@uab.edu, and yjiang@ms.soph.uab.edu. Ellen Funkhouser, Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, E-mail: emfunk@uab.edu. Tsiri Agbenyega, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Kumasi, Ghana, E-mail: tsiri@ghana.com. Julian C. Rayner, Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, E-mail: jrayner@uab.edu. John E. Ehiri, Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, E-mail: jehiri@email.arizona.edu. Archer Turpin, Komfo Anokye Teaching Hospital, Kumasi, Ghana, E-mail: Tsiri@ghana.com. Jonathan K. Stiles, Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA, E-mail: jstiles@msm.edu. William O. Ellis, Department of Biochemistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Kumasi, Ghana, E-mail:elliswo@yahoo.com. Jonathan H. Williams, College of Agricultural and Environmental Sciences, University of Georgia, Griffin, GA, E-mail: twillia@griffin.uga.edu.

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