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Associations between Peripheral Plasmodium falciparum Malaria Parasitemia, Human Immunodeficiency Virus, and Concurrent Helminthic Infection among Pregnant Women in Malawi

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  • Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Malawi Ministry of Health and Population, Lilongwe, Malawi

Approximately 2 billion persons worldwide are infected with schistosomiasis and soil-transmitted helminthes (STH), many in areas where endemic malaria transmission coexists. Few data exist on associations between these infections. Nested within a larger clinical trial, primigravid and secundigravid women provided blood samples for human immunodeficiency virus (HIV) testing and peripheral malaria films and stool and urine for evaluation of STH and Schistosoma spp. during their initial antenatal clinic visit. The most common parasitic infections were malaria (37.6%), S. haematobium (32.3%), and hookworm (14.4%); 14.2% of women were HIV-infected. S. haematobium infection was associated with lower malarial parasite densities (344 versus 557 parasites/μL blood; P < 0.05). In multivariate analysis, HIV and hookworm infection were independently associated with malaria infection (adjusted odds ratio = 1.9 and 95% confidence interval = 1.2–3.0 for HIV; adjusted odds ratio = 1.9 and 95% confidence interval = 1.03–3.5 for hookworm). Concurrent helminthic infection had both positive and negative effects on malaria parasitemia among pregnant women in Malawi.

Author Notes

*Address correspondence to Michael C. Thigpen, 3150 Rampart Road, Fort Collins, CO 80521. E-mail: mthigpen@cdc.gov

Authors' addresses: Michael C. Thigpen, Division of Vector Borne Infectious Disease, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, E-mail: mthigpen@cdc.gov. Scott J. Filler, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: SFiller@cdc.gov. Peter N. Kzaembe, Baylor College of Medicine Children's Foundation, Malawi, Lilongwe, E-mail: pnkazembe@malawi.net. Monica E. Parise, Division of Parasitic Diseases and Malaria, Center for Global Health, Center for Disease Control and Prevention, Atlanta, GA, E-mail: mparise@cdc.gov. Allan Macheso, UNICEF Malawi, Lilongwe 3, Malawi E-mail: amacheso@unicef.org. Carl H. Campbell, Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), Center for Tropical and Emerging Global Diseases (CTEGD), The University of Georgia, Athens, GA, E-mail: ccamp@uga.edu. Robert D. Newman, Global Malaria Programme, World Health Organization, Geneva, E-mail: newmanr@who.int. Richard W. Steketee, Malaria Control and Evaluation Partnership in Africa (MACEPA), PATH, Seattle, WA, E-mail: rsteketee@path.org. Mary Hamel, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: mlh8@cdc.gov.

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