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Malarial Infection and Curable Sexually Transmitted and Reproductive Tract Infections Among Pregnant Women in a Rural District of Zambia

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  • 1 Department of Biological Sciences, University of Zambia, Lusaka, Zambia.
  • | 2 Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • | 3 Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia.
  • | 4 Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia.
  • | 5 Faculty of Health Sciences, Africa University, Mutare, Zimbabwe.
  • | 6 Department of Medical Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
  • | 7 Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia.
  • | 8 Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia.
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Malarial infection and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are important causes of adverse birth outcomes. Reducing the burden of these infections in pregnancy requires interventions that can be easily integrated into the antenatal care (ANC) package. However, efforts to integrate the control of malarial infection and curable STIs/RTIs in pregnancy have been hampered by a lack of evidence related to their coinfection. Thus, we investigated the prevalence of coinfection among pregnant women of rural Zambia. A prospective cohort study was conducted in Nchelenge District, Zambia, involving 1,086 first ANC attendees. We screened participants for peripheral malarial infection and curable STIs/RTIs (syphilis, Chlamydia, gonorrhea, trichomoniasis, and bacterial vaginosis), and collected relevant sociodemographic data at booking. Factors associated with malarial and STI/RTI coinfection were explored using univariate and multivariate regression models. Among participants with complete results (N = 1,071), 38.7% (95% confidence interval [CI] = 35.7–41.6) were coinfected with malaria parasites and at least one STI/RTI; 18.9% (95% CI = 16.5–21.2) were infected with malaria parasites only; 26.0% (95% CI = 23.5–28.8) were infected with at least one STI/RTI but no malaria parasites, and 16.4% (95% CI = 14.1–18.6) had no infection. Human immunodeficiency virus (HIV)-infected women had a higher risk of being coinfected than HIV-uninfected women (odds ratio [OR] = 3.59 [95% CI = 1.73–7.48], P < 0.001). The prevalence of malarial and STI/RTI coinfection was high in this population. An integrated approach to control malarial infection and STIs/RTIs is needed to reduce this dual burden in pregnancy.

Author Notes

* Address correspondence to Enesia Banda Chaponda, Department of Biological Sciences (Room 405), University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia. E-mail: enesia.chaponda@gmail.com

Financial support: This study was financially supported by the International Centers of Excellence for Malaria Research (ICEMR) in southern Africa, and the U.S. National Institutes of Health from NIH/NIAID grant U19AI089680 (Malaria Transmission and the Impact of Control Efforts in southern Africa) with John Hopkins University Bloomberg School of Public Health and the University of Zambia School Of Medicine (UNZA-SoM), and the Research Support Center at the UNZA-SoM through the southern African Consortium for Research Excellence (SACORE), which is part of the African Institutions Initiative grant of the Wellcome Trust (Company No. 2711000), a charity (No. 210183) registered in England, as well as the Commonwealth Scholarship Commission in the United Kingdom.

Authors' addresses: Enesia Banda Chaponda, Department of Biological Sciences, University of Zambia School of Natural Sciences, Lusaka, Zambia, E-mail: enesia.chaponda@gmail.com. R. Matthew Chico, Department of Disease Control, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, E-mail: matthew.chico@lshtm.ac.uk. Jane Bruce, Department of Disease Control and Vector Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: jane.bruce@lshtm.ac.uk. Charles Michelo, Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia, E-mail: ccmichelo@yahoo.com. Bellington Vwalika, Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia, E-mail: bvwalika@rzhrg-mail.org. Sungano Mharakurwa, Faculty of Health Sciences, Africa University, Mutare, Zimbabwe, and Department of Medical Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, E-mail: mharakurwas@africau.edu. Mike Chaponda, Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia, E-mail: mikechaponda@yahoo.com. James Chipeta, Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia, E-mail: assistdeanresearch@smuth-mru.org.zm. Daniel Chandramohan, Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: daniel.chandramohan@lshtm.ac.uk.

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