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The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya

Ayisi, John Ga,b; van Eijk, Anna Ma,b; ter Kuile, Feiko Oa,b,c; Kolczak, Margarette Sc; Otieno, Juliana Ad; Misore, Ambrose Od; Kager, Piet Ab; Steketee, Richard Wc; Nahlen, Bernard Lc,e

Epidemiology & Social

Objective: To determine the effect of dual infection with HIV and malaria on birth outcomes and maternal anaemia among women delivering at a large public hospital in Kisumu, western Kenya.

Subjects and methods: Data on obstetric and neonatal characteristics, maternal and placental parasitaemia, and postpartum haemoglobin levels were collected from women enrolled in a cohort study of the interaction between malaria and HIV during pregnancy.

Results: Between 1996 and 1999, data were available from 2466 singleton deliveries. The maternal HIV seroprevalence was 24.3%, and at delivery 22.0% of the women had evidence of malaria. Low birthweight, preterm delivery (PTD), intrauterine growth retardation (IUGR) and maternal anaemia (haemoglobin < 8 g/dl) occurred in 4.6, 6.7, 9.8 and 13.8% of deliveries, respectively. Maternal HIV, in the absence of malaria, was associated with a 99 g (95% CI 52–145) reduction in mean birthweight among all gravidae. Malaria was associated with both IUGR and PTD, resulting in a reduction in mean birthweight of 145 g (95% CI 82–209) among HIV-seronegative and 206 g (95% CI 115–298) among HIV-seropositive primigravidae, but not among multigravidae. Both HIV and malaria were significant risk factors for postpartum maternal anaemia, and HIV-seropositive women with malaria were twice as likely to have anaemia than HIV-seronegative women with or without malaria.

Conclusion: Women with dual infection are at particular risk of adverse birth outcomes. In areas with a moderate or high prevalence of HIV and malaria, all pregnant women should be the focus of malaria and anaemia control efforts to improve birth outcomes.

From the aCentre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; bDepartment of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; cDivision of Parasitic Diseases, NCID, Centers for Disease Control and Prevention, Atlanta, GA, USA; dMinistry of Health, Kisumu, Kenya; and eRoll Back Malaria, World Health Organization, Geneva, Switzerland.

Correspondence to: John G. Ayisi, Centre for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Tel: +254 35 22902; fax: +254 35 22981; e-mail:

Received: 22 June 2001; revised: 20 September 2002; accepted: 8 October 2002.

Disclaimer: The use of trade names is for identification only and does not imply endorsement by the Kenya Medical Research Institute or the Ministry of Health, Kenya, or by the Public Health Service, US Department of Health and Human Services.

© 2003 Lippincott Williams & Wilkins, Inc.