title: The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya. jayisi@kisian.mimcom.net
authors.forename: John G
authors.initials: JG
authors.lastname: Ayisi
authors.forename: Anna M
authors.initials: AM
authors.lastname: van Eijk
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
authors.forename: Margarette S
authors.initials: MS
authors.lastname: Kolczak
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Otieno
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Misore
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Nahlen
mesh_terms: D000328:Adult; D000740:Anemia / Q000469:parasitology / Q000821:virology; D005260:Female; D005317:Fetal Growth Retardation / Q000469:parasitology / Q000821:virology; D006679:HIV Seropositivity / Q000150:complications*; D015497:HIV-1; D006779:Hospitals, Public; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007630:Kenya; D016778:Malaria, Falciparum / Q000150:complications*; D007752:Obstetric Labor, Premature / Q000382:microbiology / Q000469:parasitology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D015597:Pregnancy Complications, Parasitic