The effect of dual infection with HIV and malaria on pregnancy outcome in western Kenya.
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.
Ayisi
John G
JG
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya. jayisi@kisian.mimcom.net
van Eijk
Anna M
AM
ter Kuile
Feiko O
FO
Kolczak
Margarette S
MS
Otieno
Juliana A
JA
Misore
Ambrose O
AO
Kager
Piet A
PA
Steketee
Richard W
RW
Nahlen
Bernard L
BL
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