Risk factors for helminth, malaria, and HIV infection in pregnancy in Entebbe, Uganda.
BACKGROUND
Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.


OBJECTIVE
To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy.


METHODS
The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression.


RESULTS
There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus) showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities.


CONCLUSIONS
Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection.
Woodburn
Patrick William
PW
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. paddywoodburn@yahoo.co.uk
Muhangi
Lawrence
L
Hillier
Stephen
S
Ndibazza
Juliet
J
Namujju
Proscovia Bazanya
PB
Kizza
Moses
M
Ameke
Christine
C
Omoding
Nicolas Emojong
NE
Booth
Mark
M
Elliott
Alison Mary
AM
D000293:Adolescent; D000328:Adult; D001769:Blood / Q000469:parasitology / Q000821:virology; D018791:CD4 Lymphocyte Count; D015897:Comorbidity; D005243:Feces / Q000469:parasitology / Q000821:virology; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology*; D006373:Helminthiasis / Q000453:epidemiology*; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D008487:Medical History Taking; D008875:Middle Aged; D018512:Parasitemia / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult