title: Associations between maternal helminth and malaria infections in pregnancy and clinical malaria in the offspring: a birth cohort in entebbe, Uganda.
abstract: BACKGROUND
  Helminth and malaria coinfections are common in the tropics. We investigated the hypothesis that prenatal exposure to these parasites might influence susceptibility to malaria in childhood.
  
  
  METHODS
  In a birth cohort of 2345 mother-child pairs in Uganda, maternal helminth and malaria infection status was determined during pregnancy, and childhood malaria episodes were recorded from birth to age 5 years. We examined associations between maternal infections and malaria in the offspring.
  
  
  RESULTS
  Common maternal infections were hookworm (45%), Mansonella perstans (21%), Schistosoma mansoni (18%), and Plasmodium falciparum (11%). At age 5 years, 69% of the children were still under follow-up. The incidence of malaria was 34 episodes per 100 child-years, and the mean prevalence of asymptomatic malaria at annual visits was 5.4%. Maternal hookworm and M. perstans infections were associated with an increased rate of childhood clinical malaria (adjusted hazard ratio [aHR], 1.24, 95% confidence interval [CI], 1.10-1.41; aHR, 1.20, 95% CI, 1.05-1.38, respectively). S. mansoni infection had no consistent association with childhood malaria.
  
  
  CONCLUSIONS
  This is the first report of an association between helminth infections in pregnancy and malaria in the offspring and indicates that helminth infections in pregnancy may increase the burden of childhood malaria morbidity.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS.
authors.forename: Juliet
authors.initials: J
authors.lastname: Ndibazza
authors.forename: Emily L
authors.initials: EL
authors.lastname: Webb
authors.forename: Swaib
authors.initials: S
authors.lastname: Lule
authors.forename: Harriet
authors.initials: H
authors.lastname: Mpairwe
authors.forename: Miriam
authors.initials: M
authors.lastname: Akello
authors.forename: Gloria
authors.initials: G
authors.lastname: Oduru
authors.forename: Moses
authors.initials: M
authors.lastname: Kizza
authors.forename: Helen
authors.initials: H
authors.lastname: Akurut
authors.forename: Lawrence
authors.initials: L
authors.lastname: Muhangi
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Vennervald
authors.forename: Alison
authors.initials: A
authors.lastname: Elliott
mesh_terms: D000328:Adult; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000453:epidemiology / Q000469:parasitology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology / Q000469:parasitology*; D014454:Uganda / Q000453:epidemiology
keywords: childhood; coinfections; helminths; malaria; pregnancy
references.citation: Infect Immun. 1998 Nov;66(11):5167-74
references.pmid: 9784518
references.citation: Parasit Vectors. 2010 May 19;3:44
references.pmid: 20482866
references.citation: Am J Trop Med Hyg. 2005 Jun;72(6):702-7
references.pmid: 15964953
references.citation: Trop Med Int Health. 2007 Dec;12(12):1442-9
references.pmid: 18076550
references.citation: Trans R Soc Trop Med Hyg. 2007 Sep;101(9):899-907
references.pmid: 17555783
references.citation: PLoS Negl Trop Dis. 2010 Nov 16;4(11):e887
references.pmid: 21103367
references.citation: Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):88-98
references.pmid: 18165479
references.citation: Trans R Soc Trop Med Hyg. 2003 Mar-Apr;97(2):198-9
references.pmid: 14584377
references.citation: Clin Diagn Lab Immunol. 2005 Mar;12(3):375-9
references.pmid: 15753250
references.citation: Trends Parasitol. 2006 Aug;22(8):350-1; author reply 351-2
references.pmid: 16798090
references.citation: Parasite Immunol. 2004 Aug-Sep;26(8-9):365-9
references.pmid: 15679634
references.citation: Trans R Soc Trop Med Hyg. 1978;72(3):262-73
references.pmid: 675786
references.citation: PLoS Med. 2005 Dec;2(12):e407
references.pmid: 16259531
references.citation: PLoS Negl Trop Dis. 2010 Nov 09;4(11):e882
references.pmid: 21085468
references.citation: Am J Trop Med Hyg. 2006 Aug;75(2):219-25
references.pmid: 16896122
references.citation: Rev Inst Med Trop Sao Paulo. 1972 Nov-Dec;14(6):397-400
references.pmid: 4675644
references.citation: P N G Med J. 2000 Sep-Dec;43(3-4):161-5
references.pmid: 11939296
references.citation: Immunobiology. 2007;212(6):475-90
references.pmid: 17544832
references.citation: Am J Trop Med Hyg. 2007 Dec;77(6):1091-5
references.pmid: 18165528
references.citation: J Infect Dis. 2008 Sep 15;198(6):920-7
references.pmid: 18721060
references.citation: Malar J. 2004 Nov 15;3:43
references.pmid: 15544703
references.citation: PLoS Negl Trop Dis. 2009 Jun 30;3(6):e473
references.pmid: 19564904
references.citation: Trans R Soc Trop Med Hyg. 1995 Sep-Oct;89(5):521-2
references.pmid: 8560530
references.citation: Trends Parasitol. 2007 Apr;23(4):159-64
references.pmid: 17336160
references.citation: Lancet Infect Dis. 2007 Feb;7(2):93-104
references.pmid: 17251080
references.citation: Clin Infect Dis. 2008 Oct 15;47(8):1017-25
references.pmid: 18781874
references.citation: Trends Parasitol. 2005 Aug;21(8):359-62
references.pmid: 15967721
references.citation: Trends Parasitol. 2003 Dec;19(12):547-51
references.pmid: 14642761
references.citation: Trans R Soc Trop Med Hyg. 2008 Oct;102(10):1039-45
references.pmid: 18656215
references.citation: Clin Trials. 2007;4(1):42-57
references.pmid: 17327245
references.citation: Parasitology. 2009 Jun;136(7):699-712
references.pmid: 19486544
references.citation: Clin Infect Dis. 2010 Feb 15;50(4):531-40
references.pmid: 20067426
references.citation: PLoS Med. 2009 Jul;6(7):e1000116
references.pmid: 19636353
references.citation: Scand J Immunol. 1992 Apr;35(4):429-37
references.pmid: 1557613
references.citation: Curr Opin HIV AIDS. 2012 May;7(3):221-4
references.pmid: 22418449
references.citation: Nature. 2005 Mar 10;434(7030):214-7
references.pmid: 15759000
references.citation: Parasite Immunol. 2006 Oct;28(10):497-506
references.pmid: 16965285
references.citation: Annu Rev Immunol. 1983;1:33-62
references.pmid: 6399977
references.citation: Parasitology. 2008 Oct;135(12):1407-15
references.pmid: 18937884
references.citation: Lancet. 2004 Sep 11-17;364(9438):981-3
references.pmid: 15364190
references.citation: Trop Med Int Health. 2010 Oct;15(10):1204-9
references.pmid: 20636299
references.citation: Infect Immun. 2005 Jun;73(6):3531-9
references.pmid: 15908382
references.citation: Immunol Rev. 2004 Oct;201:89-116
references.pmid: 15361235
references.citation: Am J Epidemiol. 1997 Nov 15;146(10):826-31
references.pmid: 9384203
references.citation: Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2 Suppl):28-35
references.pmid: 11425175
references.citation: Trop Doct. 2004 Jan;34(1):27-8
references.pmid: 14959970
references.citation: JAMA. 2012 May 16;307(19):2079-86
references.pmid: 22665107
references.citation: PLoS One. 2012;7(12):e50325
references.pmid: 23236367
references.citation: Mol Biochem Parasitol. 2009 Sep;167(1):1-11
references.pmid: 19406170
references.citation: Ann Trop Med Parasitol. 2006 Oct;100(7):551-70
references.pmid: 16989681