The prevalence of plasmodium falciparum placental malaria and its association with prenatal sulfadoxime-pyrimethamine prophylaxis among HIV positive mothers in Mulago hospital.

Abstract

INTRODUCTION: HIV positive (HIV+) women are more susceptible to malaria infection during pregnancy than their HIV negative (HIV-) counterparts but the actual prevalence of infection in Ugandan pregnant women is not known. HIV infection limits the pregnant woman’s capacity to control P. falciparum parasitaemia with resultant placental malaria. This is the major determinant of its impact on foetal growth and survival. Although prenatal SP prophylaxis seems to be protective to pregnant women in general, there is growing concern that the recommended two doses prenatally may be inadequate in HIV+ mothers was determined. SIGNIFICANCE OF THE STUDY: The study gave an insight into the situation of malaria among the HIV+ pregnant women. The protection of the standard two-dose prenatal SP was not known well established due to the inadequate sample size and therefore a large b-error although these preliminary results seem to suggest that two-dose SP may not be sufficient for the HIV+ mothers. OBJECTIVES: The aim of the study was to determine the prevalence of p. falciparum placental malaria among HIV+ mothers and its association with prenatal SP prophylaxis. METHODOLOGY: This was a hospital based cross-sectional study of HIV+ pregnant women. The participants in this study were recruited at delivery from an ongoing Nevirapine cohort study in Mulago hospital where their HIV status had been determined. The history of prenatal SP prophylaxis was determined by self-report. A specimen of placental blood was collected and examined for malaria parasites using fields stain. The prevalence of placental malaria was determined. Inferences about the protection offered to HIV+ mothers by the standard two-dose prenatal SP prophylaxis were made according to its association with placental malaria. STUDY REQUIREMENTS: Quantitative data was collected using a structured questionnaire. Qualitative data on the practice of SP chemoprophylaxis was collected using key informant interviews of doctors who ran the antenatal clinics. DATA MANAGEMENT AND ANALYSIS: The prevalence of placental malaria among the HIV+ mothers was determined. The analysis also included the calculation of the odds ratio (OR), chi-squared values (X2) and their p-values and confidence intervals (CI). Adjusted ORs were calculated to control for potential confounders. Logistic regression was done to determine the association between the outcome and the variables of interest. Qualitative data was transcribed and analyzed manually. RESULTS: The prevalence of placental malaria was 9.4%. The prevalence of placental malaria among the SP users was 9.5% and among the non-users, 9.2%. The difference between the groups was not significant. The association between prenatal SP prophylaxis and placental malaria was not significant. CONCLUSION: The prevalence of placental malaria among HIV+ mothers in Mulago hospital is high. Placental malaria among HIV+ mothers is not parity specific. These preliminary results suggest that two-dose SP prophylaxis may be inadequate for HIV+ mothers but are not conclusive due to the large type II error resulting from a sample size.