Center for Neural Engineering, Department of Engineering, Science and Mechanics, Penn State University, University Park, PA, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
BMC Pregnancy Childbirth. 2020 Jun 29;20(1):379. doi: 10.1186/s12884-020-03064-x.
Malaria and HIV are common infections in Africa and cause substantial morbidity and mortality in pregnant women. We aimed to assess the association of malaria with anemia in pregnant women and to explore the joint effects of malaria and HIV infection on anemia in pregnant women.
We used nationally representative, cross-sectional demographic and health surveys (DHS) that were conducted between 2012 and 2017 across 7 countries of sub-Saharan Africa (Burundi, the Democratic Republic of the Congo, Gambia, Ghana, Mali, Senegal and Togo). The outcome variables were anemia (defined as a hemoglobin concentration < 110 g/L), and hemoglobin concentration on a continuous scale, in pregnant women at the time of the interview. We used generalized linear mixed-effects models to account for the nested structure of the data. We adjusted models for individual covariates, with random effects of the primary sampling unit nested within a country.
A total of 947 pregnant women, ages, 15-49 y, were analyzed. Prevalence of malaria only, HIV only, and malaria- HIV coinfection in pregnant women was 31% (95% CI: 28.5 to 34.5%, n = 293), 1.3% (95% CI: 0.77 to 2.4%, n = 13) and 0.52% (95% CI: 0.02 to 1.3%, n = 5) respectively. Overall prevalence of anemia was 48.3% (95% CI: 45.1 to 51.5%). The anemia prevalence in pregnant women with malaria infection only was 56.0% (95% CI: 50.1 to 61.7%); HIV infection only, 62.5% (95% CI: 25.9 to 89.8%); malaria- HIV coinfection, 60.0 (95% CI: 17.0-92.7%) and without either infection, 44.6% (95% CI: 40.7 to 48.6%). In the fully adjusted models, malaria infection was associated with 27% higher prevalence of anemia (95% CI of prevalence ratio: 1.12 to 1.45; p = 0.004), and 3.4 g/L lower hemoglobin concentration (95% CI: - 5.01 to - 1.79; p = 0.03) compared to uninfected pregnant women. The prevalence of HIV infection and malaria-HIV coinfection was too low to allow meaningful analysis of their association with anemia or hemoglobin concentration.
Malaria was associated with an increased prevalence of anemia during pregnancy.
疟疾和艾滋病毒在非洲很常见，会给孕妇带来严重的发病率和死亡率。我们旨在评估疟疾与孕妇贫血之间的关联，并探讨疟疾和艾滋病毒感染对孕妇贫血的联合影响。
我们使用了在 2012 年至 2017 年期间在撒哈拉以南非洲的 7 个国家（布隆迪、刚果民主共和国、冈比亚、加纳、马里、塞内加尔和多哥）进行的具有全国代表性的、横断面的人口与健康调查（DHS）数据。孕妇在接受采访时的结局变量为贫血（定义为血红蛋白浓度<110g/L）和血红蛋白浓度的连续尺度。我们使用广义线性混合效应模型来解释数据的嵌套结构。我们调整了个体协变量的模型，将初级抽样单位的随机效应嵌套在国家内。
共分析了 947 名年龄在 15-49 岁的孕妇。孕妇中疟疾感染、艾滋病毒感染和疟疾-艾滋病毒合并感染的患病率分别为 31%（95%CI：28.5 至 34.5%，n=293）、1.3%（95%CI：0.77 至 2.4%，n=13）和 0.52%（95%CI：0.02 至 1.3%，n=5）。贫血的总体患病率为 48.3%（95%CI：45.1 至 51.5%）。仅感染疟疾的孕妇贫血患病率为 56.0%（95%CI：50.1 至 61.7%）；艾滋病毒感染的患病率为 62.5%（95%CI：25.9 至 89.8%）；疟疾-艾滋病毒合并感染的患病率为 60.0%（95%CI：17.0 至 92.7%）；未感染任何一种病原体的孕妇贫血患病率为 44.6%（95%CI：40.7 至 48.6%）。在完全调整的模型中，疟疾感染与贫血的患病率增加 27%相关（95%置信区间患病率比：1.12 至 1.45；p=0.004），血红蛋白浓度降低 3.4g/L（95%置信区间：-5.01 至-1.79；p=0.03），与未感染的孕妇相比。艾滋病毒感染和疟疾-艾滋病毒合并感染的患病率太低，无法对其与贫血或血红蛋白浓度的关联进行有意义的分析。
疟疾与孕妇怀孕期间贫血的患病率增加有关。
