MALARIA AND GEO-HELMINTH CO-INFECTIONS AND SYNDEMICS AMONG PREGNANT WOMEN AT NANDI-HILLS SUB-COUNTY HOSPITAL, KENYA

Abstract

This study was carried out in Nandi Hills Sub-county Hospital to investigate malaria and geo-helminth co-infections and associated syndemic factors among pregnant women. A cross sectional study was used to collect data from three hundred (300) randomly selected pregnant women who attended antenatal care (ANC) and did not show any disease symptoms from March to December 2015. Stool samples were collected for geohelminth detection and blood samples for malaria parasite detection and haemoglobin (Hb) levels measurements. Collection of socio-demographics of the participants was also done using questionnaire survey. Stool samples were subjected to formal-ether concentration technique and microscopy for detection and identification of geo-helminths ova. Blood samples for malaria parasites detection and identification were processed using Field’s stain and microscopy whereas for haemoglobin (Hb) measurements, blood was subjected to diaspect haemoglobin test machine. Pearson chi square, Phi test and logistic regression were used to analyse the data. Probabilities of < 0.05 were considered significant. Geo-helminth prevalence was 30%, 15% and 1% for Ascaris lumbricoides, hookworm (Ancylostoma duodenale) and Trichuris trichiura respectively. A. lumbricoides and T. trichiura infections were of light intensity whereas A. duodenale infections were of light (12%) and moderate (3.7%) intensities. Asymptomatic P. falciparum infection prevalence was 8% and of low intensity. Malaria-geohelminth co-infections were not significant for P. falciparum-A. lumbricoides (13%) (P=0.07) but significant for P. falciparum-A. duodenale (30%) (P=0.04). Socio-demographic confounders that significantly affected malaria-A. duodenale co-infection were marital status, small family size (≤2) and being in the middle income category (ksh 10,000-20,000). P. falciparum-A. lumbricoides and P. falciparum-A. duodenale co-infections were not affected by wet and dry seasons (P=0.06 and P=0.21 respectively). P. falciparum and A. lumbricoides were negatively associated with each other (rᵠ=-0.105) whereas P. falciparum and A. duodenale were positively associated (rᵠ=0.121). Obstetric and socio-demographic/economic factors that were considered in the study maintained the trend of association for P. falciparum-A. lumbricoides and P. falciparum-A. duodenale parasites but the strength of association became variable. Antagonistic relationship for P. falciparum-A. lumbricoides co-infection was however upturned with being single, having secondary education and staying in urban rental type of settlement while the synergism for P. falciparum-A. duodenale co-infection was upturned by being single, large family size and residing in the estate camp. P. falciparum and A. duodenale infections had significant (P= 0.00) effect on Hb levels and co-infection with the two parasites having negative impact on the anaemic category, that is, Hb<11 (rᵠ=-0.105). The outcome of this study showed that there is need to diagnose and treat pregnant women for both malaria and geohelminth parasites since the parasites can co-exist. Pregnant women should be encouraged to practice early attendance of ANC to improve their health and their unborn babies. This study provides baseline information that can be exploited in prevention and control strategies of malaria and geohelminth parasites with the aim of improving the health of pregnant women as we strive to achieve millennium development goals (MDG).