Pattern of Plasmodium-intestinal helminth co-infection among pregnant women in a high transmission zone of malaria in Nigeria

Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve data from the literature, without restricting language and publication year. The Joanna Briggs Institute's critical appraisal tool for prevalence studies was used for quality assessment. STATA Version 14.0 was used to conduct the meta-analysis. The I2 statistics and Egger's test were used to test heterogeneity and publication bias. The random-effects model was used to estimate the pooled prevalence at a 95% confidence interval (CI). The review protocol has been registered in PROSPERO, with the number CRD42019144812. In total, 24 studies (n = 14,087 participants) were identified in this study. The pooled analysis revealed that 20% of pregnant women were co-infected by malaria and helminths in sub-Saharan Africa. The pooled prevalence of malaria and helminths were 33% and 35%, respectively. The most prevalent helminths were Hookworm (48%), Ascaris lumbricoides (37%), and Trichuris trichiura (15%). Significantly higher malaria and helminthic co-infection during pregnancy were observed. Health systems in sub-Saharan Africa must implement home-grown innovative solutions to underpin context-specific policies for the early initiation of effective intermittent preventive therapy.

Prevalence and effect of Plasmodium spp. and hookworm co-infection on malaria parasite density and haemoglobin level: a meta-analysis

The dual effects of co-infection of Plasmodium spp. and hookworm on malaria remain under debate. This study investigated prevalence, prevalence odds ratio (POR) of co-infection and impact of co-infection on malaria parasite density and haemoglobin levels in comparison to Plasmodium mono-infection. The protocol for this systematic review and meta-analysis is registered at PROPERO under ID: CRD42020202156. Relevant literatures were obtained from PubMed, ISI Web of Science, and Scopus on 25 December 2020. Mean difference (MD) and confidence interval (CI) of malaria parasite density and haemoglobin were compared using a random effect model. Heterogeneity was assessed using Cochrane Q and I2 statistics. Publication bias was determined by visualising funnel plot asymmetry. Of 1756 articles examined, 22,191 malaria cases across 37 studies included 6096 cases of co-infection of Plasmodium spp. and hookworm. The pooled prevalence was 20% (95% CI 15-26%, I2 99.6%, 37 studies) and was varied in terms of geographical region. Co-infection occurred by chance (OR 0.97, p 0.97, 95% CI 0.73-1.27, I2 95%, 30 studies). The mean malaria parasite density for co-infection (478 cases) was similar to Plasmodium mono-infection (920 cases) (p 0.24, MD 0.86, 95% CI - 0.58-2.29, I2 100%, 7 studies). The mean haemoglobin level for co-infection (90 cases) was similar to Plasmodium mono-infection (415 cases) (p 0.15, MD - 0.63, 95% CI - 1.49-0.23, I2 98%, 4 studies). Co-infection was common and occurred by chance but varied by geographic region. Further studies are required to investigate the mechanism of hookworm infection on malaria severity. Additionally, detection of hookworm infections among patients with malaria in endemic areas of both diseases is recommended to prevent severe malaria.

High prevalence of Plasmodium falciparum and soil-transmitted helminth co-infections in a periurban community in Kwara State, Nigeria

Prevalence of malaria and soil-transmitted helminth infections, and the burden of disease are enormous in sub-Saharan Africa. Co-infections aggravate the clinical outcome, but are common due to an overlap of endemic areas. A cross-sectional survey was conducted to assess prevalence, intensity of infection and association between malaria and soil-transmitted helminth infections in a typical periurban community in Kwara State. Fresh blood and faecal samples were examined using thick blood film and Kato-Katz smear techniques. A total of 383/471 study participants (81.3%) were infected with at least one parasite species, with the following prevalences and mean infection intensities: Plasmodium falciparum 63.7% (2313.6 parasites/μl); Ascaris lumbricoides 63.1% (3152.1 epg); Trichuris trichiura 53.3% (1043.5 epg); and hookworms 30.1% (981.7 epg). Sixty-three percent of the study population were co-infected with two or more parasite species. The prevalence of ascariasis was significantly higher in individuals infected with P. falciparum (adjusted OR: 5.87; 95% CI: 3.30-10.42). Heavy A. lumbricoides and T. trichiura infections were associated with high P. falciparum parasitaemia. Co-endemicity of malaria and soil transmitted helminth infections is an important public health problem in the study area. Multi-target integrated approaches focusing on disease intervention are essential to mitigate morbidity caused by multiple infections.