Effects of HIV infection and/or malaria on maternal and neonatal health in a high-prevalence setting

Objective: HIV infection and malaria have been associated with different complications during pregnancy and delivery. HIV-positive pregnant women are at increased risk for all adverse outcomes of malaria during pregnancy. The main objective was to analyse the obstetric and perinatal consequences of malaria, HIV infection and HIV/malaria co-infection in pregnant women and newborns, which has been less well evaluated. Methods: A cross-sectional study was carried out in the Maternity Service of the Provincial Hospital of Tete Mozambique, involving completion of a structured questionnaire that included demographic data, and information on the current pregnancy, delivery and the newborn. In total, 819 women (13-45 years old) in the immediate postpartum period were enrolled between 1 March and 31 October 2016. Results: The overall prevalence of HIV and malaria, considered separately, in pregnant women was similar to 12% (103 women with HIV and 101 with malaria). Only one-fifth of HIV-infected women knew their HIV status before pregnancy. A significantly higher proportion of women with HIV attended four or more antenatal care visits than women without HIV. Caesarean section was less frequent in HIV patients, and peripartum urinary infection was more frequent than in seronegative women (13/103 [12.6%] vs. 34/716 [4.7%]). HIV/malaria co-infection were 17/819 (2%) and was significantly associated with the development of pre-eclampsia when HIV-infected patients received anti-retroviral treatment, and with an increase in urinary tract infections around delivery. With respect to the newborn, co-infection increased the frequency of early neonatal death, as well as neonatal asphyxia and jaundice. Conclusions: In Mozambique, the prevalence of malaria and HIV infection in women of childbearing age continues to be high and contributes additively to complications during pregnancy and childbirth, and in the newborn. Therefore, integrating HIV, malaria and reproductive health services is essential if maternal and foetal outcomes are to improve.