Plasmodium falciparum and helminth coinfection in a semiurban population of pregnant women in Uganda

Background. Helminth infections and malaria are widespread in the tropics. Recent studies suggest helminth infections may increase susceptibility to Plasmodium falciparum infection. If confirmed, this increased susceptibility could be particularly important during pregnancy-induced immunosuppression. Objective. To evaluate the geographical distribution of P. falciparum - helminth coinfection and the associations between P. falciparum infection and infection with various parasite species in pregnant women in Entebbe, Uganda. Methods. A cross-sectional study was conducted at baseline during a trial of antihelminthic drugs during pregnancy. Helminth and P. falciparum infections were quantified in 2507 asymptomatic women. Subjects' socioeconomic and demographic characteristics and geographical details were recorded. Results. Hookworm and Mansonella perstans infections were associated with P. falciparum infection, but the effect of hookworm infection was seen only in the absence of M. perstans infection. The odds ratio [OR] for P. falciparum infection, adjusted for age, tribe, socioeconomic status, HIV infection status, and location was as follows: for individuals infected with hookworm but not M. perstans, 1.53 (95% confidence interval [CI], 1.09 - 2.14); for individuals infected with M. perstans but not hookworm, 2.33 ( 95% CI, 1.47 - 3.69); for individuals infected with both hookworm and M. perstans, 1.85 (CI, 1.24 - 2.76). No association was observed between infection with Schistosoma mansoni, Trichuris, or Strongyloides species and P. falciparum infection. Conclusions. Hookworm - P. falciparum coinfection and M. perstans - P. falciparum coinfection among pregnant women in Entebbe is more common than would be expected by chance. Further studies are needed to elucidate the mechanism of this association. A helminth-induced increase in susceptibility to P. falciparum could have important consequences for pregnancy outcome and responses to P. falciparum infection in infancy.