Clinical, Sociodemographic and Placental Histologicalfeatures in Preterm Births With Placental Malaria and Hiv Coinfection in Bungoma County Referral Hospital, a Retrospective Cohort Study
Abstract
Background
Prematurity is the largest killer of children under 5 years of age. Malaria and HIV are both
associated with prematurity due to partial maternal vascular malperfusion. This may be due
to the altered angiogenesis associated with the two diseases. The structural changes
associated with malaria and HIV coinfection in the placentae of premature births have largely
not been described. This study aimed at determining the clinical, sociodemographic and
histological differences in the parenchyma of placentae of preterm births with malaria and
HIV coinfection compared to those without.
Methods
Twenty-five placentae of preterm birth with malaria and HIV coinfection were randomly
selected and compared to twenty-five of those without malaria and HIV coinfection. Clinical
data were abstracted. Light microscopy was used to determine histological features by a
qualified pathologist while histomorphometric features of the terminal villous were analyzed
using Fiji® image analysis software. Quantitative data were analysed using IBM Statistical
Package for Social Sciences version 26 and results were presented in tables; a significance
level of 0.05% was considered.
Results
Women with malaria and HIV coinfection were younger (26 years vs 29 years)and had a
lower parity (2 vs 3) and level of education (most in the primary level) when compared to
women without malaria and HIV coinfection. Placentae of malaria and HIV coinfection
compared to those without were significantly associated with partial maternal vascular
malperfusion with a RR of 2.10 CI (1.26-3.49). Placental weight, villous perimeter, and area
were significantly lower in cases as compared to controls (454g vs. 488g (119.32μm vs.
130.47μm) and (937.93μm2vs. 1132.88μm2) respectively. The results were verified by a
blinded independent pathologist.
Conclusion
Partial maternal vascular malperfusion was significantly higher in preterms with Malaria and
HIV coinfection and should therefore be considered an important aspect of the
pathophysiology of preterm births in these two conditions. Public health interventions
targeting young pregnant women as well as increasing the level of education would reduce
the burden of these two diseases and preterm births.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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