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.