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. 2024 Sep 18;2(2):e000501.
doi: 10.1136/bmjph-2023-000501. eCollection 2024 Dec.

Prevalence and risk factors of curable sexually transmitted and reproductive tract infections and malaria co-infection among pregnant women at antenatal care booking in Kenya, Malawi and Tanzania: a cross-sectional study of randomised controlled trial data

Georgia R Gore-Langton  1 , Mwayiwawo Madanitsa  2   3 , Hellen C Barsosio  4 , Daniel T R Minja  5 , Jacklin Mosha  6 , Reginald A Kavishe  6 , George Mtove  5 , Samwel Gesase  5 , Omari A Msemo  5 , Simon Kariuki  4 , Kephas Otieno  4 , Kamija S Phiri  7 , John P A Lusingu  5 , Crispin Mukerebe  6 , Alphaxard Manjurano  6 , Pius Ikigo  6 , Queen Saidi  7 , Eric D Onyango  4 , Christentze Schmiegelow  8   9 , James Dodd  10 , Jenny Hill  10 , Helle Hansson  8 , Michael Alifrangis  8 , Julie Gutman  11 , Patricia Jean Hunter  12 , Nigel Klein  12 , Ulla Ashorn  13 , Asma Khalil  14 , Matt Cairns  15 , Feiko O Ter Kuile  4   10 , R Matthew Chico  1
Affiliations

Prevalence and risk factors of curable sexually transmitted and reproductive tract infections and malaria co-infection among pregnant women at antenatal care booking in Kenya, Malawi and Tanzania: a cross-sectional study of randomised controlled trial data

Georgia R Gore-Langton et al. BMJ Public Health. .

Abstract

Objectives: Malaria and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are associated with adverse pregnancy outcomes. This study reports the prevalence and risk factors of curable STIs/RTIs, STI/RTI co-infection and STI/RTI and malaria co-infection among HIV-negative pregnant women at their first antenatal care visit in Kenya, Malawi and Tanzania.

Methods: HIV-negative pregnant women of all gravidae (n=4680) were screened for syphilis with point-of-care tests and treated if positive. Separately, women provided blood samples (n=4569) for rapid plasma reagin (RPR) testing; positive cases were confirmation by Treponema pallidum particle agglutination (TPPA). Women also provided dried blood spots for batch testing of malaria by retrospective polymerase chain reaction (PCR (n=4226) methods. A randomly selected subgroup of women provided vaginal swabs for chlamydia, gonorrhoea and trichomoniasis testing by retrospective PCR batch testing (n=1431), and bacterial vaginosis diagnosis by Nugent scoring (n=1402).

Results: Malaria prevalence was 14.6% (95% CI 13.6 to 15.7), 45.9% (43.4 to 48.4) of women were positive for at least one curable STI/RTI and 6.7% (5.5 to 8.1) were co-infected with malaria and a curable STI/RTI. Prevalence of individual STIs/RTIs ranged from 28.5% (26.2 to 30.9) for bacterial vaginosis to 14.5% (12.7 to 16.4) for trichomoniasis, 13.8% (12.1 to 15.7) for chlamydia, 2.7% (1.9 to 3.6) for gonorrhoea and 1.7% (1.4 to 2.2) for RPR/TPPA-confirmed syphilis. The prevalence of STI/RTI co-infection was 10.1% (8.7 to 11.8). Paucigravidae, at highest risk of malaria, were also at greater risk of having chlamydia, gonorrhoea and bacterial vaginosis than multigravidae.

Conclusions: Of women infected with malaria, 49.0% also had a curable STI/RTI and one in five women with at least one STI/RTI were co-infected with more than one STI/RTI. Current antenatal interventions that address malaria and curable STIs/RTIs remain suboptimal. New approaches to preventing and managing these infections in pregnancy are urgently needed.

Trial registration number: NCT03208179.

Keywords: epidemiology; prevalence; public health.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Frequency of unique combinations of sexually transmitted infection and reproductive tract infection co-infections. BV, bacterial vaginosis; CT, chlamydia; NG, gonorrhoea; SYPH, syphilis; TV, trichomoniasis;.
See this image and copyright information in PMC

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