EPIDEMIOLOGY OF MALARIA AND OPPORTUNISTIC INFECTIONS AMONG HIV-POSITIVE INDIVIDUALS AND PREGNANT WOMEN IN PARTS OF ONDO STATE

Abstract

This research study investigates the prevalence and risk factors for malaria and opportunistic infections among individuals and pregnant women living with HIV in parts of Ondo-State, Nigeria. It also examines their adherence to antiretroviral therapy as well as the impact of malaria and opportunistic infections on pregnancy outcome among HIV-positive pregnant women receiving care at major public health facilities within the four selected local government areas, which are Akure South, Akure North, Ondo West and Ondo East. A total of 441 patients living with HIV consented to participate in the study including 93 pregnant women and 348 individuals. The microscopic examination of the blood smears of each patient was carried out for malaria parasites, patients medical records were carefully perused for ongoing treatment on any opportunistic infection(s). The patients were also checked for other opportunistic infections especially those easily diagnosed through physical examinations. Patient’s stool samples were examined microscopically for intestinal opportunistic parasites that may be responsible for diarrhea, which happens to be the prevailing opportunistic infection among them. Socio demographic information were obtained through a well structured questionnaire and their adherence to antiretroviral therapy was measured through a self reported data obtained from the participants using a 4-day recall semi structured follow up questionnaire adapted from Adults AIDS Clinical Trials Group (AACTG). The overall prevalence of malaria among the HIV-positive individuals examined in the study was 47% and it is higher in Akure LGAs (51%) than Ondo LGAs (38%). Among the HIV-infected pregnant women, the prevalence of malaria infection was 52.7% and is equally higher among participants in Akure LGAs (61.1%). Some of the risk factors associated with malaria infections include Age (Chi square (X2) = 23.58, level of significance (P) =0.02), Educational level (X2 = 6.64 P =0.04) and the use of Insecticide Treated Bed Nets (X2 = 7.11, P =0.01). However among the pregnant women, factors such as CD4 cell counts (X2 = 9.22, P =0.03), high temperature (X2 = 11.36, P =0.00) and gravidity (X2 = 5.29, P =0.04) were observed to be malaria predisposing risk factors. The overall prevalence of opportunistic infections among HIV-positive individuals sampled in this study was 42% and the most frequent conditions include chronic diarrhea (10.9%), tuberculosis (10.3%), vaginal candidiasis (8.3%), oral candidiasis (6.9%) and dermatitis (6.9%). The most prevalent intestinal opportunistic parasite is Cyclospora cayatenensis, there are few cases of Isospora belli and other parasites common among the participants include Ascaris lumbricoides. Adherence to antiretroviral therapy among the participants was 56% and was significantly related to age (χ2= 14.31, P=0.03), marital status (χ2= 9.47, P=0.01), medication burden (χ2= 9.07, P=0.01) and “ART type” (χ2= 19.09, P= 0.00). Adherence was observed to be higher among pregnant women and may be responsible for minimal adverse birth outcome recorded in this study. Low birth weight was prevalent among the newborns and common among mothers co-infected with malaria. This study attests to the continuous spread of HIV among populace in the four LGAs sampled and that mothers patronizing unlicensed clinic and traditional birth attendants risk the vertical transmission of the infection. Evidences abound through the study that HIV patients are at risk of frequent malaria episodes and other opportunistic infections including diarrhea, tuberculosis and candidiasis but these infections are significantly minimized among patients with good adherence to antiretroviral therapy and those with no serious underlying conditions such as diabetes, hypertension or heart related infections. Some of the recommendations provided through this study include innovative approaches to improving adherence, sanction of unlicensed maternity homes and rehabilitation of homosexuals, drug injectors and prostitutes who have become reservoirs of HIV infections.