Determinants of Hemoglobin Levels at Antenatal Enrollment: Impact of Malaria Infection and HIV among Pregnant Women in Bamenda, Northwest Cameroon
Yannick-Duclair Tchinde
Department of Microbiology and Parasitology, Faculty of Science, The University of Bamenda, P. O. Box 39 Bamenda, Cameroon.
Lem Edith Abongwa
Department of Biochemistry, Faculty of Science, University of Bamenda, Bambili, P. O. Box 39, Cameroon.
Mabu Maxim Bindamu
Department of Biochemistry, Faculty of Science, University of Bamenda, Bambili, P. O. Box 39, Cameroon and Laboratory of Molecular Biology and Biotechnology, IMPM, MINRESI, Yaoundé, P.O. Box 13033, Cameroon.
Helen Ngum Ntonifor *
Department of Microbiology and Parasitology, Faculty of Science, The University of Bamenda, P. O. Box 39 Bamenda, Cameroon and Department of Animal Biology and Conservation, Faculty of Science, The University of Bamenda, P. O. Box 39 Bamenda, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Malaria and HIV remain major contributors to maternal anemia in sub-Saharan Africa. This study investigated the relationship between malaria burden, HIV status, and hemoglobin levels and identified predictors of anemia and malaria among pregnant women at antenatal enrollment in Bamenda. A hospital-based cross-sectional study was conducted from January to April 2023 among pregnant women attending their first antenatal care visit at the Azire Integrated Health Center. All consenting participants completed a questionnaire and provided venous blood samples. Malaria infection and parasite density were determined by microscopy, HIV status was determined using RDTs and medical records, and hemoglobin concentration was measured using a hemoglobinometer. All statistical analyses were conducted using R version 4.4.0 and RStudio. Of the 242 pregnant women enrolled, the prevalence of malaria was 42.98% (104/242), HIV prevalence was 7.44% (18/242), malaria-HIV coinfection was 2.89% (7/242), and anemia prevalence was 23.97% (58/242). Malaria prevalence was highest among women older than 35 years (47.37%, 9/19) and urban residents (43.31%, 55/127), whereas anemia was most frequent among women younger than 20 years (37.50%, 6/16). Anemia severity was markedly higher (p < 0.0001) among malaria-positive participants, with 33.65% (35/104) having mild anemia and 14.42% (15/104) having moderate anemia. The overall geometric mean parasite density was 974.3 ± 3.86 parasites/µL. Parasite density was elevated among HIV-positive (2312.92 ± 2.88 parasites/µL) and anemic women, with the highest value observed among those with both HIV infection and anemia (2659.8 ± 2.97 parasites/µL). The combined burden of malaria and HIV highlights the need for integrated screening and early interventions at antenatal enrollment, with particular emphasis on malaria control and anemia prevention among HIV-infected and younger pregnant women in malaria-endemic settings.
Keywords: Malaria, HIV, pregnancy, hemoglobin, anemia, parasitemia, antenatal care, coinfection, pregnant women