{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T16:41:03Z","timestamp":1776184863933,"version":"3.50.1"},"reference-count":62,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,11,2]]},"abstract":"<jats:p>Malarial infection and curable sexually transmitted and reproductive tract infections (STIs\/RTIs) are important causes of adverse birth outcomes. Reducing the burden of these infections in pregnancy requires interventions that can be easily integrated into the antenatal care (ANC) package. However, efforts to integrate the control of malarial infection and curable STIs\/RTIs in pregnancy have been hampered by a lack of evidence related to their coinfection. Thus, we investigated the prevalence of coinfection among pregnant women of rural Zambia. A prospective cohort study was conducted in Nchelenge District, Zambia, involving 1,086 first ANC attendees. We screened participants for peripheral malarial infection and curable STIs\/RTIs (syphilis, <jats:italic>Chlamydia<\/jats:italic>, gonorrhea, trichomoniasis, and bacterial vaginosis), and collected relevant sociodemographic data at booking. Factors associated with malarial and STI\/RTI coinfection were explored using univariate and multivariate regression models. Among participants with complete results (<jats:italic>N<\/jats:italic> = 1,071), 38.7% (95% confidence interval [CI] = 35.7\u201341.6) were coinfected with malaria parasites and at least one STI\/RTI; 18.9% (95% CI = 16.5\u201321.2) were infected with malaria parasites only; 26.0% (95% CI = 23.5\u201328.8) were infected with at least one STI\/RTI but no malaria parasites, and 16.4% (95% CI = 14.1\u201318.6) had no infection. Human immunodeficiency virus (HIV)-infected women had a higher risk of being coinfected than HIV-uninfected women (odds ratio [OR] = 3.59 [95% CI = 1.73\u20137.48], <jats:italic>P<\/jats:italic> &lt; 0.001). The prevalence of malarial and STI\/RTI coinfection was high in this population. An integrated approach to control malarial infection and STIs\/RTIs is needed to reduce this dual burden in pregnancy.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0370","type":"journal-article","created":{"date-parts":[[2016,9,27]],"date-time":"2016-09-27T03:48:47Z","timestamp":1474948127000},"page":"1069-1076","source":"Crossref","is-referenced-by-count":23,"title":["Malarial Infection and Curable Sexually Transmitted and Reproductive Tract Infections Among Pregnant Women in a Rural District of Zambia"],"prefix":"10.4269","volume":"95","author":[{"given":"Enesia Banda","family":"Chaponda","sequence":"first","affiliation":[{"name":"Department of Biological Sciences, University of Zambia, Lusaka, Zambia."},{"name":"Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Matthew","family":"Chico","sequence":"additional","affiliation":[{"name":"Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Bruce","sequence":"additional","affiliation":[{"name":"Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Michelo","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bellington","family":"Vwalika","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sungano","family":"Mharakurwa","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Africa University, Mutare, Zimbabwe."},{"name":"Department of Medical Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Chaponda","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Chipeta","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Chandramohan","sequence":"additional","affiliation":[{"name":"Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Am J Trop Med Hyg","first-page":"517","article-title":"Epidemiology, malaria and pregnancy","volume":"33","author":"McGregor","year":"1984"},{"key":"ref2","series-title":"Bull World Health Organ","first-page":"9","article-title":"Adverse birth outcomes in United Republic of Tanzania\u2013impact and prevention of maternal risk factors","volume":"85","author":"Watson-Jones","year":"2007"},{"key":"ref3","series-title":"Trans R Soc Trop Med Hyg","first-page":"232","article-title":"Malaria infection of the placenta in The Gambia, west Africa; its incidence and relationship to stillbirth, birthweight and placental weight","volume":"77","author":"McGregor","year":"1983"},{"key":"ref4","series-title":"Lancet","first-page":"587","article-title":"Stillbirths: rates, risk factors, and acceleration towards 2030","volume":"387","author":"Lawn","year":"2016"},{"key":"ref5","series-title":"Bull World Health Organ","first-page":"1005","article-title":"An analysis of malaria in pregnancy in Africa","volume":"61","author":"Brabin","year":"1983"},{"key":"ref6","series-title":"Sex Transm Dis","first-page":"167","article-title":"Sexually transmitted infections and adverse pregnancy outcomes among women attending inner city public sexually transmitted diseases clinics","volume":"38","author":"Johnson","year":"2011"},{"key":"ref7","series-title":"Am J Epidemiol","first-page":"1247","article-title":"Association of Chlamydia trachomatis and Mycoplasma hominis with intrauterine growth retardation and preterm delivery","volume":"129","author":"Investigators of the Johns Hopkins Study of Cervicitis and Adverse Pregnancy Outcome","year":"1989"},{"key":"ref8","series-title":"Sex Transm Infect","first-page":"314","article-title":"Pregnancy outcomes in women infected with Chlamydia trachomatis: a population-based cohort study in Washington state","volume":"83","author":"Blas","year":"2007"},{"key":"ref9","series-title":"Sex Transm Infect","first-page":"672","article-title":"Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study","volume":"89","author":"Liu","year":"2013"},{"key":"ref10","series-title":"Eur J Epidemiol","first-page":"493","article-title":"Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study","volume":"26","author":"Rours","year":"2011"},{"key":"ref11","series-title":"J Infect Dis","first-page":"531","article-title":"Maternal gonococcal infection as a preventable risk factor for low birth weight","volume":"161","author":"Elliott","year":"1990"},{"key":"ref12","series-title":"Sex Transm Dis","first-page":"353","article-title":"Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group","volume":"24","author":"Cotch","year":"1997"},{"key":"ref13","series-title":"Am J Obstet Gynecol","first-page":"656","article-title":"Trichomoniasis in pregnant human immunodeficiency virus-infected and human immunodeficiency virus-uninfected congolese women: prevalence, risk factors, and association with low birth weight","volume":"181","author":"Sutton","year":"1999"},{"key":"ref14","series-title":"N Engl J Med","first-page":"1737","article-title":"Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant","volume":"333","author":"Hillier","year":"1995"},{"key":"ref15","series-title":"Am J Obstet Gynecol","first-page":"175","article-title":"Bacterial vaginosis and prematurity in Indonesia: association in early and late pregnancy","volume":"169","author":"Riduan","year":"1993"},{"key":"ref16","series-title":"Am J Obstet Gynecol","first-page":"965","article-title":"Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy","volume":"150","author":"Minkoff","year":"1984"},{"key":"ref17","series-title":"Intermittent Preventive Treatment of Malaria in Pregnancy Using Sulfadoxine-Pyrimethamine (IPTp-SP)","author":"World Health Organization","year":"2012"},{"key":"ref18","series-title":"A Strategic Framework for Malaria Prevention and Control During Pregnancy in the Africa Region","author":"World Health Organization","year":"2004"},{"key":"ref19","series-title":"Lancet Infect Dis","first-page":"1029","article-title":"Coverage of intermittent preventive treatment and insecticide-treated nets for the control of malaria during pregnancy in sub-Saharan Africa: a synthesis and meta-analysis of national survey data, 2009\u201311","volume":"13","author":"van Eijk","year":"2013"},{"key":"ref20","series-title":"Clin Infect Dis","first-page":"323","article-title":"Impact of sulfadoxine-pyrimethamine resistance on effectiveness of intermittent preventive therapy for malaria in pregnancy at clearing infections and preventing low birth weight","volume":"62","author":"Desai","year":"2015"},{"key":"ref21","series-title":"JAMA","first-page":"594","article-title":"Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis","volume":"309","author":"Kayentao","year":"2013"},{"key":"ref22","series-title":"Sex Transm Dis","first-page":"369","article-title":"Estimating the public health burden associated with adverse pregnancy outcomes resulting from syphilis infection across 43 countries in sub-Saharan Africa","volume":"42","author":"Kuznik","year":"2015"},{"key":"ref23","series-title":"World Health Organ Tech Rep Ser","first-page":"1","article-title":"Management of patients with sexually transmitted diseases. Report of a WHO Study Group","volume":"810","author":"World Health Organization","year":"1991"},{"key":"ref24","series-title":"Sex Transm Dis","first-page":"371","article-title":"How effective is syndromic management of STDs? A review of current studies","volume":"27","author":"Pettifor","year":"2000"},{"key":"ref25","series-title":"JAMA","first-page":"2079","article-title":"Prevalence of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa","volume":"307","author":"Chico","year":"2012"},{"key":"ref26","series-title":"Lancet","first-page":"2454","article-title":"Prevention of malaria in pregnancy: a fork in the road?","volume":"386","author":"Chico","year":"2015"},{"key":"ref27","series-title":"Malar J","first-page":"380","article-title":"High burden of malaria infection in pregnant women in a rural district of Zambia: a cross-sectional study","volume":"14","author":"Chaponda","year":"2015"},{"key":"ref28","series-title":"2010 Census of Population and Housing","first-page":"12","author":"Central Statistical Office (CSO)","year":"2011"},{"key":"ref29","series-title":"Health Management Information System (HMIS)","author":"Ministry of Health","year":"2008"},{"key":"ref30","series-title":"Acta Trop","first-page":"293","article-title":"A study of the genomic diversity of Plasmodium falciparum in Senegal. 2. Typing by the use of the polymerase chain reaction","volume":"49","author":"Mercereau-Puijalon","year":"1991"},{"key":"ref31","series-title":"Am J Trop Med Hyg","first-page":"325","article-title":"Detection of very low level Plasmodium falciparum infections using the nested polymerase chain reaction and a reassessment of the epidemiology of unstable malaria in Sudan","volume":"54","author":"Roper","year":"1996"},{"key":"ref32","series-title":"J Clin Microbiol","first-page":"297","article-title":"Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation","volume":"29","author":"Nugent","year":"1991"},{"key":"ref33","series-title":"Sex Transm Infect","first-page":"72","article-title":"Detection of Neisseria gonorrhoeae by PCR using orf1 gene as target","volume":"78","author":"Chaudhry","year":"2002"},{"key":"ref34","series-title":"Cell Mol Biol (Noisy-le-grand)","first-page":"819","article-title":"Trichomonas vaginalis: repeated DNA target for highly sensitive and specific polymerase chain reaction diagnosis","volume":"40","author":"Kengne","year":"1994"},{"key":"ref35","series-title":"Immunol Invest","first-page":"157","article-title":"DFA, EIA, PCR, LCR and other technologies: what tests should be used for diagnosis of Chlamydia infections?","volume":"26","author":"Schachter","year":"1997"},{"key":"ref36","series-title":"Maternal, Newborn, Child and Adolescent Health","author":"World Health Organization","year":"2016"},{"key":"ref37","series-title":"J Infect Dis","first-page":"948","article-title":"Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes","volume":"186","author":"Watson-Jones","year":"2002"},{"key":"ref38","series-title":"EpiData (version 3.1). A Comprehensive Tool for Validated Entry and Documentation of Data","author":"Lauritsen","year":"2003\u20132005"},{"key":"ref39","series-title":"Stata Statistical Software: Release 13","author":"StataCorp","year":"2013"},{"key":"ref40","series-title":"JAMA","first-page":"2879","article-title":"Socioeconomic status in health research: one size does not fit all","volume":"294","author":"Braveman","year":"2005"},{"key":"ref41","series-title":"Zambia Demographic and Health Survey 2013\u201314","author":"Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], ICF International","year":"2014"},{"key":"ref42","series-title":"Bull World Health Organ","first-page":"773","article-title":"Syphilis-associated perinatal and infant mortality in rural Malawi","volume":"71","author":"McDermott","year":"1993"},{"key":"ref43","series-title":"J Infect Dis","first-page":"940","article-title":"Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy","volume":"186","author":"Watson-Jones","year":"2002"},{"key":"ref44","series-title":"PLoS Med","first-page":"e1001233","article-title":"Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis","volume":"9","author":"Mabey","year":"2012"},{"key":"ref45","series-title":"Trans R Soc Trop Med Hyg","first-page":"357","article-title":"Pyrethroid-impregnated bed nets for personal protection against malaria for Afghan refugees","volume":"90","author":"Rowland","year":"1996"},{"key":"ref46","series-title":"Malar J","first-page":"31","article-title":"A cohort study of the effectiveness of insecticide-treated bed nets to prevent malaria in an area of moderate pyrethroid resistance, Malawi","volume":"14","author":"Lindblade","year":"2015"},{"key":"ref47","series-title":"Sex Transm Infect","first-page":"473","article-title":"High prevalence of sexually transmitted infections in pregnant adolescent girls in Tanzania: a multi-community cross-sectional study","volume":"91","author":"Hokororo","year":"2015"},{"key":"ref48","series-title":"Trans R Soc Trop Med Hyg","first-page":"245","article-title":"Prevalence of Chlamydia trachomatis infection in Samoan women aged 18 to 29 and assessment of possible risk factors: a community-based study","volume":"109","author":"Walsh","year":"2015"},{"key":"ref49","series-title":"Sex Transm Infect","first-page":"194","article-title":"Prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Papua New Guinea","volume":"91","author":"Wangnapi","year":"2015"},{"key":"ref50","series-title":"Am J Trop Med Hyg","first-page":"41","article-title":"The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa","volume":"71","author":"ter Kuile","year":"2004"},{"key":"ref51","series-title":"Am J Trop Med Hyg","first-page":"42","article-title":"Impairment of a pregnant woman's acquired ability to limit Plasmodium falciparum by infection with human immunodeficiency virus type-1","volume":"55","author":"Steketee","year":"1996"},{"key":"ref52","series-title":"Sex Transm Dis","first-page":"61","article-title":"Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases","volume":"19","author":"Wasserheit","year":"1992"},{"key":"ref53","series-title":"J Acquir Immune Defic Syndr","first-page":"301","article-title":"Risk factors for HIV infection among women in Dar-es-Salaam, Tanzania","volume":"7","author":"Kapiga","year":"1994"},{"key":"ref54","series-title":"Expert Rev Anti Infect Ther","first-page":"1303","article-title":"On the pathway to better birth outcomes? A systematic review of azithromycin and curable sexually transmitted infections","volume":"11","author":"Chico","year":"2013"},{"key":"ref55","series-title":"Malar J","first-page":"255","article-title":"Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy","volume":"7","author":"Chico","year":"2008"},{"key":"ref56","series-title":"Lancet","first-page":"2507","article-title":"Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial","volume":"386","author":"Desai","year":"2015"},{"key":"ref57","series-title":"N Engl J Med","first-page":"928","article-title":"Dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy","volume":"374","author":"Kakuru","year":"2016"},{"key":"ref58","series-title":"Malar J","first-page":"197","article-title":"In vivo efficacy of sulphadoxine-pyrimethamine for the treatment of asymptomatic parasitaemia in pregnant women in Machinga District, Malawi","volume":"14","author":"Gutman","year":"2015"},{"key":"ref59","series-title":"J Infect Dis","first-page":"109","article-title":"Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali","volume":"191","author":"Kayentao","year":"2005"},{"key":"ref60","series-title":"Am J Trop Med Hyg","first-page":"813","article-title":"Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection","volume":"59","author":"Parise","year":"1998"},{"key":"ref61","series-title":"JAMA","first-page":"2603","article-title":"Effect of sulfadoxine-pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review","volume":"297","author":"ter Kuile","year":"2007"},{"key":"ref62","series-title":"Med J Zambia","first-page":"234","article-title":"Factors associated with home deliveries in a low income rural setting-observations from Nchelenge district, Zambia","volume":"37","author":"Mwewa","year":"2010"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/5\/article-p1069.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/5\/article-p1069.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/5\/article-p1069.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:53:40Z","timestamp":1723067620000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/5\/article-p1069.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,2]]},"references-count":62,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0370","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,2]]}}}