Background. Anaemia is common in sub-Saharan Africa, and parasitic infections could worsen its burden during pregnancy. Moreover, women become susceptible to malaria during pregnancy. We investigated Plasmodium falciparum (P. falciparum) and Schistosoma haematobium (S. haematobium) infections and determined their association with anaemia during pregnancy. Methods. A cross-sectional study involving 707 pregnant women attending antenatal care visits (ANC) and 446 at delivery was conducted in Battor and Adidome hospitals. Pregnant women were screened by microscopy and qPCR for P. falciparum and S. haematobium infections. Haemoglobin (Hb) levels were determined, and most participants received intermittent preventive treatment during pregnancy (IPTp) during ANC till delivery. Regression analyses were performed for associations between parasite infection and anaemia. Results. P. falciparum microscopy prevalence at ANC and delivery was 8% and 2%, respectively, and by PCR 24% at ANC and 12% at delivery. Anaemia prevalence at ANC was 52% and 49% at delivery. There was an increased risk of anaemia with P. falciparum infection ( ; ). IPTp ( ) and age ( ) were associated with increased Hb levels at delivery. S. haematobium prevalence by microscopy was 4% at ANC and 2% at delivery. No significant correlation between S. haematobium and Hb levels was observed ( g/dl; ). Conclusion. High anaemia prevalence was observed during pregnancy, and P. falciparum infection was associated with anaemia at ANC. Low S. haematobium prevalence could be attributed to previous praziquantel treatment during mass drug administration. Routine diagnosis and treatment of S. haematobium infections in endemic areas could be initiated to reduce schistosomiasis during pregnancy.

Background: Soil Transmitted helminths and schistosomiasis may have implications for pregnancy outcomes especially, in rural communities. In Adidome (a rural community) and Battor (a semi-rural community), soil and water contact activities expose inhabitants to helminth infections. There is, however, limited information on the prevalence and determinants among pregnant women in these areas. The present study was conducted to access the prevalence, knowledge and perceptions about helminthiasis among pregnant women accessing obstetric care at Adidome Government Hospital and Battor Catholic Hospital in the Volta region of Ghana. Methodology/Principal Findings: A cross-sectional survey was conducted by recruiting 1,295 pregnant women out of which only 616 representing 47.5% provided stool samples for analysis. Sociodemographic characteristics and participant knowledge on helminth infection transmission, symptoms and prevention were collected by questionnaire and analyzed using STATA. Preserved stool specimen were processed and examined for helminth eggs by Kato Katz, and genomic DNA extracted from aliquots, was tested for S. mansoni and N. americanus . Prevalence of helminths and participant knowledge were expressed in proportions. Chi-square and Fisher’s exact test were used to show association at P < 0.05 significant level. Intestinal helminth infections found among participants at ANC were T. trichiura (0.4%), N. americanus (0.4%) and S. mansoni (0.4%). At delivery, a PCR prevalence of 5% was observed for S. mansoni . A high proportion of study participants, 82.5% in Adidome and 87.1% in Battor do not take dewormers on regular basis. Also, a high proportion of participants did not receive any dewormer prior to sample collection. Although knowledge on helminth transmission, risks and prevention were low, levels of prevalence of infection with helminths were also low. Conclusion/Significance: Intensifying health education as community-based interventions is necessary for the total and effective control and elimination of schistosomiasis and STH in the study area. Author summary: Adidome and Battor are two communities sited close to the Volta Lake which is known to be infested with intermediate hosts for schistosomiasis. Consequently, there has been continued efforts towards control by mass deworming especially among pre-school and school-going children. Despite these control efforts, infections persist as older age groups including pregnant women are often left out of such programs. The fertile soil in the Volta basin encourages farming activities which further expose the people to soil transmitted helminths. There is therefore a need to evaluate community knowledge on helminth infection and precautions to be taken to improve on the control efforts in the areas. The study selected two district Hospitals (a private Hospital in Battor and a government Hospital in Adidome) as study sites. Stool samples collected from pregnant women reporting for the first antenatal care and for delivery were examined for the presence of helminths. Knowledge about helminths among participants were collated by questionnaire. Although prevalences of helminth infections were low, knowledge about helminth infections were also low. However, participants from Battor appear more knowledgeable about helminth infections than those in Adidome. Our study therefore suggests intensive public health education as an intervention for control.

Ghana has made significant strides in maternal healthcare under the National Health Insurance Scheme, but more effort is required to achieve the Sustainable Development Goal 3.1 target of <70 deaths/100,000 live births from the current 308 deaths/100,000. This study sought to investigate knowledge about ANC, ANC attendance, knowledge about malaria and IPTp among pregnant women, visiting a government Hospital in Mafi-Adidome (a rural community) and a private Hospital in Battor-Dugame (a rural-urban community) in the Volta region (a high malaria endemic area in Ghana). A total of 1295 consenting pregnant women participated in the study. Information on sociodemographic characteristics, knowledge about ANC, IPTp and knowledge about malaria were collected by questionnaire. Chi-square tests were used to compare proportions of variables across the two study sites. Higher proportion (70.8%) of participants accessing Battor Catholic Hospital showed adequate knowledge about ANC than 38.1% in Adidome Government Hospital ( X ² (7) =105.11; p<0.001). Also, higher numbers (46.6%) in Battor Catholic Hospital showed adequate knowledge on the timing for IPTp administration than 21.1% in Adidome Government Hospital ( X ² (2) =83.37; p80%) possess and use mosquito bed nets for malaria prevention. A lower proportion (46.6%) of participants in Battor Catholic Hospital made the WHO recommended 4-7 visits compared to 50.2% participants in Adidome Government Hospital. Age, marital status, employment and education influenced utilization of antenatal and delivery services. More sensitization on the importance of ANC and hospital delivery is needed in the study areas.

Background: HLA-G (Human Leukocyte Antigen-G) is a non-classical molecule belonging to the major histocompatibility complex (MHC) class I family, located on chromosome 6 within the MHC region, which is pivotal in promoting immune tolerance. The immune-suppressive ability of Human Leukocyte Antigen (HLA-G) and its binding to fetal maternal interface predispose pregnant women to Plasmodium falciparum ( Pf ) infection and pregnancy loss, respectively. Alterations in hematological parameters may accelerate the severity of malaria infection. Limited data is available about the effects of malaria infection on hepatocytes and how this endangers the lives of the mother and the fetus due to liver injury. Thus, this study evaluated HLA-G and Hematobiochemical levels and their association with malaria infection and miscarriage among pregnant women in the Ghanaian population. Materials and Methods: This case-control study recruited forty-six (46) Pf -infected pregnant women and forty-six (46) Pf -uninfected pregnant women from the Bibiani Anhwiaso Bekwai Municipality, Ghana. A well-structured questionnaire was administered to obtain sociodemographic and clinical data from 21 ^st December 2022–20 ^th December 2023. 10 ml venous blood samples were collected from each participant for Pf parasite testing using the Pf HRP2 RDT test kit (CareStart TM Malaria PfHRP2/pLDH Ag RDT, Access Bio, Inc., USA), and the results were confirmed with microscopy. Hematobiochemical profile analyses were done using the Sysmex automated hematology and chemistry analyser. Plasma HLA-G levels were quantified using a sandwich ELISA (Maxisop ELISA plate), and their corresponding concentrations were determined. Results: The results shows a significant difference in the use of IPT-SP and Pf infection, with 31(67.4%) for Pf positive vs 18(39.1%) for Pf negative among those who were not on IPT-SP and 15(32.6%) for Pf positive vs 28(60.9%) for Pf negative for those who were on IPT-SP (p = 0.007)., Multivariate regression crude analysis shows increased ALT levels among the malaria-infected pregnant women [β = 7.091(95% CI = 1.563–32.182) p = 0.011] compared to the negative group. This finding was insignificant after adjusting for age, IPT-SP use and Trimester. ALP, on the other hand, shows significantly increased levels among the malaria-infected pregnant women compared to the malaria-negative pregnant women for both crude [β = 13.301(95% CI = 1.577–112.208) p = 0.017] and adjusted [β = 17.524(95% CI = 1.534–200.20), p = 0.02] analysis. In a comparative analysis, we found that GLR (G) and PLR (H) levels were significantly higher in participants with Pf infections compared to participants without Pf infection ( p < 0.05). We also found that women with a history of miscarriage had considerably higher sHLA-G levels [50.14 (36.30–71.00) vs. 35.44(31.84–42.72)] than women with no history of miscarriage. Conclusion: Pf infection in pregnant Ghanaian women was associated with elevated ALP, GLR, and PLR, indicating hepatic dysfunction and systemic inflammation. The non-use of IPTp-SP among pregnant women was significantly associated with active Pf infection, highlighting the importance of chemoprophylaxis. Increased sHLA-G levels in women with miscarriage suggest an immunological link to pregnancy loss. Further prospective investigation of sHLA-G as a biomarker of adverse pregnancy outcome in malaria-endemic settings with a larger sample size is required.

Background: The coexistence of type 2 diabetes mellitus (T2DM) and malaria presents a significant public health concern, particularly in malaria-endemic regions. T2DM’s immunomodulatory effects may influence immune responses to infectious diseases, but its impact on naturally acquired antibodies against malaria vaccine candidate antigens remains unclear. This study investigated how T2DM-malaria comorbidity affects IgG responses to malaria vaccine candidate antigens (GLURP-R2, GLURP-RO, MSP3, MSP1, AMA-1 and CSP) among individuals in the Central Region of Ghana. Methods: This hospital-based case-control study recruited a total of 144 participants 40 with diabetes, 25 with both diabetes and malaria, 41 with malaria only, and 38 controls (hospital staff without malaria or diabetes matched by age and sex). Malaria status and parasitaemia were confirmed using microscopy, blood glucose levels were measured via glucometer, and antibody levels were quantified using indirect ELISA. Data were analyzed using parametric and non-parametric statistical methods. Results: Patients with malaria-diabetes comorbidity exhibited significantly higher parasitaemia levels compared to those with malaria alone [1702 (IQR1 = 926.50, IQR3 = 4102) vs. 932 (IQR1 = 722.50, IQR3 = 1321), p = 0.02]. Relative to the negative control group, IgG responses to GLURP-R2 were markedly elevated, showing a 1.60-fold increase in the comorbidity group (β = 0.47 [95% CI: 0.10–0.83], p = 0.01) and a 1.43-fold increase in the malaria-only group (β = 0.36 [95% CI: 0.04–0.69], p = 0.03). Among individuals with comorbidity, IgG levels to GLURP-R0 and MSP1 were also 1.43-fold higher (β = 0.36 [95% CI: 0.03–0.68], p = 0.03) and 1.42-fold (β = 0.35 [95% CI: 0.09–0.61], p < 0.05), respectively. Conversely, antibody responses to MSP3, AMA1, and CSP did not differ significantly between the study groups (p > 0.05). In the multivariate regression model adjusted for age and sex, individuals with comorbidity exhibited significantly elevated IgG responses, showing a 1.38-fold increase to GLURP-R0 (β = 0.32 [95% CI: 0.07–0.59], p = 0.027) and a 1.34-fold higher response to MSP1 (β = 0.29 [95% CI: 0.02–0.47], p = 0.048), relative to the malaria-only group. Conclusion: These findings suggest that diabetes may enhance malaria parasite multiplication while also augmenting IgG antibody responses to malaria vaccine candidate antigens in individuals with comorbidity. Further research is required to elucidate the mechanisms by which diabetes influences antibody responses to malaria infection and its potential implications for malaria vaccine development.

Aim: In sub-Saharan Africa, approximately 40 million pregnant women are exposed to parasitic diseases such as malaria caused by Plasmodium falciparum, Schistosome parasites, and soil-transmitted helminths (STHs). When parasitic diseases share the same habitat and overlap in distribution, then high co-infection rates occur. The co-infection can lead to consequences for the child, such as intrauterine growth retardation, low birth weight, pre-term delivery, and neonatal mortality. Methods: The objective of the study was to determine the nature and extent of coinfection from 100 samples collected from the Battor (50) and Adidome (50) towns of Ghana in collaboration with the Noguchi Memorial Institute for Medical Research, University of Ghana. Results: Out of 50 for the Adidome towns determined for P. falciparum by Rapid Diagnostic Test (RDT), Malaria Pan-specific Antigen (PAN), and Malaria Pf kit, 39 were true positive (TP), 8 were true negative (TN), and 30 were false negative (FN). For Battor, 19 were TP, 12 TN, and 20 FN. For S. mansoni in Adidome via polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), 21 tested positive, and 29 were negative, with 52.5% sensitivity and 100% specificity. For S. haematobium, 28 were positive and 22 negative using PCR with 70% sensitivity and 100% specificity. In LAMP, 28 were positive, and 22 negatives, with 70% sensitivity and 100% specificity. In Battor PCR for S. mansoni, 28 positives and 22 negatives with 68.3% sensitivity and 100% specificity. In LAMP, 32 were positive, and 18 were negative, with 80% sensitivity and 100% specificity. For S. haematobium, PCR showed 30 positive and 20 negative, with 73.2% sensitivity and 100% specificity. With LAMP, 21 were positive, and 29 negatives, with 51% sensitivity and 100% specificity. In both towns, 20–30 years had the highest infection prevalence for P. falciparum, S. mansoni, S. haematobium, and Strongyloides stercoralis. Conclusion: The results will be utilized as a part of the continuous surveillance for future research aiming at gathering nationally representative data in Ghana on the prevalence of coinfection and proposing interventions based on that for the vulnerable pregnant women population.