Prevalence, Hematological, and Biochemical Correlates of Malaria-HBV Co-Infection among Pregnant Women in Enugu State, Nigeria

Abstract

Nigeria bears a heavy dual burden of malaria and Hepatitis B virus (HBV) globally. Because both pathogens target the liver during critical phases of their life cycles, co-infection can result in significant hematological and biochemical interactions. This study evaluated the prevalence of single and co-infections of malaria and HBV in Enugu State, as well as their impact on hematological and biochemical parameters.  A hospital-based cross-sectional study was conducted across three healthcare facilities in Enugu State. Structured questionnaires were administered to 250 consenting pregnant women to gather socio-demographic data. Body Mass Index (BMI) was recorded using standard procedures. Blood samples were collected for parasitological and microbiological evaluation using standard procedures. Automated and manual techniques were used to analyze hematological indices (hemoglobin, packed cell volume (PCV), white blood cell count (WBC), and platelets) and biochemical markers (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)). Among the 250 pregnant women sampled, the prevalence of single malaria infections was 51.2% (n=128), while the prevalence of single HBV infections was 4.8% (n=12). The antenatal profile indicated that 11.2% (n=28) of the pregnant women were HIV positive. The prevalence of malaria-HBV co-infection was found to be 8.4% (n=21), with none of the women with malaria-HBV co-infection testing positive for HIV; however, some exhibited HBV-HIV co-infection. Socio-demographic characteristics showed no significant association with any infection status (p > 0.05). Notably, single HBV infection was significantly associated with BMI (p = 0.045). Hematological analysis revealed that women co-infected with malaria and HBV had significantly lower (p < 0.05) mean hemoglobin (9.70+1.35 g/dL) and PCV (29.10+4.04%) levels compared to those with single HBV (10.90+1.32 g/dL and 32.70+3.96%) and malaria infections (10.32+1.38 g/dL and 30.96+4.14%), respectively. Other parameters did not differ significantly across groups (p > 0.05). Results suggest that there is a moderate burden of malaria-HBV co-infection among pregnant women in Enugu State, posing an equal threat across different socio-economic strata. Co-infection significantly worsens the maternal clinical profile by driving down hemoglobin and PCV levels.  Furthermore, HBV infection in overweight or obese pregnant individuals highlights the risk of gestational diabetes.