Determinants of Hemoglobin Levels at Antenatal Enrollment: Impact of Malaria Infection and HIV among Pregnant Women in Bamenda, Northwest Cameroon

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.