Assessment of Some Haemotological Parameter on Malaria Patient
CHAPTER ONE
OBJECTIVE OF THE STUDY
The aim of this study was to determine changes in the hematological parameters of patients with malaria infection in Nigerian population of Africa. Alterations in the hematological indices may strengthen the suspicion of malaria, prompting more meticulous search for malaria parasite, and timely institution of specific therapy. George and Ewelike Ezeani (2002).
CHAPTER TWO
LITERATURE REVIEW
Malaria is a mosquito-borne infectious disease of humans and other animals caused by protists (a type of microorganism) of the genus Plasmodium. It begins with a bite from an infected female mosquito, which introduces the protists via its saliva into the circulatory system, and ultimately to the liver where they mature and reproduce. The disease causes symptoms that typically include fever and headache, which in severe cases can progress to coma or death. Malaria is widespread in tropical and subtropical regions in a broad band around the equator, including much of Sub-Saharan Africa, Asia, and the Americas.
Five species of Plasmodium can infect and be transmitted by humans. The vast majority of deaths are caused by P. falciparum while P. vivax, P. ovale, and P. malariae cause a generally milder form of malaria that is rarely fatal. The zoonotic species P. knowlesi, prevalent in Southeast Asia, causes malaria in macaques but can also cause severe infections in humans. Malaria is prevalent in tropical regions because the significant amounts of rainfall, consistently high temperatures and high humidity, along with stagnant waters in which mosquito larvae readily mature, provide them with the environment they need for continuous breeding. Disease transmission can be reduced by preventing mosquito bites by distribution of mosquito nets and insect repellents, or with mosquito-control measures such as spraying insecticides and draining standing water.
The World Health Organization has estimated that in 2010, there were 216 million documented cases of malaria. Around 655,000 people died from the disease (roughly 2000 per day), most of whom are Patients in Africa.[1] The actual number of deaths may be significantly higher, as precise statistics are unavailable in many rural areas, and many cases are undocumented. Malaria is commonly associated with poverty and is also a major hindrance to economic development.
Despite a clear need, no vaccine offering a high level of protection currently exists. Efforts to develop one are ongoing. Several medications are available to prevent malaria in travelers to malaria-endemic countries (prophylaxis). A variety of anti-malaria medications are available. Severe malaria is treated with intravenous or intramuscular quinine or, since the mid-2000s, the artemisinin derivative artesunate, which is superior to quinine in both Patients and adults and is given in combination with a second anti-malaria such as mefloquine. Resistance has developed to several anti-malaria drugs, most notably chloroquine and artemisinin.
MEANING OF MALARIA
The word malaria comes from 18th century Italian mala meaning “bad” and aria meaning “air”. Most likely, the term was first used by Dr. Francisco Torti, Italy, when people thought the disease was caused by foul air in marshy areas. It was not until 1880 that scientists discovered that malaria was a parasitic disease which is transmitted by the anopheles mosquito. The mosquito infects the host with a one-cell parasite called plasmodium. Not long after they found out that Malaria is transmitted from human-to-human through the bite of the female mosquito, which needs blood for her eggs.
CHAPTER THREE
MATERIALS AND METHODS
SELECTION OF SUBJECTS:
This was a prospective study involving Patients (from 1year to 10 years) with malaria parasitaemia in which the full blood count is compared with Patients without malaria parasitaemia (control) at the General Hospital Owerri , Nigeria from March to May 2007. Those with concomitant illnesses such as bronchopneumonia and sickle cell anaemia were excluded from the study. Patients who satisfied the inclusion criteria were enrolled after informed consent from parents/guardians. Ethical approval was obtained from Ethics Committee of the UPTH. Collection of blood sample: A standard clean venepuncture technique was used to collect 5mls of blood into a dipotassium EDTA bottles and samples were analysed within 24 hours of collection. Laboratory assessment of hematological parameters/malaria parasite: All the haematological parameters were carried out by manual methods as described by Bain (1996). Haemoglobin concentration was determined by the cyanmethaemoglobin method as described by Babara and Bates (2001) , packed cell volume by microhaemotocrit method while white blood cell (WBC) count and differentials were estimated using the method of Dacie and Lewis (1991). Platelet count was performed using the International Committee on Standards in Hematology (ICSH) approved procedures (Jeremiah and Oburu 2010). Platelets were counted under the microscope using the improved Neubaeur counting chamber. Results were expressed as platelet × 109/L. As a quality control measure, a thin smear of each sample was made and stained with Giemsa stain. The Giemsa-stained film was examined under the light microscope to rule out platelet clumps and to ensure that the platelets were spread evenly before the actual count was done by a trained biomedical scientist/hematologist. Malaria parasite was detected using the quantitative buffy coat (QBC) technique as developed by Becton-Dickinson. Species were identified by thick blood film microscopic examination. QBC is a relatively new method of identifying the malaria parasite in peripheral blood. The key features of the method are centrifugation and staining of centrifuged and compressed cell layer with acridine orange in a predictable area of the QBC tube and its examination under ultraviolet (UV) light source.
CHAPTER FOUR
RESULTS
A total of 100 Patients were recruited for the study. Fifty Patients had P.falciparum malaria while the remaining was negative and were used as controls. There were 30 males and 20 females giving a male: female ratio of 1:1.5. Of the Patients with malaria 32 (64%) were below 5 years while 18 (36%) were above 5 years. Table 1 shows the mean value of the hematological parameters in patients and control subjects. There was significant reduction in the hemoglobin and platelet levels in Patients with malaria compared to the control (P≤ 0.05). Neutrophil level in the subjects with malaria was lower than the control (P> 0.05). The mean monocyte count was low in subjects with malaria but higher when compared with the control (P≤ 0.05). Table 2 shows progressive decrease in the platelet count with the severity of malaria (P≤ 0.05).
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
DISCUSSION
Malaria infection remains a serious health problem in sub-Saharan Africa including Nigeria (Ekanem, 1991; Dzeing-Ella et al. 2005). We found significant reduction in the haemoglobin concentration in Patients with malaria parasitaemia compared to controls and our findings is similar to an earlier finding (Ho and White, 1999). High levels of parasitaemia particularly with P.falciparum cause more destruction of red blood cells hence reducing haemoglobin levels leading to anaemia. This may be as a result of haemolysis of parasitized red blood cells, accelerated removal of parasitized red blood cells and ineffective erythropoiesis (Bashawri et al., 2002). There was a significantly reduced mean total white blood cell (WBC) count among the Patients with malaria infection than the control in this study. Our finding is in consonance with reports of Ho and white. However, recently an Indian study found leucocytosis in malaria infected Patients which is at variance with our finding (Maina et al. 2010) which found normal values. Furthermore, white blood cell differentials like lymphocyte and neutrophils were normal in Patients with malaria and control. Although, significantly lower values were observed among Patients with malaria than the control. Nonetheless, monocyte count of Patients with malaria in our study was low, but higher than the control (P<0.05). Phagocytosis of malaria pigment by monocytes may be responsible for the relatively higher figures in the malaria infected subjects than the control. Low levels of monocytes and lymphocyte in malaria had been reported previously (Erhart et al., 2004).
CONCLUSION
In conclusion, malaria infection is an important factor that alters hematological indices in Patients in Nigeria. Presence of thrombocytopenia in a patient with acute febrile illness in the tropics increases the probability of malaria and enhances prompt initiation of treatment. Also the degree of thrombocytopenia may be a useful tool in the determination of severity of malaria infection in the tropics.
RECOMMENDATION
From the result of the work carried out, I recommend that every household in Nigeria should use malaria prevention tools and methods to avoid malaria infection which will lead to death if not treated and also keep the environment clean to avoid outbreak of mosquito.
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