Evaluation of Malaria Treatment Among People Living With HIV/AIDs
Chapter One
Objective of the research
The broad objective of the study is to evaluate malaria treatment among people living with HIV/AIDs, however, the specific objectives are:
- To ascertain the first line of actions by the HIV/AIDs patients when infected with malaria
- To ascertain the challenges of treatment
- To ascertain the relationship between socio-clinical characteristics and malaria treatment.
CHAPTER TWO
REVIEW OF RELATED LITERATURE
This chapter reviews the literature on the evaluation of malaria treatment among people living with Hiv/Aids. It discusses issues arising from the topic of interest as viewed from different perspectives, with a view of giving a theoretical and empirical foundation to the study.
LITERATURE REVIEW
Available research findings suggests that both human immunodeficiency virus (HIV) and malaria parasite infection act synergistically resulting in worse health outcomes Skinner et al 2008. Anemia, increase plasma viral load and decrease CD4 count among HIV infected are some of the worse health outcomes due to frequent episodes of symptomatic malaria Hochman S and Kim K(2009) Hochman S and Kim K(2009)Tay et al (2015). HIV may facilitates geographic expansion of malaria in areas where HIV prevalence is high. Therefore repeated increase in HIV viral load due to recurrent co-infection may be an important factor promoting the spread in sub-Sahara Africa Alemu et all (2013). In tropical countries pathophysiological, clinical and epidemiological interactions between HIV and pathogenic organisms especially malaria parasites constitute a concern of public health implication [6]. Opportunistic infections caused by viruses, parasites, bacteria, fungi and other pathogens remain as major causes of mortality among HIV patients [7]. Daily cotrimoxazole chemotherapy is recommended by the world health organization (WHO) as a major strategy of preventing opportunistic infections among HIV infected clients in Sub-Saharan Africa [8]. Despite strong research evidence of its strong antimalarial prophylactic properties, the efficacy and long term usage may be limited because of potential antifolate resistance drawback [9]. HIV and malaria infection particularly with plasmodium parasites are both pathogens that induce significant perturbation and activation of the immune system. Both pathogens (HIV and malaria) may be contributing factors in the modification of each other’s development, disease severity and disease progression rate [10]. The greatest burden of disease due to both HIV and malaria (predominantly Plasmodium falciparum) occurs commonly in Sub-Saharan Africa [11]. The potential consequences of both diseases’ interaction, including understanding their reciprocal effects on host immune response and their combined effect on host response to other pathogens is important [11]. Infection of HIV and malaria are among the two most important global health problems of developing countries including Nigeria which was reported to cause more than 4 million deaths a year, with HIV infection increasing the risk of and severity of malaria infection and burdens [12]. Furthermore, HIV in turn facilitates the rate of malaria transmission which in turn causes strong CD4 cell activation and up-regulation of pro-inflammatory and cytokines production which create an ideal microenvironment for the spread of HIV among CD4 cells for rapid HIV-1 replication Alemu et all (2013). HIV infection and malaria is worrisome because they coexist mostly in African countries Alemu et all (2013)Akenji et all (2013) but studies differs in their findings on the interactions between the two infections [15] [16]. In an environment where malaria is common, the incidence of clinical malaria episodes is reported to be higher in patients with CD4 cell counts 500 cells/μl. [17]. Hence high incidence of fever identified among immunosuppressed adults may lead to misclassification of illness episodes as malaria [17]. HIV and malaria both destroy important cells required for proper immunological and hematological functioning of the body [18]. Enhanced T-cell activation in HIV and malaria co-infected patients could worsen the immune response to both diseases Chavele H et all (2005). Non-immune HIV-infected patients are significantly more likely to have severe malaria than non-immune non-HIV-infected patients with odds ratio, 4.15 (95% confidence interval, 1.57–10.97; p = 0.003) Chavele H et all (2005).
CHAPTER THREE
RESEARCH METHOD
This chapter describes the procedure to be adopted in carrying out the study. It is presented under the following sub-headings: design of the study, area of the study, population of the study, sample and sampling technique, instrument for data collection, validation of the instrument, reliability of the instrument, method of data collection and method of data analysis.
Design of the Study
The design for this study was a descriptive survey research design. Descriptive survey research design, according to Nworgu (2006), aims at collecting data on, and describing in a systematic manner, the characteristic features or facts about a given population. This research design was considered appropriate for this study because it describes a situation as it is and identifies present conditions of the existing situation. Hence, the research design helped the researcher to have in-depth and representative information on the evaluation of malaria treatment among people living with Hiv/Aids.
Area of the Study
The study was conducted in primary schools in Nsukka Education Zone of Enugu State. We included HIV infected male and female adult patients aged 18 years and above receiving HIV care and treatment services at General Hospital Umuguma owerri, Imo State. These patients were duly registered into the HIV care and treatment program in the hospital and had willfully consented by signing consent forms to participate in the study. The familiarity of the researcher with the terrain and location of the school in the area for easy distribution and collection of data also necessitated the choice of General Hospital Umuguma.
Population of the study
Population of a study is a group of persons or aggregate items, things the researcher is interested in getting information regarding the malaria treatment among persons with Hiv/Aids. 200 Hiv/Aids infected persons undergoing malaria treatment were selected randomly by the researcher as the population of the study.
CHAPTER FOUR
PRESENTATION OF RESULT
The results of the study are presented in tables in accordance with the research questions guiding the study.
Research Question 1:
- What is the first line of actions by the HIV/AIDs patients when infected with malaria?
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
INTRODUCTION
It is important to reiterate that the objective of this study was the evaluation of malaria treatment among people living with Hiv/Aids.
In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in evaluation of malaria treatment among people living with Hiv/Aids.
SUMMARY
This study was undertaken to study the effects of computerized accounting systems on the control of payroll fraud in Nigeria public sector. The study opened with chapter one where the statement of the problem was clearly defined. The study objectives and research hypotheses were defined and formulated respectively. The study reviewed related and relevant literatures. The chapter two gave the conceptual framework, empirical and theoretical studies. The third chapter described the methodology employed by the researcher in collecting both the primary and the secondary data. The research method employed here is the descriptive survey method. The study analyzed and presented the data collected in tables and the hypotheses were tested using the Spearman Rank Order While the fifth chapter gives the study summary and conclusion.
CONCLUSION AND RECOMMENDATIONS
HIV infection affects the clinical presentation, severity and response to treatment of malaria cases. The clinical impact of these interactions varies depending on the intensity of malaria transmission in the area (and consequent level of host immunity) and the individual affected (e.g. adult, child or pregnant woman) (Kamya, 2000). However, in different malaria HIV co-endemic countries there has been little or no research conducted regarding this topic. The aim of this article is, therefore, to review existing information about HIV malaria interactions, the effect of malaria on HIV transmission and progression and the implications related to prevention and treatment of coinfection.Infection of HIV and malaria are among the two most important global health problems of developing countries including Nigeria which was reported to cause more than 4 million deaths a year, with HIV infection increasing the risk of and severity of malaria infection and burdens. In this project we found out that that patients are of the view that even if the hospitals can handle their cases they still prefer to peform self-medication but still agree that hospital treatment is the best and that the challenges experienced during the cause of treatment have not been met to a high extent, finally we found that there are relationships between socio-clinical characteristics and malaria treatment which affect the way they want to receive treatments to a high extent.
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