Malaria Parasite and Its Effect to Human Health
CHAPTER ONE
OBJECTIVE OF THE STUDY
This study investigated the effect of malaria on human health specifically the effect of malarial infection on blood cells at university of Uyo teaching hospital, Uyo Akwa Ibom state, Nigeria. This study investigates the ability of malaria parasites to invade and grow in different red cell populations as well as the intrinsic growth rate of the parasite
CHAPTER TWO
LITERATURE REVIEW
MALARIA GLOBAL OVERVIEW
Malaria is a disease that is associated with poverty due to poor sanitary and environmental conditions. The rich and powerful live in sanitary surroundings with easy access to medical facilities, while the poor live in crowded urban slums and remote rural areas which favour transmission. In 2006, World Health Organization (WHO) estimated that 3.3 billion persons were at risk of acquiring malaria. Of these, 247 million were infected (86% in Africa) and nearly 1 million (mostly African children) die of the infection. In 2008, malaria was still endemic in 109 countries worldwide, 45 of them in Africa.
WHO estimated that approximately 1.1 million persons were still dying of malaria (WHO, 2008). Some 11 percent of all child deaths worldwide are estimated to occur in Nigeria. Malaria is the leading cause of child death in the country and around 250,000 Nigerian children die every year from the disease. While children under the age of five and pregnant women are particularly vulnerable, almost the entire population of Nigeria is at risk of contracting malaria (Malaria Consortium, 2015).
The problem of malaria was brought to lime light at the ministerial conference on malaria held in Amsterdam in October, 1992. New global control strategy was formulated and emphasis was laid on the patient and only on prevention where it is cost effective and sustainable. Four elements were identified including disease management, vector control, epidemic control and malaria situation analysis (TDR, 1994). Then, as a follow up to the global malaria control, a plan for the control of malaria in Africa was drawn up in Brazzaville, Congo. According to the plan, by 1992, 16 out of 20 African countries proved to have malaria epidemic should have started implementing plans to prevent and control the scourge (TDR, 1994). Also by 1997, there should be a fall of 20% in the incidence of severe malaria and mortality in at least 32 of 42 countries with endemic malaria.
To meet up with the above plan a new global initiative for the control of malaria was launched in 1997 by WHO and is known as “Roll Back Malaria”. WHO in outlining the challenges of Roll Back Malaria (RBM) acknowledged the fact that one fifth (1/5th) of the world’s population is at risk of malaria and that the proportion increases yearly as a result of climate change, environmental damage, breakdown in health care and war (WHO, 1999).
As a result of the world’s renewed struggle against malaria, the African Union (AU) launched its own African for malaria control in 21st Century, which became “Roll Back Malaria in Africa”.
CHAPTER THREE
Materials and Methods
878 malaria patients who presented clinically with signs and symptoms of malaria infection in the medicine OPD and IPD. This prospective study was carried out at Department of Microbiology, Central Pathology Laboratory, MGM Medical College and Hospital, UYO, Nigeria, over a period of one year from January 2013 to December 2013.
Sampling strategy
The patient’s name, age, sex, details of history and clinical examination findings, history of blood transfusion, antimalarial treatment if any were recorded in requisition form. After obtaining informed consent, 3-5 ml blood specimens were collected in EDTA Vacutainer tube from antecubital vein of all patients by taking sterile precaution.
Microscopic examination
After collection of blood samples thick and thin smear were prepared and stained with Field stain. After drying, the slides were examined under light microscope using an oil-immersion lens (100x magnification) after putting a drop of paraffin oil. Positive result of malaria given if at least one asexual form of parasite was detected in 100 microscopic fields in thick blood film otherwise the report was given as negative. Blood parasite density was determined from the thin films by counting the number of parasites in 200 white blood cells (WBCs).
Haematological tests
Measurement of haemoglobin, red blood cells, white blood cells and platelets count were done by using ADVIA® 2120i Hematology system (SIEMENS). The cell count was cross check by experienced pathologists at Pathology laboratory, MGM Medical College and Hospital, Kamothe, UYO by using microscopy.
CHAPTER FOUR
Results and Discussion
This prospective study was carried out at Microbiology laboratory and Pathology laboratory to find the prevalence of malarial infection at tertiary care centre. Total numbers of suspected cases 4,878 were studied. Out of which 809 cases were positive for malaria. Prevalence rate were 16.58%.
Effect of malarial parasitic infection on blood cells was studied on 809 blood smear diagnosed cases of malaria in a university of uyo. Statistical analysis was done by using chi-square test, Z test and SPSS software (version 17.0).
Muhammad Idris et al.6 from Abbottabad, Pakistan, reported on 1994 patients out of 145 (7.2%) patients were found infected to malaria.
Sahar et al.7 from Muzaffargarh district, Punjab-Pakistan, reported on 10,028 suspected malaria cases, of which, 208 (2.07%) were confirmed as P. falciparum patients.
Effect of malarial infection on Haemoglobin (Hb) levels, low values of Hb were found consistently with Plasmodium falciparum as compared to Plasmodium vivax.
CHAPTER FIVE
SUMMARY AND CONCLUSION
SUMMARY
Effect of malarial infection on Red blood cell (RBC) counts, low values of RBC count were seen with Plasmodium falciparum {2-2.5 million (34%), 2.6-3(32%), 3.1-4 million (19%) and 4.1-5 million (13%)} as compared to Plasmodium vivax. Mixed species showed values closer to Plasmodium falciparum. = 27.185, df=8, (p < 0.001), significant.
Effect of malarial infection on White blood cell (WBC) count, Plasmodium falciparum cases showed low WBC counts {< 500 (47%), 5001-6000 (17%)} as compared to Plasmodium vivax (21% and 15%). This study was statistically Effect of malarial infection on platelet counts, Plasmodium falciparum consistently showed low platelet count {< 40 thousand (47%), 41-50 thousand (17% and 51-60 thousand (13%)} as compared to Plasmodium vivax (21%, 11% and 10%) respectively. This study was statistically significant = 36.222, df=22, (p < 0.029).
Christopher Igbeneghu et al.8 from Southwestern Nigeria reported on 733 malaria subjects. Mean values of haematocrit, leucocyte, platelet and haemoglobin concentration for subjects with mixed Plasmodium spp. were significantly lower than those for subjects with P. falciparum only or P. malariae only. Mean parasite density of mixed
Plasmodium spp. infection was significantly higher than that of P. falciparum only or P. malariae. Mixed Plasmodium spp. exhibited positive interactions resulting in aggravated effect
Manas Kotepui et al. 9 from Thailand studied that red blood cells (RBCs) count, haemoglobin (Hb), platelets count, white blood cells (WBCs) count, neutrophil, monocyte, lymphocyte and eosinophil counts were significantly lowered in malarial infection. Thrombocytopenia was present in 84.9% of malaria-infected patients (P value < 0.0001).
CONCLUSION
The conclusion of the study is out of 4878 suspected cases of malaria, malarial parasites were detected in 809 blood smear (16.58%). Effect of malarial infection on Haemoglobin (Hb) levels, low values of Hb were found consistently with Plasmodium falciparum On Red blood cell (RBC) counts, low values of RBC count were seen with Plasmodium falciparum and mixed species showed values closer to it. Plasmodium falciparum cases showed low WBC counts. Plasmodium falciparum consistently showed low platelet counts. This study suggests that Plasmodium falciparum infection have more effects on blood cells than other malarial parasite. All these findings were statistically significant
significant = 151.788, df=14, (p < 0.001).
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- Muhammad Idris, Javed Sarwar, Jamila Fareed. Pattern of malarial infection diagnosed at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2007; 19(2):35-36.
