BY
SARKI
ALHAJI
AUGUST,
2009
ABSTRACT
A study of Malaria Parasites among children aged
1-10 years attending Specialist Hospital and Federal Medical Centre Gombe,
Gombe State, was conducted between March and May 2009. Blood smears were
obtained from 200 children from the two hospitals, forty five of the children
were tested again using rapid test kits method for Plasmodium falciparum only. Out of the 200 children examined, 128
(64%) had plasmodium infections. With Specialist Hospital Gombe 63 (96.9%)
having a higher prevalence rate than Federal Medical Centre Gombe 65 (48.1%)
(Table 1&2). Furthermore, the prevalence of plasmodium infections showed
that there was no significant difference among the age groups, with age group
4-6 (17.5%) and 7-10 (17.5%) having the same prevalence rates respectively, age
groups 1-3 (29%) having highest prevalence rate. Males (34%) had a significant
higher prevalence rate than females (30%). The study revealed that Malaria is a
major public health problem among the children aged 1-10 years in Gombe. Hence,
preventive measures are necessary.
INTRODUCTION
Background
of the Study
Malaria
is an acute and chronic disease caused by an obligate intracellular protozoan
of the genus plasmodium (Eneanya, 1996).
The Malaria parasite was discovered
in 1880 by Laveran a military physician working in Constantine Algeria
(Ksogstad, 1996).
Malaria
is a parasitic disease of mammals including birds and reptiles. It is the most
common disease amongst school children and young adults in Africa. (CDC, 2000).
Malaria
is a life threatening diseases transmitted by the female anopheles mosquito.
Malaria is by far the most important insect transmitted disease (Curtis, 1991).
The
female mosquito needs blood meal for egg development, hence the need to bite.
Out of approximately 430 known species of anopheles, only 30-50 transmit
malaria in nature (FMOH, 1991).
The successful development of the malaria
parasite in the mosquito vector (from the “gametocyte” stage to the
“sporozoite” stage) depends on several factors. The most important is ambient
temperature and humidity (higher temperatures accelerate the parasite growth in
the mosquito) and whether the anopheles survives long enough to allow the
parasite to complete its cycle in the mosquito host (“Sporogonic” or extrinsic”
cycle, duration is 10 to 18 days). Differently from the human host, the
mosquito host does not suffer noticeably from the presence of the parasites
(CDC, 2006).
The
vectors of human malaria all belong to the genus Anopheles whose adults are
recognized by their “tail in the air” posture, dapped wings in most tropical
species and long pair of palps beside the proboscis in the female (Curtis,
1991).
Malaria
remains the important parasitic disease in the tropics with over half of the
world’s population being at risk. In African alone, malaria has been estimated
to cause the dearth of million children annually (WHO, 2003).
WHO
estimate that there are 300-500 million cases of clinical malaria per year,
with 1.4-2.6 million deaths, mainly among African children (WHO, 2003).
Malaria
is therefore a major cause of infant mortality and is the only insect borne
parasitic disease comparable in impact to the world’s major killer disease like
diarrhea, acute respiratory infections, tuberculosis and AIDS (Curtis, 1991).
In
Nigeria, malaria is the most common cause of out patient to hospitals and it
consistently rank among the three most important cause of death among children
(CDC, 2000).
Four
species of malaria parasites can affect humans under natural conductions:
Plasmodiurn falciparum, P. vivax, P. ovale and P. malariae. The first two
species cause the most infections worldwide. Plasmodium faicIparum is the agent
of severe, potentially fatal malaria, causing an estimated 700,000-2.7 million
deaths annually, most of them in young children in Africa (CDC, 2006).
Plasmodium
vivax and P. ovale have dormant hirer state parasites (“hypnozoites”), which
can reactive (“relapse”) and cause malaria several months or years after the
infecting mosquito bite (CDC, 2006).
Plasmodium malariae produced
long-lasting infections and if left untreated can persist asymptomatically in
the human host for years, even a life time (CDC, 2006).
Justification
of the Study
·
Information on malaria
at local level is scanty and the effects of the diseases on the population are
not well documented for which reason, this study has been designed to provide
baseline pre-control data required for planning.
·
Plasmodium falcparum is
the most virulent in the tropics and is resistant to various anti-malaria
drugs.
·
Scope
and Limitation of the Study
This
study is restricted to two hospitals in Gombe i.e. Federal Medical Centre and
Specialist Hospital Gombe as sample hospitals for samples collection and
analysis.
Aims
and Objectives
The
aim of this study is to screen children for the species of
Plasmodium causing malaria in
humans.
The
objective is to determine the prevalence of malaria among children between the
ages of 1-10 years.
MATERIALS
AND METHOD
Study
Area
The area of the study
is the federal medical centre Gombe and Specialist Hospital Gombe, the capital
of Gombe State Lies between latitude 110 81 N and 110
241 N, longitude 110 021 E and 110
181 E. It has a population of about 2.1 million people and an area
of 18,000 km2. The temperature averages 30°C with an annual rainfall
of 52cm, the predominated occupation of its people is agricultural and
livestock rearing.
Study
Population and Sample Size
This study was done on
children aged 1-10 years attending Federal Medical Centre and Specialist
Hospital Gombe. Two hundred children were screened within three months i.e.
Mach, April and May for the presence of malaria parasites. 135 children were
screened in Federal Medical Centre where as 65 children in Specialist Hospital
Gombe.
Laboratory
Procedures
Sample
Collection
Blood samples were
collected with care and adequate safety precautions to ensure test result are
reliable, contamination of the samples was avoided and infection from blood
transmissible pathogens was also prevented. Protective gloves were worn when
collecting and handling blood samples. The blood samples were collected into
EDTA bottle/container which were labeled with information such as Name of the
Patient, Date, Sex, Age, Laboratory and Hospital Numbers.
Thin/Thick
Blood Film Preparation
A small drop of blood
was placed on a clean microscopic slide near the end of a slide, a spreader was
used to smear a blood steadily across the slide in a steady even movement at an
angle of 45°, and the slide was allowed to dry and labeled appropriately.
Staining
Procedure
1
volume of Leishman stain was flooded on the slide for few minutes, 2 volumes of
buffered distil water of PH 6.8 was added and left for further 10 minutes, the
slide was washed thoroughly under tap water to differentiate (the colour should
be salmon pink), the slide was left to dry and back of the slide was clean with
cotton wool soaked in alcohol.
Microscopic
Examination
A
drop of oil immersion was placed on a stained slide and viewed under compound microscope
in order to identify the Plasmodium parasites as well as the intensity of the
parasites. Positive or negative results were recorded accordingly.
Test
Kits Procedure
The
test kits method was used in 45 samples as fast diagnostic method for Plasmodium
falciparum.
The
sealed pouch was opened by tearing along the notch, test strip from the pouch
was removed, 10il sample was added on the absorbant area of test strip and the
diluent for three drops was added, the result was read at 10 minutes in a
result area.
RESULTS
Table
1 shows the distribution of Malaria in relation to age in Specialist Hospital
Gombe. Out of 65 children that were tested, age 1-3 years 28 were tested and
these number 28 (43.1%) were found infected, age 4-6 years 17 were tested and
16 (24.6%) were found infected and also age 7-10 years 20 were tested and 19
(29.2%) were found infected.
Table
2 shows the distribution of Malaria in relation to age in Federal Medical
Centre Gombe. Out of 135 children that were tested, age 1-3 years 64 were
tested and 30 (22.2%) were found infected, age 4-6 years 36 were tested and 19
(14.1%) were found infected and age 7-10 years; 35 were tested and also 16
(11.9%) were found infected.
Table
3 shows the overall distribution of Malaria in relation to age. Out of 200
children that were tested, age 1-3 years; 92 were tested and out of these
number, 58 (29%) were found infected, age 4-6 years; 53 were tested and out of
these number, 35 (17.5%) were found infected and age 7-l0years; 55 were tested
and out of these number, 35 (17,5%) were also found infected.
Table
1: Distribution of malaria in relation to
age at specialist hospital Gombe
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
1-3
|
28
|
28
|
43.1%
|
4-6
|
17
|
16
|
24.6%
|
7-10
|
20
|
19
|
29.2%
|
Total
|
65
|
63
|
96.9%
|
Table
2: Distribution of malaria in relation to
age at Federal Medical Centre Gombe.
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
1-3
|
64
|
30
|
22.2%
|
4-6
|
36
|
19
|
14.1%
|
7-10
|
35
|
16
|
11.9%
|
Total
|
135
|
65
|
48.1%
|
Table
3: Overall distribution of malaria in
relation to age
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
1-3
|
92
|
58
|
29%
|
4-6
|
53
|
35
|
17.5%
|
7-10
|
55
|
35
|
17.5%
|
Total
|
200
|
128
|
64%
|
Table
4: Distribution of malaria in relation to
age and sex at specialist hospital Gombe
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
|||
Males
|
Females
|
Males
|
Females
|
Males
|
Females
|
|
1-3
|
15
|
13
|
15
|
13
|
23.1%
|
20%
|
4-6
|
7
|
10
|
6
|
10
|
9.2%
|
15.4%
|
7-10
|
11
|
9
|
10
|
9
|
15.4%
|
13.8%
|
Total
|
33
|
32
|
31
|
32
|
47.7%
|
49.2%
|
Table
5: Distribution of malaria in relation to
age and sex federal medical centre Gombe
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
|||
Males
|
Females
|
Males
|
Females
|
Males
|
Females
|
|
1-3
|
41
|
28
|
18
|
12
|
13.3%
|
40%
|
4-6
|
25
|
11
|
11
|
8
|
8.4%
|
5.9%
|
7-10
|
12
|
28
|
8
|
8
|
5.9%
|
5.9%
|
Total
|
78
|
57
|
37
|
28
|
27.4%
|
20.7%
|
able 6: Overall Distribution of Malaria in Relation
to age and sex
Age (year)
|
Number examined
|
Number infected
|
% Infected
|
|||
Males
|
Females
|
Males
|
Females
|
Males
|
Females
|
|
1-3
|
56
|
36
|
33
|
25
|
16.5%
|
12.%
|
4-6
|
32
|
21
|
17
|
18
|
8.5%
|
9%
|
7-10
|
23
|
32
|
18
|
17
|
9%
|
8.5%
|
Total
|
111
|
89
|
68
|
60
|
34%
|
30%
|
Figure
6: Percentage of children infected with plasmodium species at both Hospitals.
Overall distribution of
Plasmodium parasites by sex and age which were calculated by chi-square test,
concluded that there were no significant different between infection by sex and
age since X2 cal value is less than X2 tab value at P <0.05 and degree of freedom
1 and 2 respectively (appendix 5 and 6).
Interpretation of Test Kits Results
Positive Result:
- In addition to a pick colored control (C) line, a distinct pick colored line
was also observed in the test (T) area.
Negative Result:
- Only one colored line appears on the control (C) area. No apparent strip on
the test (T) area.
Invalid Result: -
A total absence of colour line in both regions or only one color line on the
test area. It is an indication of procedure error and/or the test reagent has
deteriorated.
Discussion
This
study has shown that the overall prevalence of plasmodium parasite was 64%
(128/200) among children ages 1 — 10 years attending two hospitals in Gombe
metropolis. The reported prevalence of plasmodium infections was high. This
agreed with the work of (WHO, 2003) which reported a prevalence of (58%)
malaria parasite among children in Banjul the capital of Gambia. It was
observed that the prevalence in Gombe is higher than that of Gambia.
Furthermore, this finding is lower when compared to (80%) prevalence reported
among children in the malaria endemic village of Erunmu in Southwest Nigeria.
This shows moderate prevalence of malaria in this area compared to 94%
prevalence reported by (Umar, 2006) in Gombe metropolis. This could be
attributed to the weather, Umar research work done in rainy season which is
known to increase the prevalence of malaria since it provides more breeding
sites for the vector of malaria.
The
prevalence of infection recorded for wet season in Udi Enugu State, was 59.8%
(Eneanya, 1998), while 58.3% was reported for children aged 0 — 5 years in
Awka, Anambra State (Mbanugo and Ejims, 2000) and 61 % recorded in Abuja (Matur
et al, 2001). These are similar with the present study in Gombe metropolis.
In
this study, it was found that specialist hospital had the higher prevalence of
plasmodium infection than the Federal medial centre Gombe. This may be due to
excessive visits of malaria patients to specialist hospital than Federal Medial
centre Gombe. Because of cost implication.
Also in this study, it was
found that children between the ages of 1 and 3 years had the highest
prevalence of plasmodium infections (table 3) compared with the other age
groups. This may be due to the fact that at that age, their immunity to
parasitic infections has not been fully developed. The prevalence of plasmodium
infections has been found to reduce with other ages (4-6 and 7—10 years). The
prevalence of parasitic infections among the different age groups in the
present study was not significant (P< 0.05) indicating that the occurrences
of these infections on these age groups were the same (table 3).
The
present study has shown that plasmodium infections were more common in the male
than in the female subjects (Table 6). The present result conforms with the
recorded higher prevalence of plasmodium infection in male than in female in
these two hospitals in Gombe metropolis. However, studies have shown that
females have better immunity to parasitic disease and this was attributed to
genetic and hormonal factors (Krogstad, 1996).
In
this study, males of ages 1 — 3 years had the highest prevalence of malaria
(table 10). This may have been attributed to their young ages. It has been
reported that Plasmodiurn infection was more prevalent in young children
because of their relatively less developed immune system.(Krogstad, 1996).
In
this study, there were results that show positive in rapid test kits method for
plasmodium falciparum while they were negative in microscopic observation
(Appendix 4). This finding indicated that children may have become infected
again after treatment with the local drugs. It is also possible that the
Plasmodium parasites may have developed resistance to some anti-malarial drugs
like chloroquine.
The
elimination half life of Sulfadoxine (100 to 231 hours) and Pyrimethamine (54
to 148 hours), strongly favours re-infection than development of resistance.
The possibilities of combining this drug with its useful therapeutic life have
been reported (Krogstad 1996). The possible strategies for halting or reversing
this trend include the temporary withdrawal of Sulfadoxine-Pyrimethamine drug,
or combining it with other effective anti- malarial drugs, for example
Amodiaquine and the Artemisinin derivatives (Krogstand, 1996).
Community
health care workers must take in to account, cost considerations and
affordability in view of the poor economic status of rural communities where
the drugs are mostly needed. The high prevalence recorded during follow-up
investigation may also be an indication of re-infection rather than drug
failure. This is because the life cycle of the malaria parasite is usually
fourteen days. People who are using mosquito bed net will experience a lower
prevalence (Krogstad, 1996).
Conclusion
The
high infection rate with Plasmodium falciparum
causes great concern in this study and this was recognized through rapid test
kits method.
This
study, therefore strongly suggest that hospital surveillance may be a useful
tool in monitoring malaria disease and the result presented suggests that there
should be completely mobilization and health education in order to:
i.
Reduce man-vector
contact.
ii. Reduce frequent of self medical and in complete
prophylaxis
iii. Encourage
proper and prompt utilization of available health care facilities.
iv. This
high infection rate with Plasmodium
falciparum causes great concern in population is indicative of active
transmission i.e. the population is at high risk of malaria infection.
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