|Year : 2017 | Volume
| Issue : 1 | Page : 57-62
Comparative prevalence of Plasmodium falciparum malaria in patients attending Okelele Health Centre, Okelele, Ilorin, Nigeria
Olatunji Matthew Kolawole1, Olugbenga A Mokuolu2, Yetunde A Olukosi3, Tolulope O Oloyede1
1 Department of Microbiology, Faculty of Life Science, Infectious Diseases and Environmental Health Research Group, University of Ilorin, Ilorin, Kwara, Nigeria
2 Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
3 Department of Nutrition and Biochemistry, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
|Date of Web Publication||18-Jan-2017|
Dr. Olatunji Matthew Kolawole
Department of Microbiology, Faculty of Life Science, Infectious Diseases and Environmental Health Research Group, University of Ilorin, Ilorin, Kwara
Source of Support: None, Conflict of Interest: None
Background: In Okelele, Ilorin, Kwara State, Nigeria, malaria remains an important public health concern with a little information about its prevalence.
Objective: To determine the prevalence of malaria infection at Okelele Health Centre, Okelele, Ilorin.
Methodology: A cross-sectional descriptive study in which patients were diagnosed clinically with severe or uncomplicated malaria at the study site was conducted. Rapid diagnostic testing (RDT) for malaria and microscopy using Giemsa staining by thick and thin blood smears were done for study patients.
Results: In this study, 200 malaria patients attending Okelele Health Centre, Okelele, Ilorin, were tested for malaria infection, with females having the highest prevalence rates and parasitemia density. The highest positivity rates were found in children <6 years while adolescents had the lowest prevalence rates. Socioeconomic factors of patients such as occupation and education played a major role in malaria prevalence.
Conclusion: Although RDT is quick and easy to use, negative malaria cases gotten by RDT should be confirmed by expert microscopy to prevent misdiagnosis of malaria.
Keywords: Infection, malaria, parasite, prevalence
|How to cite this article:|
Kolawole OM, Mokuolu OA, Olukosi YA, Oloyede TO. Comparative prevalence of Plasmodium falciparum malaria in patients attending Okelele Health Centre, Okelele, Ilorin, Nigeria. Indian J Health Sci Biomed Res 2017;10:57-62
|How to cite this URL:|
Kolawole OM, Mokuolu OA, Olukosi YA, Oloyede TO. Comparative prevalence of Plasmodium falciparum malaria in patients attending Okelele Health Centre, Okelele, Ilorin, Nigeria. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2019 Jul 16];10:57-62. Available from: http://www.ijournalhs.org/text.asp?2017/10/1/57/198590
| Introduction|| |
Plasmodium parasites which are transmitted to people through the bites of infected female Anopheles mosquitoes are known to cause a life-threatening disease called malaria., The vast majority of deaths are caused by Plasmodium falciparum and Plasmodium vivax, while Plasmodium ovale and Plasmodium malariae cause a generally milder form of malaria that is rarely fatal. The zoonotic species Plasmodium knowlesi, prevalent in Southeast Asia, causes malaria in macaques monkeys but can also cause severe infections in humans.
The African Region is the most affected by malaria, and this accounts for about 80% of the estimated 219 million malaria episodes worldwide in 2010 and 90% of the malaria deaths the same year. P. falciparum is more prevalent in Sub-Saharan Africa than in other regions of the world. In most African countries, more than 75% of cases were due to P. falciparum, whereas in most other countries with malaria transmission, other plasmodial species predominate. From the year 2000-2015, the incidence of new cases of malaria had 37% reduction while death rate fell by 60% on a global scale. An excessively high malaria case of 88% and 90% death cases by malaria was recorded in Sub-Saharan Africa.
In Nigeria, malaria transmission is intense and stable; the disease is responsible for 60% of outpatient visits to health facilities, 30% of childhood deaths, 25% of death in children under 1 year, and 11% of maternal death. The financial loss due to malaria annually is estimated to be about 132 billion naira in the form of treatment costs, prevention, loss of man-hours, etc. A need thus exist to determine the prevalence of malaria and ascertain the effectiveness of RDT commonly used in determining the prevalence of malaria in Nigeria in comparison to microscopy.
| Methodology|| |
This study was conducted at the General Outpatient ward of Okelele Health Centre, Ilorin, Kwara State, Nigeria, between October and November 2012.
Two hundred patients presenting with symptoms of malaria were recruited based on the doctors' clinical investigation. Five milliliters of the blood sample of each patient was collected intravenously by a clinician using a sterile syringe. Rapid diagnostic testing (RDT) for malaria was done using commercially available CareStart™ ; thick and thin blood films for parasite detection, characterization, and classification of degree of parasitemia were also prepared as described by Cheesbrough. Questionnaires were administered to all the patients.
The study obtained an ethical clearance from the Ethical Review Committee of the University of Ilorin Teaching Hospital. Furthermore, informed consents were obtained from individual patients/guardians after a clear explanation of the objectives and logistics of the study had been carefully explained to them (Ethical Clearance Reference Number: UITH/CAT/189/14/35).
Degree of parasitemia
The classification of the degree of parasitemia was graded as "low density" (≤1000 parasites/μl of blood), "medium density" (1000-9999 parasites/μl of blood), and "high density" (10, 000 parasites/μl of blood).
Statistical Package for Social Sciences version 15.0 (IBM, USA) for Windows was used to test for the level of significance of the result obtained. Both continuous and discrete variables were generated. The relationship between discrete variable and outcome of interest was tested using the Chi-square test. Relationship between continuous variable and outcomes was determined using SPSS. P < 0.05 was considered statistically significant.
| Results|| |
Using RDT, 45 (22.5%) infants, 18 (9.0%) school children, 4 (2.0%) adolescents, and 26 (13%) adults were positive (P = 0.182), while for microscopy, 74 (37%) infants, 27 (13.5%) school children, 6 (3.0%) adolescents, and 47 (23.5%) adults were positive, with infants having highest parasite density of 29,280.42 parasites/μl of blood (P = 0.445) [Table 1].
[Table 2] shows the prevalence rate of malaria infection in relation to the gender of the patients. For both RDT and microscopy, more females were positive for malaria than males, with females having the highest parasite density of 21,650.47 parasites/μl of blood. These were not statistically significant.
The prevalence of the infection as related to the hematological parameters such as blood group and genotype based on both microscopy and RDT revealed that highest prevalence rates of 72.0% and 45.5%, respectively, were noticed among patients who did not know their blood group, i.e., 187 (93.5%) of the 200 patients sampled while 8 (4%), 2 (1%), and 3 (1.5%) of the remaining patients were O, A, and B blood groups, respectively. Patients with blood group O had prevalence of 1.0% and 3.5% while A and B had zero percentage for RDT (P = 0.103) and 1.0% and 0.5%, respectively, for microscopy (P = 0.228).
Of the 200 patients, 188 did not know their genotype and had the highest prevalence rates of 45.5% (RDT) and 72.5% (microscopy). Among those who knew their genotype, 1 out of 9 patients having AA genotype was positive using RDTs and 7 out of 9 were positive for malaria infection using microscopy with a parasite density of 222.22 parasites/μl. From the 3 (1.5%) patients who were AS genotype, 1 (0.5%) and 2 (1.0) were positive for RDT (P = 0.082) and microscopy (P = 0.911), respectively.
[Table 3], [Table 4], [Table 5] show the socioeconomic status of the patients as related to the malaria infection.
|Table 3: Prevalence of malaria infection based on type of education of the subjects |
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|Table 4: Prevalence of malaria infection based on level of formal education of the subjects |
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|Table 5: Prevalence of malaria infection based on occupation of the subjects |
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Analysis based on the use of insecticides by the patients revealed that those who did not use insecticides had a lower frequency of 14.5% for RDT and 24.5% for microscopy (14728.03 parasites/μl) while others who reported to use insecticide had highest prevalence of 32.0% and 52.5% for RDT and microscopy (24017.01 parasites/μl), respectively (P = 0.610; P = 0.515).
Further analysis regarding the frequency of insecticide usage showed that 43 (21.50%) for RDT and 69 (44.5%) for microscopy of 89 (44.55%) patients who used it regularly were positive while 1 (0.5%) for RDT and 9 (4.5%) for microscopy of 11 (5.5%) patients who seldom use insecticides were also positive (P = 0.046 and P = 0.968). Patients who used insecticides regularly also had parasite density of 25655.71 parasites/μl while those who seldom used had 3749.09 parasites/μl.
| Discussion|| |
The highest malaria positivity rates were found in infants <6 years, followed by adults 20 years and above. Adolescents aged 13-19 years had the lowest positivity rates of malaria infection. Infants under the age of 6 years also had the highest levels of parasitemia (29280.42 parasites/μl) and this corresponds with the previous findings., 41.5% (83) of respondents in this study presented with low parasitemia <1000, 16.0% (32) had moderate parasitemia ≤9999, while 19.5% had high parasitemia ≥10, 000.
These could be attributable to the low developing immunity of infants under 6 years. Adults, 20 years and above, could have had such high positivity rates due to the kind of jobs they do which may have exposed them to more mosquito bites, thus leading to malaria parasitemia, and can also be due to decreasing immunity in older adults.
Females were the dominant group (127 females) in the study and had higher malaria prevalence rates. This could be due to the good health-seeking behavior of the females involved in this study. This correlates with previous work,, where the prevalence of malaria infection was higher in females than males with no significance difference but in contrast to others where there was higher prevalence of malaria infection in males and females with statistical significance.,
One hundred and eighty-seven (93.5%) participants in this study did not know their blood group. This was probably due to the fact that majority of the participants in this study had little or no formal education and as such were ignorant of the advantages of knowing one's blood group. Malaria prevalence by ABO blood grouping was highest in the O blood group by both RDT and microscopy (1.0% for RDT and 3.5% for microscopy) while it was lowest in the B blood group. This is in support of previous work, but in contrast to another where A blood group malaria parasite infection was highest.
In addition, worrisome was the fact that majority (94.0%) of the participants involved in this study did not know their genotypes. Of those who did, malaria prevalence was highest in the Hb AA group. This could be attributed to the fact that Hb AS and Hb SS groups do not allow for parasites to survive due to little oxygen being made available to the P. falciparum parasite (this was not statistically significant). There was no participant having the Hb SS genotype in this study. This correlates to other studies which reported higher malaria parasitemia in people with Hb AA genotype.,,
One hundred and eight (54%) participants of this study had no formal education and had the highest positivity rates of 22.5% for RDTs and 39.0% for microscopy. This was statistically significant (P = 0.003 for RDTs and 0.041 for microscopy). However, people who had acquired at least primary education had the highest parasitemia levels (33760.00 parasites/μl), followed by those with no formal education (18063.70 parasites/μl) while people who had acquired tertiary education had the lowest parasitemia levels (197.14 parasites/μl). This corroborated the finding which reported highest cases of malaria among those with no formal education (50.1%) and the lowest was seen among the graduates (22.9%), but this was not significant (P > 0.05). The high prevalence of parasitemia among people without formal education could possibly be that they are not enlightened on how to prevent malaria infection.
A greater proportion of participants in this study had no occupation (65.5%) with the highest prevalence of malaria (53.0%) and parasitemia (32284.15). However, top civil servants and executive officers had the lowest infection and parasitemia levels. This study shows that malaria affects more poor people than rich people although it is not an exclusive disease of the poor. This corroborates a work which stated that poor households and individuals are prevented from consuming goods and services that otherwise would protect them against the risks of malaria. In a survey conducted in Nigeria, it was discovered that the prevalence of fever was highest among children from the poorest households compared to 15.8% among the middle households and lowest among the wealthiest.
This study has provided a comparative analysis of three main forms of malaria diagnosis, i.e., clinical, antigen detection (use of RDTs), and microscopy. It has further confirmed microscopy as the gold standard for malaria diagnosis as not all the clinically diagnosed malaria cases were positive for malaria infection, but the highest rates for infection were obtained by microscopy. This study has also shown that RDT-negative malaria cases should be confirmed by expert microscopy to totally rule out malaria infections. In addition, it has also further strengthened the need for proper and accurate diagnosis of malaria before drug administration to prevent misdiagnosis, overdiagnosis, and over-treatment of malaria cases. In addition, proper and accurate diagnosis of malaria before drug administration will minimize P. falciparum resistance to antimalarial drugs.
| Conclusion|| |
Although RDT remains the most commonly used method of determining malaria prevalence in Nigeria, due to its cost, accessibility and ease of usage, a need still exist to incorporate microscopy as a confirmation tool, so as to reduce the incidence of malaria misdiagnosis.
We wish to acknowledge the patients that consented to the study for their cooperation and the staffs of Okelele Health Centre for their technical assistance and support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]