EVALUATION OF HAEMATOLOGICAL PROFILES OF WOMEN AND CHILDREN INFECTED WITH MALARIAL PARASITES IN BOSSO AND PAIKORO LOCAL GOVERNMENT AREAS OF NIGER STATE

ABSTRACT

Malaria continues to be a major public health challenge especially in the African region despite the availability of anti malarial drugs and the application of several preventive strategies such as the use of insecticide treated nets, indoor residual spraying, and intermittent preventive treatment in pregnancy. This study was aimed at investigating the prevalence of malaria parasite and its effect on the  haematological  indices  among  women  and  children  attending  selected  government  health facilities in Bosso and Paikoro Local Government Areas of Niger State, Nigeria. Blood samples were collected  from  500  Patients  attending  selected  Primary  Health  Care  facilities  in  both  local government areas. Examination for Plasmodium was carried out using rapid diagnostic test cassette for the qualitative detection of Histidine Rich Protein II (HRP-II) antigen of Plasmodium fulciparum in human whole blood. The haematological analysis was carried out using automated standard methods.  An overall  prevalence of 49  %  was  obtained  for the study area.  Bossso  LGA had  a prevalence of 48 % while Paikoro LGA had 50 % prevalence. Of the total population, children recorded malaria prevalence of 70.7 %, pregnant women had 44.6 % while the non pregnant women recorded 33.9 % prevalence. Age, gender, educational background, occupation, haemoglobin content and blood group were all statistically significant at p < 0.05 indicating that these parameters could be regarded as risk factors that predispose to malarial infection. The haematological analysis revealed that there was association between anaemia and malaria as the severities were measured at p < 0.05. These severities ranged from mild, moderate and to severe anaemia. Genotype AA recorded more cases of malarial parasite infection than the other genotypes. A prevalence of 50.2 % was seen among the genotype AA population. The least prevalence of 16.6 % was recorded among subjects with genotype SS. Among the children, age group 10-12 years recorded the highest prevalence (75.0 %) of malaria and was followed by age group 0-4 with prevalence of 70.8 %. Age group 41-50 recorded the lowest malaria prevalence of 35.7 %. Age is seen from this study as a risk factor influencing malarial infection as P was at 0.05. To sustain the considerable progress made in the global fight to control and eliminate malaria, more efforts should be channeled into effective enforcement of the various control strategies such as the use of Insecticide Treated Nets (ITN), Intermittent Preventive Treatment in Pregnancy (IPTP), Larva Source Management (LSM) and Indoor Residual Spraying (IRS).

CHAPTER ONE

1.0        INTRODUCTION

1.1       Background to the Study

Malaria is a life threatening parasitic disease transmitted by female Anopheles mosquitoes (Millicent and Gabriel, 2015). It is the most highly prevalent tropical disease with high morbidity, mortality, and with high economic and social impact (Dawaki et al., 2016). The parasite attacks and destroys the red blood cell and may affect vital body organs like brain, liver and kidneys (Etusim et al., 2013).

Malaria remains a major public health problem in some countries of the world, with Africa bearing the larger burden and Nigeria still bearing a high percentage in Africa in spite of interventions from international organizations over the previous years to reduce the incidence and mortality rate. These intervention programs include Roll Back Malaria (RBM), Millennium Development Goals (MDGs), Global Malaria Action Plan (GMAP), Sustainable Development Goals (SDGs) and Global Technical Strategy for Malaria 2016-2030 (Edogun et al.. 2017; Aregbeshola and Khan, 2017). Tremendous gains have been made in the fight against malaria. This success has been attributed to the adoption of the artemisinin combination therapy (ACT) as first line drug treatment in malaria endemic regions and also the scale – up of intervention efforts such as the use of long lasting insecticide nets (LLIN), intermittent prevention treatment (IPT) for pregnant women, vector control measures and more importantly increased  funding (Aregbeshola and  Khan,  2017).  Despite  these  gains,  malaria still remains a major health challenge in Nigeria with high morbidity and mortality. Malarial status as a major public health problem in Nigeria remains unchanged due to weak health system, high rate of poverty, poor   investment in the health of the Nigerian population by governments at all levels and inequitable access to quality health care services (White et al., 2011). The knowledge, attitude and practices of households also contribute to the prevalence of malaria.  Many households especially the vulnerable group which are children under 5 years of age, women and pregnant women still do not sleep under insecticide treated   nets (ITNs) due to factors such as family size, level of education, gender of household  head,  place of residence,  geo-political  zone,  knowledge that  ITNs  prevent malaria, and socio-economic status (Ezeama et al., 2014).  A lot of households seek malaria treatment in pharmacy stores and other types of places rather than public or private health facilities. This may be due to better accessibility and shorter waiting time.   On the other hand, many caregivers and parents do not take their children for diagnostic testing.   The disease reportedly accounts for an estimated 60% of outpatient hospital visits in Nigeria, 30% of hospitalizations, 30% of under-five mortalities, 25% of infant mortalities and 11% of maternal mortalities (Ali et al., 2017). Malaria is holo-endemic in Nigeria, with a steady transmission rate throughout the year which comprises of a distinctive rainy and dry season (Millicent and Gabriel, 2015).

About 51% of malaria cases and deaths in Nigeria occur in rural villages away from effective diagnostic or treatment facilities (WHO, 2010). Early diagnosis and prompt effective treatment of malaria illness has been a cornerstone of malaria control. The reduction of morbidity and the interruption of parasite transmission by means of community-based anti-malarial treatment require an accurate, rapid and practical method of diagnosis. Over the past years, developments in rapid field diagnostic techniques based on the demonstration of parasite antigens have opened new possibilities for improved rural malaria diagnosis that is independent of centralized diagnostic services.   There have been a considerable number of reports about knowledge, attitudes, and practices relating to malaria and its control from different parts of Africa. In spite of the giant strands in the control of malaria, misconceptions concerning malaria still exist and that practices for the control of malaria have been unsatisfactory. However, epidemiological patterns of malaria are widely different from one place to another (White et al., 2011). Specific data of a place collected can help in the making of a design of improved programme for strategic malaria control for a particular location. There are available effective low-cost strategies for the treatment of malaria, but any attempt to control a disease such as malaria in an area or locality should first of all be preceded by an extensive evaluation of the magnitude of the prevailing situation; a complete description of the health problems of the community comprising an account not only of the prevalence, but also of the community’s view of its own problems and its use of existing health services.

In order to increase the chance of success of any malaria intervention, the planning and implementation must be based upon proper epidemiological analysis and application of interventions that address specific needs of localities and countries (Dawaki et al., 2016). There is thus the need to complement the current research agenda primarily directed towards reducing morbidity and mortality, with one; that aims to identify key knowledge gaps and will define the strategies and tools that will result in further reduction in the burden of malaria. Operational research is one of the approaches for identifying gaps and areas of malaria control that need to be enhanced as well as for evaluating effectiveness of intervention for possible scale up. Operational research as defined by Ajayi et al. (2017) is the search for knowledge on interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programmes in which the research is being done. Employing malaria operational research (MOR) findings in the planning of national malaria control programmes is gaining increased attention. Operational research can be very instrumental in providing answers to what changes, where, why, when and how these changes should be implemented to ensure smooth transition from control to elimination (Maduka, 2018). However, malaria operational research has continued to receive little attention and the relevance of the ones being conducted to ensure the needed progress from malaria control to elimination is not certain. However, poor attention has been paid to exploring the priority research topics by researchers and malaria control implementers in Nigeria (Ajayi et al., 2017). The challenging question faced by the world is whether we are winning the war against malaria or is malaria winning the war? The findings of this study will be useful in planning a sustainable malaria operational research agenda towards eliminating malaria in the nation.

1.2       Statement of the Research Problem

The  Federal  Ministry  of  Health  in  Nigeria  has  a  targeted  goal  of  reducing  all  malaria-related morbidity and mortality to zero level by the year 2020, but has so far been unable to achieve this as the target year is here with us and as such, malaria is still a serious issue of concern in public health.

Despite the fact that malaria is a preventable and curable disease and that treatment is currently cheap, it is still one of the leading causes of death in Nigeria. Several cases of maternal mortality, infant mortality, abortive pregnancy, and low birth weight have been traced to malaria. Moreso, most of the rural communities and even some of the urban areas still lack the proper knowledge of the vectors responsible for transmitting the disease. They still keep stagnant water and bushes which serve as breeding areas for the vector around their residence.

1.3       Justification for the Study

Over the years there has been intermittent rising and falling in malaria mortality. There is need therefore to  periodically ascertain  the status  of  malaria and  thereby help  in  policy making and building of new intervention strategies that are locality based.

Prevalence studies and other community based malaria surveys are important tools for assessing the impact and effectiveness of malaria control measures and programmes at local and national levels.

This research will help in determining current malaria burden in the study areas. Apart from cases that are reported to hospitals there are no records of field surveys of malaria in the study areas.

1.4       Aim and Objectives of the Study

The aim of this study was to determine the prevalence of malaria burden and haematological profile among women and children attending selected government health facilities in Bosso and Paikoro local government areas (LGAs) of Niger State, Nigeria.

The specific objectives were to:

i.          determine  the  incidence  of  malaria  infection  among  women   and  children  attending government health facilities in Bosso and Paikoro LGAs of Niger State using the Rapid diagnostic kit.

ii.        determine the sensitivity of rapid diagnostic test cassette.

iii.       determine  haematological  profiles  of  Plasmodium  infected  subjects  in  comparison  with those not infected with the parasite.

iv.       relate demographic factors to the transmission of malaria in the study area.

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