TABLE OF CONTENTS
Title page
Certification
Dedication
Acknowledgement
Table of contents
Abstract
List of tables
List of figures
List of plates
CHAPTER ONE
INTRODUCTION AND LITERATURE REVIEW
1.1. Introduction
1.1.2 Epidemiology of malaria
1.1.3 Justification of the study
1.1.4 Objectives of the study
1.2 Literature Review
1.2.1 Malaria
1.2.2 Prevalence and its transmission indices
1.2.3 Pathology of malaria
1.2.4 Mosquitoes prevalent in Anambra State
1.2.5 Malaria parasitological diagnosis
1.2.6 Management of malaria protocol
1.2.7: Effective and integrated management of childhood malaria in Nigeria
1.2.8: Home managements of childhood malaria
1.2.9: Effects of malaria infection on biological profile of the infected child
1.2.9.1: Effects on haematology
1.2.9.2: Biochemical alterations in childhood malaria
1.2.9.3: Effects of malaria on the nutritional status of children
CHAPTER TWO
MATERIALS AND METHODS
2.1 Study Area
2.1.1 Study population
2. 1.2 Climate and vegetation
2.2 Study Design
2.3. Sampling Technique
2.4 Ethical Clearance and Exclusion Criteria
2.5 Parasitological Examination
2.5.1: Collection of blood sample
2.5.2: Preparation of thick films blood smears for microscopy
2.5.3: Determination of haematological parameters from blood samples
2.6: Laboratory Determination of Biochemical Parameters from Blood Sample
2.6.1: Sodium ion (Na+) determination
2.6.2: Determination of total protein
2.6.3: Bilirubin assay
2.6.4: Determination of alkaline phosphatase (ALP):
2.6.5: SGOT and SGPT assay:
2.6.6: Total iron assay:
2.7: Determination of the Effect of Malaria on the Nutritional Status of Children
2.8: Determination of Malaria Prevalence for the past Five (5) Years from Government Hospitals Records in Anambra State, Nigeria
2.9: Data Analysis
CHAPTER THREE
RESULTS
3.1. Prevalence of Malaria in the Studied Communities in Anambra State, Nigeria
3.2.1: Prevalence of malaria in hospitals in Anambra State, Nigeria
3.2.2: Comparison of communities and hospitals malaria prevalence in Anambra State, Nigeria
3. 2.3: Prevalence of malaria in Anambra State, Nigeria from 2005 -2010
3.3 Biochemical and Haematological Indices of Home and Hospital Managed Childhood Malaria of Infected and Uninfected Children in Anambra State, Nigeria
3.3.1 Serum levels of some biochemical and haematological indices of malaria infected and uninfected children in Anambra State, Ngeria
3.3.2 Biochemical and haematological indices, and the parasite density of infected and uninfecred children from communities and hospitals in Anambra State, Nigeria
3.3.3 Biochemical and haematological indices, and the parasite density, of malaria infected male and female children in Anambra State, Nigeria
3.3.4: Effects of sex on the biochemical and haematological indices, and the parasite density of malaria infected male and female children in Anambra State, Nigeria
3.3.5. Biochemical and haematological indices, and gametocytes count of malaria infected and uninfected children in Anambra State, Nigeria (communities and hospitals)
3.3.6: Effects of gametocytes count on the biochemical and haematological indices, and the parasite density of malaria infected children from communities and hospitals in Anambra State, Ngiera
3.3.7: Biochemical and haematological indices, and parasite density of malaria infected and uninfected children of different age groups from communities and hospitals in Anambra State, Nigeria
3.3.8: Effectes of age on the biochemical and haematologica indices, and parasite density of malaria infected children in Anambra State, Nigeria
3.3.9: Interaction of parasite density and, biochemical and haematological indices of malaria parasite infected children in Anambra State, Nigeria (community and hospital survey)
3.3.10. Effects of parasite density on the biochemical and haematological indices of malaria infected children in Anambra State, Nigeria
3.4. Nutritional Status of Malaria Infected and Uninfected Children from Communities and Hospitals in Anambra State, Nigeria
3.5. Knowledge, Attitude and Perceptions of Malaria by Mothers/Caregivers in Anambra State, Nigeria
3.5.1 Demographic details of mothers/caregivers in Anambra State, Nigeria
3.5.2: Assessment of mother’s/caregiver’s knowledge on malaria transmission and use of ITNs in Anambra State, Nigeria
3.5.3: Recognized symptoms, home treatment and choice of drugs by mothers/care givers in Anambra State, Nigeria
3.5.4: Treatment decision, access to drugs, effectiveness of drugs and further treatment seeking behavior of mothers/caregivers in Anambra State, Nigeria
3.5.4: Prevalence of malaria infection among those using insecticide treated bed nets in
Anambra State, Nigieria
CHAPTER FOUR
DISCUSSION
4.1 Prevalence of Community and Hospital Childhood Malaria in Anambra State, Nigeria
4.2: Biochemical and Haematological Status of Malaria Infected and Uninfected Children from the Communities in Anambra State, Nigeria
4.3: Biochemical and Haematological Status of Malaria Infected and Uninfected Children from Hospitals in Anambra State, Nigeria
4.4: Comparsion of the Biochemical and Haematological Indices of Malaria Infected and Uninfected Children from Communities and Hospitals in Anambra State, Ngeria
4.5. Nutritional Status of Malaria Infected and Uninfected Children in Anambra State, Nigeria
4.6 Knowledge, Attitude and Percepton of Mothers/Caregivers about Childhood Malaria and Home Management (HMM) in Anambra State, Nigeria
4.7: CONCLUSONS AND RECOMMENDATIONS
REFERENCES
Appendixes
ABSTRACT
This study investigated the effects of home (community) and hospital management of childhood malaria on the prevalence, haematology, biochemical and nutritional indices of malaria parasite infected children in Anambra State, Nigeria. It also evaluated the knowledge, attitude and perceptions of mothers/caregivers about childhood malaria and their home management practices. A total of 248 children between the ages of 0 – 14.9 years and 653 house holds randomly sampled were involved in the study. Blood samples were collected from 134 male childrene (39 from communities and 95 from hospitals) and 114 females (43 from communities and 71 from hospitals). These children were treated for malaria infection either in the hospitals or in their homes by their mothers/caregivers. Serum levels of sodium ion (mmol/l), total protein (g/dl), bilirubin (mg/dl), alkaline phosphatase (ALP iu/l), serum glutamate oxaloacetate transaminase (SGOT u/l), serum glutamate pyruvate transaminase (SGPT u/l) together with packed cell volume (PCV %), haemoglobin (Hb mg/dl) and white blood cell (WBC mcl) were assessed using standard methods. Anthropometric data – age, height, weight and mid-upper arm circumference (MUAC) were collected using standard scale, tape and MUAC UNICEF insertion tape. Chi – s quare, Fisher – least significance difference, t – test, analysis of variance, multipl e regression and Epi Info were employed to test significant differences among the variables. For all determination, the significant difference was set at p<0 .05.="" 46.3="" 94.0="" age="" and="" community="" for="" hospital="" in="" infection="" malaria="" not="" p="" parasite="" prevalence="" sex="" significant="" the="" was="" while="">0.05). Differences in the community prevalence of malaria was not significant (p>0.05) but the monthly and seasonal prevalences differed significantly (p<0 -="" .05="" 0.14="" 0.25="" 0.26="" 0.29="" 0="" 10.90="" 100="" 10="" 11.78="" 11="" 14.9="" 1="" 28.25="" 28.27="" 3.75="" 4.9="" 458="" 5.56="" 5="" 9.9="" a="" age="" aged="" also="" and="" birilubin="" both="" chil="" children="" communities="" comparing="" comparison="" count.="" count="" dependant.="" different="" dren="" female="" gametocyte="" group="" groups="" had="" hb="" higher="" homes.="" hospital="" hospitals="" in="" infected="" infection="" level="" levels="" lower="" malaria="" male="" males.="" males="" mean="" of="" old="" other="" p="" parameters="" parasite="" pcv="" respectively.="" respectively="" sampled="" serum="" sgot="" showed="" significant="" significantly="" span="" survey.="" surveyed="" than="" that="" the="" to.35="" to="" wbc="" were="" where="" with="" years=""> control. Changes in the serum level of sodium ion (Na+, SGOT, ALP and SGPT may not be associated with malaria infection. The prevalence of malnutrition (weight-for-height Z - scores) among malaria uninfected in the community and hospital surveys was 26.7% (14.2 – 44% 95% C.I.) and 9.2% (4.7 – 17.1 95% C.I.) respec tively, while the prevalence among the malaria parasite infected children was 21.4% and 7.4% in the community and hospital respectively. The average number of malnourished children with Z-scores
CHAPTER ONE
INTRODUCTION AND LITERATURE REVIEW
1.1. Introduction
Malaria is one of the most important causes of morbidity in the world. It is a vector borne infectious disease caused by a eukaryotic protista of the genus Plasmodium. The disease is transmitted by female Anopheles mosquitoes which carry infective sporozoite stage of Plasmodium parasite in their salivary glands (Akinleye, 2009). It is transmitted from person to person through the bite of a female Anopheles mosquito that is infected with one of the four species of
Plasmodium: Plasmodium ovale, Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae. Children under five years and pregnant women are particularly vulnerable to the disease due to their weaker immune systems (WHO, 2000). Malaria is an acute and chronic disease caused by obligate intracellular Protozoa of the genus Plasmodium. The zoological family Plasmodidae contains protozoan parasites found in the blood of birds, reptiles and mammals (Akinleye, 2009).
P. falciparum are found throughout tropical Africa, Asia and Latin America. P vivax is worldwide in tropical and some temperate zones. P. ovale is mainly in West Africa, while P. malariae is worldwide but very patchy in distribution (TDR, 2000). P. falciparum is responsible for about 80% of malaria infection in man and P. vivax is not seen among Africans especially West Africans due to the absence of the Duffy blood group (Afolabi Lesi and Adenuga, 1996).
1.1.2 Epidemiology of malaria
Malaria killed 437,000 children befor their fifth birthday in 2013, the majority in sub-Saharan Africa (WHO, 2014). It is a mosquito-borne infection that killed an estimated 1.1 million people in 1998 and with an estimated 300 to 1600 million new cases, but in 2013 the desease caused an estimated 453,000 under – five deaths. Ac cording to the latest estimates, malaria mortality rates were reduced by about 47% globally and by 54% in the WHO African Region between 2000 and 2013. The incidence rates declined by 30% around the world and by 34% in the African region. These substantial reductions occurred as a result of a major scale-up of vector control interventions, diagnostic testing and treatment with artemisinin - based combination therapies, or ACTs. The absolute numbers of malaria cases and deaths are not going down as fast as they could. The disease still took an estimated 627 000 lives in 2012......
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