ABSTRACT
The Prevalence of P.falciparum and helminths infection among Irrigation and Non-Irrigation Communities in Jibia Local Government Area, Katsina State, Nigeria was determined from July 2014 to May 2015.Venous blood, urine and stool samples were collected from 420 individuals in the communities ranging from ages 1 to ≥ 50 years by systematic sampling of households for the detection of Plasmodiun falciparum parasites, Schistosoma heamatobium ova and intestinal eggs and oocyst. Thick and thin blood films were made using standard parasitological procedures. The sedimentation method was used to concentrate ova from the urine samples .The formol-Ether concentration method by centrifugation was used to concentrate ova from the stool samples. Structured questionnaires were administered to obtain information on age, sex and other risk factors for infection. Out of the total of 420 (210 each from irrigation and non-irrigation communities) blood samples examined, 150 were positive for P.falciparum representing a prevalence of 35.7% of the study population. Out of the total of 420 urine samples examined, 216 were positive for Schistosoma heamatobium parasite ova with an overall prevalence of 51.4% whereas 137 were positive for intestinal helminths parasite eggs with an overall prevalence of 32.6% of the study population. There is no significant difference (P > 0.05) in P. falciparum infections between irrigation (40.0%) and non-irrigation (31.4%) communities but the difference was highly significant (P < 0.05) for urinary S. haematobium infections in irrigation (68.1%) and non-irrigation communities (34.7%) and intestinal helminths infections in irrigation (45.2%) and non-irrigation communities (20.0%) of Jibia LGA. Prevalence of P. falciparum infections was significantly associated (OR= 1.8, P < 0.05) with gender (male = 52.3%, female =37.4%) in the irrigation communities only. S. haematobium infections was significantly (P < 0.05) associated with irrigation farming (OR= 4.0), male gender (OR= 3.5), 31-40 years age group (OR= 1.8), source of water from dam reservoir (OR= 3.1) , fishing (OR= 4.3), contact with dam reservoir water (OR= 3.6) and use of pit toilet (OR= 1.5) whereas for intestinal helminths infections with irrigation farming (OR= 3.3), male gender (OR=2.1), 1-10 years age group (OR= 1.9), source of water from dam reservoir (OR= 6.4) ,farming (OR= 1.8), schooling (OR= 1.7), contact with dam reservoir water (OR= 5.5) and open field defeacation (OR= 3.8). Ascaris lumbricoides was the most prevalent of intestinal helminths with prevalence of 14.5% than S. stercoralis (9.5%), Hookworm (4.7%), Enterobius vermicularis (3.6%).While the least was Hymenolepis diminuta which was only observed in the non-irrigation communities with a prevalence of 0.2%. The prevalence of co-infection (15.0%) between P.falciparum and helminths infections is low. Intestinal S.mansoni was not encountered. The findings of the study suggest that P.falciparum and helminths infections occur among irrigation and non-Irrigation Communities in Jibia LGA, Katsina State. It is therefore recommended that epidemiology surveillance and an integrated approach for malaria and helminthiasis that is readily adapted to the local disease spectrum and socio-ecological settings is necessary in order to curb the infections in the communities.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the Study
Throughout evolutionary history, humans have been infected with parasites. It is estimated that over one third of the world's population, mainly individuals living in the tropics and sub-tropics, are infected by one or more parasitic helminths (worms) and protozoans (De Silva et al., 2003; Snow et al., 2005). Malaria, schistosomiasis and soil transmitted helminths infections (STH) are considered the most important parasitic infection in Sub-Saharan Africa (Chitsulo et al., 2000; WHO, 2002). The diseases share the same geographical distribution and occur as co-infection in humans and thus interact with regards to susceptibility, infection level, and pathology (De Silva et al., 2003; Utzinger et al., 2004).
Having over half a million deaths to its credit annually, malaria of which approximately half of the world‟s population is at risk, remains single handedly the number one killer of young children in sub-Saharan Africa where 90% of the deaths occur (Greenwood, 2002). Although the World Health Organization reports that malaria deaths have been reduced by 33% in the WHO African region, a child still dies every minute as a result of malaria (WH0, 2012). Globally, more than two billion people live in areas where they are at risk of contracting malaria and the estimated annual incidence of clinical malaria is greater than 300 million cases. More than one million people die every year from the direct causes of malaria, with children under the age of five years living in sub-Saharan Africa at highest risk (Breman, 2001). In 2001, the disease accounted for an estimated loss of 44.7 million disability adjusted life years (DALYs) with a DALY loss > 87% occurring
in sub-Saharan Africa (WHO, 2003); in 2002, the estimated malaria burden rose to 46.5 million DALYs (WHO, 2004). An estimated 90% of this burden is related to environmental factors (WHO, 2002).
In many developing countries, the most prevalent and important helminths are the soil – transmitted nematodes particularly Ascaris lumbricoides, Strongyloides stercoralis, Trichuris trichiura and hookworms (Ancylostoma duodenale and Necator americanus) (WHO, 2002). Human schistosomiasis results from an infection by trematode blood flukes of the genus Schistosoma (Gryseels et al., 2006). Their distribution is influenced by sanitation, population movement, availability of suitable water bodies for breeding of the snail intermediate host and so on. For example high rates of malaria infection and helminths infections such as hookworm, ascariasis and schistosomiasis were constantly recorded among migrant population working in irrigation schemes in Awash Valley than migrant populations employed in rain-fed agriculture in the semiarid Setit Humora area (Kloos and Leman, 1980). It is known that irrigation and the construction of dams along with poor sanitary practices often result in rapid spread of shistosomiasis, since the aqueous environment provides suitable conditions for the intermediate snail hosts (Mazigo et al., 2010).
In most irrigation systems, water is not only used for agricultural purposes, but also for all kinds of domestic, municipal, industrial and recreational purposes (van der Hoek et al., 2001). These irrigation activities may influence the water quantity, quality or both (Van der Hoek et al., 2001). Canals and drains may create ideal breeding sites for mosquitoes and snails bringing the vectors, intermediate hosts and the disease closer to
the people. Many field studies have described the influence of irrigation on the spread of these water- related diseases such as malaria, schistosomiasis, fascioliasis, filariasis, onchocerciasis, dengue fever, yellow fever, Rift Valley fever and encephalitis (Oomen et al., 1990). The distance between irrigation infrastructure and residence may determine how often and how intensely the population is exposed to vectors or infested water (Oomen et al., 1990; Konradsen et al., 2003; Boelee et al., 2006).
Whether an individual water project triggers an increase in malaria and schistosomiasis, transmission largely depends on the epidemiological setting, socio-economic factors, vector management and health seeking behaviour of the persons at risk of infection (Keiser et al., 2005).
Diseases such as malaria and helminths infections are usually most prominent in the poorest and most economically disadvantaged people of the society. Most times these infections do not occur singly but in a multiple way thereby leading to severe consequences. Individuals co-infected with P. falciparum and S. mansoni have been observed to develop more severe forms of hepatosplenomegaly compared to individuals infected with either of the parasites (Tschikuka et al., 1996, Booth et al., 2004).
1.2 Statement of the Problem
Despite the growing interest to investigate co-infection and their related clinical consequences worldwide, there are very few longitudinal community based studies that have attempted to investigate the interactions between malaria, schistosomes and STH infection (Egwunyenga et al., 2001, Mwangi et al., 2006). Though these infections often co-exist, most studies focus on individual diseases.
Each year, more than 200 million people contract malaria – a disease that disproportionately affects children and pregnant women. An estimated 10,000 pregnant African women and 200,000 infants die as a result of malaria infection during pregnancy (WHO, 2013). Schistosomiasis is a chronic parasitic disease caused by blood flukes (Trematodes) of the genus Schistosoma. Schistosomiasis transmission has been reported from 78 countries (WHO, 2013). In sub- Saharan Africa, schistosomiasis is widespread with foci of high prevalence and high morbidity found adjacent to rivers, lakes and irrigation schemes (Konradsen et al., 2003). In a prevalence study in Katsina State, Idris et al. (2001) reported infection rates of 12% and 3.3% for S. haematobium and S. mansoni respectively among primary schooling pupils.
Soil transmitted helminths (STHs) infection are among the most prevalent of chronic human infection. STHs are transmitted to humans through contact with parasite eggs or larvae that thrive in the warm and moist soil of the world‟s tropical and subtropical countries. Poverty, inadequate water supplies and sanitation are important determinants of transmission of STH infections. In such conditions, soil-transmitted helminths species are commonly co-endemic (Bethony et al., 2006, WHO, 2002). However, reports on parasitic infection are solely made on malaria or helminths alone.
Several researches on Helminths parasites are carried out among schooling-age children, which are achieved due to the knowledge of prevalence and intensity of the disease in such age-groups, and the ease of access to the age-groups while in schoolings for urine and stool samples. However, surveys for active infection in all the age-groups in the
community may give an overall community data base for the prevalence of the disease (Tchuem et al., 2003).
There are unreported cases of helminth-Plasmodium co -infection levels among different households and individuals in the communities of the study area. Research works on helminths in Katsina State were based on single species of either S. haematobium (Ofoezie et al., 1996) or S. mansoni infection (Ukoli, 1984) and reports of co-infection with both S. haematobium and S. mansoni species (Idris et al., 2001; Idris and Ajanusi, 2002).
Helminth-Plasmodium co-infection have been investigated and the prevalence ranged from 16% in Uganda and Cameroon, (Nkuo-Akenji et al., 2006) to 26.5% in Tanzania (Mazigo et al., 2010) to 60% in Nigeria (Abanyie et al., 2013).
1.3 Justification
The outcome of this research will provide baseline data on the prevalence of Plasmodium and helmith infection in the study area. It will also provide parameters for promoting healthy behaviour in agricultural, domestic, occupational and recreational activities which expose them to infection, elucidate the epidemiology of co-infection for formulating intervention strategy, prevention and control efforts in the study area.
The survey of infection in all the age-groups in the community will give an overall community data based on socio-demographic status of members of the communities as well as knowledge on water contact activities. An analysis based on selected countries in Africa, showed that there is a risk ratio of 2.4 and 2.6 for urinary schistosomiasis (caused
by S. hematobium) and intestinal schistosomiasis (caused by S. mansoni), respectively, among persons living adjacent to dam reservoirs (Steinmann et al., 2006). It is also reported that persons living near land that had been irrigated for agricultural use had an estimated risk of infection ratio of 1.1 for urinary schistosomiasis and 4.7 for intestinal schistosomiasis (Steinmann et al., 2006).
1.4 Aim of the Research
The aim of the study is to evaluate the impact of irrigation farming and other risk factors on the prevalence of Plasmodium and helminths infections among irrigation and non-irrigation communities in Jibia Local Government Area, Katsina State
1.5 Objectives
i. To determine the prevalence of Plasmodium, Schistosoma haematobium and intestinal helminths infections in irrigation and non-irrigation communities in Jibia LGA, Katsina State.
ii. To determine the association between some risk factors and prevalence of Plasmodium, S. haematobium and intestinal helminths infections in irrigation and non-irrigation communities in Jibia LGA, Katsina State.
iii. To determine the prevalence of co- infections of Plasmodium, S. haematobium and intestinal helminths infections in irrigation and non-irrigation communities in Jibia LGA, Katsina State.
i. There is no significant differences in the prevalence of Plasmodium, S. haematobium and intestinal helminths infections in irrigation and non-irrigation communities in Jibia LGA, Katsina State.
ii. There are no significant associations between some risk factors and prevalence of Plasmodium, S. haematobium and intestinal helminths infections in irrigation and non-irrigation communities in Jibia LGA, Katsina State.
iii. There are no Plasmodium and helminths co-infections in irrigation and non-irrigation communities of Jibia LGA, Katsina State.
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