ABSTRACT
Malaria in pregnancy (MiP) is a serious public health
problem which can be minimized by the use of Insecticides Treated Nets (ITNs) and
Intermittent Preventive Treatment of malaria in pregnancy (IPTp). Inflammatory
protein biomarker especially C-reactive protein and serum amyloid A can be used
to detect MiP at subclinical level.A total of 547 pregnant women were screened
from three Primary Health Centers (PHCs) Samaru, with 75Plasmodium
falciparum positive. Malaria was diagnosed by both HRP2 (RDT) and Giemsa
staining techniques, while socio-demographic data was obtained using
semi-structured pretested questionnaires.Haemato-analyzer was used for
Hb-concentration, leucocytes and platelets counts, while spectrophotometry was
used for Iron, Zinc, Copper and Albumin estimations.ELISA technique was used
for serum C-reactive protein, Amyloid A, Ferritin and Transferrin
determinations. Results obtained showed 13.7% prevalence rate of P.
falciparum infection.The peak age specific incidence was 15-19 years
(17.5%), with mean parasite density of 5925. Those with no-formal education
were affected mostly (17.4%) with parasite burden of 4419; while across
occupation there was no difference in terms of infection rate and mean parasite
density. Pregnant women were mostly predisposed to P. falciparum
infection due to non-availability of ITNs, 41.3% of pregnant mothers had not
use nets at all during pregnancy.Majority(68.3%) of the pregnant mothers
complied with the use of IPTp, which may have led to reduced prevalence of P.
falciparuminfection in the study area. Incidence of P. falciparum
infection varied significantly according to gestation period and parity, 19.9%
for first trimester with mean parasite density of 7644 and primigravidae(19.0%)
with mean parasite density of 9764 respectively. Patients with malaria and
concomitant iron deficiency anemia (IDA) had mean sTfR level of 7.7 ±0.26 ng/ml
(0.1- 5.0ng/ml), and Ferritin level of 385.8±56.6(22.5-278.6)pmol/L. Soluble Transferrin
in normal subjects and patients with P. falciparum malaria showed
no significant difference (p > 0.05). Statistically significant difference (p
< 0.001) was observed in patients with malaria and concomitant IDA as
compared to normal control group. This results showed that estimation of
changes in some Acute Phase Proteins (CRP and SAA), despite the lack of
diagnostic specificity may be useful to clinicians because such changes reflect
the presence and intensity of inflammatory process (malaria infection), as well
as trace element metabolism during malaria infection. The cohabitation of
parasite manifestation and nutritional deficiency of trace elements creates
damage in the health of infected population, due alteration in Zn/Cu ratio.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background Information
The scourge never ends’. This may be an apt description for
one of the most prevalent infectious diseases-malaria. Globally, 3.3 billion
people in 106 countries are at risk of malaria. In 2012, malaria caused an
estimated 627,000 deaths, mostly among African children. Asia, Latin America,
and to a lesser extent the Middle East and parts of Europe are also affected
(WMD, 2014). Pregnant women and the under-fives form the bulk of its worst
victims in endemic areas (Enatoet al., 2007).
Tackling malaria in pregnancy contributes to three of the
Millennium Development Goals (MDGs), namely: goals 4 (To reduce child
mortality), 5 (To improve maternal health) and 6 (To combat HIV/ AIDS, malaria
and other diseases). Almost 30 million women are threatened by malaria in
pregnancy (MiP) annually with about 10,000 maternal mortalities attributed to
the disease each year and about 200,000 new born deaths annually (Mokuolu,
2011).
It is obvious that malaria in pregnancy causes tremendous
strain on the already weakened health systems in endemic countries. The
emergence of the human immunodeficiency virus (HIV) scourge has worsened the
dimension of the already precarious condition. These all combined to make
malaria infection a major public health problem in the tropics and subtropics(Cohen
et al., 2005).
In the developing
world, young women,
pregnant women, their
infants and children frequently experience a cycle where
under-nutrition (macronutrient and micronutrient) and repeated infection lead
to adverse consequences that can continue from one generation to 1
the next. Infants born prematurely or
with low birth weight (LBW) are at increased risk of early death or at risk of
poor growth and development in childhood and adolescence (Steketeeet al., 2001).
The poor growth resulting in underweight and stunting leaves reproductive-age
women at risk in their early pregnancies of delivering premature or LBW
infants. In addition, the micronutrient deficiencies, particularly iron and
folate deficiencies (which contribute to anemia), leave the young women at risk
of anemia leading to inadequate oxygen-carrying capacity and risk in pregnancy
of delivering premature or LBW infants (Steketeeet al.,2006).
It was suggested that offspring of placental-infected multigravida
women have the highest risk of P. falciparum during the first years of life
compared to children of Primigravid placental non-infected women. Plasmodium
falciparum is the only human malaria parasite with a clear and substantial
adverse effect on pregnancy, nutrition during pregnancy and pregnancy outcome
(Brabin, 1991). The first reaction of the body to immunological stress is the
innate, non-specific response preceding specific immune reactions. The acute
phase response (APR) is a prominent systemic reaction of the organism to local
or systemic disturbances in its homeostasis caused by infection, tissue injury,
trauma or surgery, neoplastic growth or immunological disorders (Gordon and
Koy, 1985; Gruyset al., 1999).
Intensive studies of the immune response to malaria parasites
in human beings have provided a wealth of information about the cells and
cytokines implicated in the pathophysiology of survival and fatal outcome in
severe infections. This suggests that a crucial balance might exist during the
inflammatory response to malaria infection and unbalanced response leads to
severe disease. In mild malaria, inflammatory response might be down regulated by
anti-inflammatory cytokines, including interleukin 4, interleukin 10 and Transforming
Growth Factor B (TGF-B) (Lucia and Salvatore, 2002).
The pathophysiological response to infection with Plasmodium
falciparum is highly variable. It depends on several factors including
previously acquired immunity and the production of cytokines such as
interleukin-1 (IL-1) and tumor necrosis factor (TNF), y-interferon (ɤ -IFN),
and interleukin-6 (IL-6). Secretion of these mediators is thought to be
responsible for many of the clinical features of malaria (Inigo and Manuel,
2002).
Although the stimulus to acute phase reactants production is
not fully understood, macrophage derived cytokines including IL-6, TNF, and
IL-1 are thought to be important (Gabay and Kushner, 1999).
Estimation of other changes in acute-phase proteins, despite
the lack of diagnostic specificity, is useful to clinicians because such
changes reflect the presence and intensity of an inflammatory process. Thus,
measurements of plasma or serum C-reactive protein can be used to differentiate
inflammatory from non-inflammatory conditions and are useful in managing the
patient's disease, since the concentration often reflects the response to and
the need for therapeutic intervention. In some diseases, such as rheumatoid
arthritis, serial measurements of C-reactive protein are of prognostic value.
Serum amyloid A concentrations usually parallel those of C-reactive protein,
although some studies indicate that serum amyloid A is a more sensitive marker
of inflammatory disease. At present, assays for serum amyloid A are not widely
available (Gabay and Kushner, 1999).
C-reactive protein is a pentameric protein molecule which has
been conserved over a long period
of evolution. It
binds to phosphorylcholine epitopes
found in Streptococcus pneumoniae and many parasites,
these binding results in the activation of .the classical complement pathway. Increased
concentrations of C-reactive protein have also been used to distinguish acute
pyogenic from viral meningitis. Serum amyloid A is the precursor of amyloid A protein
found in the amyloid fibrils present in secondary amyloid deposits. Both
proteins increase in concentration in the serum up to 1000 times in response to
inflammatory stimuli, whether infective or traumatic. Measurement of acute
phase reactants like C-reactive protein or serum amyloid A has been used to
monitor the response to antibacterial treatment (Gruyset al., 2005).
1.2 Statement of
Research Problem
Malaria infection (especially of Plasmodium falciparum)
during pregnancy is a significant health problem with substantialrisk to the
pregnant women, her fetus and new born child (WHO, 2013).
The use of cytokines for the diagnosis of malaria has been in
practice for sometimes. But their short half-life in serum makes assay
difficult to interpret for clinical purposes (Gabay and Kushner, 2009).
Acute phase proteins concentrations have been advocated as
objective biochemical indices of disease activity in a number of different
inflammatory processes. Though, it is not well documented whether parasitemia
can mount a comprehensive acute phase protein response and if so, whether this
is achieved by increasing acute phase protein synthesis due to the presence of
malaria parasite (Yapiet al., 2010).
1.3 Justification
An emerging view is that pathogenesis of malaria is a complex
process in which a common outcome might be reached by different routes. This
idea emphasizes the relevance of diagnostic and prognostic parameters
in predicting the specific risk associated with different clinical
characteristics (Miller et al., 2002).
This study was designed to test whether measurement of acute
phase reactants instead of cytokine concentration would prove valuable in the
diagnosis of malaria (especially of Plasmodium falciparum) in addition to
standard laboratory methods, also whether sequential measurement would be
valuable in assessing response to antimalarial treatment.
Clinical studies in large groups of patients with a variety
of disorders confirmed the rapid production and exceptionally wide dynamic
range of the serum amyloid A (SAA) response. It is as sensitive a marker for
the acute phase as C- reactive protein (CRP). Therefore, determination of APPs
can be used as fact in monitoring health of individual subjects especially when
several acute phase variables are combined in an index (Gruyset al., 2005).
1.4 Aim
To assess the nutritional status and some Acute Phase
Proteins levels of pregnant women with Plasmodium falciparum attending three
Primary Health Care centers, in Samaru Zaria.
1.4.1 Specific Objectives
i. To determine the prevalence rate of P. falciparum infection
in pregnant women attending PHCs in Samaru Community.
ii. To document the socio-demographic characteristics of pregnant
women with malaria (Plasmodium falciparum)and assess use of Intermittent
Preventive Treatment for prevention of Malaria in Pregnancy (IPTp).
iii. To determine the relationship between malaria parasite
density, parity and gestation period of pregnant mothers Infected with Plasmodium
falciparum.
iv. To assess changes in indices of Iron
status (Fe, Hb, serum Ferritin/ Transferrin) during Plasmodium falciparum
infection in pregnancy.
v. To determine relationship between the nutritional status of
pregnant women with and without Plasmodium falciparum Infection.
vi. To determine the effect of malaria parasite burden on
C-reactive protein and serum amyloid A among pregnant women with parasitemia.
1.5 Null Hypothesis
There’s no relationship between Acute Phase Proteins (APP)
production and malaria parasite density.
For more Nutrition & Dietetics Projects Click here
================================================================Item Type: Project Material | Size: 107 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.