Assessment Of Some Haemotological Parameter On Malaria Patient
Hematological parameters are measurable indices of the blood that serve as a marker for disease diagnosis. The aim of this study was to evaluate hematological parameters of patients with malaria in Nigeria. This was a prospective study in which the full blood count of patients, with malaria attending the General Hospital Owerri, Nigeria from March to May 2007, were analyzed. Data was analyzed using SPSS version 15.0 software. P value of less than or equal to 0.05 is considered as statistically significant. A total of 100 patients were recruited for the study. Fifty patients had P.falciparum malaria while the remaining was negative and were used as controls.
There were more males with malaria (n=30) than females (n=20) and thirty two (64%) were below 5years while 18(36%) were above 5 years. Lymphocyte and monocyte counts were elevated among patients with malaria relative to the control while haemoglobin and platelet levels were significantly decreased (P ≤0.05). The platelet level decreases as the degree of malaria parasitaemia increases. Haemalogical parameters in patients with malaria infection are deranged. Thrombocytopenia could be used to determine presence and severity of malaria.
1.1 Background to the Study
Malaria is one of the most prevalent human infections worldwide resulting in 225 million cases each year (WHO, 2010). It is caused by protozoa parasite of the genus plasmodium which infects and destroys red blood cells. Four species of plasmodia (P. falciparum, P. malariae, P. ovale and P. vivax) cause malaria in humans of which P. falciparum is the most common cause of morbidity and mortality (Taylor-Robinson, 1998; Das and Pan, 2006).Malaria kills an average of 1 million Patients in Africa annually, Snow et al., (2005). In Nigeria about 96 millionpeople are exposed to malaria, and out of these 64 million people get infected and almost 300,000 deaths are being reported annually in the general population, of which over 100,000 deaths are of Patients (Alaribe et al.,
2006). Haematological parameters are measurable indices of blood that serve as a marker for disease diagnosis (Petel et al., 2004). Haematological abnormalities such as anaemia and thrombocytopaenia have been observed in patients with malaria (Ladhani et al. 2002; et al. 2007).
The key feature of the biology of the Plasmodium falciparum, the predominant malaria species, is the ability of the infected red blood cells to adhere to the lining of the small blood vessels (Richard et al., 1998). Such sequestered parasites provide considerable obstruction to tissue perfusion. In addition, it is becoming clear that in severe malaria there may be marked reductions in the deformability of uninfected RBCs (Dondorp et al., 2000). RBCs destruction is an inevitable part of malaria, and anaemia further compromises oxygen delivery. Severe anaemia may arise from multiple poorly understood processes including acute haemolysis of uninfected RBCs and dyserythropoeisis, as well as through the interaction of malaria infection with other parasites infection and with nutritional deficiencies (Dondorp et al., 2000). The aim of this study was to determine changes in the haematological parameters of Patients with malaria infection in Nigerian population of Africa. Alterations in the haematological indices may strengthen the suspicion of malaria, prompting more meticulous search for malaria parasite, and timely institution of specific therapy.
Malaria which is the most prevalent infectious disease in the tropical and subtropical regions of the world is of great public health importance (Mishra et al., 2003; Umar et al., 2007; Mia et al., 2011).The World Health Organization reports that malaria, the deadly parasitic disease is responsible for nearly ninety percent of death in Africa (Ogbodo et al., 2010). One-fifth of infants’ death in Africa is caused by the scourge of malaria (Snow et al., 2005; WHO, 2010). In Nigeria, approximately 0.25 million deaths of Patients under the age of five is caused by malaria yearly (UNICEF, 2009). Typhoid fever which is also endemic in Africa is more severe in infants and the elderly (Preston and Boreszyk, 1994; Gatsing et al., 2006).
Both malaria and typhoid exhibit close symptomatology and epidemiology (Nsutebu and Ndumbe, 2001; Brian and Wahinuddin, 2006). The first case of malaria-typhoid co-infection occurred among American soldiers in 1862 (Bynum, 2002). The high incidence and prevalence of malaria-typhoid co-infection became popular almost ten years ago whereas the fact that malaria has been prevalently high is already recognized and accepted (Uneke, 2008). The onset and progression of the malaria infection is characterized by vast alterations in hematological and biochemical parameters (Bidaki and Dalimi, 2003). The World health Organization’s (WHO) criteria acknowledges that some biochemical and hematological features should raise the severity of malaria (World Health Organization, 2000).
In different parts of the world including Nigeria, scientific materials on hematological and biochemical alterations in acute falciparum malaria are available (Mishra et al., 2003; Egwunyenga et al., 2004; Bidaki and Dalimi, 2003; Udosen, 2003), but none have really been reported from Sango-Ota, Ogun State, Nigeria and also scientific information on the impact of malaria-typhoid co-infection on hematological and biochemical parameters are scanty. This study examined the effect of malaria and malaria-typhoid co-infection on some hematological and biochemical indices. The study population includes only the febrile patients that have been clinically said to have malaria and malaria-typhoid co-infection from the results of their malaria and widal tests, respectively.
1.2 Aim and Objective of the Study
The aim of this study was to determine changes in the hematological parameters of patients with malaria infection in Nigerian population of Africa. Alterations in the hematological indices may strengthen the suspicion of malaria, prompting more meticulous search for malaria parasite, and timely institution of specific therapy. George and Ewelike Ezeani (2002)
1.3 Justification of the Study
Information on the association of haemotological parameter on malaria patient in Nigeria is scanty but very necessary because malaria is highly endemic in the country. The mortality and morbidity rates of the infection are also high especially in high risk groups such as children and pregnant women. Unfortunately , this information is very scanty in Nigeria and has not been investigated in imo State. Renal failure (Serum creatinine >3mg/dl) and jaundice (bilirubin>3mg/dl) may be indicative of severe malaria and therefore requires special attention. In Nigeria, cases of inadequate treatment of malaria is quite high among the urban and rural poor. This is because of the high level of self medication that arise from difficulties inherent in weak health care system which make people to report to hospitals as a last resort. Majority of Nigerians and the urban and rural poor in many countries of sub-Saharan Africa also use local herbs and plants as their main sources of medicines instead of complementary sources. Though some of these herbs may be very effective, others are not and the implication is that the impairment of organ functions which would have been transient, present only during the duration of the disease, will gradually progress to chronic organ dysfunction with its disastrous consequences .It therefore becomes absolutely necessary that malaria involvement in renal impairment in Nigeria be assessed. This will ensure proper management of malaria infection with its associated complications.
Discussion, Conclusion and Recommendation
Malaria infection remains a serious health problem in sub-Saharan Africa including Nigeria (Ekanem, 1991; Dzeing-Ella et al. 2005). We found significant reduction in the haemoglobin concentration in Patients with malaria parasitaemia compared to controls and our findings is similar to an earlier finding (Ho and White, 1999). High levels of parasitaemia particularly with P.falciparum cause more destruction of red blood cells hence reducing haemoglobin levels leading to anaemia. This may be as a result of haemolysis of parasitized red blood cells, accelerated removal of parasitized red blood cells and ineffective erythropoiesis (Bashawri et al., 2002). There was a significantly reduced mean total white blood cell (WBC) count among the Patients with malaria infection than the control in this study. Our finding is in consonance with reports of Ho and white. However, recently an Indian study found leucocytosis in malaria infected Patients which is at variance with our finding (Maina et al. 2010) which found normal values. Furthermore, white blood cell differentials like lymphocyte and neutrophils were normal in Patients with malaria and control. Although, significantly lower values were observed among Patients with malaria than the control. Nonetheless, monocyte count of Patients with malaria in our study was low, but higher than the control (P<0.05). Phagocytosis of malaria pigment by monocytes may be responsible for the relatively higher figures in the malaria infected subjects than the control. Low levels of monocytes and lymphocyte in malaria had been reported previously (Erhart et al., 2004).
In conclusion, malaria infection is an important factor that alters hematological indices in Patients in Nigeria. Presence of thrombocytopenia in a patient with acute febrile illness in the tropics increases the probability of malaria and enhances prompt initiation of treatment. Also the degree of thrombocytopenia may be a useful tool in the determination of severity of malaria infection in the tropics.
From the result of the work carried out, I recommend that every household in Nigeria should use malaria prevention tools and methods to avoid malaria infection which will lead to death if not treated and also keep the environment clean to avoid outbreak of mosquito.
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