Prevalence of malaria infection in children in Anambra state, Nigeria after change of policy from presumptive/clinical to confirmed diagnosis

In 2011, WHO change malaria case-management policy from presumptive treatment of fevers to parasitological diagnosis and targeted treatment with artemisinin combination therapy (ACTs). Between 2010 and 2012, a series of activities were undertaken to support the implementation of the new policy. Regular monitoring of the quality of malaria case-management was carried out to inform policy makers, implementers and donors agencies on the implementation progress. This study was carried out to estimate the effects of this new WHO policy on the prevalence of malaria parasite infection in children from selected communities in Anambra State, Nigeria. This study was conducted in thirteen communities purposively selected from thirteen local government areas in Anambra State using children aged 0 – 14.90 years. Venous blood samples were collected from 82 and 166 children from the communities and hospitals, respectively for thick films blood smears for microscopy. Chi-square (χ2) and Fisher least significance difference test were used to analyse the data collected. The overall prevalence of malaria based on the community survey in Anambra State was 46.30 %, while the prevalence of malaria based on hospital survey was 94.60 %. The result of this study showed that there was no significant difference in infection rate in relation to age in both community and hospital survey. There should be proper management of childhood malaria in the homes and hospitals. This could be achieved by training and retraining of health care workers and mothers/care givers in the formal health care delivery systems to ensure quick and accurate diagnosis of malaria parasite infection of children in Anambra State, Nigeria.Keywords: Prevalence of malaria, Children, Anambra State, Nigeria, Presumptive policy, Confirmed diagnosis, Hospital malaria vs. Community malari

Symptoms associated in the diagnosis and management of malaria in a semi urban tropical community

study of symptoms associated in the diagnosis and management of malaria in a semi urban community of Enugu State, South-Eastern Nigeria was conducted. Structured qualitative and quantitative questionnaires were administered along an in-depth interview to assess the knowledge, attitude, behaviour and practice (KABP) among school children and pregnant women attending ante-natal clinic hospitals and to ascertain their health-seeking behaviour. Symptomatic diagnosis of the 352 pregnant women and children, showed that 260 (79%) did not manifest any of the malarial symptoms within the past three months as at the time of the study, 20 (5.7%) patients had fever alone, chill and blisters (0.9%), headache, diarrhoea and joint pain (0.3%), and weakness and anorexia (0.6%), respectively. Recent fever combined with chill was highest 2.8%, followed by anorexia and weakness 2.0%, fever with headache, and weakness 1.7%, fever with anorexia and or vomiting 1.4%, fever with chill and headache and/ or amber urine or joint pain or anorexia or frequent sleeping 1.1%, headache with weakness 1.1%. Forty six (46) antenatal care patients out of the 352 population sampled for symptomatic diagnosis to predict malaria infection in symptomatic patients with recent history of treatment showed low sensitivity (41.6%), but highly specific (80%), low positive value (45.7%), high negative predictive value (77.3%), low false positive rate (20%), moderately high false negative rate (58.4%) and a high J-index (78.7%). The axillary temperature was poorly predictive for negative samples with normal axillary temperatures. The mean axillary temperature among children with positive malaria test was 37.0°C and negative malaria test was 36.4°C. Antenatal patients with positive test were 36.5°C and negative malaria test was 35.1°C. Self-diagnosis and presumptive treatment are evident based in the prevention and prompt treatment of malaria disease and this method is prevalent in the rural communities and should be an adjunct to routine microscopy in clinical diagnosis.Keywords: Malarial symptoms, Anorexia, Diagnostic, Axillary, Sensitivity and predictive valueAnimal Research International (2012) 9(2): 1560 – 156

Haematological indices of malaria infected residents of Isu community, Onicha local government area, Ebonyi state, Nigeria

Malaria as a major mosquito-borne public health problem is likely to initiate changes in haematological parameters of its sufferers. This study investigated the changes in haematological indices of malaria infected residents of Isu community in Onicha Local Government Area of Ebonyi State. A two-stage sampling design was adopted in which selection of villages constituted the first stage/Primary Sampling Units (PSUs) where three (3) villages (Isuachara, Agbabor and Mgbala-ukwu) out of the seven villages were selected using simple random sampling. In the second stage, a simple random sample of 240 individuals was taken from the three villages using 95% confidence level and a margin of error of 6.32% with a standard deviation of 0.5. Thick blood smears of venous blood stained with Giemsa were examined microscopically for malaria parasitaemia (MP) and its intensity. Those negative for malaria parasite served as controls. Haematological indices (packed cell volume (PCV)), total leucocyte counts (TLC) and white blood cell differentials of malaria positive and negative individuals were determined using standard procedures. Packed cell volume and monocytes of malaria infected individuals were higher and differed significantly from those of uninfected individuals (p<0.05). Correlation analysis showed significant association between the total leucocyte count, packed cell volume and eosinophil count and intensity of malaria parasites. From the results of this study, intensity of malaria parasite altered the values of haematological indices of the sufferers. It was therefore recommended that the diagnosis of malaria and changes in haematological parameters of patients should go hand in hand in our health institutions for effective management and control of the infection.Keywords: Malaria, Haematological, Indices, Parasites, Infected, Resident

A six year review of the trends in prevalence of malaria infection in children in secondary and tertiary health care outlet in Anambra state, Nigeria

This study examined the trends of malaria infection among in children in the paediatric unit of some tertiary and secondary health outlet in Anambra State, Nigeria over a six year period. A retrospective study of malaria prevalence in children aged 0 – 14.9 years between January 2005 and December 2010 was conducted to establish the trends. There was an increase in the number of children with malaria infection from 2005 to 2010. Seasonal prevalence occurred with 52.3% malaria parasite infection during rainy season and 47.7% during the dry season. Children between the ages of 0 – 3 years had the highest malaria prevalence between 2005 – 2010. There was an overall yearly increase in the number of malaria cases which may be as a result of influx of mothers/caregivers to the hospitals for further treatment after initial home management of malaria in their children.Keywords: Trends, Malaria, Prevalence, Children, Tertiary and secondary health outlet, Anambra State, Nigeri

Comparative analysis of acon-Plasmodium falciparum rapid malaria diagnostic test with routine microscopy among school children and pregnant women in a rural community in Enugu State, Nigeria

There are currently two methods for the direct diagnosis of malaria: the thin blood smear and the thick smear. A third method called the Acon-Plasmodium falciparum (Acon-Pf) (a new cheap malaria rapid diagnostic test) has been developed. This was the first study comparing the three methods in rapid malaria diagnosis among school children and pregnant women in Enugu State, Nigeria, using qualitative and quantitative questionnaires that address their knowledge, attitude, behaviour and practice. In this study, 352 whole blood samples of individuals with suspected falciparum malaria were investigated among pregnant women attending antenatal clinic and school children in rural communities in Enugu State. The following parameters were determined: intrinsic validity, predictive values, species diagnostic power and logistic factors. Acon-Pf had the following characteristics: 91.5 % sensitivity, 87.2 % specificity, 64.3 % positive predictive values, 97.6 % negative predictive values, high malaria infection rate determination of 58.7%, reduced mean packed cell volume (0.25 mmol/L) in malaria patients, correct species diagnosis including both the trophozoite and gametocyte stages of Plasmodium falciparum. The Acon-Pf positive test result ranged from light to thick coloured bands and the time required for the test was 1.3 – 15 ± 5 minutes. The cost per Acon-Pf test cassette at bulk purchase was N112.50 (US$0.90) without the service charge as compared with thick smear (N 300.00, US$ 2.50) and N 350.00 (US$ 2.90) for thin smear. The study found that Acon-Pf is suitable along side microscopy in the accurate diagnosis of malaria in Enugu State. The use of Acon- Pf and thick smear tests in parallel, first collecting the Acon-Pf results, as it contributes in reading the thin smear result for confirmation of species, diagnosis and assessment of parasitaemia. Thus, Acon-Pf test device is a viable cost effective adjunct to routine microscopy and a reliable option for malaria diagnosis in remote and emergency situations.Keywords: Acon-Pf, Routine microscopy sensitivity, Specificity, Intrinsic validity, Predictive values, Parasitaemia, Trophozoite, Gametocyte, Diagnostic power, Epidemiology, Logistic factorsAnimal Research International (2012) 9(2): 1585 – 160