Intestinal helminth infections among pregnant Cameroonian women

Objectives: To investigate the prevalence and intensity of intestinal helminth infections in pregnant Cameroonian women and assess their anaemic status.Design: Longitudinal study.Setting: Buea Integrated Health Centre, Muea Health Centre, Mutengene Integrated Health Centre and the University of Buea Life Sciences Laboratory.Subjects: Two hundred and six pregnant women.Interventions: Stool and blood samples were collected from 206 pregnant women during three consecutive visits of each participant to the clinic, and used for identification and quantification of eggs of soil-transmitted nematodes and determination of packed cell volume respectively. The pregnant women received mebendazole and iron tablets on the day of enrollment at the antenatal clinic to control helminth infections andanaemia.Main outcome measures: The impact of antenatal clinical visits on the prevalence of helminth infections and the anaemic status of the women during pregnancy were assessed.Results: The results revealed that infection rate of intestinal nematodes was 47.10/0 during the first antenatal visit. This dropped to 27.2% during the second visit and 8.70/0 during the third visit. The prevalence was significantly higher in primigravidae than multigravidae during the first (P<0.001) and second (P<0.03) antenatal visits. More single women than married women were found infected with intestinal nematodes during the three visits, the difference being significant only during the first visit(P<0.01). Most of the infected women were those who attended clinic at Muea, a semiurban community. At the first antenatal visit, multigravidae had a heavier load of all three nematode species than primigravidae while single women carried a heavier burden of A. lumbricoides and T. trichiura than married women. At the second visit, primigravidae and single women carried a heavier burden of Ascaris and hookworm than multigravidae and married women respectively. Overall, the intensity of helminth infection increased after the first visit while prevalence dropped, but both had dropped by the third visit. The Ascaris/Trichuris combination was the most prevalent in mixed species infections, while A. lumbricoides was the most prevalent in single species infection. The prevalence of anaemia (PCV<31%) was 53.4% on the first antenatal visit, 50.0% on the second and 28.2% on the third antenatal visit. Significantly more primigravidae than multigravidae were anaemic on the first and second visits (P<0.003and P<0.001 respectively). More anaemic cases were recorded among women attending clinic in Mutengene than in Muea and Buea (P<0.05).Conclusion: Prevalence of soil-transmitted helminth infections in pregnant Cameroonian women was 47.1 %, with single and mixed species infections present at 28.6% and 18.5% respectively. Primigravidae and single women were more vulnerable to helminth infections than multigravidae and married women. The results provide evidence in support of anthelmintic treatment in prenatal programmes

Seroepidemiology of Toxoplasmosis in Pregnant Women Attending the University Teaching Hospital in Yaounde, Cameroon

Purpose: The study was carried out to investigate the epidemiology and associated toxoplasmosis predisposing risk factors in Cameroon. Methods: The survey took place at the Yaounde University Teaching Hospital from May to June 2008. Serum samples were collected from 110 pregnant women attending the ante natal clinic using aseptic techniques after obtaining informed consent. The samples were analysed using toxo-lgG immunocomb and toxo-IgM “capture” ELISA. A structured questionnaire was used to collect information on predisposing risk factors for toxoplamosis from each patient. Data was analysed on Epi-Info using confidence intervals and chi-square statistic test. Results: The average age of the women was 27.9+5.8years and the mean gestational age was 4.1+0.2months. The overall IgG seroprevalence was 65.5% {95% CI: 53.7-71.7%} and that of IgG and IgM co-infection was 2.7%. The seroprevalence was 75% in the first trimester, 60.6% in the second trimester and 50% in the third trimester. No statistically significant relationships were established between anti-toxoplasma IgG and IgM antibodies and abortion history, meat consumption, potable water sources, cat ownership and age. Conclusion: The prevalence of IgG antibodies to Toxoplasma gondii is high and the first trimester in pregnancy carries the highest risk. All pregnant women should be screened for toxoplasmosis and educated on predisposing risk factors during antenatal visits.Keywords: Toxoplasma gondii, Pregnancy, IgG, IgM, Prevalenc

Diagnostic comparison of malaria infection in peripheral blood, placental blood and placental biopsies in Cameroonian parturient women

<p>Abstract</p> <p>Background</p> <p>In sub-Saharan Africa, <it>Plasmodium falciparum </it>malaria in pregnancy presents an enormous diagnostic challenge. The epidemiological and clinical relevance of the different types of malaria diagnosis as well as risk factors associated with malaria infection at delivery were investigated.</p> <p>Method</p> <p>In a cross-sectional survey, 306 women reporting for delivery in the Mutenegene maternity clinic, Fako division, South West province, Cameroon were screened for <it>P. falciparum </it>in peripheral blood, placental blood and placental tissue sections by microscopy. Information relating to the use of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine, history of fever attack, infant birth weights and maternal anaemia were recorded.</p> <p>Results</p> <p>Among these women, <it>P. falciparum </it>infection was detected in 5.6%, 25.5% and 60.5% of the cases in peripheral blood, placental blood and placental histological sections respectively. Placental histology was more sensitive (97.4%) than placental blood film (41.5%) and peripheral blood (8.0%) microscopy. In multivariate analysis, age (≤ 20 years old) (OR = 4.61, 95% CI = 1.47 – 14.70), history of fever attack (OR = 2.98, 95% CI = 1.58 – 5.73) were significant risk factors associated with microscopically detected parasitaemia. The use of ≥ 2 SP doses (OR = 0.18, 95% CI = 0.06 – 0.52) was associated with a significant reduction in the prevalence of microscopic parasitaemia at delivery. Age (>20 years) (OR = 0.34, 95% CI = 0.15 – 0.75) was the only significant risk factor associated with parasitaemia diagnosed by histology only in univariate analysis. Microscopic parasitaemia (OR = 2.74, 95% CI = 1.33–5.62) was a significant risk factor for maternal anaemia at delivery, but neither infection detected by histology only, nor past infection were associated with increased risk of anaemia.</p> <p>Conclusion</p> <p>Placenta histological examination was the most sensitive indicator of malaria infection at delivery. Microscopically detected parasitaemia was associated with increased risk of maternal anaemia at delivery, but not low-grade parasitaemia detected by placental histology only.</p

An update of malaria infection and anaemia in adults in Buea, Cameroon

<p>Abstract</p> <p>Background</p> <p>Anaemia is caused by many factors in developing countries including malaria. We compared anaemia rates in patients with malaria parasitaemia to that of patients without malaria parasitaemia.</p> <p>Findings</p> <p>A cross-sectional study was carried out from November 2007 to July 2008 in health units in Buea, Cameroon. Adult patients with fever or history of fever were included in the study. Information on socio-demographic variables and other variables was collected using a questionnaire. Malaria parasitaemia status was determined by microscopy using Giemsa stained thick blood smears. Haemoglobin levels were determined by the microhaematocrit technique.</p> <p>The study population consisted of 250 adult patients with a mean age of 29.31 years (SD = 10.63) and 59.44% were females. 25.60% of the patients had malaria parasitaemia while 14.80% had anaemia (haemoglobin < 11 g/dl). Logistic regression revealed that those with malaria parasitaemia had more anaemia compared to those without malaria parasitaemia(OR = 4.33, 95%CI = 1.21-15.43, p = 0.02) after adjusting for age, sex, rural residence, socioeconomic status, use of antimalarials, use of insecticide treated nets(ITN) and white blood cell count.</p> <p>Conclusions</p> <p>In adult patients with fever in this setting, malaria parasitaemia contributes to anaemia and is of public health impact. Our results also provide a baseline prevalence for malaria parasitaemia in febrile adults in health units in this setting.</p

Impact of Inconsistent Policies for Transfusion-Transmitted Malaria on Clinical Practice in Ghana

Background: Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa. Methods/Principal Findings: We randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&amp;G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received antimalarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7 % and 24 % of recipients in medicine and O&amp;G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patient

Plasmodium falciparum population dynamics in a cohort of pregnant women in Senegal

<p>Abstract</p> <p>Background</p> <p>Pregnant women acquire protective antibodies that cross-react with geographically diverse placental <it>Plasmodium falciparum </it>isolates, suggesting that surface molecules expressed on infected erythrocytes by pregnancy-associated malaria (PAM) parasites have conserved epitopes and, that designing a PAM vaccine may be envisaged. VAR2CSA is the main candidate for a pregnancy malaria vaccine, but vaccine development may be complicated by its sequence polymorphism.</p> <p>Methods</p> <p>The dynamics of <it>P. falciparum </it>genotypes during pregnancy in 32 women in relation to VAR2CSA polymorphism and immunity was determined. The polymorphism of the <it>msp2 </it>gene and five microsatellites was analysed in consecutive parasite isolates, and the <it>DBL5ε + Interdomain 5 </it>(<it>Id5</it>) part of the <it>var2csa </it>gene of the corresponding samples was cloned and sequenced to measure variation.</p> <p>Results</p> <p>In primigravidae, the multiplicity of infection in the placenta was associated with occurrence of low birth weight babies. Some parasite genotypes were able to persist over several weeks and, still be present in the placenta at delivery particularly when the host anti-VAR2CSA antibody level was low. Comparison of diversity among genotyping markers confirmed that some PAM parasites may harbour more than one <it>var2csa </it>gene copy in their genome.</p> <p>Conclusions</p> <p>Host immunity to VAR2CSA influences the parasite dynamics during pregnancy, suggesting that the acquisition of protective immunity requires pre-exposure to a limited number of parasite variants. Presence of highly conserved residues in surface-exposed areas of the VAR2CSA immunodominant DBL5ε domain, suggest its potential in inducing antibodies with broad reactivity.</p

Host candidate gene polymorphisms and clearance of drug-resistant Plasmodium falciparum parasites

Resistance to anti-malarial drugs is a widespread problem for control programmes for this devastating disease. Molecular tests are available for many anti-malarial drugs and are useful tools for the surveillance of drug resistance. However, the correlation of treatment outcome and molecular tests with particular parasite markers is not perfect, due in part to individuals who are able to clear genotypically drug-resistant parasites. This study aimed to identify molecular markers in the human genome that correlate with the clearance of malaria parasites after drug treatment, despite the drug resistance profile of the protozoan as predicted by molecular approaches