ASSESSMENT OF THE ROLE OF MALARIA IN THE AETIOLOGY OF RENAL IMPAIRMENT IN ISU COMMUNITY IN EBONYI STATE, NIGERIA


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TABLE OF CONTENTS

Title page
Certification
Dedication
Acknowledgements
Table of Contents
List of Tables
List of Figures
List of Appendixes
Abstract

CHAPTER ONE:  INTRODUCTION AND LITERATURE REVIEW
1.1       Introduction
1.1.1    Background history of malaria
1.1.2    Justification of the study
1.1.3    Objectives of the study
1.2       Literature review
1.2.1    Epidemiology and incidence of malaria
1.2.2    Malaria burden
1.2.3    Life cycle of malaria parasite
1.2.3.1 Life cycle in man or vertebrate host
1.2.3.2 Life cycle in mosquito
1.2.4    Mode of transmission
1.2.4.1 Vector transmission
1.2.4.2 Blood transfusion
1.2.4.3 Congenital transmission
1.2.5    Symptoms of malaria
1.2.6    Diagnosis
1.2.7    Socio-cultural beliefs on malaria
1.2.8    Pathological effects of malaria
1.2.8.1 Host erythrocyte modification
1.2.8.2 Cytoaherence and knob formation
1.2.8.3 Endothelial cell receptors
1.2.8.4 Antigenic variation
1.2.8.5 Human genetics and innate resistance to malaria
1.2.8.6 Organ pathology
1.2.9    Epidemiology of malarial renal impairment
1.2.10  Pathogenesis of malaria renal impairment
1.2.11  Clinical presentation of malaria renal impairment
1.2.12  Management of malarial renal impairment

CHAPTER TWO
2.0       MATERIALS AND METHODS
2.1       Study area
2.2       Ethical consideration
2.3       Sampling technique
2.3.1    Malaria parasite determination and quantification
2.3.2    Determination of haematological indices
2.3.2.1 Total white blood count
2.3.2.2  Differential counts
2.3.2.3  Packed cell volume
2.3.3    Determination of biochemical parameters
2.3.3.1 Determination of serum urea
2.3.3.2 Determination of serum creatinine
2.3.3.3 Measurement of serum albumin
2.3.4    Determination of serum electrolytes
2.3.4.1 Measurement of serum sodium and potassium
2.3.4.2 Measurement of serum biocarbonate chlride ions
2.3.5    Investigation of urine samples
2.3.5.1 Measurement urine for protein
2.3.5.2 Measurement of urine density
2.3.5.3 Measurement of urine pH
2.3.6    Ultrasonographic examination of kidneys
2.3.7    Statistical analysis

CHAPTER THREE
3.0       RESULT
3.1       Overall prevalence of malaria parasitaemia in the study population
3.1.1    Intensity of malaria parasitaemia among malaria positive individuals
3.1.2    Mean parasite intensity among malaria Positive Individuals
3.2       Biochemical parameters of malaria Positives and Negatives individuals
3.2.1    Biochemical parameters among malaria positive and negative individuals by sex
3.2.2    Comparison of biochemical parameters of malaria positive and negative individuals by age
3.3       Serum electrolytes among malaria positive and negative individuals
3.3.1    Comparison of serum electrolytes among malaria positive and negative individuals by sex
3.3.2    Comparison of serum electrolytes among malaria positive and negative individuals age
3.4       Haematological parameters among malaria positive and negative individuals
3.4.1    Haematological parameters among malaria positive individuals by sex
3.4.2    Haematological parameters among malaria positive individuals by age
3.5       Mean kidney sizes of malaria positive and negative individuals
3.6       Prevalence of malaria after treatment of infected individuals
3.6.1    Intensity of  malaria parasites before and after treatment of infected individuals
3.6.2    Prevalence of malaria parasites after treatment by sex and age
3.7       Comparison of biochemical parameters of malaria positive individuals before and after  treatment
3.8       Mean serum electrolytes of  malaria positive individuals before and after treatment
3.9       Haematological parameters of malaria positive individuals before and after treatment

CHAPTER FOUR
4.0       DISCUSSION
4.1       Prevalence of malaria parasitaemia in the study area
4.2       Biochemical parameters of malaria infected and uninfected individuals
4.3       Serum Electrolytes in malaria positive and negative individuals
4.4       Hematological Parameters of malaria infected and uninfected individuals
4.5       Malaria parasite prevalence after the treatment of infected individuals
4.6       Findings
4.7       Recommendations
4.8       References
Appendices




ABSTRACT

This study, the involvement of malaria in renal impairment among individuals in selected villages of Isu community in Onicha Local Government Area of Ebonyi State was investigated. 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 selected, 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. Malaria negative individuals served as controls. Biochemical parameters (Total protein, serum creatinine, urea and albumin), haematological indices (packed cell volume (PCV)), total leucocyte counts (TLC) and differentials and electrolytes of malaria positive and negative individuals were determined using standard procedures. Ultrasonographic examination of kidneys was carried out to compare the features and sizes of both malaria positive and uninfected individuals. Malaria positive individuals were treated with current anti-malaria drugs and post treatment examination of the parameters were carried out three weeks after the treatment. This is to investigate the effects of treatment. The overall prevalence and parasite intensity in the study population were 37.5% (n = 90) and 2361+857.55p/┬ÁL respectively. most of the infected individuals had mild infection. There was no difference in infection rate by sex. Among the age groups, the prevalence of malaria parasite was higher in younger individuals but the differences were not statistically significant (P>0.05). Biochemical parameters of malaria positive individuals were higher than those of the uninfected. The differences were statistically significant (P<0 .05="" albumin="" except="" for="" level="" the=""> 0.05). Packed cell volume and monocytes of malaria infected individuals were higher and differed significantly from those of uninfected individuals (p<0 .05="" and="" concentration="" difference="" electrolytes="" in="" individuals="" malaria="" negative="" no="" of="" ph="" positive="" sg="" significant="" the="" there="" was="">0.05). The electrolytes, SG and pH of malaria positive and negative individuals did not differ statistically (p>0.05). Among the age groups, there was no marked difference in the biochemical, haematological and electrolyte levels of malaria positive and negative individuals (P>0.05). In malaria positive individuals, correlation analysis showed that there was positive but insignificant association between the intensity of malaria parasitaemia and total protein and albumin (r=0.0.198 and r=0.052) respectively while statistically significant positive association existed between malaria intensity, urea and creatinine (r=0.348 and r=0.602). The total leucocyte count, packed cell volume and eosinophil count also showed mild significant association with intensity of malaria parasite while no significant association existed between intensity of malaria parasite and electrolytes. After treatment, the prevalence of malaria parasite was drastically lowered to 9.1% with those still infected having only mild infection (26.3%). Biochemical parameters were also lowered and significant differences were observed in all of them (P< 0.01) while there was no significant difference between malaria parasite and the electrolytes, the SG and pH levels (P>0.05). The mean values of haematological parameters significantly reduced except the packed cell volume. Only the TLC count and eosinophils, showed significant association with MP while electrolytes did not. The ultrasonographic imaging of the kidneys of malaria infected and uninfected individuals showed that malaria parasitaemia altered the sizes of the kidneys of malaria positive individuals and some of them lost their cortico-medullary differentiation. Malaria infection may therefore be said to contribute to renal impairment as treatment of infected individuals with anti-malaria drugs significantly lowered the parameters that may lead to renal problems. It is therefore recommended that the diagnosis of malaria and renal function should go hand in hand in our health institutions. Renal impairment due to malaria infection will thus be prevented and recovery of diagnosed patients may be achieved by early treatment of malaria. This will invariably lead to reduction in both mortality and morbidity rates of both malaria infection and renal impairment.





CHAPTER ONE
INTRODUCTION AND LITERATURE REVIEW

1.1  INTRODUCTION

1.1.1 Background History of Malaria


The term malaria originated from Italian: meaning bad air and the disease was called ague or mesh fever due to its association with swamps in humid regions of the world (Cheesbrough, 1999). It is an ancient disease that has plagued humans throughout history (Joy et al., 2003). It is a term used for acute or chronic infection caused in man or other vertebrates such as mice and donkeys. Malaria remains one of the most pressing health problems in the world with an estimated 300-500 million cases annually of which 90% occurs in Africa (Tarimo et al.,1998). It is the most important infection of great global public health concern and by far the world’s most important tropical parasitic disease that kills more people than any other communicable disease except tuberculosis(Yah et al., 2005). According to WHO (2000) about 500 million people are affected by malaria at any time and approximately 2 million of them mostly children die each year (Raven and Johnson, 2002; Onyesome and Onyemakonor, 2011).

The global malaria situation continues to show no real improvement. Downward trends in the number of reported cases are maintained in some countries but are counter balanced by increasing trends in others. According to WHO (1987), there has been very little change in the geographical distribution of malarious areas but within countries, areas of rural economic exploitation have become foci for intense malaria transmission. The malaria situation in sub-Saharan Africa is grim and the disease constitutes a leading cause of poverty in the region (Wenceslaus, 2000). This is because African region has the greatest number of people exposed to stable malaria transmission and the greatest burden of malaria morbidity and mortality in the world (WHO, 1996; Snow et al., 1999). The problems associated with malaria.....



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