Open Access Original Research Article

Plasmodium falciparum Specific IgE, IgG and Anti-GPI IgG Antibodies in Cameroonian Children with Severe and Uncomplicated Malaria

Eric A. Achidi, Tobias O. Apinjoh, Judith K. Anchang-Kimbi, Clarisse N. Yafi, Richard Besingi, Nancy W. Awah, Marita Troye-Blomberg

International Journal of TROPICAL DISEASE & Health, Page 157-172
DOI: 10.9734/IJTDH/2012/1122

Aims: We investigated the role of antibodies in the pathogenesis of severe malaria in children by measuring and comparing plasma levels of antibodies to glycosyl phosphatidy linositol (GPI) and crude Plasmodium falciparum extract. 
Study Design: Cross-sectional case-control study.
Place and Duration of Study: Five health institutions in two towns and seven primary schools in the South West region of Cameroon between April 2003 and December 2005.
Methodology: A total of 649 children including 25, 156 and 233 cases of cerebral malaria (CM), severe malaria anaemia (SMA) and uncomplicated malaria (UM) respectively were recruited from health institutions and 233 apparently healthy controls (HC) from schools using predefined inclusion criteria. Malaria parasitaemia was determined by light microscopy using Giemsa-stained thick blood smears, haemoglobin level using a haemoglobinometer and blood cell count using a haemocytometer. The levels of total IgE, P. falciparum IgG, IgE and anti-GPI IgG antibodies were measured from plasma by the ELISA technique. 
Results: The mean white blood cell count (WBC) was higher in the severe malaria group compared with the HC group. Geometric mean parasite densities were significantly different (P<0.001) amongst the study groups but similar in the two severe malaria groups (Severe Malaria Anaemia and Cerebral Malaria). Seropositivity for IgG antibodies to P. falciparum was different within the study groups (P<0.001) and higher in the clinical cases compared to the HC group. Mean levels of anti-GPI IgG and P. falciparum specific IgE and IgG antibodies were significantly different among the study participant categories. Mean plasma levels of these antibodies were higher in the UM and HC groups when compared with the severe malaria groups. There was a significant positive correlation between the age of the participant and levels of anti-GPI IgG (P<0.001), P. falciparum IgE (P = 0.027) and total IgE (P = 0.020) antibodies.
Conclusion: Our observation of lower levels of anti-GPI and P. falciparum specific IgE antibodies in the severe group compared with the control group suggest a protective role of these antibodies in the pathogenesis of severe malaria. The correlation observed between P. falciparum IgE, IgG and GPI IgG antibody levels with age confirm previous reports that immunity to malaria develops with age and is partially dependent on antibody production.

Open Access Original Research Article

Sociodemographic Determinants of Mortality in Hospitalized Under-Five Children at a Secondary Health Care Centre in the Niger Delta

Matthias M. Okposio, Monday O. Unior, Felix O. Ukpeteru

International Journal of TROPICAL DISEASE & Health, Page 173-181
DOI: 10.9734/IJTDH/2012/1491

Aims: To determine the socio-demographic factors associated with mortality in hospitalized under-5 children in the Niger Delta region of Nigeria.
Study Design: Cross-sectional study.
Place and Duration of Study: Paediatric unit of Mariere Memorial Central Hospital Ughelli, Nigeria between October 2011 and February 2012.
Methodology: All inpatients aged 29 days to ≤ 60 months who met the inclusion criteria were consecutively enrolled and information on a range of demographic and clinical factors obtained using a structured questionnaire. The primary outcome variable was mortality. Data was coded and analysed using SPSS version 16 software.
Results: Of the 600 children recruited for the study, 345(57.5%) were males while 255(42.5%) females. The case fatality rate was 51(8.5%). Significant risk factors associated with mortality were maternal age >30 years (p=0.001), low maternal educational status (0.001), lower socioeconomic class (p=0.006), late presentation (p=0.004). However, multiple logistic regression analysis showed late presentation to be the strongest determinant of mortality. ((OR=4.83, 95%CI: 1.458 to 15.993, p=0.01).
Conclusion: Social factors play a significant role in the eventual health outcomes in hospitalized under-5 children with late presentation being the strongest predictor of mortality. Effort should therefore be made at creating awareness on seeking early treatment for childhood illnesses in recognized hospitals.

Open Access Original Research Article

Association of IL-10 & IL-10RA Polymorphisms with Lymphatic Filariasis in South Indian Population

Yasmeen Sheik, Sameera Fatima Qureshi, Ananthapur Venkateshwari, Saeed Nourmohammadi, Basheeruddin Mohammad, Pratibha Nallari

International Journal of TROPICAL DISEASE & Health, Page 182-197
DOI: 10.9734/IJTDH/2012/1525

Aim: The filariasis infection is initiated by mosquito derived third stage larva (L3), which establishes itself in different immunocompetent niches by adopting different evasion and immunomodulatory mechanisms. Immunological and clinical outcomes can vary considerably at the individual and population levels during lymphatic filariasis infection. The protein product coded by the interleukin-10 (IL-10) gene has broad immunomodulatory function in filarial load and patency of the disease. The potential influence of altered IL-10 expression encoded by IL-10 promoter single nucleotide polymorphisms (SNPs) and IL-10RA signaling pathway, in pathogenesis and clinical outcome of filarial infection was established in the present study 
Study Design: Genetic association based on case-control study.
Place and Duration of Study: Lymphatic filariasis cases referred to National Filariasis Control Program (NFCP), Siddipet, Medak, Andhra Pradesh, India between Feb 2006 to Dec 2009.
Methodology: A total of 100 non-endemic, 50 endemic and 118 lymphatic filariasis patients were included in the present study based on clinical and diagnostic criteria. Genetic polymorphisms in the IL-10 promoter region (-1082G/A, -819C/T and -592 A/C) and IL-10 RA coding region S138G were screened following PCR-RFLP and ARMS-PCR technique respectively.
Results: Patients with familial aggregation of lymphedema exhibited significant association with IL-10 -1082 ‘A’ allele (A vs G OR 2.68, CI - 1.12-6.37, P=0.02) coding for lower IL-10 levels. Similarly the G variant of IL-10RA S138G SNP revealed a significant association with lymphatic filariasis in the endemic population studied (GG vs AA OR 2.50 CI-1.22-5.13, P= 0.021). The Haplotype analysis also revealed the low signaling ATA is significantly associated with the disease in this cohort (P=0.03). The Multifactor Dimensionality Reduction Analysis (MDR) for IL-10 and IL-10RA SNPs interaction revealed the three locus model as the best model wherein the epistatic interactions of variant G allele of IL-10RA S138G, the A allele of the -1082G/A and the T allele of the -819C/T SNPs in IL-10 were found to be a possible risk genotype for filarial infection. (TA = 0.5230, CV-10/10, P=0.001).
Conclusion: IL-10 promoter haplotypes and IL-10 RA S138G polymorphisms are the possible genetic determinants of susceptibility to lymphatic filariasis. Further functional studies are warranted to validate these results.

Open Access Original Research Article

Determinants of Delivery Outcomes in Teenage Mothers at a University Teaching Hospital, South-Eastern, Nigeria

Henry A.A. Ugboma, Johnson A. Obuna, Emmanuel O. Ndukwe, Boniface N. Ejikeme

International Journal of TROPICAL DISEASE & Health, Page 198-206
DOI: 10.9734/IJTDH/2012/1509

Aim: This study aims at identifying some delivery outcome determinants in teenage mothers and evaluating the effect of booking in light of these parameters.
Study Design: A retrospective study. 
Place and Duration of Study: Teenage mothers who delivered in a teaching hospital in Nigeria over a 5-year period (between 1st Jan, 2003 and 31st Dec, 2007).
Method: Labour ward register and midwives report books were used to get their hospital numbers. These case notes were retrieved subsequently from the health records department and relevant data extracted.
Results: There were 8,297 deliveries during the study period and 453 cases of teenage mothers giving a teenage delivery incidence of 5.5%. Of the total teenage deliveries, older teenage mothers (16-19 years) constituted 94.7% while younger teenage mothers were 5.3%. Booked teenage mothers were 83.5% while 16.5% were unbooked. Still birth rate was 87 per 1000. No maternal death was recorded among the teenage mothers. Older teenagers had better obstetric indices such as higher vaginal delivery rate, lower caesarean section and instrumental delivery rate, reduced blood loss, better Apgar scores and less intra uterine fatal deaths than younger teenagers. However, some of these were not statistically significant and in some cases, were barely marginal.
Conclusion: Influence of age on teenage delivery and other biological risk factors may not be as much as earlier perceived. Paying special attention to the socio-economic condition of teenage mothers and by extension, their access to essential obstetric care, may obviate the poor obstetric outlook hitherto attached to it.

Open Access Original Research Article

A Comparative Study of Contraceptive Use among Rural and Urban Women in Osun State, Nigeria

Adebimpe Wasiu Olalekan, Asekun-Olarinmoye Esther Olufunmilayo

International Journal of TROPICAL DISEASE & Health, Page 214-224
DOI: 10.9734/IJTDH/2012/1308

Aims: To compare contraceptive practices among rural and urban women in Osun State, South-western Nigeria.
Study Design: Cross-sectional descriptive study.
Place and Duration of Study: Osun state in southwestern Nigeria. The study was carried out between January and June 2010.
Methodology: One thousand and twenty four women of reproductive age group, including 512 rural and 512 urban women were selected into this study using multistage sampling method. Research instrument used were pre-coded, pre-tested, semi structured interviewer administered questionnaires. Data was analyzed using the SPSS software.
Results: Four hundred and thirteen rural respondents and 475 urban respondents were aware of contraceptives with only 86(16.8%) and 239(46.7%) respectively using a contraceptive method.” Seventeen (3.3%) and 95(18.6%) of rural and urban respondents respectively used their contraceptive methods consistently. Thirty eight (7.4%) and 118(23.1%) of rural and urban respondents respectively used a condom the last time they had sexual intercourse. Mean number of births per woman was 3.4+1.8 births per woman in rural and 2.9+1.5 births per urban woman. Sixty nine (13.5%) of rural and 164(32.0%) of urban respondents had discontinued their contraceptive method at one time or the other. Women with formal education in both locations had about one-half the fertility rate compared to women with no formal education (OR=0.59, 95% CI=0.45–0.95, p=0.001). Similarly, women who used contraceptives in both locations had about one-twelfth fertility rate compared to women not using contraceptives (OR=0.08, 95% CI=0.06–0.12 and p=0.019).”
Conclusion: Awareness and use of contraceptives was higher in urban than rural respondents under study. Fertility was also higher among urban than rural women.

Open Access Short Communication

Effect of Storage Temperature and Sample Volume on Brucella melitensis Isolation from Goat Milk

Jennifer A. Zambriski, Ryan C. Maves, Daryl V. Nydam, Viterbo Ayvar, David Cepeda, Rosa Castillo, Andre Díaz-Pino, Mayuko Saito, Robert H. Gilman

International Journal of TROPICAL DISEASE & Health, Page 207-213
DOI: 10.9734/IJTDH/2012/1738

Aim: To determine the impact of storage temperature and sample volume on milk culture success under a simulated field setting.
Study Design: Prospective cohort study.
Place and Duration of Study: Centro de Salud Global UPCH, Tumbes, Peru and Naval Medical Research Unit SIX, Lima, Peru. April, May and June 2010.
Methodology: We aseptically collected milk from unvaccinated goats, and then experimentally inoculated the pooled milk sample with B. melintensis in order to compare the effect of two different sample volumes (2ml and 5ml) and two different storage temperatures (4ºC and -20ºC) on culture success. 
Results: We achieved higher culture success in refrigerated (4ºC) versus frozen (-20ºC) samples (OR 4, 95% CI 1.7, 9.6) and with 5-ml versus 2-ml aliquots (OR 9, 95% CI 3.3, 26.6). 
Conclusion: In resource-poor field settings where cold-chain and transportation are unreliable, use of ice for sample storage and transport of goat milk is an acceptable method for the purpose of culturing B. melintensis.

Open Access Case Study

Risk Factors Associated with Bites due to Two Viperid Snakes: A Case Control Study

Senanayake Abeysinghe Mudiyanselage Kula, Kosala Gayan Abeysundara Dissanayake Wee, Ashoka Rathnathilake, Pallegoda Vithanage Ranjith Kumarasiri

International Journal of TROPICAL DISEASE & Health, Page 225-230
DOI: 10.9734/IJTDH/2012/1904

Aims: This study was to assess victim’s environmental and behavioural risk factors that promote bites from two viperid snakes.
Study Design: A case control study.
Place and Duration of Study: Medical wards, General Hospital, Kurunegala, Sri Lanka, between June to December 2010.
Methodology: Cases were recruited prospectively from consecutive admissions to the General Hospital, Kurunegala, Sri Lanka with proven viperid bites. Age and gender matched control group was selected from relatives and neighbourhood of the cases in a ratio of 1 case: 2 controls. 
Results: There were 56 cases and 112 controls with mean age 44 years and 45 years respectively. Of the 13 risk factors assessed, 7 risk factors showed a significant association with viperid bites. Those were (1) being in an ill lit place (OR, 95% CI= 6.6 (3.25-13.4), (2) being in outdoor places (OR, 95% CI= 148.8 (43.7-506), (3) working in a field (OR, 95% CI= 175 (31.4 – 976), (4) occupation as a field worker (OR, 95% CI= 5.3 (2.3-12 ), (5) low level of financial status (OR, 95% CI=9.9(2.75- 35.5), (6) lack of attached toilet (OR, 95% CI= 7.38 (2.15- 25.3), (7) presence of small rodents in the compounds (OR, 95% CI= 11 (4.88-24.9). 
Conclusion: Identifying easily remediable risk factors would help in preventing viperid snake bites.