Open Access Original Research Article

Microscopy Negative Malaria during a Peak Transmission Season in a Malaria Endemic Setting: Diagnostic Accuracy of RDTs, Expert Microscopy and the Value of Presumptive Treatment

Charles O. Odongo, Peter Wambi, Jennifer Ajok, Ian Musinguzi, Samuel Oluka, Anita Wanyana, Denis Anywar, Alfred Andama, Victoria Katawera

International Journal of TROPICAL DISEASE & Health, Page 239-244
DOI: 10.9734/IJTDH/2015/14415

Aim: We investigated all malaria symptomatic patients with microscopy-negative results during a peak malaria transmission season to ascertain the need for presumptive treatment of malaria among these patients.
Justification: Due to improved malaria control measures, the administration of anti-malarial drugs to symptomatic patients with negative microscopy results is uncalled for. However, in malaria endemic low resource settings, this practice is upheld especially during peak transmission seasons. There is paucity of data to either support or discourage this practice in these settings.
Study Design: It was a cross-sectional study.
Place and design of study: This study was conducted at Gulu regional referral hospital, Uganda, between October and November 2012.
Methodology: A routine blood smear (BS) was examined for all the 542 malaria symptomatic participants. A rapid diagnostic test (RDT) was performed on all patients with negative BS results. All smears were later read by expert microscopists.
Results: Of the 542 patients seen, 503 (92.8%) had negative routine BS results. Eighty nine (7.2%) were excluded due to history of treated fever in the previous two months. Of the 414 qualifying participants, 14 (3.4%) were positive by RDT and 6 (1.4%) were positive by expert microscopy. Nearly all participants (12/14) with microscopy-negative but RDT-positive results were children less than 5 years.
Conclusion: At a rate of 3.4% true malaria cases, presumptive treatment of all malaria symptomatic cases offers a marginal benefit to children less than five years and is an uncalled-for expense among adults. Prescription practices consistent with these findings could greatly improve rational anti-malarial use and minimize costs, especially in sub-Saharan Africa.

Open Access Original Research Article

Gastrointestinal Helminth Infections in HIV Seropositive and Seronegative Patients in Dschang, Cameroon

Maffo Tatsinkou Claudine Grâce, Wabo Poné Josué, Fopa François, Mpoame Mbida

International Journal of TROPICAL DISEASE & Health, Page 245-251
DOI: 10.9734/IJTDH/2015/14579

Background: Helminth infections are widely spread around the world and constitute a major public health problem. They present one of the most common parasitic infections worldwide with a greater proportion occurring in the less developed areas of the world like Sub-Saharan Africa. This area has the highest regional prevalence of Human Immunodeficiency Virus (HIV) in the world. Due to the overlapping geographical distribution of these infections, coinfection between helminths and HIV are likely to be common. Little has been reported on the relationship between HIV status and the presence of these parasites in Dschang.
Aim: This study was undertaken to determine and compare prevalence and intensity of helminth infections between Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) infected (seropositives) or non infected (seronegatives) patients.
Methods: Patients were recruited using the registration number at their arrival in the District and Saint Vincent de Paul hospitals of Dschang. For each subject, stool and blood samples were collected. Qualitative and quantitative analysis of stool samples were carried out using Willis and McMaster techniques respectively. As for serological analysis of HIV/AIDS, the test was done using DETERMINE HIV1/HIV2 rapid test and IMMUNOCOMB test for confirmation.
Results: Five hundred and seventy (570) patients were recruited following inclusion criteria. One hundred and seven (107) were seropositives and four hundred and sixty three (463) seronegatives. The overall prevalence of helminthic infections was 23.11%. Ascaris lumbricoides, Trichuris trichiura, hookworm and Capillaria hepatica were found with respective prevalences of 10.9%, 6.8%, 3.2% and 0.2%. The general prevalences were 10.28% and 20.73% for HIV seropositives and seronegatives respectively. The mean intensities of infection were 182.25±566.12, 130.95±153.79, 91.66±104.67 and 50±0.00 epg for A. lumbricoides, T. trichiura, hookworm and C. hepatica respectively. In seropositives, these values were 50±0.00, 68.75±88.30, 50±0.00 and 0±0.00 epg while in seronegatives; they were 282.41±831.46, 145.59±167.59, 94.11±107.35 and 50±0.00 epg for A. lumbricoides, T. trichiura, hookworm and C. hepatica, respectively. Seropositives were statistically significant (p<0.05) less infected with helminths than seronegatives. Elsewhere, the mean intensities of infection were lower in seropositives than in seronegatives.
Conclusion: The prevalence and parasite loads are fewer in seropositives than in seronegatives. Therefore, harboring HIV is not associated with increasing in helminths prevalence.

Open Access Original Research Article

Economic Stress and the Secondary Sex Ratio: Ireland, Iceland, Greece and Latvia

Grech Victor

International Journal of TROPICAL DISEASE & Health, Page 252-259
DOI: 10.9734/IJTDH/2015/13450

Introduction: Male live births occur slightly in excess of female live births at a ratio of approximately 0.515 (male/total births). Stress has been shown to reduce M/F, including stress engendered by contracting economies. This study was carried out in order to ascertain whether the economic depression caused by the Eurozone recession at the end of the previous decade influenced M/F in the European countries most heavily affected, namely Iceland, Ireland, Greece and Latvia.
Methods: Annual data on male and female live births were obtained directly from the World Health Organisation except for Latvia which was obtained from Eurostat. Quarterly data for Ireland was obtained from the Irish Central Statistics Office.
Results: There were no significant changes in M/F except in Ireland which showed a sharp and highly significant dip in 2007 due to a fall in M/F in the last quarter only (p<0.0001).
Discussion: Darwinian evolution should encourage species to adapt to changing circumstances by altering the odds of having a child of a specific gender. Parents without stress and in good condition should produce sons since these are theoretically capable of producing more offspring, and vice-versa. The findings for Ireland support the contention that economic stress is also capable of depressing M/F.

Open Access Original Research Article

Serum Lipid Profile of Alloxan-induced Diabetic Rats Fed Triticum aestivum-based Diet

B. O. Ajiboye, N. O. Muhammad, H. O. B. Oloyede

International Journal of TROPICAL DISEASE & Health, Page 260-268
DOI: 10.9734/IJTDH/2015/12877

Diabetes mellitus (DM) is a metabolic disorder in which carbohydrate, protein and lipid metabolism is not properly regulated by insulin. Many indigenous medicinal plants have been successfully used to manage diabetes. However, the use of dietary management is most advocated. Thus, the aim of this study was to evaluate the antihyperlipidemic potential of wheat-based diet in alloxan-induced diabetic rats. Forty (40) albino rats (Rattus norvegicus) were grouped into four with ten (10) animals in each. Diabetes was induced by the intra-peritoneal injection of alloxan monohydrate (150mg/kg body weight). Group A consists of (non-diabetic) rats fed yam based-diet; group B, (diabetic) rats fed yam flour-based diet and treated with metformin; group C (diabetic) rats fed wheat-based diet while rats in group D (untreated) were fed yam based-diet for four (4) weeks. There was a significant reduction (p < 0.05) in the concentration of glucose, triglycerides, cholesterol, LDL cholesterol, VLDL cholesterol and a significant increase (p <0.05) in the level of HDL cholesterol. It is considered that feeding diabetic patient with Triticum aestivum (wheat)-based diet would assist in the management of diabetes mellitus.

Open Access Original Research Article

Challenges of Malaria Diagnosis in Paediatric Patients at a Nigerian Hospital

R. E. Oladokun, O. K. Ige, B. Ogunbosi, B. Brown

International Journal of TROPICAL DISEASE & Health, Page 269-275
DOI: 10.9734/IJTDH/2015/9965

Aims: This study compares the performance of routine malaria diagnostic tests, and explores the challenges of malaria diagnosis in paediatric patients in an endemic setting in South West Nigeria.
Study Design: Cross sectional study
Place and Duration of the Study: The study was conducted at the children’s outpatient and emergency units of the University College Hospital, Ibadan, Nigeria. Patients seen between May and August, 2013 were enrolled in the study.
Methodology: The records of all 532 children aged six months to12 years who received treatment for an acute febrile illness at the hospital during the study period were reviewed. The proportion of children classified as having malaria by clinical diagnosis, Rapid Diagnostic Test (RDT) and blood smear microscopy were compared. Factors associated with test positivity were explored using multivariate analysis.
Results: By clinical diagnosis 45.2% of children were diagnosed as having malaria, 37.6% tested positive to malaria parasite on RDT and 19.3% had positive blood smears on microscopy. Logistic regression showed that with RDTs, younger children were less often found to be positive than older children [OR: 0.594 (0.401-0.879)]. A similar lower probability of positivity was found for younger children on microscopy [OR0.624 (0.391-0.996)]. Positive smears were however recorded 3.9 times more often for those who gave a history of fever compared to those who did not [OR: 3.882 (1.154-13.057)].
Conclusion: The true malaria morbidity among these paediatric patients remains questionable due to the differences in the results produced by the different diagnostic methods. The clinical implication of RDT-positive but microscopy-negative samples may be grave if microscopy results are erroneous. Quality control systems and surveillance of routine malaria diagnostics are imperative to limit misdiagnosis of malaria in this endemic setting.