Open Access Original Research Article

Parasitological Surveys on Malaria in Rural Balombo (Angola) in 2007-2008: Base Line Data for a Malaria Vector Control Project

Carnevale Pierre, Dos Santos Maria, Alcides Moniz Soyto, Besnard Patrick, Foumane Vincent, Fortes Filomeno, Trari Bouchra, Manguin Sylvie

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/JTDH/2018/41783

Study Design: Balombo area (Angola) f from each other to avoid the possibility of active flights of the mosquitoes and “contamination” of treated or control villages.

Methodology: Classical Cross Sectional Surveys (CSS) were symptomless children <15 years. During data analysis this sample was stratified into the 3 conventional age groups: <5 years (often considered as “at risk group"); 2-9 years (often used for classical endemicity index) and <15 years already used in other vector control studies. The 3 classical parasitological  indicators:  plasmodial  prevalence,  parasite  load,  gametocyte  prevalence  were compared between these 3 age-groups to select the most relevant for further analysis and evaluation of the efficacy of vector control implemented. Blood thick films prepared in the field were colored and microscopically examined at the Malaria Control Program's laboratory of the medical department of the Angolan oil company Sonamet (Lobito).

Results: 4625 thick drops were made during the 38 regularly carried out field surveys. Plasmodium falciparum was the predominant species with few mixed P. falciparum + P. malariae infection and a single P. malariae one. The overall Plasmodic index was 42.7%, gametocyte index was 4.4% and high parasite load (> 10.000 par./ml) were noticed in children, even very young, without clinical symptoms. Classical seasonal variations of plasmodic index and some variations according to age group were observed. Gametocytic indices showed relatively stable levels with age group.

Conclusion: Statistical analysis showed that “under 15 years” age group could be a relevant indicator to evaluate the efficacy of a vector control programme and it increases the sample size allowing to perceive even small variations induced by vector control. Variability of parasitological index according to age groups, villages, season, confirmed the importance of regularly surveys to know precisely the situation before the implementation of control operations for reliable further evaluation. Missing such base line data induced the failure of a former vector control project in Angola.

Open Access Original Research Article

Cost of Treatment of Severe Malarial Anemia in Children Living in Western Kenya

Stacey M. O. Gondi, Collins Ouma, Harrysone Atieli, Walter Otieno

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2018/42626

Aims: The Western region in Kenya is holoendemic to malaria and experiences stable P. falciparum malaria transmission. Households and healthcare providers in this region incur costs in the management of malaria and malaria related complications. However, information regarding the cost of severe malaria anemia (SMA) management remains almost unknown. The aim of this study was to study the costs incurred by the household and healthcare providers in the management of SMA in children of 10 years and below.

Study Design: Cross-section study.

Place and Duration of Study: Jaramogi Odinga Oginga Teaching and Referral Hospital (JOOTRH) from September 2014 to July 2015.

Methodology: It was open to all children ≤10 years (n=271) admitted and diagnosed with SMA (hemoglobin <5.0 g/dl and any density P. falciparum parasitemia). Data were extracted from the participants’ medical files. Parents/guardians of the participants were interviewed on the costs incurred throughout the management of the disease.

Results: It would cost an overall average of US$ 38.83 per child to treat a case of SMA in Western Kenya. The mean cost of treating a child <5 years and >5 years was nearly the same at US$ 38.95 and US$ 38.44 respectively (p=0.7850). The mean household cost for <5 years old was significantly lower at US$ 18.43 compared to US$ 30.08 in the >5 years old children (p<0.001). The mean provider cost was significantly higher in the <5 years old as (US$ 22.55) compared to US$ 17.22 in the >5 years old (p=0.0027) children.   

Conclusion: Mean total cost for SMA treatment was same for children under 5 years and above 5 years of age. The difference was who spent the highest costs. The provider incurred the highest cost for children under 5 and the households incurred the highest cost for children above 5 years. Even though treatment of malaria for the under 5 years old children is considered free of cost, the households still incur costs in the management of SMA.

Open Access Original Research Article

The Determinants of Hospital Delivery among Booked Parturient in a Tertiary Health Facility in South-South Region of Nigeria: Situation Analysis of the Niger Delta University Teaching Hospital

A. O. Addah, E. M. Ikeanyi

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/IJTDH/2018/40679

Objective: To determine the hospital delivery rate and identify the associated factors for hospital delivery among booked parturients at the Niger Delta University Teaching Hospital.

To determine the behavioural pattern of participants who delivered in NDUTH during the antenatal period and in labour.

Methodology: This was a descriptive, retrospective cross-sectional study carried out at The Niger Delta University Teaching Hospital (NDUTH), Nigeria. Four hundred and one participants were enlisted for the study.

Results: The hospital delivery rate was 28.9% while the mean antenatal visits were 6.05 (S.D 3.36).  Factors related to hospital delivery: Age-the youngest group, for instance, are more unlikely to deliver in a hospital (OR =0.09, 95% CI 0.01-0.067, P = 0.019).  Education- The least educated were unlikely to deliver in hospital, (OR = 0.04, 95% CI 0.1-0.34, P =0.003) while those with secondary education were 34 times more likely to deliver in hospital (OR = 0.34; 95% CI 0.2-0.57, P = 0.000) compared those with tertiary education as the reference group. Antenatal care- the participants with the least ANC sessions, have the lowest odd of hospital delivery (OR = 0,19, 95 % CI  0.08-0.44, P = 0.000). Other participants characteristics like religion, marital status, occupation and parity were found not to be statistically significant in the prediction of hospital delivery. The mean antenatal visits by participants was 6.05 (S.D3.36), gestational age at booking was 23.08 (S.D 6.50), 26% visited TBAs.  Prelabour rupture of fetal membranes at home- 37.9% (n=116), while 75% (n=44) of those who ruptured membranes at home presented within 12 hours to the hospital. The degree of cervical dilatation on admission to hospital: 42.2% in latent phase and 33.6% in the early phase of active lour.        

Conclusion: This study concluded that antenatal care attendance impacted on the prospect of hospital delivery. Encouraging antenatal care uptake and attendance will improve the participants access to their physicians throughout pregnancy, delivery by skilled providers with the improvement of women’s health at the end of pregnancy.

Open Access Original Research Article

Out-of-Pocket Spending and Access to Healthcare Services in Sokoto, Nigeria

R. A. Oladigbolu, M. O. Oche, A. U. Kaoje, G. J. Gana, M. A. Makusidi

International Journal of TROPICAL DISEASE & Health, Page 1-13
DOI: 10.9734/IJTDH/2018/40972

Background: User fees paid through out-of-pocket spending (OOPS) impede access to healthcare services, particularly among the poor. The study aimed to assess the households’ pattern of out-of-pocket spending, predictors of access to healthcare, and to explore their socio-economic (SES) status differences in paying for their healthcare.

Methodology: This was a descriptive cross-sectional study design. The instrument was a pre-tested, semi-structured interviewer-administered the questionnaire. Association between variables was assessed using the chi-square test and logistic regressions at a <.05.

Results: The mean age of respondents was 41.7 ± 12.6 years. Generally, 94% of payments were made through ‘formal’ out-of-pocket spending (user-fees) with most respondents having to source for funds from own money (90.5%). Households in the lower social class were more likely to pay for their healthcare through OOPS (X2 = 11.4, p = 0.001) and often patronized traditional care and PHC. User-fees and lower social class were significant predictors of poor access to healthcare.

Conclusion: This study brought to the fore that user-fees (or formal OOPS) negatively impacts on the access to healthcare services at the health facilities. The Federal Government should explore and other sources of financing that are efficient, equitable, fair and sustainable like the Community-Based Insurance Scheme (CBIS) and National Health Insurance Scheme (NHIS) and also increase investment and public spending on health.

Open Access Original Research Article

Malaria Related Deaths among Children with Manifestations of Fever Symptoms on Admission in a Secondary Health Care Institution in Western Region of Ghana - a Retrospective Study

Verner N. Orish, Adekunle O. Sanyaolu, Mahama Francois, Bruku K. Silverius, Onyekachi S. Onyeabor, Chuku Okorie, Nnaemeka C. Iriemenam

International Journal of TROPICAL DISEASE & Health, Page 1-15
DOI: 10.9734/IJTDH/2018/42278

Background: Malaria is a major contributor to deaths in children especially in sub-Saharan Africa. Children less than five years of age are susceptible to malaria infection in endemic regions leading to serious complications. Malaria causes death in children either directly through Cerebral Malaria (CM) and Severe Malaria Anaemia (SMA) or indirectly through co-morbidity with pneumonia or a sequela like hypoglycemia.

Methods: This retrospective study examined malaria-related deaths among children at Effia-Nkwanta hospital within a study period of 3 years.

Results: A total of 1,416 medical records were reviewed, out of which 223 were medical records of children with fatal outcomes. Deaths over the study period due to all causes were 15.7% (223/1416) and confirmed malaria was 13.7% (40/292). Deaths due to all causes and confirmed malaria decreased from 21.6% and 24.3% in 2010 to 11.1% and 4.4% in 2012, respectively. Anti-malarial testing was done for 152 of the children with 40 positive and 112 negative results. Seventy-one children had no malaria testing done on them, with 23.4% in 2010 40.3% in 2011 and 35.5% in 2012. Anti-malarial treatment was administered to 83% of children who tested negative and 80% of children without anti-malarial testing.

Conclusion: Deaths in the children declined from 2010 to 2012 in this study. Despite this improvement, there was poor anti-malarial testing and improper use of anti-malarial treatment. National malaria programs should ensure improvement in anti-malarial testing and strict adherence to the anti-malarial treatment protocol.