Open Access Original Research Article

C-Reactive Protein as an Inflammatory Biomarker for the Assessment of Malaria Parasitemia in a Tertiary Health Care Facility in Rivers State, Nigeria

Dada A. Emmanuel, Eze N. Chinwe, Akawa B. Ayodeji

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/ijtdh/2019/v39i430210

Aim: To use C-Reactive Protein (CRP) in assessing` malaria and malaria parasitemia among out-patients in the University of Port Harcourt Teaching Hospital (UPTH).

Study Design: Cross-sectional descriptive study.

Place and Duration of Study: This study was carried out at the Out Patients Department (OPD) of the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. It was conducted between November 2017 and April 2018.

Methodology: This study was done on 400 subjects between the ages of 11 and 60 years which consisted of 254 falciparum malaria infected patients and 164 non-infected patients. Quantitative analysis of Serum CRP was done using the High Sensitivity C-Reactive Protein (HsCRP) enzyme immunoassay test kit (Biocheck©) while malaria diagnosis was done using microscopy Giemsa thick and thin film prepared on separate slides, slides were observed under the ×10 and ×100 objectives of the light microscope. Slides viewed under a high power field with parasite density less than three (<3), between 3 and 10 (3-10), from eleven to nineteen (11-19) and greater or equal to 20 (≥20) were classified as scanty, one plus (+), two pluses (++) and three pluses (+++) respectively. Data analysis was done using statistical packages for social science (SPSS) version 21.

Results: The results showed a significant (p<0.001) overall mean high serum CRP concentration (25.63±14.40 mg/l) in the malaria infected patients compared to 3.74±1.02 mg/l in the non-infected group, with a direct increment of the CRP level from the scanty to the three pluses with 9.50±0.37 mg/l, 13.51±1.6 mg/l, 44.19±2.62 mg/l and 53.84±1.75 mg/l recorded for scanty, one plus, two pluses and three pluses respectively. CRP correlated positively and significantly with malaria parasitemia (r = 0.89; p < 0.001).

Conclusion: The abnormally elevated level of CRP in the infected patients showed that CRP is a positive biomarker for Plasmodium falciparum malaria and can be used as an indicator of the disease coupled with other febrile symptoms.

Open Access Original Research Article

Factors Influencing Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State Southeast Nigeria

C. P. Igweagu, O. H. Chime, O. C. Ekwueme

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/ijtdh/2019/v39i430211

Background: The Acquired Immune – deficiency syndrome (AIDS) is a terminal illness caused by a retrovirus known as the Human Immune-deficiency virus (HIV). HIV/AIDS is a leading cause of death in sub-saharan Africa. Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa with 1.9 million people living HIV in 2018. Antiretroviral therapy (ART) has significantly reduced morbidity and mortality, prolonged life expectancy and improved quality of life among people living with HIV/AIDS infection (PLWHA). To be most effective ART requires a near perfect level of adherence. Poor adherence compromises treatment effectiveness, leading to treatment failure and development of drug resistance. Non-adherence is also characterized by increased morbidity, mortality and great economic loss.

This study assessed the effect of health education on factors influencing adherence to ART among PLWHAs in Enugu State.

Methodology: A health education intervention was carried out among 312 persons living with HIV/AIDS receiving ART in Enugu metropolis to improve their perception and adherence to antiretroviral therapy.

A structured questionnaire was used to collect data from 312 people living with HIV/AIDS (156 each in the study and control groups), who were selected by multistage sampling. Subsequently, health education was conducted among the study group. Three months after this intervention its effects were assessed through a survey using the same structured questionnaires employed in the baseline survey.

Results: Knowledge of supportive and limiting factors of adherence improved significantly among the study group than the controls post-intervention (P<0.001). The factors that facilitated adherence included follow-up visits, adequate information education/counseling and supportive relationships. The limiting factors were drug side-effects, forgetfulness, finance and travel time to clinic.

Conclusion: Health education improved knowledge of supportive factors of ART adherence among PLWHAs in Enugu State, and this should be promoted.

Open Access Original Research Article

Further Analyses of Trends in Malaria Diagnoses and Incidence Rates (2014-2018) in Edo State, Nigeria

A. Ebomwonyi, A. O. Omorogie, M. A. E. Noutcha, M. C. Abajue, S. N. Okiwelu

International Journal of TROPICAL DISEASE & Health, Page 1-12
DOI: 10.9734/ijtdh/2019/v39i430212

Background: The United Nations Inter-Agency and Expert Group on Millennium Development Goals (MDGs), established incidence rate as one of the indicators for monitoring progress on Malaria control. Data on malaria incidence rates in Edo State, Nigeria, 2006-2013 were published in 2015. The current study focused on incidence rates, 2014-2018. In addition, trends in malaria diagnoses were also investigated.

Methods: Records of numbers of patients from the 18 Local Government Areas (LGAs) complaining of malaria, at LGA Health Centres, State Hospitals, etc. were obtained from the Department of Disease Control, State Ministry of Health, Benin City. Patients were placed in 3 categories: Fever, without malaria confirmation, confirmed uncomplicated, confirmed severe. Human population records over the 5-year period were obtained from the Nigeria Population Commission, Benin City. Incidence rates were calculated and relative proportions of patients in the 3 categories determined.

Results: The numbers of fever cases, without malaria confirmation, varied across LGAs and constituted 58.00-68.00% of all fever cases annually. In confirmed cases of malaria, most were uncomplicated. The highest numbers of confirmed cases were in Egor and Oredo LGAs. The pattern was similar in uncomplicated and severe cases. The ratios of uncomplicated and severe cases of malaria varied significantly (p<0.05) annually. Malaria incidence rates varied among LGAs in each of the years: 2014 (0.75-5.48%), in 2015 (0.24-2.55%), in 2016 (1.44-5.21%), in 2017 (1.17-9.69%), in 2018 (0.63-4.03%). However, these differences were not significant (p>0.05). In the period 2014-2018, malaria incidence rates of 5.00% and above were recorded only 5times across LGAs: Egor, 2014 (5.48%); Esan Central, 2016 (5.14%; Ovia southwest, 2016 (5.21%), 2017 (9.69%); Uhunmwnde, 2017 (5.05%).

Conclusion: The decline in malaria incidence rates, 2014-2018, over the 2006-2013 data indicates progress. However, there are still daunting challenges which have been detailed in the text. These results also highlight the need for malaria test confirmation rather than utilizing fever as the exclusive symptom for malaria. All stakeholders must intensify efforts to ensure that this downward trend in malaria incidence rates is sustained.

Open Access Original Research Article

Strategic of Implementation of Ergonomic Positions for Nurses in Healthcare Department with SAST and AHP Methods in Qatar

Ria Budi Sundoro, Kohar Sulistyadi, Syahfirin Abdulla

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/ijtdh/2019/v39i430213

Background: Performing ergonomic positions in nursing care both directly and indirectly is very fundamental. However, it need the strategy to implement ergonomic positions for the nurses. Aims of research to determine strategies that can be applied by the Healthcare Department Management in the application of ergonomic positions for nurses in Qatar.

Methods: Data analysis using SAST (Strategic Assumption Surfacing and Testing) and AHP (Analytic Hierarchy Process) for prioritized the criteria and alternative.

Result: SAST analysis shows all assumptions that appear contained in quadrant I (Certain Planning Region), Process to affect working conditions assumptions with values ​​5.3 - 5.3 (Certainty – Important) are considered as definite and important in apply an ergonomic strategy. In the AHP analysis, Top Down with a value of 0.345 as the most priority choice for criteria level, and Ergonomic Committee Effectiveness being the choice with the highest value 0.231 in alternative level. Both strategies being selected in carrying out an ergonomic position strategy.

Conclusions: In the AHP method, Process to affect working condition has been choose as certainty and important strategy to be implemented. In the SAST method, to achieve the goal, Top Down selected in criteria level and Ergonomic committee effectiveness in the alternative level.

Open Access Original Research Article

Genetic Polymorphisms of Pfcrt K76T and Pfmdr1 N86Y among Asymptomatic School Children in Forest Communities of Ekondo Titi Subdivision along the Cameroon-Nigeria Border Area

Bonaventure Tientche, Jerome Fru-Cho, Damian Nota Anong, Theresa K. Nkuo-Akenji

International Journal of TROPICAL DISEASE & Health, Page 1-16
DOI: 10.9734/ijtdh/2019/v39i430214

Aims: The study sought to quantify Plasmodium infection and molecular markers for chloroquine resistance among asymptomatic school children.

Study Design: The study was cross-sectional.

Place and Duration of Study: The study was carried out in Ekondo Titi Subdivision near Cameroon's south-western border with Nigeria from March to May and from September to October 2014.

Methodology: The prevalence of human Plasmodium species was determined by nested PCR (Polymerase Chain Reaction) using DNA from dried blood spot in six primary schools. A PCR/RFLP analysis (Restriction Fragment Length Polymorphism) was used to determine the prevalence of chloroquine resistance (CQR) associated pfcrt 76T and pfmdr 1 56Y point mutations in Plasmodium falciparum asymptomatic school children.

Results: A nested PCR amplifying the 18S small-subunit ribosomal RNA (SSU rRNA) gene of Plasmodium in 205 samples confirmed 76.1% of the isolates as asymptomatic P. falciparum infections, with a substantial proportion 22% of P. malariae infection. Among these, 3.6% were single P. malariae infections and 15.1% were P. falciparum and P. malariae mixed infections. Mixed P. falciparum and   P. ovale infections were 2.0%. Of the 156 Plasmodium falciparum, positive samples by species-specific PCR, 107 samples with P. falciparum mono-infection were analyzed for the presence of drug resistant alleles pfcrt 76T and pfmdr1- Y 86. The prevalence of pfcrt 76T mutation (74.6%) was higher than that of the pfmdr1-Y86 mutation (25.4%). Logistic regression analysis of socio-demographic factors predicted no significant association between pfcrt 76T mutation with gender and communities.

Conclusions: The results indicated a high prevalence of P. malariae and mixed infection in the area under study. The high-level distribution of the pfcrtT76 observed in the study could be possibly attributed to the fact that CQ remained widely used at the community level more than 14 years after  withdrawal.