Abstract
Malaria is an important global health disease which puts individuals, particularly children, at a greater risk of mortality. Plasmodium falciparum is distinguished from the rest of the Plasmodia by its high level of parasitaemia. They infect liver cells (hepatocytes), and multiply into merozoites and rupture liver cells in the process, prior to infection of red blood cells. This study sought to estimate the extent to which P. falciparum parasitaemia correlates with hepatocellular dysfunction among Ghanaian children suffering from acute malaria in three malaria endemic districts in Ashanti Region and to predict liver dysfunction from the estimation of haemoglobin (HB) levels. A prospective uncontrolled before- and after study was conducted among under five years children with acute malaria (n = 300) and a control group (n = 20) within the same age brackets. The serum activities of liver enzymes such as aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) were measured in patients and control subjects. The study observed an inverse relationship between mean HB and parasitaemia (mean HB level of 10.34 ± 0.14 versus parasitaemia <10,000 parasites/μL as against 8.06 ± 0.16 versus parasitaemia ≥10,000 parasites/μL). The mean levels of AST, ALT, ALP and GGT were higher (p < 0.0001) in the serum of the infected children before treatment compared with post treatment. Moreover, the receiver operating characteristics (ROC) curve was applied to establish that HB level at 10.9 g/dL predicted liver dysfunction with the area under the curve (AUC) being 0.75 ± 0.03 (P < 0.0001). The parasitaemia estimation and prediction of hepatocellular dysfunction in Ghanaian children with acute malaria could be done via HB levels.
Highlights
Malaria is the single most important cause of morbidity and mortality in Ghana [1]
The disease is very prevalent in the tropics and each year approximately 300–500 million malaria infections caused by Plasmodium falciparum culminate in over one million deaths, wherein over 75 % occur in African children aged less than five [2, 3]
The present study showed that HB levels could be used to predict liver dysfunction in Ghanaian under five children with acute malaria before the initiation of chemotherapy (Figure 1)
Summary
The disease is very prevalent in the tropics and each year approximately 300–500 million malaria infections caused by Plasmodium falciparum culminate in over one million deaths, wherein over 75 % occur in African children aged less than five [2, 3]. P. falciparum malarial infection has been shown to significantly increase the serum activities of aspartate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) in a manner that positively correlates with the parasites’ density [10]. No study in Ghana had explored the power of haemoglobin (HB) levels to predict hepatocellular dysfunction in Ghanaian children less than five years. There is the need to establish the relationship between parasitaemia density and HB levels as well as the potential of the latter to predict hepatocellular dysfunction among Ghanaian children with acute malaria
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