High Malaria Parasitemia Research Articles

High malaria parasitemia in an Italian man and severe delayed hemolytic anemia.

Parenteral artesunate has become the choice treatment of cases of high parasitemia malaria. We report the case of an Italian man with a high malaria parasitemia who promptly improved with intravenous artenusate, but who developed a delayed severe hemolytic anemia associated with intravenous artesunate treatment, requiring blood trasfusions.

Basic coagulation parameters and platelet count among malaria patients attending at Addis Zemen Primary Hospital, Northwest Ethiopia.

Malaria is an intravascular parasitic-related blood disease that causes bleeding, coagulopathy, and thrombocytopenia. However, limited data shows the effect of Plasmodium species infection on basic coagulation parameters and platelet count. Thus, this study aimed to assess basic coagulation parameters and platelet count among malaria patients. A cross-sectional study was conducted among 240 study participants (120 cases and 120 controls) from June 1, 2021, to February 30, 2022. A convenient sampling technique was employed to select study participants. The blood sample was collected by a trained laboratory technologist for platelet counts, prothrombin time (PT), partial thromboplastin time (PTT), international normalization ratio (INR), blood film, and serological testing. The collected data were analyzed in SPSS version 23. Data were analyzed by the Mann-Whitney U test, Kruskal Wallis H, and Spearman's rank-order correlation tests. Descriptive findings were presented through median, tables, and chart. In all cases, a P-value < 0.05 was considered statistically significant. The percentage of mild, moderate, and high malaria parasitemia levels per microliter of blood was 21.7%, 20%, and 58.3%, respectively. The overall median malaria parasitemia was 10,304 per microliter of blood. Among malaria patients, 77.5%, 61.7%, and 51.7% had prolonged PT, INR, and APTT, respectively as compared to control. Moreover, 26.7% of Plasmodium-infected participants had mild thrombocytopenia as compared to the control group (P < 0.001). The value of PT, APTT, and INR were significantly elevated, whereas the level of platelet count was inversely reduced when the malaria parasitemia level increased as compared to controls (p < 0.001).

Evaluation of Malaria Parasitaemia among COVID-19 Patients in Rivers State, Nigeria

This study was an exploratory prospective observational study in a cohort of patients on admission with COVID-19 in some health institutions in Nigeria. Patients within the age group of less than 25 years to greater than 50 years of age with PCR-confirmed diagnosis of SARS-CoV-2 infection, involved only those who gave consent. Ethical concern was highly upheld. Taro Yamman formula was used to determine the sample size of 400 and probability sampling technique used. Primary and secondary data sources were used. Clinical assessments and blood sample collected at one point in time following standard protocol according to WHO. Malaria diagnosis was done using microscopy through thin and thick film using Gemisha staining. All data were analyzed for descriptive statistics- frequency and percentage distributions and prevalence rates. Total malaria prevalence rate in the study was high 327 (81.8%) and in terms of severity the older age group (&gt;50years) had high (84.8%) malaria parasitaemia. However, low parasiteamia 154 (38.5%) was common regardless of the age groups and formed the majority of malaria parasites detected while the high malaria parasitaemia was least with 59 (14.8%). The prevalence of COVID-19 co-infection with malaria was high as recorded in this study. The age group &gt;50years had the highest number of COVID-19 patients with high malaria parasitemia. The study findings highlight the significance of understanding the possible medical and therapeutic implications of such overlapping co-infections in malaria endemic area with high morbidity burden. Routine Malaria screening and treatment should be an integral aspect of COVID-19 treatment regimen in malaria endemic region with much emphasis among the geriatrics. All malaria elimination programme and roll back malaria core values should be strengthened from vector control, to use of insecticide treated nets and others should be regularly practiced.

Concomitant Bacteremia in Adults With Severe Falciparum Malaria.

BackgroundApproximately 6% of children hospitalized with severe falciparum malaria in Africa are also bacteremic. It is therefore recommended that all children with severe malaria should receive broad-spectrum antibiotics in addition to parenteral artesunate. Empirical antibiotics are not recommended currently for adults with severe malaria.MethodsBlood cultures were performed on sequential prospectively studied adult patients with strictly defined severe falciparum malaria admitted to a single referral center in Vietnam between 1991 and 2003.ResultsIn 845 Vietnamese adults with severe falciparum malaria admission blood cultures were positive in 9 (1.07%: 95% confidence interval [CI], .37–1.76%); Staphylococcus aureus in 2, Streptococcus pyogenes in 1, Salmonella Typhi in 3, Non-typhoid Salmonella in 1, Klebsiella pneumoniae in 1, and Haemophilus influenzae type b in 1. Bacteremic patients presented usually with a combination of jaundice, acute renal failure, and high malaria parasitemia. Four bacteremic patients died compared with 108 (12.9%) of 836 nonbacteremic severe malaria patients (risk ratio, 3.44; 95% CI, 1.62–7.29). In patients with >20% parasitemia the prevalence of concomitant bacteremia was 5.2% (4/76; 95% CI, .2–10.3%) compared with 0.65% (5/769; 0.08–1.2%) in patients with <20% parasitemia, a risk ratio of 8.1 (2.2–29.5).ConclusionsIn contrast to children, the prevalence of concomitant bacteremia in adults with severe malaria is low. Administration of empirical antibiotics, in addition to artesunate, is warranted in the small subgroup of patients with very high parasitemias, emphasizing the importance of quantitative blood smear microscopy assessment, but it is not indicated in most adults with severe falciparum malaria.

Hematological Profiles of Malaria Infected Adult Patients in Raya Alamata Hospital, Northeast Ethiopia.

Hematological changes are the most common complications occurred in malaria pathology. Anemia, thrombocytopenia, and mild-to-moderate atypical lymphocytosis are the main hematological changes occurred in malaria infection. Therefore, this study aimed to compare hematological profiles of malaria-infected adult patients in the Raya Alamata Hospital, Northeast Ethiopia from February 1, 2019, to April 30, 2019. The hospital-based comparative cross-sectional study was done to compare the hematological profiles of a total of 238 study participants, consisting of 119 malaria-infected patients as cases and 119 malaria negatives as controls. Malaria diagnosis was done by thick and thin blood film microscopy. We determined the hematological parameters using an automated DiRUi BCC/3000B hematology analyzer. Data for the different hematological parameters were expressed as mean (± SD). A binary logistic regression model was constructed for categorical dependent variables to see the associations with predictors. In this study, the mean values of red blood cell count, hemoglobin, mean corpuscular volume, platelet count, and eosinophil count were significantly lower in the cases than the controls. The prevalence of anemia and thrombocytopenia in malaria patients were 39.5% and 56.3%, respectively. Being female, and having high malaria parasitemia were found significantly associated with thrombocytopenia. The odds of developing thrombocytopenia was 8.4-fold higher in malaria patients with high malaria parasitemia. Anemia and thrombocytopenia were the common hematological abnormalities observed in malaria patients. Therefore, malaria patients should be assessed for the presence of such hematological abnormalities and need to be managed timely.

Prevalence and associated risk factors of anaemia among women attending antenatal and post-natal clinics at a public health facility in Ghana

BackgroundAnaemia among pregnant women and post-partum mothers is a public health challenge in Ghana, especially in the Volta Region. While literature abounds on anaemia among pregnant women, the same cannot be said for anaemia among post-partum mothers in the region. This study, therefore, examined the prevalence and associated risk factors of anaemia among women attending antenatal care and post-natal care.MethodsThis descriptive cross-sectional survey recruited 409 pregnant women and 194 post-natal mothers attending antenatal and post-natal care, at the Hohoe Municipal Hospital. Background characteristics were collected using a semi-structured questionnaire, blood samples were analysed for the presence of anaemia and malaria parasitaemia and folders were reviewed for estimated blood loss.ResultsWe found the prevalence of anaemia among pregnant women and post-partum mothers to be 33 and 16% respectively. Higher malaria parasitaemia (2%) was found in pregnant women compared with postpartum mothers (1%). We found that 4% of post-partum mothers had abnormal blood loss (301mls-500mls) whereas 5% of them had postpartum haemorrhage (>500mls) during child birth. A univariate logistics regression of anaemia status on some risk factors in pregnant women showed no significant association between anaemia and any of the risk factors. Among post-partum mothers, only mothers’ age was statistically significant in the univariate analysis [COR = 0.27 (95% CI:0.103, 0.72);0.008]. Mothers aged 20–29 were 73% less likely to be anaemic.ConclusionThe prevalence of anaemia among pregnant women found in this study points to a situation of moderate public health problem according to WHO cut-off values for the public health significance of anaemia. Strategies should therefore be put in place to encourage thorough health education and promotion programmes among both pregnant and post-partum women.

Evaluation of Malaria Parasitemia Among HIV/AIDS Individuals Attending the Bamenda Regional Hospital Treatment Center

Malaria parasitemia and HIV/AIDS coinfection is very common particularly in sub-Saharan Africa where the burden of both infections fall. Therefore, an understanding of how the two infections interact is important for the control of both diseases. In Cameroon some studies have been carried out on the prevalence of malaria parasitemia in HIV with varying results. A high prevalence of malaria parasitemia among these individuals could imply the need for systematic screening and/or treatment of HIV individuals for possible malaria infection hence improving on the care of these individuals. A low prevalence could also imply limiting resources directed towards the diagnosis of malaria in HIV individuals. Objectives: The objective of the study was to determine the prevalence of malaria parasitaemia in HIV/AIDS individuals in Bamenda Regional Hospital (BRH) Treatment Center. Methods: A cross-sectional study was conducted involving 310 HIV-positive individuals attending the BRH HIV/AIDS Treatment Centre during a period of 3 months from 1st of February to April 30th 2018. Participants’ consent was obtained followed by sociodemographic and other useful data via a standardized questionnaire. Capillary blood samples were collected and malaria parasitaemia determined by blood smear microscopy. Results: An overall malaria parasitemia prevalence of 24.5% was observed in this study with mean parasite density of 150 trophozoites/µL. Malaria parasitemia prevalence was significantly higher in HAART naïve (37.5%) individuals than HAART experienced (23.81%) individuals (<i>p</i><0.05). The differences in level of parasite density in relation to gender and marital status were statistically significant (<i>p</i><0.05) while that of the various age groups was not significant (<i>p</i><0.05). Lower CD4 count levels were significantly related to high density malaria parasitemia (<i>p</i><0.05). Also the percentage of parasite density >400 trophozoites/µL was higher (80%) in those not using cotrimoxazole prophylaxis than those on cotrimoxazole prophylaxis (20%). Hence non- use of cotrimoxazole prophylaxis was significantly associated with high density malaria parasitemia (<i>p</i><0.05). Conclusions The prevalence of malaria parasitemia in HIV/AIDS individuals was high in the study area and malaria parasitemia prevalence in HAART naïve individuals was significantly higher than in HAART experienced individuals. Also gender, marital status low CD4 count and non use of cotrimoxazole prophylaxis were significantly related to high density malaria parasitemia.

Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative.

BackgroundIn order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.MethodsData for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented.ResultsIn this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28).ConclusionThis study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.

Malaria and anaemia in pregnant and non-pregnant women of child-bearing age: a cross-sectional study

Background: Malaria infection during pregnancy is a major public health problem globally. Anaemia is often an adverse outcome of severe parasitic infections during pregnancy in developing countries. Pregnant are more susceptible to Plasmodium falciparum infections than non-pregnant women of child-bearing age. The objective of this study was to comparatively investigate malaria and anaemia in pregnant and non- pregnant women of child-bearing age.Methods: A cross-sectional comparative study, in which 380 pregnant women and 380 non-pregnant women were screened for the study. The study was conducted at the Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh, India. Participants’ demographic data were collected via the administration of questionnaires. In addition, their blood samples were analysed for haemoglobin level and Malaria parasites, while stool samples from the pregnant women were examined for intestinal parasites.Results: The study revealed that pregnant women have higher malaria parasitaemia (12.6%) and anaemia (62.6%). The species of Plasmodium isolated from the pregnant women were P. falciparum (85.4%), P. malariae (4.2%) and P. ovale (10.4%). Malaria parasitaemia was higher in the primigravidae (14%). However multi-gravidae recorded the highest anaemia prevalence (67.1%). Age of pregnant women was a factor affecting malaria parasitaemia with a significant P-value and (P value = 0.0041).Conclusions: Pregnant women were more susceptible to malaria and anaemia than non-pregnant women of child-bearing age. Most of the pregnant women reported at antenatal clinic during the second trimester. Primigravidae however recorded the highest malaria parasitaemia. The main species of Plasmodium observed in the blood samples was falciparum.

Increased Severity and Mortality in Adults Co-Infected with Malaria and HIV in Maputo, Mozambique: A Prospective Cross-Sectional Study

BackgroundCo-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality.MethodsIn a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed.FindingsA total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone.InterpretationsHIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.

Physical condition of Olyset® nets after five years of utilization in rural western Kenya

BackgroundLong-lasting insecticidal nets (LLINs) are a cornerstone of malaria control at present, and millions are used each day across the globe. However, there is limited information about the durability of LLINs under different conditions of utilization and there is no consensus about when a LLIN ceases to be protective due to physical deterioration. This knowledge is important for malaria control programmes to plan for procurement and replacement.MethodsA cross-sectional survey of 208 households where Olyset® nets distributed five years ago were still present was conducted in the village of Sauri, western Kenya, in the context of the Millennium Villages Project. Information on bed net utilization and maintenance was collected in each household through a structured questionnaire, and one five-year-old Olyset® net from each sampled household was randomly selected and collected for physical examination. All holes larger than 0.5 cm were measured in each net, registering their position, and a hole index was calculated following WHO guidelines. Nets were classified as in good condition, moderately damaged or badly torn based on the hole index. The analysis explored the associations between demographic and socioeconomic characteristics of households, patterns of bed net utilization and maintenance and physical condition of the nets. Additional analysis was conducted using malaria prevalence data collected in a separate survey to explore if there was any association between the condition of the net collected in a household and the presence of malaria parasites in members of that household.Results81.4% of Olyset® nets distributed five years ago were still present in the surveyed households, and 98.97% of the nets were reportedly used the previous night. Nets had an average of 34.2 holes (95% CI 30.12-38.22), and the mean hole index was 849 (95% CI 711–986), IQR 174–1,135. 15.2% of nets were still in good condition, 46.1% were moderately damaged and 38.7% were badly torn after five years of utilization. There was no association between household characteristics or patterns of bed net utilization or maintenance and physical condition of the nets. The only predictor of the physical condition of the net was the cleanliness at the time of examination. There was a difference of 17.6 percentage points in the proportion of households with at least one blood smear positive for Plasmodium falciparum between households with a net in good condition (5.3%) and those with a moderately damaged or badly torn net (22.9%), 95% CI (0.04-0.305), t=2.77 with unequal variance, p=0.009.ConclusionsOlyset® nets were used extensively in Sauri, western Kenya after five years of distribution, regardless of their physical condition. However, only 15% were found in good condition. Nets in good condition seem to be still protective after five years of utilization, while nets with more than 100 cm2 of holed surface may be associated with higher malaria parasitaemia at household level. Continued replacement of damaged nets and promotion of net maintenance and repair may be necessary to maintain the protective effectiveness of LLINs.

Malaria and Anaemia in Pregnant and Non-Pregnant Women of Child-Bearing Age at the University Hospital, Kumasi, Ghana*

Background: Malaria infection during pregnancy is a major public health problem in tropical and subtropical regions globally. Anaemia is often an adverse outcome of severe parasitic infections during pregnancy in developing countries. Pregnant women in malaria-endemic communities are more susceptible to Plasmodium falciparum infections than non-pregnant women of child-bearing age. Objective: To comparatively investigate malaria and anaemia in pregnant and non-pregnant women of child-bearing age. Design: A cross-sectional comparative study. Three hundred and eighty pregnant women and 380 non-pregnant women were screened for the study. Setting: The study was conducted at the University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Measurements: Participants’ demographic data were collected via the administration of questionnaires. In addition their blood samples were analyzed for haemoglobin level and malaria parasites, while stool samples from the pregnant women were examined for intestinal parasites. Results: The study revealed that pregnant women have higher malaria parasitaemia (12.6%) and anaemia (62.6%). The species of Plasmodium isolated from the pregnant women were P. falciparum (85.4%), P. malariae (4.2%) and P. ovale (10.4%). Malaria parasitaemia was higher in the primigravidae (14%). However multigravidae recorded the highest anaemia prevalence (67.1%). Age of pregnant women was a factor affecting malaria parasitaemia with a significant P-value and OR (P value = 0.0041, 0R = 7.61). Conclusions: Pregnant women were more susceptible to malaria and anaemia than non-pregnant women of child-bearing age. Most of the pregnant women reported at antenatal clinic during the second trimester. Primigravidae however recorded the highest malaria parasitaemia. The main species of Plasmodium observed in the blood samples was falciparum.