ASSESSMENT OF THE ROLE OF MALARIA IN THE AETIOLOGY OF RENAL IMPAIRMENT IN ISU COMMUNITY IN EBONYI STATE, NIGERIA
ABSTRACT
This study, the involvement of malaria in renal impairment among individuals in selected villages of Isu community in Onicha Local Government Area of Ebonyi State was investigated. A two-stage sampling design was adopted in which selection of villages constituted the first stage/Primary Sampling Units(PSUs) where three (3) villages (Isuachara, Agbabor and Mgbala-ukwu) out of the seven villages were selected using simple random sampling. In the second stage, a simple random sample of 240 individuals was taken from the three villages selected, using 95% confidence level and a margin of error of 6.32% with a standard deviation of 0.5 .Thick blood smears of venous blood stained with Giemsa were examined microscopically for malaria parasitaemia (MP) and its intensity. Malaria negative individuals served as controls. Biochemical parameters (Total protein, serum creatinine, urea and albumin), haematological indices (packed cell volume (PCV)), total leucocyte counts (TLC) and differentials and electrolytes of malaria positive and negative individuals were determined using standard procedures. Ultrasonographic examination of kidneys was carried out to compare the features and sizes of both malaria positive and uninfected individuals. Malaria positive individuals were treated with current anti-malaria drugs and post treatment examination of the parameters were carried out three weeks after the treatment. This is to investigate the effects of treatment. The overall prevalence and parasite intensity in the study population were 37.5% (n = 90) and 2361+857.55p/µL respectively. most of the infected individuals had mild infection. There was no difference in infection rate by sex. Among the age groups, the prevalence of malarria parasite was higher in younger individuals but the differences were not statistically significant (P>0.05). Biochemical parameters of malaria positive individuals were higher than those of the uninfected. The differences were statistically significant (P<0.05) except for the albumin level (P> 0.05). Packed cell volume and monocytes of malaria infected individuals were higher and differed significantly from those of uninfected individuals (p<0.05). There was no significant difference in the concentration of electrolytes, SG and pH of malaria positive and negative individuals (P>0.05). The electrolytes, SG and pH of malaria positive and negative individuals did not differ statistically (p>0.05). Among the age groups, there was no marked difference in the biochemical, haematological and electrolyte levels of malaria positive and negative individuals (P>0.05). In malaria positive individuals, correlation analysis showed that there was positive but insignificant association between the intensity of malaria parasitaemia and total protein and albumin (r=0.0.198 and r=0.052) respectively while statistically significant positive association existed between malaria intensity, urea and creatinine (r=0.348 and r=0.602). The total leucocyte count, packed cell volume and eosinophil count also showed mild significant association with intensity of malaria parasite while no significant association existed between intensity of malaria parasite and electrolytes. After treatment, the prevalence of malaria parasite was drastically lowered to 9.1% with those still infected having only mild infection (26.3%). Biochemical parameters were also lowered and significant differences were observed in all of them (P< 0.01) while there was no significant difference between malaria parasite and the electrolytes, the SG and pH levels (P>0.05). The mean values of haematological parameters significantly reduced except the packed cell volume. Only the TLC count and eosinophils, showed significant association with MP while electrolytes did not. The ultrasonographic imaging of the kidneys of malaria infected and uninfected individuals showed that malaria parasitaemia altered the sizes of the kidneys of malaria positive individuals and some of them lost their cortico-medullary differentiation. Malaria infection may therefore be said to contribute to renal impairment as treatment of infected individuals with anti-malaria drugs significantly lowered the parameters that may lead to renal problems. It is therefore recommended that the diagnosis of malaria and renal function should go hand in hand in our health institutions. Renal impairment due to malaria infection will thus be prevented and recovery of diagnosed patients may be achieved by early treatment of malaria. This will invariably lead to reduction in both mortality and morbidity rates of both malaria infection and renal impairment.