EFFECTS OF MANAGEMENTS OF MALARIA ON HAEMATOLOGICAL BIOCHEMICAL AND NUTRITIONAL CHANGES IN CHILDREN IN ANAMBRA STATE, NIGERIA
ABSTRACT
This study investigated the effects of home (community) and hospital management of childhood malaria on the prevalence, haematology, biochemical and nutritional indices of malaria parasite infected children in Anambra State, Nigeria. It also evaluated the knowledge, attitude and perceptions of mothers/caregivers about childhood malaria and their home management practices. A total of 248 children between the ages of 0 – 14.9 years and 653 house holds randomly sampled were involved in the study. Blood samples were collected from 134 male childrene (39 from communities and 95 from hospitals) and 114 females (43 from communities and 71 from hospitals). These children were treated for malaria infection either in the hospitals or in their homes by their mothers/caregivers. Serum levels of sodium ion (mmol/l), total protein (g/dl), bilirubin (mg/dl), alkaline phosphatase (ALP iu/l), serum glutamate oxaloacetate transaminase (SGOT u/l), serum glutamate pyruvate transaminase (SGPT u/l) together with packed cell volume (PCV %), haemoglobin (Hb mg/dl) and white blood cell (WBC mcl) were assessed using standard methods. Anthropometric data – age, height, weight and mid-upper arm circumference (MUAC) were collected using standard scale, tape and MUAC UNICEF insertion tape. Chi – square, Fisher – least significance difference, t – test, analysis of variance, multiple regression and Epi Info were employed to test significant differences amopng the variables. For all determination, the significant difference was set at p<0.05. Malaria prevalence in the community was 46.3% while in the hospital, prevalence was 94.0%. Malaria parasite infection was not significant for age and sex (p>0.05). Differences in the community prevalence of malaria was not significant (p>0.05) but the monthly and seasonal prevalences differed significantly (p<0.05). The female children infected with malaria parasite had a significantly (p<0.05) higher mean PCV than the male in both communities (31.73 ± 458 to 28.25 ± 3.75) and hospitals (31.12 ± 11.78 to 28.27 ± 5.56) surveyed, respectively. Also the female infected children had a significantly (p<0.05) higher WBC count than males. The males had significantly (p<0.05) higher SGOT in the hospital sampled than in homes. Serum levels of WBC in malaria infection were gametocyte count dependant. Gametocyte count of 1 – 10 and 11 – 100 in both communities and hospitals surveyed respectively had significant (p<0.05) different WBC count. In the age group comparison, children 0 – 4.9 years had significant higher (p<0.05) mean serum level of birilubin (0.55 ± 0.25 to.35 ± 0.14) (p<0.05). Children aged 10 – 14.9 years old had significantly (p<0.05) higher mean level of Hb (10.30 ± 0.29 to 10.90 ± 0.26) than other age groups in the survey. Comparing the parameters with age showed that the PCV and Hb of the malaria infected children aged 5 – 9.9 years where significantly (p<0.05) lower than the control. Changes in the serum level of sodium ion (Na+, SGOT, ALP and SGPT may not be associated with malaria infection. The prevalence of malnutrition (weight-for-height Z – scores) among malaria uninfected in the community and hospital surveys was 26.7% (14.2 – 44% 95% C.I.) and 9.2% (4.7 – 17.1 95% C.I.) respectively, while the prevalence among the malaria parasite infected children was 21.4% and 7.4% in the community and hospital respectively. The average number of malnourished children with Z-scores <-2SD were slightly higher than WHO standard. More malaria infected boys had Z-scores <-2SD compared to the WHO standard. Prevalence of malnutrition based on MUAC among malaria parasite infected children was very high (100% and 98.1% in community and hospital, respectively). The average number of stunted (height-for-age Z-score) children in both community and hospital survey was very high compare to WHO standard. Majority of mothers/caregivers (82.4%) knew that mosquitoes transmit malaria and 67.1% of them make use of Insecticide Traeted Nets (ITNs) while 68.6% of infections were treated at home. From the result of this study the prevalence of malaria in the hospitals was very high; therefore, it is still the major cause of attendance to out-patient clinics across government hospitals in Anambra State, Nigeria. The PCV and Hb concentration of malaria infected children were significantly lower than the uninfected while the WBC, SGOT and birilubin of infected children were signifiantly increased. The prevalence of malnutrition and underweight was not high but more number of children was stunted. The knowledge, attitude and perception of mothers/caregivers about malaria and home treatment suggest that laboratory examination of blood samples to confirm the presence of infection should be combined with presumptive treatment of malaria in the homes.