PLASMA LIPID, SERUM PROTEIN AND BODY MASS INDICES AMONG Plasmodium falciparum MALARIA-INFECTED WOMEN ATTENDING ANTENATAL CLINICS IN IGBO-EZE NORTH LOCAL GOVERNMENT AREA, ENUGU STATE.
ABSTRACT
A cross-sectional study on the plasma lipid, serum protein and body mass indices of Plasmodium falciparum-malaria infected women attending antenatal clinics in Igbo-Eze North Local Government Area, Enugu State, Nigeria was conducted from August to December 2015. Weight and height of the pregnant women were measured using a beam balanced scale and a standiometer. Questionnaire was used to screen the women in compliance with outlined standard inclusion criteria. Venous blood samples for malaria diagnosis (microscopy) and plasma lipid and serum protein assays were collected from the anticubital fossa. Enzymatic and spectrophotometric methods for lipid and protein assays using Randox Diagnostic kits were employed. A total of 75 pregnant women at antenatal visit in the District Hospital consented to this study. Anthropometric measurements and malaria diagnosis were conducted on all. Those that qualified for lipid and protein assays were 72. The overall mean age was 27.60 ± 0.71 years, and body mass index (BMI), 27.65 ± 0.52 kg/m2. Overall pregnancy-associated malaria prevalence was 50.7% (38/75) and mean parasite density 11289.74 ± 22901.73/μL of red blood cells (RBC). The overall mean total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were 164.12 ± 4.26mg/dl, 65.98 ± 2.54mg/dl, 159.12 ± 8.90mg/dl and 66.70 ± 4.26mg/dl respectively. The total protein (TP), albumin, globulin and albumin to globulin ratio (A/G) were 6.18 ± 0.15g/dl, 3.34 ± 0.07g/dl, 2.85 ± 0.14g/dl and 1.55 ± 0.12 respectively. Pregnancy-associated malaria prevalence in multigravidae was 57.5%, secundigradae, 50.0% and primigravidae, 38.1%. Plasmodium falciparum parasitaemia was significantly higher (ρ = 0.001) in primigravidae (263.13 ± 58.23) x 103/μL compared to the secundigravidae (92.14 ± 4.72) x 103/μL and multigravidae (65.22 ± 20.17) x 103/μL, and in the nulliparous women compared to their primiparous and multiparous counterparts (ρ = 0.002). Parasite prdensity varied significantly with maternal age (ρ = 0.020). There were no significant variation in parasite prevalence and density by communities of residence. TC was significantly higher (ρ = 0.047) in 3rd trimester (172.63 ± 5.62mg/dl) compared to the 2nd trimester (156.06 ± 5.94mg/dl) and so was TG (ρ = 0.013) and LDL-C (ρ = 0.036). TC was significantly lower (ρ < 0.05) in <20 age group compared to 20 – 29 and 30 – 39 age group. HDL-C was significantly lower (55.76 ± 3.98mg/dl) in the 18.5 – 24.9 BMI categories compared to the 25.0 – 29.9 categories (74.55 ± 3.49mg/dl). TC, HDL-C and LDL-C were lower in group with pregnancy-associated malaria compared to their uninfected counterpart. Malaria infected pregnant women at the 3rd trimester had significantly lower TC (ρ = 0.004) and LDL-C (ρ = 0.025) concentration compared to their uninfected counterparts. Total protein, albumin, globulin and A/G showed no significant variation (ρ > 0.05) by gravidity, parity or trimester of pregnancy. Only A/G among the protein parameters showed consistent decline in the infected though not significantly (ρ > 0.05). Only HDL-C was significantly higher in those with >20000/μL parasite density compared to those with < 20000/μL. Age correlated negatively with parasite density, while TC and BMI showed a positive linear relationship with age of the pregnant women. Albumin concentration correlated positively with BMI. Usage of mosquito bednet was significantly low among the studied population (ρ < 0.05). Pregnancy-assocated malaria induces modifications to maternal biochemical architecture that is dependent on age and duration of pregnancy. High density of P. falciparum in the primigravid and nulliparous women highlights the need for adequate and prompt diagnosis and treatment. It may not be necessary to suffer pregnant women with stress of fasting before their lipid assays are conducted as non-fasting lipid profile showed similar outcome to that reported for fasting by other studies.