Malaria and helminth co-infection and nutritional status of febrile patients in southern Ethiopia

Because the mechanisms by which Plasmodium and helminth parasites affect nutritional status are different, these parasites likely have additive effects when they co-exist in a host. This study aimed to compare the prevalence of undernutrition in patients infected with either Plasmodium or helminths and those co-infected with the two types of parasites. Acute febrile patients suspected of having malaria who attended the outpatient clinic at Dore Bafeno Health Center between December 2010 and February 2011 were examined for Plasmodium parasites using Giemsa-stained thick and thin blood smears and for helminths using the thick Kato-Katz method. Nutritional status was determined using anthropometric indices generated from height and weight measurements. Of the 702 patients examined, 34.5% were infected with helminths alone, 12.3% were infected with Plasmodium alone, and 19.4% co-infected with Plasmodium and intestinal helminths. Out of the patients examined, 44.9% were undernourished. The prevalence of undernutrition was not significantly different between those patients not infected with Plasmodium or helminth species and those infected with Plasmodium or helminth species. The differences in the odds of undernutrition were also not significant between patients who were co-infected with different Plasmodium and helminth species and those with single infections with Plasmodium or helminth species in our multivariable logistic regression model adjusted for the confounding effects of age and sex. The prevalence of undernutrition was comparable in patients infected with Plasmodium or helminths alone and those co-infected with Plasmodium and helminths in Dore Bafeno Health Center, Southern Ethiopia. However, further studies are needed in areas of intense transmission where both parasites are endemic to elucidate whether the impact of Plasmodium and helminth co-infection on undernutrition is additive or multiplicative

Community awareness of intestinal parasites and the prevalence of infection among community members of rural Abaye Deneba area, Ethiopia

<p><b>OBJECTIVE</b>To assess the knowledge of Abaye Deneba community members regarding intestinal parasites and prevalence of intestinal parasitic infections.</p><p><b>METHODS</b>Knowledge about intestinal parasites was assessed by administering a questionnaire to 345 randomly selected household heads. Parasitological stool examination of 491 randomly selected individuals was done using the formol ether concentration technique.</p><p><b>RESULTS</b>Knowledge of the Abaye Deneba community about parasitic diseases such as schistosomiasis, amoebiasis, ascariasis and taeniasis was very low. However, 204 (59.3%) members correctly responded that the cause of giardiasis is related to contaminated water and 176 (51.2%) knew how to prevent it. In some cases, respondents did correctly identify causes, symptoms of intestinal parasite infection and ways to prevent it, but they did not accurately link it to the appropriate disease caused by the different intestinal parasite species. Among the 491 stool samples examined, 50.2% of study participants showed infection with at least one intestinal parasite. Schistosoma mansoni was the most prevalent (41.3%) followed by Trichuris trichiura(9.4%), Ascaris lumbricoides (8.4%), Taenia saginata (2.4%), Enterobius vermicularis (2.0%) and hookworm (0.4%). Prevalence of schistosomiasis was highest in men aged 15-24 years.</p><p><b>CONCLUSIONS</b>Intestinal parasitic infection is highly prevalent in communities of the Abaye Deneba area. Nevertheless, the knowledge of the community members about the parasite is less. Implementation of preventive chemotherapy, supplemented with health education, provision and use of sanitary facilities would be recommended to reduce morbidity and control transmission of intestinal parasites in this area.</p>

Community awareness of intestinal parasites and the prevalence of infection among community members of rural Abaye Deneba area, Ethiopia

Objective: To assess the knowledge of Abaye Deneba community members regarding intestinal parasites and prevalence of intestinal parasitic infections.Methods:Knowledge about intestinal parasites was assessed by administering a questionnaire to 345 randomly selected household heads. Parasitological stool examination of 491 randomly selected individuals was done using the formol ether concentration technique.Results:Knowledge of the Abaye Deneba community about parasitic diseases such as schistosomiasis, amoebiasis, ascariasis and taeniasis was very low. However, 204 (59.3%) members correctly responded that the cause of giardiasis is related to contaminated water and 176 (51.2%) knew how to prevent it. In some cases, respondents did correctly identify causes, symptoms of intestinal parasite infection and ways to prevent it, but they did not accurately link it to the appropriate disease caused by the different intestinal parasite species. Among the 491 stool samples examined, 50.2% of study participants showed infection with at least one intestinal parasite. Schistosoma mansoni was the most prevalent (41.3%) followed by Trichuris trichiura(9.4%), Ascaris lumbricoides (8.4%), Taenia saginata (2.4%), Enterobius vermicularis (2.0%) and hookworm (0.4%). Prevalence of schistosomiasis was highest in men aged 15-24 years.Conclusions:Intestinal parasitic infection is highly prevalent in communities of the Abaye Deneba area. Nevertheless, the knowledge of the community members about the parasite is less. Implementation of preventive chemotherapy, supplemented with health education, provision and use of sanitary facilities would be recommended to reduce morbidity and control transmission of intestinal parasites in this area.

Association between intestinal helminth infections and underweight among school children in Tikur Wuha elementary school, Northwestern Ethiopia

The association of intestinal helminths with under nutrition varies by locality. The objective of this study was to investigate the nature of the association of helminth infection with the nutritional status of school children in Tikur Wuha Elementary School, northwestern Ethiopia. A total of 403 school children were examined for intestinal helminth infection [stool samples] and nutritional status, thick Kato-Katz and anthropometric techniques, respectively during a baseline survey. Among these children, 235 were treated for helminth infection and re-examined for weight changes four weeks after treatment. Among the 403 study participants, 29.3%, 28.3% and 58.3% were stunted, underweight and infected with intestinal helminths, respectively. In the multivariate regression model, the probability of being underweight was significantly higher in children who were infected with intestinal helminths, aged 5-10 years and male compared with children who were without helminth infection, aged 11-15 years and female, respectively. The association of helminths with low body mass was strong in the case of hookworm infection, and the probability of being underweight significantly decreased with every one-year increase in the age of the children. The means for weight, weight-for-age z-scores and body mass index-for-age z-scores of the children significantly increased four weeks after treatment for helminth infection, with a single dose of albendazole and/or praziquantel. Helminth-infected male children in the 5- to 10-year-old age group were more vulnerable to undernutrition, which decreased four weeks after treatment. Thus, deforming of children living in the area might be important for improving their nutritional status

Laboratory assessment of the molluscicidal and cercariacidal activities of Balanites aegyptiaca

Objective: To assess the molluscicidal and cercariacidal activities of aqueous extracts ofBalanites aegyptiaca (B. aegyptiaca) against Ethiopian Biomphalaria pfeifferi (B. pfeifferi), Lymnaea natalensis (L. natalensis) and Schistosoma mansoni (S. mansoni) cercariae. Methods:Extracts of seeds, endocarp, mesocarp, and fruit of B. aegyptiaca were tested for their activities against adult B. pfeifferi and L. natalensis. The cercariacidal activity of the seeds of the plant was also evaluated against S. mansoni. Bioassays were carried out following the methods recommended by WHO. Snail mortalities were compared between each plant part and snail species, and LC50 and LC90 values for the plant parts tested were computed. The cercariacidal activity of the plant was assessed by exposing the mice to the cercariae pre-exposed to aqueous extract of B. aegyptiaca seeds. Results:For the molluscicidal activities of seeds, endocarp, mesocarp and whole fruit, the LC50 values against B. pfeifferi were 56.32, 77.53, 65.51 and 66.63 mg/L, respectively, while the respective LC90 values were 77.70, 120.04, 89.50 and 97.55 mg/L. Similarly, the LC50 values for the seeds, endocarp, mesocarp and whole fruit against L. natalensis were 80.33, 92.61, 83.52 and 87.84 mg/L, respectively, while the respective LC90 values were 102.30, 138.21, 115.42 and 127.69 mg/L. B. pfeifferi were found to be more susceptible to B. aegyptiaca than L. natalensis. S. mansoni cercariae exposed to 15 mg/L of extract of seeds were incapable of infecting mice. The mean egg load of tissue was reduced in mice infected with the cercariae exposed to 5 and 10 mg/L of the extract. Conclusions:The aqueous extracts of different parts of B. aegyptiaca exhibited reasonable molluscicidal activity against B. pfeifferi and L. natalensis, as well as cercariacidal activity against S. mansoni cercariae. However, comprehensive laboratory evaluation is recommended prior to field tests of the plant parts since their impact on other aquatic biota is not known.

Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia

Objective: To evaluate the efficacy and side effects of praziquantel (PZQ) in the treatment of schistosomiasis in Ethiopia. Methods: In a cross-sectional study, stool specimens were collected from randomly selected 299 school children in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia, in April 2010. Stool specimens were examined using a single Kato-Katz thick smear for Schistosoma mansoni (S. mansoni) ova. Children who were found positive for S. mansoni were treated with a single oral dose of PZQ at 40 mg/kg bw and interviewed for treatment-related symptoms 24 hours after drug administration. Four weeks post-treatment, stool specimens were collected from the same children and examined following the same procedure as in the pre-treatment. Drug efficacy was determined based on cure and egg reduction rates. Results: Pre-treatment prevalence of S. mansoni infection was 74.9% with geometric mean egg count of 268. The evaluated generic PZQ produced an overall cure rate of 73.6% (P<0.000 1, OR: 8.33, CI: 5.3-13.1) and egg reduction rate of 68.2% (P=0.03, F=0.64). The cure rate showed significant association with age (χ2=11, P=0.004), the highest rate being observed in the 15-22 age group. 83% of S. mansoni infected children showed various treatment-related symptoms, the most frequent being headache, nausea, and abdominal pain. These symptoms were associated with age (P<0.001) and pre-treatment intensity of infection (P<0.05). Conclusions: The present observations revealed relatively lower cure and egg reduction rates of the PZQ evaluated as compared to previous reports for other PZQ brands in Ethiopia. Hence, in depth studies are recommended to clarify whether the present relatively lower cure rate is the actual cure rate of the praziquantel evaluated, treatment failure, or reduced susceptibility of the parasite. Treatment-related side effects observed were transient and tolerable.

Association of ABO blood group and Plasmodium falciparum malaria in Dore Bafeno Area, Southern Ethiopia

<p><b>OBJECTIVE</b>To assess the distribution of ABO blood group and their relationship with Plasmodium falciparum (P. falciparum) malaria among febrile outpatients who sought medical attention at Dore Bafeno Health Center, Southern Ethiopia.</p><p><b>METHODS</b>A total of 269 febrile outpatients who visited Dore Bafeno Health Center, Southern Ethiopia, were examined for malaria and also tested for ABO blood groups in January 2010. The blood specimens were collected by finger pricking, stained with Geimsa, and examined microscopically. Positive cases of the parasitemia were counted. CareStart™ Malaria Pf/Pv Combo was also used to test the blood specimens for malaria. ABO blood groups were determined by agglutination test using ERYCLONE(®) antisera. Data on socio-demographic characteristics and treatment status of the participants were also collected. Chi-square and ANOVA tests were used to assess the difference between frequencies and means, respectively.</p><p><b>RESULTS</b>Out of a total of 269 participants, 178 (66.2%) febrile patients were found to be infected with Plasmodium parasites, among which 146 (54.3%), 28 (10.4%), and 4 (1.5%) belonged to P. falciparum, P. vivax, and mixed infections, respectively. All febrile patients were also tested for ABO blood groups and 51.3%, 23.5%, 21.9% and 3.3% were found to be blood types of O, A, B and AB, respectively. Both total malaria infection and P. falciparum infection showed significant association with blood types (P<0.05). The proportion of A or B but not O phenotypes was higher (P<0.05) in individuals with P. falciparum as compared with non-infected individuals. The chance of having P. falciparum infection in patients with blood groups A, B and AB was 2.5, 2.5 and 3.3 times more than individuals showing blood O phenotypes, respectively. The mean P. falciparum malaria parasitaemia for blood groups A, B, AB, and O were 3 744/µL, 1 805/µL, 5 331/µL, and 1 515/µL, respectively (P<0.01).</p><p><b>CONCLUSIONS</b>The present findings indicate that individuals of blood groups A, B and AB are more susceptible to P. falciparum infection as compared with individuals of blood group O. Nevertheless, further in depth studies are required to clearly establish the role that ABO blood group plays in P. falciparum malaria.</p>

Association of ABO blood group and Plasmodium falciparum malaria in Dore Bafeno Area, Southern Ethiopia

Objective: To assess the distribution of ABO blood group and their relationship with Plasmodiumfalciparum (P. falciparum) malaria among febrile outpatients who sought medical attention at Dore Bafeno Health Center, Southern Ethiopia. Methods: A total of 269 febrile outpatients who visited Dore Bafeno Health Center, Southern Ethiopia, were examined for malaria and also tested for ABO blood groups in January 2010. The blood specimens were collected by finger pricking, stained with Geimsa, and examined microscopically. Positive cases of the parasitemia were counted. CareStartTM Malaria Pf/Pv Combo was also used to test the blood specimens for malaria. ABO blood groups were determined by agglutination test using ERYCLONE? antisera. Data on socio-demographic characteristics and treatment status of the participants were also collected.Chi-square and ANOVA tests were used to assess the difference between frequencies and means, respectively. Results: Out of a total of 269 participants, 178 (66.2%) febrile patients were found to be infected with Plasmodium parasites, among which 146 (54.3%), 28 (10.4%), and 4 (1.5%) belonged to P. falciparum, P. vivax, and mixed infections, respectively. All febrile patients were also tested for ABO blood groups and 51.3%, 23.5%, 21.9% and 3.3% were found to be blood types of O, A, B and AB, respectively. Both total malaria infection and P. falciparum infection showed significant association with blood types (P<0.05). The proportion of A or B but not O phenotypes was higher (P<0.05) in individuals with P. falciparum as compared with non-infected individuals. The chance of having P. falciparum infection in patients with blood groups A, B and AB was 2.5, 2.5 and 3.3 times more than individuals showing blood O phenotypes, respectively. The mean P. falciparum malaria parasitaemia for blood groups A, B, AB, and O were 3 744/μL, 1 805/μL, 5 331/μL, and 1 515/μL, respectively (P<0.01). Conclusions: The present findings indicate that individuals of blood groups A, B and AB are more susceptible to P. falciparum infection as compared with individuals of blood group O. Nevertheless, further in depth studies are required to clearly establish the role that ABO blood group plays in P. falciparum malaria.