Cytokine Profiles and Antibody Responses to Plasmodium Falciparum Malaria Infection in Individuals Living in Ibadan; Southwest Nigeria

Background: The ability of the host immune system to efficiently clear Plasmodium falciparum parasites during a malaria infection depends on the type of immune response mounted by the host. Study design: In a cross-sectional study; we investigated the cellular-and antibody responses in individuals with P. falciparum infection; in an attempt to identify immunological signs indicative of the development of natural immunity against malaria in Ibadan; Nigeria. Levels of IL-10; IL-12(p70); IFN-a; and IgM; IgG and IgG1-4 subclasses in the serum of 36 symptomatic children with microscopically confirmed malaria parasitaemia and 54 asymptomatic controls were analysed by ELISA. Results: IFN-a and IL-10 were significantly higher in the symptomatic children (p=0.009; p=0.025 respectively) than in the asymptomatic controls but no differences were seen for IL-12(p70). Estimated higher ratios of IFN-a/IL-10 and IFN-a/IL-12 were also observed in the symptomatic children while the asymptomatic controls had higher IL-12/IL-10 ratio. The mean concentration levels of anti-P. falciparum IgG1; IgG2; IgG3 antibodies were statistically significantly higher in the individuals 5 years of age than 5 years while anti-P. falciparum IgG3 antibodies were notably low in 5 years category. Children 5 years had higher IgM antibodies than IgG and the expression of IgG subclasses increased with age. Conclusion: Taken together; malaria infection is on a delicate balance of pro- and anti-inflammatory cytokines. The higher levels of IFN-a seen in the symptomatic children (6months) may be instrumental in immune-protection against malaria by limiting parasite replication. The observed variations in immunoglobulin subclass levels were age- dependent and exposure-related

Epidemiological Factors that Promote the Development of Severe Malaria Anaemia in Children in Ibadan

Background: Effective control and management of severe malaria cases depends on a clear understanding of the local epidemiological factors and specific clinical manifesta- tions of the disease in the different endemic regions. Objectives: To determine the prevalence of severe malaria and epidemiological factors that affect the development of malaria anaemia. Methods: A cross-sectional survey was carried out among children below 5 years of age; at the Adeoyo State Maternity Hospital;Ibadan; Nigeria. Question-naires and case histories were taken from patients clinically diagnosed of malaria.Thus; 372 volunteers wererecruited into the study from the 3131 paediatric cases that reported over the10-week period to the out-patient department (OPD) ofthe hospital. 229 (61.6) of the recruited volunteers presented with fever (37.5 oC) at consultation.These had malaria parasite andPCV tests done. Results: Clinical diagnosis was confirmed microscopically in 78(290/372) for Plasmodium infection using thick film slides. Anaemia (PCV 28) prevalence was 28.2. Factors that contributed to the rapid progression of uncomplicated malaria to severestatus included: age of the child; level of parasitaemia; careless response and attitude of parents or guardians to fever in the children;parents' preoccupation with their jobs or other healthy children and unwillingness to use available health facilities. Conclusion: The study underscores the need for community involved partnership for malaria control especially through healtheducation for the home manage- ment of malaria; espeically among those experiencing some form of inequity in access to healthcare

Clinical manifestations and immune response to MSP 1(19) in severe paediatric malaria in Adeoyo state maternity hospital, Ibadan.

A 10-week cross-sectional study was carried out at the Adeoyo State Maternity Hospital (Beere, Ibadan), Southwestern Nigeria in order to determine (a) the prevalence of severe malaria, (b) identify the predominant clinical presentations that characterise the disease in children below 5 years and the pattern of antibody responses to MSP 19 elicited in severe malaria complications. Three thousand, one hundred and thirty-one cases reported to the Out Patients' Department; of these, 372 (11.8%) subjects were recruited on the basis of doctors' diagnosis of severe malaria, malaria and other complications. Six per cent (188/3131) ofthe patients were admitted. Serum samples for 320 ofthe 372 subjects were analysed for antibodies specific to MSP 1(19) by ELISA. The highest antibody responses occurred in the age group 2-5 years. Parasite prevalence was 77.9% (290 of 372 subjects) and parasite density ranged from 80 to >100000 parasites/microL blood. Fever (an average temperature of 38.6 +/- 0.4 degrees C and peak at 41 degrees C) and severe malaria were the major clinical manifestations of malaria amongst the study population. Severe malaria was found to be associated with other features such as cough, vomiting and diarrhoea.