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ASSESSMENT OF MALARIA AND TYPHOID COINFECTION AMONG INDIVIDUALS ATTENDING TELA PHCC IN GASSOL LGA TARABA STATE

ABSTRACT

The broad objective of this study is to present an assessment of malaria and typhoid co-infection among individuals attending Tela PHCC in Gassol LGA Taraba State. Venepunture technique was used for collection of the blood samples. A total of 250 patients with clinical suspicion of malaria and typhoid fever comprising of 113 males and 137 females were examined. Giemsa stained thick and thin blood films were used to detect malaria parasites in the samples.Typhoid fever was diagnosed from each sample using Widal reagents and cultural method.The data generated from this study were presented using descriptive statistics. The results were analyzed in percentage and Chisquare. In conclusion, the result of the study shows that malaria prevalence rate (80.8%) is high in PHCC Tella. The prevalence rate of malaria and typhoid fever co-infection (28.0%) was equally high. There was a substantial result discrepancy between widal test (46.8%) and blood culture (0.8%) for the diagnosis of typhoid fever. The study therefore recommended that the incidence of typhoid and malaria co-infection could be reduced to minimal if diagnosis of typhoid fever by cultural method is emphasized in our clinical hospital laboratories. This will also improve patient management by cutting down cost of treatment and eliminate other risks associated with misuse of antibiotics.

CHAPTER ONE

INTRODUCTION

Background of the study

Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles Mosquito. Malaria has been the focus of multiple declarations, and a range of targets have been set since the beginning of the millennium this is because approximately half of the world population is at risk of malaria.(WHO, 2015). According to Ukaegbu et al., (2014), Malaria is a life threatening disease caused by five species of protozoan parasite of the genus Plasmodium namely P. falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi.

Globally, an estimated 3.3 billion people in 97 countries and territories are at risk of being infected with malaria and developing disease and 1.2 billion are at high risk as opined by WHO (2011); Iwuafor et al., 2016). Notably, nearly all human deaths by malaria are caused by P. falciparum, mainly in sub-Saharan Africa. It is estimated that 198 million cases of malaria occurred globally in 2013 and the disease led to 584,000 deaths representing a decrease in malaria case incidence and mortality rates of 30% and 47% since 2000, respectively (WHO, 2013 and 2014). It is considered a disease of poverty and duly recognized as a public health problem with overwhelming medical, social and economic implications (Isah et al., 2011). Within endemic countries, the poorest and most marginalized communities are the most severely affected, having the highest risks associated with malaria, and the least access to effective services for prevention, diagnosis and treatment (World Bank, 2014).

On the other hands, typhoid fever, also known simply as “typhoid” is a symptomatic bacterial infection due to Salmonella typhi equally called Salmonella enterica serotype Typhi (Modebe et al., 2014; Wain et al., 2015). It is acquired by the ingestion of food and/or water contaminated with the faeces of an infected person, which contain the bacterium, Salmonella enteric serovar typhi; humans are the only infected (Ukaegbu et al., 2014). Risk factors include poverty as a result of poor sanitation and poor hygiene (Wain et al., 2015). In the year 2000 and 2010, an estimated 21.7 million and 13.5 million typhoid fever illnesses were recorded. Between years 2000 and 2013, it resulted in estimated 217,000 and 161,000 deaths respectively (Crump et al., 2010; Buckle et al., 2010). Infants, children, and adolescents in south-central and Southeast Asia experience the greatest burden of illness (Crump et al., 2004). Nonetheless, outbreaks of typhoid fever are frequently reported from sub-Saharan Africa and countries in Southeast Asia (Muyembe et al, 2009 and Baddam et al, 2012).

Consequently, due to the geographical overlap of both infections, co-infections are very common. However, the precise incidence of the concurrent malaria and typhoid fever in most geographical areas is largely uncertain, as both share social circumstances which are imperative to their transmission; individuals in areas endemic for both diseases are at substantial risk of contracting both these diseases, either concurrently or an acute infection superimposed on a chronic one (Keong et al., 2006).

Statement of the problem

Malaria and typhoid fever remain the disease of major public health importance and cause of morbidity and mortality in tropical Africa. Both diseases are common in many countries of the world where the prevailing environmental conditions of warm, humid climate, poor sanitary habits, poverty and ignorant exist. These two diseases have been associated with poverty and underdevelopment (Ammon, 2013). Malaria and typhoid fever often present with mimicking symptoms especially in the early stages of typhoid fever (Ammah et al., 1999; Ohanu et al., 2003). While high prevalence of malaria is an established fact, it is only within the last decade that an unusually high number of illnesses have been diagnosed as malaria co-existing with typhoid fever. The situation often presents a diagnostic problem and in some cases could lead to diagnostic confusion. As a result of this, the importance of definitive laboratory-based diagnosis cannot be overstated, before an individual is said to have concurrent malaria and typhoid fever, the presence of Plasmodium species and Salmonella enteric sub-sp enterica serotype typhi must be demonstrated in the patient’s laboratory specimens (Uneke 2006). Therefore it is against this background that this study seeks to present an assessment of malaria and typhoid co-infection among individuals attending Tela PHCC in Gassol LGA Taraba State.

Objective of the Study

The broad objective of this study is to present an assessment of malaria and typhoid co-infection among individuals attending Tela PHCC in Gassol LGA Taraba State. Specifically, the study seeks to:

To determine the prevalence of malaria and typhoid fever among individuals attending Tela PHCC in Gassol LGA Taraba State.

To investigate the rate of co-infection with respect to the use of widal test and blood culture methods for diagnosing typhoid fever in Tela PHCC in Gassol LGA Taraba State.

To ascertain the overall prevalence of malaria and typhoid fever co- infections among patients in Tela PHCC in Gassol LGA Taraba State.

Research Question

What is the prevalence of malaria and typhoid fever among individuals attending Tela PHCC in Gassol LGA Taraba State.

What is the rate of co-infection of malaria and typhoid in individuals attending in Tela PHCC in Gassol LGA Taraba State using use of widal test and blood culture methods for diagnosing typhoid?

What is the overall prevalence between malaria and typhoid fever infections among patients in Tela PHCC in Gassol LGA Taraba State.

Significance of the study

The findings from this study would be useful to the following; patient, ministries of health, hospitals, policy makers and health practitioners . To health practitioners, the result of the study would help them in caring adequately and planning well for patients attending the clinic when treating them for malaria and typhoid. This study will help policy makers to formulate relevant policies on malaria and typhoid prevention .This study would be useful to government and parastatal by educating them on the need to provide concerted health education intervention to improve the attitude and knowledge of Taraba State resident regarding poor health seeking behavior and adequate strategies for malaria and typhoid prevention especially with the use of insecticide, treated Net, adequate funding, etc. necessary for controlling and reducing incidence of malaria and typhoid in the general public.

Scope of the study

The scope of this study borders on the assessment of malaria and typhoid co-infection among individuals attending Tela PHCC in Gassol LGA Taraba State. The study will further discuss the risk factors leading to malara and typhoid infection. The study will also examine rate of co-infection of malaria and typhoid in individuals attending in Tela PHCC in Gassol LGA Taraba State using use of widal test and blood culture methods for diagnosing typhoid.

1.7 Limitation of the study

Financial constraint– Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
Time constraint– The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.