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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 30-32

Malaria parasitemia in HIV-infected children attending antiretroviral therapy clinic in a teaching hospital


Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria

Date of Web Publication11-Apr-2017

Correspondence Address:
Ben Oloche Onankpa
Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, PMB 2370, Sokoto, Sokoto State
Nigeria
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DOI: 10.4103/1118-8561.204329

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  Abstract 


Background: Malaria and HIV are important health problems in developing countries. They cause more than 4 million deaths a year globally. The interaction of these two infections is both synergistic and bidirectional. We determined the prevalence of malaria coinfection in HIV-infected children attending antiretroviral therapy (ART) clinic. Materials and Methods: A prospective study of all HIV-infected children attending the ART clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, over a 5-year period was carried out. Malaria parasite was identified by Giemsa-stained blood films using a light microscopy. Statistical analysis was carried out using SPSS version 20.0. Results: The total numbers of children screened were 236. Of those, 73 (31%) had malaria/HIV coinfection. One hundred and twenty-one (51.3%) were males and 115 (48.7%) were females. The mean age of the children was 8.63 ± standard deviation 3.76 years (range of 1–17 years). Conclusions: The study shows that the rate of malaria and HIV coinfection is high. Prompt treatment of malaria and malaria disease prevention are recommended for children.

Keywords: Children, HIV, malaria parasitemia


How to cite this article:
Onankpa BO, Jiya NM, Yusuf T. Malaria parasitemia in HIV-infected children attending antiretroviral therapy clinic in a teaching hospital. Sahel Med J 2017;20:30-2

How to cite this URL:
Onankpa BO, Jiya NM, Yusuf T. Malaria parasitemia in HIV-infected children attending antiretroviral therapy clinic in a teaching hospital. Sahel Med J [serial online] 2017 [cited 2020 Dec 3];20:30-2. Available from: https://www.smjonline.org/text.asp?2017/20/1/30/204329




  Introduction Top


The two most common infections facing Sub-Saharan Africa and to a lesser extent, other developing countries are malaria and HIV.[1],[2] Estimated 38 million Africans are infected with HIV-1,[1],[2] and there is a yearly incidence of 300 million to 500 million cases of malaria.[1],[2],[3],[4] Interactions between the two diseases pose major public health problems. Over 3 million deaths were reported between 2003 and 2008 from malaria and HIV.[1],[2],[3],[4] Nigeria bears up to 25% of malarial disease burden in Africa and contributes significantly to the one million lives lost per year in the region (300,000 childhood deaths annually)[4] Furthermore, the mean parasite density is about 12-fold higher in HIV-positive individual compared with the HIV-negative.[5],[6],[7],[8] Malarial parasitemia is observed to be more common in HIV-positive patients, especially those with low CD4+ counts with consequent higher rate of clinical malaria.[8]

Previous studies found no significant difference in incidence and/or severity of malaria infection between HIV-infected and HIV-uninfected individuals.[9],[10] More recent works however suggest that the incidence of symptomatic malaria and the severity of illness are increased during coinfection with HIV.[1],[6],[7],[8] However, given the prevalence of both HIV and malaria, even a small effect of coinfection on the severity of clinical disease could have significant public health implications.[11],[12]

This study was therefore carried out to determine the burden of malaria parasite in HIV-infected Nigerian children.


  Materials and Methods Top


Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria, serves as the referral center to three of its neighboring states and Niger Republic. The study was a 5-year cross-sectional, prospective study (January 1, 2009,–December 31, 2013) of all perinatally HIV-infected children attending the antiretroviral therapy (ART) clinic. Malaria parasite was identified by Giemsa-stained blood films using a light microscopy (a + and above constitutes parasitemia). The results were entered into a pro forma. The children were enrolled into the study only after the parents agreed and for children aged 10–17 years; a signed written consent form was obtained. Ethical approval was sort and obtained from the UDUTH Ethics Committee.

Data were manually checked for completeness, entered into Microsoft excel spreadsheet, and analyzed using statistical package for the social sciences (SPSS) version 20.0 (IBM Corp, Armonk, NY). The means, ratio, and percentages were calculated, and the statistical significance was set at P< 0.05.


  Results Top


Two hundred and thirty-six HIV-infected children comprising 121 (51.3%) males and 115 (48.7%) females attending the ART clinic were studied. The mean age of the children was 8.63 ± 3.76 years (range: 1–17 years). Of the 236 HIV-infected children, 73 (30.9%) were positive for malaria parasite [Table 1].
Table 1: Clinical and demographic characteristics of 236 HIV--infected children and that of 73 HIV--malaria coinfected children

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The characteristics of children with malaria and HIV coinfection are shown in [Table 2]. Forty-two (57.5%) males had malaria-HIV coinfection, while 31 (42.5%) females were coinfected (P = 0.001, χ2 = 11.06). Majority (30/73; 41.1%) of the children with malaria-HIV coinfection were from the low socioeconomic class. Over 70% of the entire 236 children studied were also first seen at Stage I of the WHO clinical staging.
Table 2: Comparison of children with malaria mono--infection and those with HIV--malaria coinfection (n=236)

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  Discussion Top


Malaria and HIV are of great health concern worldwide. It is estimated that 38 million Africans are infected with HIV,[1],[2],[3] and each year, 300 million to 500 million people suffer from malaria.[2],[3] Results from our study revealed that of the 236 children studied, 73 (31.0%) had malaria and HIV coinfection. This prevalence rate is higher than those earlier reported from Ghana (15.5%),[1] Malawi (21%),[13] and Ethiopia (4.8%).[14] This difference is most likely due to the fact that Ethiopia has low HIV prevalence. Their combined actions (deaths from malaria-HIV coinfection) accounted for over three million deaths between 2003 and 2008 and with more than a million cases each year.[5] Previous studies observed no significant difference in incidence and/or severity of malaria infection between HIV-infected and HIV-uninfected individuals.[9],[10] Although previous studies observed no significant difference in incidence and/or severity of malaria infection between HIV-infected and HIV-uninfected individuals,[9],[10] more recent works including the current study suggest that the incidence of malaria appear to be high in the presence of HIV infection.[6],[7],[8]

Given the high prevalence of both HIV and malaria, even a small effect of coinfection on the severity of clinical disease could have significant public health implications.[11],[15],[16]

In this study, when both sexes were compared, there was significant male (57.5%) preponderance for those with HIV-malaria coinfection. This is in agreement with earlier works.[1],[13] Over 70% of the entire studied 236 children who were HIV-positive were first seen at Stage I of the WHO clinical staging. This may be attributed to the gains/successes of the pediatric ART clinic and the access to the prevention of mother-to-child program of the study area. Previous reports showed that malaria-HIV coinfection is more common in the low socioeconomic class and that HIV increases the severity of malaria.[17],[18],[19] Majority (41.1%) of the children with malaria-HIV coinfection in the current study were from the low socioeconomic class. This may be attributable to the poor nutritional status of children from low socioeconomic class. It is an established fact that there is an association between child malarial infection and postnatal HIV infection among breastfeeding HIV-negative children of HIV-positive women.[7],[20] In our study, 67 (92.0%) of the children with malaria-HIV coinfection had vertical transmission of HIV from their mothers. Therefore, we suggest that malaria prevention in such infants may decrease the risk of HIV mother-to-child transmission.

Limitations

In this 5-year study, we determined the prevalence of malarial parasitemia among HIV-positive children attending our ART clinic; however, we did not determine the relationship between CD4 count and parasite density. This will be done in subsequent report.


  Conclusions Top


The prevalence of HIV-malaria coinfection is high in the study population. We recommend prompt treatment and prevention of malaria in HIV-infected children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tagoe DN, Boachie J. Assessment of the impact of malaria on CD4+ T cells and haemoglobin levels of HIV-malaria co-infected patients. J Infect Dev Ctries 2012;6:660-3.  Back to cited text no. 1
    
2.
World Health Organization. The Roll Back Malaria Partnership. Available from: http://www.rbm.who.int/publications.html. [Last accessed 2011 Jun 05].  Back to cited text no. 2
    
3.
UNAIDS. Joint United Nations Programme on HIV/AIDS. AIDS Epidemic Update, December, 2004. Geneva: UNAIDS; 2004.  Back to cited text no. 3
    
4.
Sani UM, Jiya NM, Ahmed H. Evaluation of a malaria rapid diagnostic test among febrile children in Sokoto, Nigeria. Int J Med Sci 2013;3:334-40.  Back to cited text no. 4
    
5.
World Health Organization. World Health Report. Introduction and Overview; 2008. Available from: http://www.who.int/whr/2008/overview/en/index.html. [Last accessed on 2011 Jun 14].  Back to cited text no. 5
    
6.
Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, et al. Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: A cohort study. Lancet 2000;356:1051-6.  Back to cited text no. 6
    
7.
Gonçalves BP, Huang CY, Morrison R, Holte S, Kabyemela E, Prevots DR, et al. Parasite burden and severity of malaria in Tanzanian children. N Engl J Med 2014;370:1799-808.  Back to cited text no. 7
    
8.
Alemu A, Shiferaw Y, Addis Z, Mathewos B, Birhan W. Effect of malaria on HIV/AIDS transmission and progression. Parasit Vectors 2013;6:18.  Back to cited text no. 8
    
9.
Chandramohan D, Greenwood BM. Is there an interaction between human immunodeficiency virus and Plasmodium falciparum? Int J Epidemiol 1998;27:296-301.  Back to cited text no. 9
    
10.
Nguyen-Dinh P, Greenberg AE, Mann JM, Kabote N, Francis H, Colebunders RL, et al. Absence of association between Plasmodium falciparum malaria and human immunodeficiency virus infection in children in Kinshasa, Zaire. Bull World Health Organ 1987;65:607-13.  Back to cited text no. 10
    
11.
Erhabor O, Babatunde S, Uko KE. Some haematological parameters in plasmodial parasitized HIV-infected Nigerians. Niger J Med 2006;15:52-5.  Back to cited text no. 11
    
12.
Chirenda J, Murugasampillay S. Malaria and HIV co-infection: Available evidence, gaps and possible interventions. Cent Afr J Med 2003;49:66-71.  Back to cited text no. 12
    
13.
Kublin JG, Patnaik P, Jere CS, Miller WC, Hoffman IF, Chimbiya N, et al. Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: A prospective cohort study. Lancet 2005;365:233-40.  Back to cited text no. 13
    
14.
Kassa D, Petros B, Messele T, Admassu A, Adugna F, Wolday D. Parasito-haematological features of acute Plasmodium falciparum and P. vivax malaria patients with and without HIV co-infection at Wonji sugar estate, Ethiopia. Ethiop J Health Dev 2005;19:132-9.  Back to cited text no. 14
    
15.
Birku Y, Mekonnen E, Björkman A, Wolday D. Delayed clearance of Plasmodium falciparum in patients with human immunodeficiency virus co-infection treated with artemisinin. Ethiop Med J 2002;40 Suppl 1:17-26.  Back to cited text no. 15
    
16.
French N, Gilks CF. Royal society of tropical medicine and hygiene meeting at Manson House, London, 18 March 1999. Fresh from the field: Some controversies in tropical medicine and hygiene. HIV and malaria, do they interact? Trans R Soc Trop Med Hyg 2000;94:233-7.  Back to cited text no. 16
    
17.
Kamya MR, Gasasira AF, Yeka A, Bakyaita N, Nsobya SL, Francis D, et al. Effect of HIV-1 infection on antimalarial treatment outcomes in Uganda: A population-based study. J Infect Dis 2006;193:9-15.  Back to cited text no. 17
    
18.
Agbede OO, Ajiboye TO, Olatunji M, Kolawole OM, Babatunde SA, Odeigha OL. Evaluation of CD4+ T cells in HIV patients presenting with malaria at the University of Ilorin Teaching Hospital, Nigeria. EXCLI J 2010;9:58-66.  Back to cited text no. 18
    
19.
Grimwade K, French N, Mbatha DD, Zungu DD, Dedicoat M, Gilks CF. Childhood malaria in a region of unstable transmission and high human immunodeficiency virus prevalence. Pediatr Infect Dis J 2003;22:1057-63.  Back to cited text no. 19
    
20.
Onankpa BO, Airede LR, Ibitoye PK, Idowu D. Pattern of paediatric HIV/AIDS a 5-year experience in a Tertiary Hospital. J Natl Med Assoc 2008;100:821-5.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2]



 

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