Sahel Medical Journal

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 24  |  Issue : 2  |  Page : 70--74

Asymptomatic malaria parasitaemia among HIV infected children and adolescents


Surajudeen Oyeleke Bello1, Esther Solomon Audu2, Ikrama Hassan3, Efe Abolodje4, Ishaku Bako5,  
1 Department of Paediatrics, Dalhatu Araf Specialist Hospital Lafia Nasarawa State, Makurdi, Benue State, Nigeria
2 Department of Medical Microbiology, Dalhatu Araf Specialist Hospital Lafia Nasarawa State, Makurdi, Benue State, Nigeria
3 Department of Public Health, Dalhatu Araf Specialist Hospital Lafia Nasarawa State, Makurdi, Benue State, Nigeria
4 Department of Paediatrics, Delta State Teaching Hospital Oghara Delta State, Makurdi, Benue State, Nigeria
5 Department of Public Health, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria

Correspondence Address:
Dr. Surajudeen Oyeleke Bello
Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State
Nigeria

Abstract

Background: Malaria manifests with life-threatening manifestations resulting in hospital admissions and sometimes death may ensue. This is more devastating among children due to high susceptibility resulting from impaired immune system following severe malaria. Human immunodeficiency virus (HIV) coinfection with malaria further compromises the immune system and increases the vulnerability. The effect of co-trimoxazole prophylaxis in curtailing malaria has not being well evaluated in our environment where both malaria and HIV are endemic. This study sets out to determine the magnitude of asymptomatic malaria among HIV-infected children and adolescents receiving care at our facility. Study Design: This was a descriptive cross-sectional study. Materials and Methods: A prospective study among HIV-infected children aged 2–18 years was enrolled in our care. Nonprobability convenience sampling was used to recruit individuals who fulfilled the criteria. Questionnaire and patients' medical records were used to gather some data. A sample was taken for malaria parasite microscopy. The analysis was done using the Statistical Package for the Social Sciences version 20. Categorical variables were presented as percentages and association assessed using Chi-square test, whereas continuous variables were presented as mean and standard deviation, and the association between two means was checked using Student's t-test. Results: The mean age of the study population is 7.02 ± 2.97 years. Of the 420 participants in this study, 92 (45.7%) had confirmed malaria. There was no significant difference in the gender, age groups, and viral loads of patients with malaria. Conclusion: There is a high prevalence of malaria coinfection with HIV in this study.



How to cite this article:
Bello SO, Audu ES, Hassan I, Abolodje E, Bako I. Asymptomatic malaria parasitaemia among HIV infected children and adolescents.Sahel Med J 2021;24:70-74


How to cite this URL:
Bello SO, Audu ES, Hassan I, Abolodje E, Bako I. Asymptomatic malaria parasitaemia among HIV infected children and adolescents. Sahel Med J [serial online] 2021 [cited 2021 Jul 31 ];24:70-74
Available from: https://www.smjonline.org/text.asp?2021/24/2/70/321242


Full Text



 Introduction



Malaria and human immunodeficiency virus (HIV) are the world most prevalent infectious diseases, more so in the tropics.[1] Malaria caused by Plasmodium species of either Plasmodium falciparum, vivax, ovale, malariae, or knowlesi, respectively, is transmitted through the bite of a carrier Anopheles mosquito.[2] Malaria manifests with life-threatening manifestations resulting in morbidity and mortality, and this is particularly more devastating among children due to high susceptibility from poorly developed immune system.[3] HIV coinfection with malaria further worsens the vulnerability of children due to a compromise of the immune system.[4] Malaria is known as one of the opportunistic infections among HIV-infected individuals, and the use of co-trimoxazole as prophylaxis is expected to reduce the occurrence of malaria.[5]

A study by Okonkwo et al.[6] among under-five children in Benin found a 34.1% prevalence of malaria among HIV-infected patients compared with 17.3% among HIV-uninfected controls. This prevalence is even much higher among children with severe immunosuppression. Furthermore, Onankpa et al.[7] in Sokoto reported a 31% prevalence of malaria/HIV coinfection among children aged 1–17 years attending the antiretroviral clinic. An earlier study in Sokoto found a 45.4% prevalence of malaria/HIV coinfection.[2] Other studies in Cameroon, Tanzania, and Ivory Coast reported 24.8%, 22.4%, and 10%, respectively.[3],[8],[9] In contrast, a cohort study by Ezeamama et al.[10] among HIV-exposed children in Tanzania found no difference in the prevalence of confirmed malaria between HIV-seropositive and HIV-seronegative children. Similarly, Ouedraogo et al.[11] in Burkina Faso reported a 3.09% coinfection of both HIV and malaria, and the study concluded that there is no relationship between malaria and HIV-induced immunosuppression.

There is a dearth of study regarding HIV and malaria coinfection in Nigeria; the few available ones are not in the North Central region. This study sets out to determine the burden of malaria parasitemia among HIV-infected children and adolescents. These may guide on the appropriateness and/or dosing of co-trimoxazole. It may also unveil the predictors of HIV/malaria coinfection. Policy-makers may also find the outcome useful for planning.

The study will answer the following research questions:

What is the prevalence of malaria among HIV-infected children and adolescents in Lafia?What are the predictive factors for HIV/malaria coinfection in Lafia?

Null hypothesis – There is a low prevalence of HIV and malaria coinfection in Lafia.

Aim and objectives

General objective

The general objectives of this study are to determine the burden of malaria among HIV-infected children and adolescents and to assess the possible predictive factors of HIV/malaria coinfection in Dalhatu Araf Specialist Hospital (DASH), Lafia.

Specific objective

The specific objectives of this study are as follows:

To determine the prevalence of malaria among HIV-infected children and adolescents in LafiaTo assess the possible predictive factors of HIV/malaria coinfection in Lafia.

 Materials and Methods



Study population

Children aged 6 months–18 years and HIV-infected children/adolescents attending either the Tuesday or Wednesday antiretroviral clinic at DASH, Lafia, between March and May 2019 were included in the study.

Lafia is the capital of Nasarawa State. The state shares a boundary with Benue, Taraba, Plateau, Kaduna, Federal Capital Territory (FCT), and Kogi states.

Study design

It is a cross-sectional study among children aged 6 months–18 years.

Study site

The study was conducted in an antiretroviral clinic at the special treatment center of DASH Lafia. The adults clinic is for Mondays and Thursdays. The description given for the staffs are for the Paediatrics section of the Anti-retroviral clinic. The center is run by two consultants, a senior registrar, two registrars, and three medical officers. They are ably supported by nurses, pharmacists, laboratory scientists, psychologists, adherence counselors, etc.

Sample size

The sample size was calculated using the formula:

[INLINE:1]

n = sample size calculated, P is the prevalence at 45.4%,[2] q = 1–p, Z = standard deviate at 95% confidence level = 1.96, d = level of precision at 5%

[INLINE:2]

n = 380 allowing for 10% attrition risk, and the minimum sample size to be used will be 420.

Inclusion criteria

All children and adolescents seen at the special treatment clinic were included in the study.

Exclusion criteria

Children with known or features of sickle cell disorderChildren with other comorbidities such as sepsis were excluded in the study.

Recruitment procedure

The emergency paediatrics unit (EPU) record of admission was used to recruit individuals who met the criteria. Their folders were then retrieved from the hospital medical records to derive their respective biodata, clinical presentation, and outcome. The above was used to complete the questionnaire by the researcher and trained assistants.

Outcome

The study outcome was asymptomatic malaria.

Ethical approval

Ethical approval was sought and obtained from the DASH Research Ethics Committee on March 12, 2019, with protocol number DASH/ADM/0340. Those with malaria coinfection were treated according to standard with either artemisinin-based combination therapy or artesunate depending on severity.

Consent

Written informed consent on participation and data publication was obtained after the study was explained to participants, and they fully understand the reasons behind the study. They were made to understand that they can withdraw from the study at any time without suffering any untoward action for refusing to participate. Full confidentiality was guaranteed.

Data analysis

The data were entered into a Microsoft Excel sheet with the variables coded before transferring into the Statistical Package for the Social Sciences version 20.0 IBM SPSS incorporated, Chicago. Categorical variables were presented with tables of frequency distribution. Mean and standard deviation of continuous variables were calculated. The association between two means was calculated using Student's t-test, whereas that between two categorical variables was calculated using Chi-square test. P < 0.05 was considered statistically significant.

 Results



Demographic characteristics of the study population

Of the total study population of 420, 212 were male (50.5%), whereas 208 were female (49.5%), with a male: female ratio of 1:1. The study participants were aged 2–18 years and were categorized into three as follows: under-five age group (2–<5 years), school age group (5–9 years), and adolescent age group (10–18 years). Most of the participants were of the school age group (52.8%), whereas the least were of the adolescent age group (23.7%), as shown in [Table 1].{Table 1}

Comparison of mean weight of the population by gender and age groups

The mean weight of the study population is 19.8 ± 7.1. There was no significant difference between the mean weight of males and females (P = 0.334). Furthermore, there was no significant difference in the mean weight by age grouping of the study population (P = 0.063) [Table 2].{Table 2}

Distribution of malaria parasite by gender and age group

Although there are more males with malaria-positive results, it has no statistically significant difference (P = 0.3550). There was also no significant difference in the malaria distribution by age group, as depicted in [Table 3].{Table 3}

Prevalence of asymptomatic malaria among human immunodeficiency virus-infected children/adolescents

Of the 420 participants recruited in this study, 192 (45.7%) had positive malaria parasite by microscopy [Figure 1].{Figure 1}

Distribution of viral loads based on malaria parasite

There is no significant difference between the amount of viral load and malaria parasite positivity (P = 0.865) [Table 4].{Table 4}

 Discussion



The mean age of this study population was 7.02 ± 2.97 years. The prevalence of asymptomatic malaria among HIV-infected children in this study was 45.7%. This finding was similar to the 45.4% reported by Unata et al.[2] in two tertiary health facilities in Sokoto. The somewhat similar study period may account for the similarity. This was higher than 34% reported by Okonkwo et al.[6] in Benin City. The disparity with our study may be attributed to the study age group which was age 2–18 years compared to the study in Benin among children under 5 years. It is also higher than 31% reported by Onankpa et al.[7] in Sokoto; the difference may be due to a higher mean age of 8.63 ± 3.76 years compared to 7.02 ± 2.97 years in the present study. It is even much higher than the finding of Aba et al.[9] in Ivory Coast. The different with the current study may be explained by the fact that theirs was among febrile adult patients.

Saracino et al.[5] in Mozambique reported 42.3% which is comparable to the finding of the present study. The reason for the similarity is not completely clear, but a similar mode of diagnosis may be a plausible explanation. The prevalence of malaria coinfection with HIV in this study is lower than 67% reported by Ezeamama et al. in Tanzania.[10] The possible reason for the difference is that their studies included HIV-exposed babies compared to the current study which was strictly among HIV-infected children.

There are more males than females in this study with coinfection but not statistically significant. Wariso and Nwauche in Port Harcourt reported a similar finding.[1] Other studies have also reported this but with lack of significant findings.[2],[4],[5]

There are more children aged between 6 and 10 years with malaria and HIV coinfection; this finding may be attributed to the better protection offered to the under-five group compared to the school age group. Continued declining maternally acquired immunity may also be a reason. The timing of this study done between March and May which was at the onset of the raining season could have an impact on the outcome as malaria is more during the raining season, especially at its peak.

 Conclusion



The prevalence of malaria coinfection with HIV is 45.7% in this study.

Efforts at controlling malaria should be strengthened, especially among HIV-positive children, as they are at risk for malaria just like their HIV-negative counterpart. A further study among cohort of HIV-positive children seeking to know the predictive factors for malaria is advocated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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