Malaria and Typhoid Fever Infection Rates in Pregnant Women

Malaria and Typhoid Fever Infection Rates in Pregnant Women plasmodium falciparum and Salmonella typhiCo- infection Among Pregnant Women in Abakaliki, Ebonyi State Nigeria.Okonkwo, E. C., Nwele, D. E., Nworie, O., Agumah, N. B., Orji, J. O.and1Nwuzo, A. C.AbstractMalaria and typhoid fever febricity argon some(prenominal) endemic in the tropics and gravid women fashion one of the utmost risk groups. This study was carried out to determine the value of malaria-typhoid co-infection in gravid women attending prenatal clinics in Federal teaching Hospital, Abakaliki, Ebonyi State Nigeria. About120 volunteer pregnant women were recruited during routine prenatal. Malaria infection was determined by qualitative immunodiagnostic assay and support by microscopic examination of fat and sharp giemsa stained slides.Typhoid infection was determined by Widalagglutination method and confirmed by privy culture. Out of 120 pregnant women studied, 49 (40.8%) were controlling for malaria parasite and equ aloney had significant titre of salmonella antibiotics. Of the 120 stool samples accomplished 29 (24.2%) were positive for salmonella. Thus, the overall rate of malaria-typhoid co-infection was 12.5% by both(prenominal) Widalagglutination and stool culture methods. The co-infection of malaria and typhoid in maternalism has a profound event on adverse pregnancy outcome. Weadvocate for routine screening and treatment of give pregnant women.Keywords Co-infection, Malaria and Typhoid, Pregnant Women, Ebony State, NigeriaINTRODUCTIONMalaria and typhoid fever (caused by plasmodium falciparum and salmonellaspp respectively) ar both diseases of public health importance which are endemic in both tropical and subtropical countries including Nigeria. The association betwixt typhoid and malaria was first described in medical literature in the middle of the 19th century by the United States Army and was mistakenly called typho-malaria fever (Smith, 2002). Recent studies in Africa seem to corroborate the relationship amid malaria and typhoid fever (Ammahetal., 2009). It is noteworthy that the socio-economic and env conjuremental condition that tend to indorse high prevalence of malaria in endemic areas also favour the infection of salmonellatyphi, the causative agent of typhoid fever. (Prasannaetal., 2011)The World Health organization has estimated that in 1995, 219 million cases of malaria were documented with about 1.2 million deaths (Brabin 1983). Malaria infection often presents with brain ache, fever, shivering, arthralgia (joint pain), vomiting, hemolytic anaemia, jaundice, hemoglobinuria and retinal damage (Brabin, 1983 Gills etal., 1999). Complications of malaria involve respiratory distress, which occurs in up to 25% of adults and 40% of children. Acute Respiratory Distress Syndrome (ARDS) whitethorn develop in 5-25% in adults and up to 29% of pregnant women, although it is exalted in young children (Isibor, et. al., 2011).Pregnant wo men are especially vulnerable to malaria infection. In Sub-Sahara Africa, maternal malaria is associated with up to 200,000 estimated infant deaths yearly (Isiboretal., 2011).Typhoid fever is considered a grammatical constituenticular risk in pregnancy because of reduced peristaltic activity in the gastro-intestinal and biliary tracts and change magnitude prevalence of biliary sludge (Bashyametal., 2007).Materials and method flying fieldThe study was carried out at the antenatal clinic, Federal Teaching Hospital, Abakaliki, Ebonyi State. force field populationThe study involved pregnant women who had fever by the season of their visit to the hospital.Sample collectionIntravenous blood sample (5ml) was cool from each participant. The samples were stored in refrigerator after collection and were processed indoors six hours. Stool samples were also collected from participants using sterile widely distributed containers.Determination of malaria infectionThis was carried out using a ntigen Rapid Test cheat method as well as Giemsa stained thick and thin blood smear for microscopic detection of P. Falciparum. Both procedures were carried out as described by Cheesbrough, (2002).Widal testWidal agglutination test was performed on all malaria positive blood samples using commercial antigen suspension and the procedure was as described by the manufacturer.Also stool culture was done to besides confirm S. Typhi. 10ml of selenite- F broth was added to 3g of the stool sample and mixed vigorously, and therefore incubated at 37oc for 24hours. Thereafter, a loopful of the sample was inoculated onto salmonella-stigella agar medium and incubated at 370c for 24 hours to get discreet colonies (Lactose fermenters were confirmed by pink colonies on SSA). The colonies were gramme stained and further subjected to biochemical analysis.ResultsOut of the 120 pregnant women at their different stages of pregnancy that participated in this present study, 49 (40.9%) were positive fo r malaria, art object 29(24.2) tested positive for S. typhi. Malaria infection was highest during the first trimester (16.7%) while S. typhi was more than customary during the third trimester. The overall malaria and typhoid fever co-infection showed a prevalence of 12.5% (see bow 1).Table 1 prevalence of P. falciparum and S. typhi among women in different stages of pregnancyStages of pregnancyN0 examinedP. falciparumS. typhiCo-infection1st trimester4020(16.7%)8(6.7%)5(4.2%)2nd trimester3011(9.2%)6(5%)4(3.3%)3rd trimester5018(15%)15(12.5%)6(5%) good12049(40.9%)29(24.2%)15(12.5%)Table 2 and 3 below shows the relative methods eng antiquated during this study. Both RDT and Microscopy methods were considered desirable as they gave positive result P. falciparumat all stages. Similarly, both widal test and culture methods gave confirmatory positive results for S. typhi.Table 2 comparative test for malaria using rapid diagnostic test and microscopy.Stage of pregnancyRDT (%)Microscopy (%)Number examined1st20(16.7)20(16.7)402nd11(9.2)11(9.2)303rd18(15)18(15)50Total49(40.9)49(40.9)120Table 3 comparative Test for S. typhi by the widal and culture methodsstages of pregnancyWidal (%)Stool culture (%)Number examined1st8(6.7)8(6.7)402nd6(5)6(5)303rd15(12.5)15(12.5)50Total29(24.2)29(24.2)120 countersignMalaria and its co-infection with typhoid fever is a major public health caper in pregnant women in Nigeria. The malaria prevalence rate of 40.9% observed in the present study suggests high endemicity and transmission of malaria parasite. The high prevalence suggests change magnitude susceptibility of pregnant women to malaria infection often due to induced immunosuppression (Ndukaetal., 206). The high prevalence could also be attributed to lack of adequate preventive measures beingness adopted by the pregnant women. Pregnant women in their first trimester were more infected with malaria as recorded in this study and this was in note of hand with the earlier findings of Ukibeetal., (2008). This could attributedto the absence of medical facility or the inability of the pregnant women to register for antenatal on time.The prevalence of malaria-typhoid co-infection among the pregnant women attending antenatal clinic in this study was 12.5%. This is comparable to previous reports (Akinyemietal., 2007 Prasanna, 2011). The observed prevalence suggests that typhoid fever is a common co-infection in malaria infected women in this part of the country. The reduction of cellular and humoral resistivity which occurs in pregnancy renders pregnant women susceptible to other infections including typhoid fever (Scholarpurka, etal., 2000). Malaria infected pregnant women are said to be more prone to typhoid fever because of the increased heamolysis in malaria which is said to increase the availability of iron in the meander especially the liver and salmonella species are believed to thrive more in iron rich tissues (Kaye and Hook, 2003). It is pertinent to not e that both typhoid and malaria in pregnant women present with management problems since most drugs used in the treatment of both diseases are contra-indicated in pregnancy. Also both diseases have been associated with pregnancy outcomes much(prenominal) as premature deliveries, spontaneous abortions, low birth weight and intra-uterine foetal deaths (Nasemetal., 2008).The transmission of P. falciparium and S. Typhi is affected by environmental factors such as unretentive environmental sanitation, poor housing and inadequate safe water supply. This could be reason for the high prevalence since majority of the pregnant women were rural dwellers. Te use of insecticide treated net, safe water supply and in-person hygiene as well as early registration for antenatal clinic of pregnant women are advocated.ReferenceAkinyemi,K.O, Bamiro, B.S and Coker, H,O (2007). Salmonellosis in Lagos, Nigeria. Incidence of Plasmodium falciparum malaria associated co- infection, patterns of germicide resistance and emergence of induced susceptibility to fluoroquinolines. Journalof Health Popul Nuttri, 25 351-358.Bashyam, H. (2007).Surviving malaria, anxious(p) of typhoid.J.Exp Med.204 (12) 2774.Brabin, B. J. (1983). An analysis of malaria in pregnancy in Africa.Bull WHO, 611005-1016.Cheesbrough, M. (2002). District lab practice in tropical countries. Part1. Cambridge press, London.Pp.211-214.Gills, H. M., Lawson, J. B., Silbelos, M., Voller, A.And Allan, N. (1999).Malaria, anaemia, and pregnancy.Ann.Tropparasitolol. 63 245-263.Isibor, J. O., Igun, E., Okodua, M., Akhite, A. O. and Isibor, E. (2011).Co-infection with malaria parasite and salmonella typhi in patients in Benin City, Nigeria.Ann Biol Res. 2(2) 361-365.Kaye, D. and Hook, E.W. (2003).The influence of heamolysis or blood loss on susceptibility to infection.Journal of immunology. 91 65-75.Khan, M. A., Mekan, S. F., Abbas, Z.And Smego, R. A. (2005).Concurrent malaria and enteric fever in Pakistan.Singapore. Med J. 46 6 25-628.Nasem, S. Anwar, S.and Ihsanullah, M. (2008). Outcome and complications of malaria in pregnancy.Gomal J med Sci 6(2) 98-101.Nduka, F.O.,Egbu, A., Okafor, C. and Naogo, V.O. (2006).Prevalence of malaria parasite.Inter J trop Med. pub Health. 2(1) 1-11.Prasanna, P. (2011). Co-infection of typhoid and malaria.J Med. Lab Diag. 2 (3) 22 -26.Scholarpurka, S. C., Mahajar, R.C., Gupta, A.N. and Wangoo, A. (2000).Cellular immunity in pregnant and non-pregnant women with malaria infection.Asia Oceania J ObseGyncol. 16 27-32.Smith, D.C. (2002). The rise and fall of typhomalaria fever.J Hist Med assort sci. 37182-220.Ukibe, S.N., Mbanugo, J.J. and Ukibe, N.R. (2008). Prevalence of malaria and increasing spleen rate in children aged 0-13 years in Awka South Local Government area of Anambra state, Nigeria J Environ Health, 5(2) 64-69.