RESUMO
BACKGROUND: Insecticide-treated nets (ITNs) are the most widely used interventions for malaria control in Africa. The aim of this study was to assess the ownership and utilization of ITNs and the knowledge of malaria and their effects on malariometric and haematological indices in children living in the Mount Cameroon area. METHODS: A community-based cross-sectional study involving a total of 405 children aged between 6 months and 14 years living in Batoke-Limbe was carried out between July and October 2017. A semi-structured questionnaire was used to document demographic status, knowledge on malaria and ITN ownership and usage. Venous blood sample was collected from each child to determine the prevalence and intensity of parasitaemia by Giemsa-stained microscopy and full blood count by auto haematology analysis to obtain white blood cell (WBC) and red blood cell (RBC) counts, haemoglobin (Hb) level, haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). A multilinear regression model was used to determine the relationship between haematological parameter as dependent variable and the independent variables. RESULTS: The overall prevalence of parasitaemia, anaemia, knowledge about malaria, ITN ownership, usage and effective usage was 46.7%, 54.7%, 40.7%, 78.8%, 50.9% and 29.9%, respectively. The prevalence of parasitaemia was significantly higher (P < 0.001) in children who ineffectively utilized ITNs (54.9%) than effective users (27.3%). Having knowledge of malaria, negatively correlated with WBC counts (P = 0.005), but positively correlated with Hb levels (P < 0.001), RBC counts (P < 0.001), Hct (P < 0.001), MCV (P < 0.001) and MCH (P < 0.001). ITN use positively correlated with WBC counts (P = 0.005) but negatively with Hb levels (P = 0.004), RBC counts (P = 0.006), and MCH (P < 0.001). Meanwhile, parasitaemia negatively correlated with Hb levels (P = 0.004), RBC counts (P = 0.01), Hct (P = 0.04) and MCHC (P = 0.015). CONCLUSION: There is need for more sensitization on the benefits of using the ITNs to meet up with the intended and expected impact of the free distribution of ITNs.
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Mosquiteiros Tratados com Inseticida , Malária/prevenção & controle , Propriedade/estatística & dados numéricos , Adolescente , Fatores Etários , Corantes Azur , Camarões/epidemiologia , Criança , Pré-Escolar , Corantes , Estudos Transversais , Feminino , Testes Hematológicos , Humanos , Lactente , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Conhecimento , Modelos Lineares , Malária/sangue , Malária/epidemiologia , Masculino , Parasitemia/sangue , Parasitemia/epidemiologia , Parasitemia/prevenção & controle , Prevalência , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The Mount Cameroon area has experienced a 57.2% decline in confirmed malaria cases between 2006 and 2013 with the implementation of different control measures but, the disease is still of public health concern. The objective of the study was to assess the burden of asymptomatic and sub-microscopic Plasmodium infection, altitudinal influence on it, their effect on haematological parameters as well as identify the risk factors of infection. METHODOLOGY: A cross-sectional community-based survey involving 1319 children of both sexes aged 6 months to 14 years was conducted between July 2017 and May 2018. Malaria parasitaemia was confirmed by Giemsa-stained microscopy, sub-microscopic Plasmodium infection by 18S mRNA using nested PCR and full blood count analysis was done using an auto haematology analyser. RESULTS: Malaria parasite, asymptomatic malaria parasitaemia and sub-microscopic Plasmodium infection and anaemia were prevalent in 36.4%, 34.0%, 43.8% and 62.3% of the children, respectively. The risk of having sub-microscopic Plasmodium infection was highest in children 5â9 (OR = 3.13, P < 0.001) and 10â14 years of age (OR = 8.18, P < 0.001), non-insecticide treated net users (OR = 1.69, P < 0.04) and those anaemic (OR = 9.01, P < 0.001). Children with sub-microscopic infection had a significantly lower mean haemoglobin (9.86 ± 1.7 g/dL, P < 0.001), red blood cell counts (4.48 ± 1.1 × 1012/L, P < 0.001), haematocrit (31.92%, P < 0.001), mean corpuscular haemoglobin concentration (313.25 ± 47.36, P = 0.035) and platelet counts (280.83 ± 112.62, P < 0.001) than their negative counterparts. Children < 5 years old (73.8%), having asymptomatic (69.8%) and sub-microscopic Plasmodium infection (78.3%) as well as resident in the middle belt (72.7%) had a higher prevalence of anaemia than their peers. CONCLUSION: The meaningful individual-level heterogeneity in the burden of asymptomatic and sub-microscopic Plasmodium infection in addition to its corollary on haematological variables among children in the different attitudinal sites of the Mount Cameroon Region accentuate the need for strategic context specific planning of malaria control and preventative measures.
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Anemia/epidemiologia , Malária Falciparum/epidemiologia , Parasitemia/epidemiologia , Plasmodium falciparum/isolamento & purificação , Adolescente , Altitude , Anemia/parasitologia , Doenças Assintomáticas , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Malária Falciparum/parasitologia , Masculino , Parasitemia/parasitologia , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Malaria and the human immunodeficiency virus (HIV) infection constitute public health problems in Cameroon including the South West Region (SWR). This study determined the prevalence of malaria parasites and haematological abnormalities in HIV positive patients in Limbe, Cameroon from April-July 2014. METHODS: The study was cross-sectional and involved 411 participants who were administered structured questionnaires to record socio-demographic and clinical data. Three hundred and nine (309) HIV positive patients and one hundred and two (102) HIV negative individuals were examined clinically and venous blood collected for malaria parasite detection, HIV infection diagnosis and full blood count analysis. RESULTS: Overall malaria parasite prevalence was 14.1% (58/411). This prevalence was significantly higher (P < 0.001) in the HIV negative participants (33.3%, 34/102) compared to the HIV positive patients (7.8%, 24/309). Amongst HIV positive participants, malaria parasite prevalence was significantly higher in female patients (P = 0.003), febrile patients (P < 0.001), anaemic patients (P = 0.015) and in patients who were not on antiretroviral treatment (ART) (P = 0.03) when compared with their respective counterparts. Among the HIV negative group, though not significant, malaria parasite prevalence was higher in females, febrile and anaemic patients when compared with their respective counterparts. Overall anaemia prevalence was 52.1% (214/309) and was significantly higher (P = 0.004) in HIV positive patients (56%, 173) than in HIV negative participants (40.2%, 41). Malaria/HIV co-infected patients had a significantly lower mean value of Hb (P = 0.002), RBC (P = 0.002) and Hct (P = 0.001) when compared with HIV-infected patients. CONCLUSION: HIV negative participants had a higher prevalence of malaria parasites than their HIV positive counterparts. Anaemia prevalence was higher in HIV positive patients than in HIV negative participants. Malaria/HIV co-infected patients presented with more red blood cell abnormalities than HIV-infected patients.
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Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Malária/epidemiologia , Plasmodium/isolamento & purificação , Adolescente , Adulto , Idoso , Animais , Antirretrovirais/administração & dosagem , Camarões/epidemiologia , Criança , Pré-Escolar , Coinfecção/parasitologia , Coinfecção/virologia , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Hospitais/estatística & dados numéricos , Humanos , Lactente , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Plasmodium/classificação , Plasmodium/genética , Prevalência , Adulto JovemRESUMO
BACKGROUND: In 2014, a study in Munyenge revealed a high prevalence of urogenital schistosomiasis (UGS) among pregnant women. This study investigated he prevalence and risk factors of UGS in pregnancy following scale-up of piped water sources from 2014 to 2017. Secondly, we compared stream usage, stream contact behaviour, infection rate and intensity with the findings of 2014. METHODS: Consenting pregnant women reporting for antenatal care (ANC) in the different health facilities were enrolled consecutively between November 2016 and January 2018. Information on age, gravidity status, residence, marital status, educational level, occupation, household water source, frequency of contact with water and stream activities were obtained using a semi-structured questionnaire. Urine samples were examined for the presence of microhaematuria and S. haematobium ova using test strip and filtration/microscopy methods respectively. Data were analysed using univariate and multivariate regression analyses and relative risk reductions calculated. RESULTS: Of the 368 women enrolled, 22.3% (82) were diagnosed with UGS. Marital status (single) (aOR = 2.24, 95% CI: 1.04-4.79), primary - level of education (aOR = 2.0; 95% CI: 1.04-3.85) and domestic activity and bathing in the stream (aOR = 3.3; 95% CI: 1.83-6.01) increased risk of S. haematobium infection. Meanwhile, fewer visits (< 3 visits/week) to stream (aOR = 0.35, 95% CI = 0.17-0.74) reduced exposure to infection. Piped water usage was associated with reduced stream usage and eliminated the risk of infection among women who used safe water only. Compared with the findings of 2014, stream usage (RRR = 23 95% CI: 19-28), frequency (≥ 3 visits) (RRR = 69 95% CI: 59-77) and intensity of contact with water (RRR = 37 95% CI = 22-49) has reduced. Similarly, we observed a decrease in infection rate (RRR = 52, 95% CI = 40-62) and prevalence of heavy egg intensity (RRR = 71, 95% CI = 53-81). CONCLUSION: Following increased piped water sources in Munyenge, S. haematobium infection has declined due to reduced stream contact. This has important implication in the control of UGS in pregnancy.
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Complicações Parasitárias na Gravidez/epidemiologia , Schistosoma haematobium , Esquistossomose Urinária/epidemiologia , Abastecimento de Água/métodos , Água/parasitologia , Adolescente , Adulto , Animais , Camarões/epidemiologia , Estudos Transversais , Feminino , Filtração , Hematúria/epidemiologia , Hematúria/parasitologia , Humanos , Microscopia , Gravidez , Complicações Parasitárias na Gravidez/etiologia , Complicações Parasitárias na Gravidez/parasitologia , Cuidado Pré-Natal , Prevalência , Fatores de Risco , Rios/parasitologia , Esquistossomose Urinária/etiologia , Esquistossomose Urinária/parasitologia , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Malaria, anaemia and malnutrition are frequently co-existing diseases that cause significant morbidity and mortality particularly among children. This study measured the prevalence, intensity and evaluated risk factors for malaria parasitaemia, anaemia and malnutrition among children living at low versus high altitude settings in the Mount Cameroon area. METHODS: A cross-sectional community based survey involving 828 children aged 6 months to 14 years was conducted between July and November 2017. Malaria parasitaemia was confirmed by light microscopy, haemoglobin concentration was measured using an auto haematology analyser, nutritional status was determined from the anthropometric measurements collected, and socioeconomic status related variables by the use of questionnaire. Anaemia and malnutrition were defined according to World Health Organization standards. Associations between predictor variables and primary outcomes were assessed using logistic regression analysis. RESULTS: Malaria parasite and anaemia were prevalent in 41.7% and 56.2% of the children, respectively while, malnutrition prevalence was 34.8% with wasting, underweight and stunting occurring in 25.7%, 19.9% and 23.7% of them respectively. Overall malaria parasite geometric mean density was 413/µL of blood (range 100-27,060). The odds of having malaria parasitaemia was highest in children 5-9 years of age [odd ratio (OR) = 1.69, P = 0.006], living in lowland (OR = 1.48, P = 0.008) as well as those whose domestic water was collected from an open source (streams/springs) (OR = 1.81, P = 0.005) than their counterparts. Being < 5 years (OR = 3.15, P = < 0.001) or 5-9 years (OR = 2.20, P < 0.001) of age, having malaria parasite (OR = 2.07, P = < 0.001) and fever in the past 2 days (OR = 1.52, P < 0.04) were identified as significant risk factors of anaemia while the age group < 5 years was the only significant risk (OR = 3.09, P = < 0.001) associated with malnutrition. CONCLUSION: While age specific attention should be given in the control of malaria (5-9 years), anaemia (< 10 years) and malnutrition (< 5 years), the existing malaria control programmes should be revised to integrate anaemia and malnutrition control strategies so as to improve upon the health of the children.
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Altitude , Anemia/epidemiologia , Malária/epidemiologia , Desnutrição/epidemiologia , Parasitemia/epidemiologia , Adolescente , Anemia/parasitologia , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Malária/parasitologia , Masculino , Desnutrição/parasitologia , Parasitemia/parasitologia , Prevalência , Saúde Pública , Fatores de RiscoRESUMO
BACKGROUND: Cardiovascular parameters can be impaired by repeated infections with P. falciparum. This study aimed at investigating the influence of gametocyte carriage on; the prevalence of fever and splenomegaly, blood pressure, heart rate and haematological indices in children <15 years, in the Mount Cameroon area. METHODS: A cross-sectional study was carried out, from February to July 2013. A child with axillary body temperature ≥37.5 °C was considered febrile and splenomegaly was investigated by palpation. Systolic and diastolic blood pressures as well as heart rate were assessed by non-invasive methods. Malaria parasites were detected and density assessed from Giemsa-stained thin and thick blood films. An auto haematology analyser was used to obtain complete blood count values such as haemoglobin (Hb), haematocrit (Hct), red blood cell (RBC) and white blood cell (WBC) counts, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular haemoglobin (MCH). Univariate analyses were used to examine influence of gametocyte carriage on fever and splenomegaly while, multiple linear regression models were used to evaluate influence of independent variables on the dependent variables. RESULTS: Of a total of 454 children examined, malaria parasitaemia, fever, splenomegaly and gametocyte carriage were detected in 36.6, 21.6, 14.3 and 7.3 % of them respectively. Children who were asexual parasite and gametocyte positive (ASP + Gam Pos) had significantly highest (P = 0.03, P = 0.002) prevalence of fever and splenomegaly (39.4 %, 33.3 %) respectively than their aparasitaemic (AP) and asexual parasite positive (ASP Pos) equivalents (19.0 %, 10.9 % and 22.8 %, 16.9 % respectively). The presence of asexual malaria parasitaemia significantly influenced the MCV (P = 0.03), MCH (P = 0.03) and heart beats /min (0.03) while gametocytaemia significantly influenced the Hb (P < 0.001), Hct (P < 0.001), RBC (P < 0.001) and systolic blood pressure (P < 0.05). CONCLUSION: Gametocyte carriage significantly influenced the prevalence of fever, splenomegaly and some cardiovascular indices. In effect, children concurrently having asexual parasitaemia and gametocytes had significantly lower, Hct, Hb levels, RBC and platelet counts and systolic blood pressure.
Assuntos
Portador Sadio/epidemiologia , Febre/epidemiologia , Malária Falciparum/diagnóstico , Esplenomegalia/epidemiologia , Adolescente , Pressão Sanguínea , Camarões/epidemiologia , Portador Sadio/parasitologia , Criança , Pré-Escolar , Estudos Transversais , Contagem de Eritrócitos , Índices de Eritrócitos , Feminino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Lactente , Modelos Lineares , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Masculino , Plasmodium falciparum/isolamento & purificação , Contagem de Plaquetas , PrevalênciaRESUMO
BACKGROUND: Global malaria has been on the decline over the past decade due to expansion of interventions. The present study aimed at determining the current status of malaria epidemiology in the context of sustained interventions and seasonal variations in Bolifamba, which represents a typical semi-urban malaria endemic community in the Cameroonian rainforest. METHODS: A monthly cross-sectional survey was carried out in Bolifamba, a multi ethnic semi-urban locality on the eastern flanks of Mt Cameroon, for a year during which blood samples were collected from participants and examined for malaria parasites by microscopy. Correlation analysis of seasonal/monthly malaria prevalence was done with weather data from Ekona, a nearby village with a meteorological station. Intervention strategy such as use of Insecticide Treated Bed Net (ITBN) and risk factors such as duration of stay in the locality, age and housing type were also investigated. RESULTS: The results revealed a malaria prevalence of 38.3 % in the rainy season, which was significantly higher than 24.4 % observed in the dry season (P < 0.0001). A high prevalence of asymptomatic malaria which was more than double the prevalence of symptomatic malaria on a monthly basis was observed, 30.7 % vs 17.8 % in the rainy and dry season respectively (p < 0.0001) and asymptomatic malaria was significantly associated with anemia (p < 0.005). April was the peak month of malaria prevalence and coincided with peak periods of both asymptomatic and symptomatic malaria. The Plasmodium falciparum parasite rates in the 2- up to 10-years age group (PfPR(2-10)) was 40.8 %. The regular use of ITBN was significantly associated with low prevalence of 31.7 % as opposed to irregular or non-usage of ITBN 38.2 % (p < 0.05). Log of parasite load was found to initially increase to 2.49 with less than 5 years of stay, and decreased gradually with increasing duration of stay in the locality (p = 0.046). Climatic factors were significantly and positively associated with monthly malaria prevalence and the strongest predictors of malaria prevalence were rainfall and minimum temperature with r values of 0.563 and 0.6 respectively. CONCLUSIONS: The study highlights the role of seasonal change in modifying malaria prevalence during the year and the beneficial effect of ITBN. It also underscores a sublime problem of asymptomatic malaria associated with anemia, and indicates that partial immunity is acquired with prolonged stay in Bolifamba. This preliminary result is the basis of ongoing work to identify the antigens involved in acquired immunity.
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Malária/epidemiologia , Floresta Úmida , Estações do Ano , Adolescente , Adulto , Anemia/epidemiologia , Anemia/microbiologia , Camarões/epidemiologia , Estudos Transversais , Feminino , Humanos , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/isolamento & purificação , Prevalência , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The contradictory results on the interaction between nutritional status and malaria warrants further investigation in various epidemiological settings, to assert the antagonistic or synergistic relationship. This study examines the prevalence, severity and predictors of malnutrition and its influence on malaria parasitaemia and anaemia severity in children in the Mount Cameroon area. METHODS: A cross-sectional study involving 454 children ≤ 14 years was carried out from February to May 2013 in Muea community. Anthropometric measures of malnutrition (z-scores < -2 standard deviations below mean) were obtained and spleen size assessed. The prevalence and density of malaria parasites were determined and haemoglobin concentration and white blood cell count obtained using an automated haematology analyzer. Univariate and multivariate analyses were used to evaluate influence of malnutrition on anaemia, malaria parasitaemia and predictors respectively. RESULTS: The overall prevalence of malnutrition was 22.8 %, with stunting being the most common form (17.1 %), followed by underweight (8.2 %) and wasting (5.5 %). Stunting was significantly higher (P < 0.01) in males (23.1 %) than in females (11.9 %). The prevalence of malnutrition was significantly highest (P = 0.03) in children ≤5 years old (29.5 %) than their counterparts. Severe stunting, wasting and underweight were prevalent in 4.9 %, 1.6 % and 1.8 % of the children respectively. Clinical malaria parasitaemia was significantly higher (P = 0.01) in children who were stunted (16.9 %) and underweight (21.6 %) than their normal counterparts (7.5 %; 8.2 % respectively). The model demonstrated sex (P = 0.006) and age group 1.1-3 years (P = 0.03) as significant predictors of malnutrition. In children who were malaria parasite negative, the prevalence of anaemia as well as severities were significantly higher (P = 0.04 and P = 0.001 respectively) in those malnourished. CONCLUSIONS: The presence of stunting in the community significantly augmented the prevalence and clinical presentation of Plasmodium infection. Malnutrition enhanced the severity of anaemia in malaria parasite negative children hence, their health and growth potential needs to be improved upon.
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Anemia/epidemiologia , Doenças Endêmicas , Malária/epidemiologia , Estado Nutricional , Parasitemia/epidemiologia , Adolescente , Anemia/parasitologia , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Malária/parasitologia , Masculino , Análise Multivariada , Parasitemia/parasitologia , Prevalência , Características de ResidênciaRESUMO
Background: Nutritional deficiencies and its consequences such as anaemia are frequent among pregnant women residing in under resource settings. Hence, this study sought to investigate specific dietary micronutrient inadequacy and its effect on maternal haemoglobin levels. Methods: This institution based cross-sectional survey enrolled 1,014 consenting pregnant women consecutively. Data on socio-demographic, economic and antenatal characteristics were recorded using a structured questionnaire. Minimum dietary diversity for women (MDD-W) was assessed using the 24-h recall method and haemoglobin (Hb) concentration (g/dL) determined using a portable Hb metre. Significant levels between associations was set at p < 0.05. Results: Among those enrolled, 40.9% were anaemic while 89.6% had inadequate dietary nutrient intake. In addition, uptake of blood supplements, haem iron, plant and animal-based foods rich in vitamin A were 71.5, 86.2, 35.5 and 12.6%, respectively. Moreover, anaemia prevalence was significantly (p < 0.05) lower in women who took iron-folic acid along with food groups rich in haem iron (38.5%) or both plant and animal vitamin A (29.0%). Besides, mean maternal Hb levels was significantly (p < 0.001) higher in women who consumed haem iron (11.08 ± 1.35) and vitamin A food groups (11.34 ± 1.30) when compared with their counterparts who did not consume haem iron (10.54 ± 1.19) and vitamin A food groups (10.74 ± 1.31). Conclusion: Dietary uptake of foods rich in haem-iron and vitamin A significantly improves Hb levels in Cameroonian pregnant women. Our findings underscore the importance of improving maternal nutritional awareness and counselling during antenatal period to reduce the anaemia burden.
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In resource limited settings, malaria and undernutrition are major public health problems in pregnancy. Therefore, this study assessed the association between malaria infection and undernutrition among pregnant women in the Mount Cameroon area. This cross-sectional study enrolled 1,014 pregnant women consecutively over a year. A structured questionnaire was used to collect socio-demographic information and clinical data. Maternal nutrition was assessed using dietary diversity (DD). Peripheral blood samples collected were used for the diagnosis of malaria parasitaemia by microscopy whereas haemoglobin (Hb) levels were determined using an Hb meter. Logistic regression was used to determine factors associated with malaria and dietary diversity. The prevalence of malaria infection and undernutrition was 17.8% and 89.6% respectively. In addition, of those infected with malaria, geometric mean parasite density was 301/µL of blood (range: 40-9280) while mean DD score was 3.57±0.82 (range: 1-7). The odds of being infected with malaria parasitaemia was highest among women enrolled in the rainy season (OR = 1.58, P = 0.043), who were farmers (OR = 2.3, P = 0.030), had a household size of < 4 individuals (OR = 1.48, P = 0.026) and who were febrile (OR = 1.87, P < 0.001). Also, attending clinic visits in Mutengene Medical Centre (OR = 2.0, P = 0.012) or Buea Integrated Health Centre (OR = 2.9, P = < 0.001), being < 25 years (OR = 2.4, P = 0.002) and a farmer (OR = 10.6, P = 0.024) as well as < 4 clinic visits (OR = 1.62, P = 0.039) were identified as predictors of undernutrition. Furthermore, the association between malaria and DD was statistically significant (P = 0.015). In this study, undernutrition was highly frequent than malaria infection. Thus, there is an urgent need to improve maternal awareness through nutritional counselling and health campaigns on the benefits of consuming at least five food groups. Besides, improved maternal dietary nutrient intake is likely to have impact on the burden of malaria parasite infection.
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Malária , Desnutrição , Complicações Parasitárias na Gravidez , Feminino , Gravidez , Humanos , Gestantes , Cuidado Pré-Natal , Camarões/epidemiologia , Estudos Transversais , Malária/epidemiologia , Complicações Parasitárias na Gravidez/epidemiologia , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Parasitemia/epidemiologia , Inquéritos e Questionários , Instituições de Assistência Ambulatorial , PrevalênciaRESUMO
Urogenital schistosomiasis (UGS) caused by Schistosoma haematobium is endemic in the South West Region of Cameroon. An understanding of the abundance and distribution of the Bulinus snail, intermediate host can inform strategic snail control programmes at a local scale. This study investigated seasonal dynamics and environmental factors influencing occurrence and abundance of freshwater snail intermediate hosts in Tiko, a semi-urban endemic focus in the Mount Cameroon area. A longitudinal malacological field survey was conducted between December 2019 and December 2020 in the Tiko municipality. Snails were collected for one year monthly at 12 different human water contact sites along a stretch of the Ndongo stream using a standardized sampling technique. Freshwater snails were identified using shell morphological features. In addition, water temperature, pH, electrical conductivity, total dissolved solutes, salinity, water depth, width and flow velocity were measured, and vegetation cover as well as substrate type were determined. Bayesian regression models were used to identify the main environmental factors affecting the occurrence and abundance of Bulinus intermediate host. In total, 2129 fresh water snails were collected during the study period. Physa (51.4%) was the most abundant genus followed by Melanoides (28.6%) then, Bulinus (15.5%), Lymnaea (4.2%), Indoplanorbis (0.2%) and Potadoma (0.1%). Seasonality in abundance was significant in Bulinus sp as well as other genera, with greater numbers in the dry season (peaks between December and February). Water temperature, a rocky or sandy substrate type associated positively with Bulinus sp, meanwhile a higher water flow rate and medium vegetation negatively influenced the snail intermediate host population. These findings underscore the importance of timing behavioural and snail control interventions against schistosomiasis as well as increase vigilance of other trematode diseases in the study area. The continuous spread of planorbid snail hosts is a major concern.
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Bulinus , Esquistossomose Urinária , Animais , Humanos , Schistosoma haematobium , Estações do Ano , Camarões/epidemiologia , Teorema de Bayes , Caramujos , Esquistossomose Urinária/epidemiologia , Água Doce , Água , EcossistemaRESUMO
BACKGROUND: Anaemia, anisocytosis, malnutrition (especially stunting) are common health problems in developing countries with children being the most vulnerable. These conditions have negative impacts on human performance, growth and development, and can further be complicated if comorbidity exists within a holoendemic stratum with strong and perennial malaria parasite transmission such as the Mount Cameroon area. The study aimed at determining the prevalence and severity malnutrition, anaemia and anisocytosis in children ≤ 5 years, living in the conflict hit malaria perennial transmission zone of the Mount Cameroon area. METHOD: A cross-sectional community-based survey involving 628 children ≤ 5 years was conducted. Malaria parasitaemia was confirmed by Giemsa-stained microscopy and the density was log transformed. Haemoglobin (Hb), mean cell volume and red blood cell distribution width were estimated using an auto-haematology analyser and defined according to WHO standards. Anthropometric indices were analysed and compared with WHO growth reference standards using WHO Anthro software. RESULTS: Plasmodium infection, anaemia, microcytic anaemia, anisocytosis and stunting were prevalent in 36.0, 72.8, 30.1, 54.1 and 29.0% of the children, respectively. The ≤ 24 months children were more moderately stunted (14.7%), with higher prevalence of microcytic anaemia (38.8%) and anisocytosis (68.8%) (P < 0.002 and P < 0.001, respectively) when compared with the older children. The mean Hb level in the study population was 10.04 g/dL with children ≤ 24 months having the least mean haemoglobin level (9.69 g/dL) when compared with their older counterparts at P < 0.001. The odds of having anisocytosis were highest among children who were malnourished (OR = 4.66, P = 0.005), those infected with malaria parasites (OR = 1.85, P = 0.007), and whose parents had a primary (OR = 3.51, P = 0.002) and secondary levels of education (OR = 2.69, P = 0.017). CONCLUSION: Malaria, anaemia, anisocytosis and undernutrition still remain severe public health concerns among children ≤ 60 months in the Mount Cameroon area. This therefore emphasizes the need for the implementation of consistent policies, programmes and activities to avoid malaria, anaemia, anisocytosis and stunting in the paediatric age group.
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The onset and rapid spread of chloroquine resistance and the introduction of amodiaquine for the treatment of uncomplicated malaria in Cameroon have influenced the proportion of Plasmodium falciparum sensitive and resistant alleles related to 4-aminoquinoline drugs. This study was undertaken to determine the prevalence of resistance markers to antimalarial 4-aminoquinolines in Douala in the Littoral Region, and Buea in the South West Region in June 2020. Dry blood spots were prepared from malaria microscopy positive cases and used for parasite DNA extraction by chelex-100 method. Plasmodium species identification was carried out by PCR amplification/agarose gel electrophoresis of 18srRNA. The Pfcrt and Pfmdr1 genes were amplified by PCR followed by restriction digestion. The prevalence of single nucleotide polymorphisms (SNPs) was compared between study sites and with previous studies carried out between 2003-2005 and 2009-2011 using the Chi square test. The results showed that Plasmodium falciparum was the dominant species occurring as mono-infections (84.6%). The wild type K76 allele of the Pfcrt gene was found in 74.9% of isolates while the wild N86, Y184 and D1246 alleles of the Pfmdr1 gene were found respectively in 87.2%, 89.6% and 100% of field isolates. The results showed a significant reduction in the mutant alleles compared to results obtained in 2003-2005 and 2009-2013. The KNYD haplotype was observed to be the most prevalent. The results indicated that there is a gradual erosion of the mutant Pfcrt and Pfmdr1 genotype and a gradual return to the sensitive P. falciparum genotype in Cameroon.
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Antimaláricos , Malária Falciparum , Humanos , Antimaláricos/farmacologia , Antimaláricos/uso terapêutico , Camarões/epidemiologia , Cloroquina/farmacologia , Cloroquina/uso terapêutico , Resistência a Medicamentos/genética , Malária Falciparum/tratamento farmacológico , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Proteínas de Membrana Transportadoras/genética , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Plasmodium falciparum , Proteínas de Protozoários/genéticaRESUMO
BACKGROUND: Both malaria and intestinal parasites are endemic in Cameroon, and their co-infection can be of great impact on anaemia among people living with HIV (PLWH). This community-based retrospective cohort study determined the prevalence and association of infections with anaemia in PLWH and HIV-negative individuals in Buea, Cameroon from March to August 2019. METHODS: The study population comprised of 190 PLWH and 216 consenting HIV-negative individuals from the Buea community. Participants were examined clinically, the collected blood sample was used for malaria parasite (MP) detection, HIV diagnosis and haemoglobin (Hb) measurement while stool samples were examined for the detection of intestinal parasites (IPs). Proportions were compared using Pearson's Chi-square test and association of anaemia with independent variables was evaluated using logistic regression analysis. RESULTS: Out of the 406 participants, MP, IPs and MP/IP co-infection prevalences were 15.5%, 13.0% and 3.0% respectively. PLWH had a higher prevalence of MP (16.3%, P = 0.17), IPs (23.7%, P Ë 0.001) and MP/IPs co-infection (3.7%, P = 0.04) when compared with HIV-negative participants. Similarly, PLWH had significantly lower mean haemoglobin value (11.10 ± 1.54 g/dL) than their HIV-negative counterparts (12.45 ± 2.06 g/dL). Also, PLWH co-infected with MP and IPs were observed to have a significantly lower mean haemoglobin value (10.6 ± 1.21 g/dL). PLWH had a significantly (P Ë 0.001) higher prevalence of mild (56.8%), moderate (18.4%) and severe (1.6%) anaemia when compared with HIV-negative counterparts. The significant risk factors associated with anaemia included being febrile (P = 0.03), MP-infected only (P = 0.001), HIV-infected only (P < 0.001), having dual (P < 0.001) or triple-infections (P = 0.03). CONCLUSION: Malaria and intestinal parasites remain public health concerns among PLWH and anaemia as a serious haematological abnormality gets exacerbated even with the viral load suppression. Hence, routine medical check-ups among PLWH are recommended.
Assuntos
Anemia/complicações , Coinfecção/epidemiologia , Infecções por HIV/complicações , Enteropatias Parasitárias/complicações , Enteropatias Parasitárias/epidemiologia , Malária/complicações , Malária/epidemiologia , Adolescente , Idoso , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por HIV/parasitologia , Hemoglobinas/metabolismo , Humanos , Lactente , Enteropatias Parasitárias/metabolismo , Enteropatias Parasitárias/virologia , Malária/metabolismo , Malária/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Increased risk of schistosomiasis in peri-urban and urban towns is not uncommon. An epidemiological survey was carried out in the Tiko Health District (THD), an unmapped transmission focus for urogenital schistosomiasis (UGS), to assess the distribution, intensity, and risk factors associated with the occurrence of UGS. METHODS: In this cross-sectional survey, 12 communities were purposively selected from four health areas (HAs) (Likomba, Holforth, Holforth-Likomba, and Mutengene) in South West Region of Cameroon between June and August 2018. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document information on socio-demographic and water contact behaviour. Urine samples were examined for Schistosoma haematobium infection using test strip, filtration, and microscopy methods. Bivariate and binary logistic regression analyses were used to identify predictors of infection. RESULTS: The overall prevalence of UGS in Likomba, Holforth-Likomba and Holforth was 31.5% [95% confidence interval (CI): 28.3-34.8] with geometric mean (GM) egg count of 28.7 (range: 2-450) eggs per 10 ml of urine. S. haematobium infection was not found in Mutengene HA. Infection was unevenly distributed among the HAs, Holforth-Likomba and Holforth being the most and least affected, respectively. The prevalence of infection varied (P < 0.001) among the affected communities, ranging from 12.0 to 56.9%. Infection status of the community related positively (P < 0.001) with proximity to stream (< 100 m), the degree of contact with water and number of improved water sources. Younger age group (5-14 years) [adjusted odds ratio (aOR): 3.7, 95% CI: 1.1-12.2] and intense water contact (degree II) (aOR: 5.2, 95% CI: 3.4-8.1) were associated with increased risk of infection. Similarly, significantly higher egg load was observed among younger aged groups (P = 0.02) and those who carried out intense water contact activities (P < 0.001). CONCLUSIONS: Generally, THD is a moderate risk endemic focus for UGS but prevalence higher than 50.0% was observed in some communities. These findings warrant immediate mass chemotherapy with praziquantel to reduce morbidity. Provision of portable water and health education are proposed measures to reduce and eventually eliminate transmission in the area.
Assuntos
Esquistossomose Urinária , Adolescente , Idoso , Animais , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Humanos , Praziquantel , Prevalência , Schistosoma haematobium , Esquistossomose Urinária/epidemiologiaRESUMO
BACKGROUND: Despite the ubiquity of polyparasitism, its health impacts have been inadequately studied. The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths (STH) following sustained control measures, as well as evaluate the outcomes and clinical correlates of infection in school-aged children (SAC) living in the schistosomiasis endemic focus of Muyuka-Cameroon. METHODS: In a cross-sectional study, urine, blood and stool samples were each collected from SAC (4-14 years) selected at random between March and June 2015. Microhaematuria in urine was detected using reagent strip and S. haematobium ova by filtration/microscopy methods. Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser. STH in stool was detected by the Kato-Katz method. Categorical and continuous variables were compared as required, Kappa value estimated and the adjusted odds ratio (aOR) in the multivariate analysis was used to evaluate association of the risk factors with infection. RESULTS: Out of the 638 SAC examined, single infection was prevalent in 33.4% while polyparasitism was 19.9%. Prevalence of S. haematobium + Plasmodium was 7.8%; S. haematobium + STH was 0.8%; Plasmodium + STH was 0.8%; while S. haematobium + Plasmodium + STH was 0.9%. Higher preponderance of S. haematobium + Plasmodium infection occurred in females, those from Likoko, did not use potable water, practiced bathing in stream and carried out open defecation than their equivalents. However, being female (aOR = 2.38, P = 0.009) was the only significant risk factor identified. Anaemia was a common morbidity (74.3%) with a slight agreement with microscopy in predicting S. haematobium and Plasmodium infections. The sensitivity and specificity of haematuria (13.0%) in predicting S. haematobium infection was 46.5% and 100% with a moderate agreement with microscopy. Co-infection with S. haematobium and malaria parasite was significantly associated with threefold odds of history of fever in the last three days. CONCLUSIONS: Polyparasitism is a public health problem in Muyuka with females most at risk. Anaemia prevalence is exacerbated in co- and triple-infections and together with a history of fever are of value in predicting polyparasitism.
Assuntos
Coinfecção/epidemiologia , Helmintíase/epidemiologia , Malária/epidemiologia , Esquistossomose Urinária/epidemiologia , Solo/parasitologia , Adolescente , Animais , Sangue/parasitologia , Camarões/epidemiologia , Criança , Pré-Escolar , Coinfecção/parasitologia , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintíase/diagnóstico , Helmintos/isolamento & purificação , Humanos , Malária/diagnóstico , Masculino , Plasmodium/isolamento & purificação , Prevalência , Fatores de Risco , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/diagnóstico , Caracteres Sexuais , Urina/parasitologiaRESUMO
BACKGROUND: Urogenital schistosomiasis (UGS) caused by S. haematobium has enormous reproductive health consequences including infertility. Reproductive aged individuals are a neglected group and not included in control programs in Cameroon. This study investigated the prevalence and severity of S. haematobium infection in the context of gender and socio-economic structures that shape behaviour among reproductive aged individuals living in Tiko, a semi-urban setting, Cameroon. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was carried out in the Tiko Health District (THD) between May to September 2019. Consenting individuals were enrolled using a convenient sampling technique and administered a semi-structured questionnaire to document data on socio-demographic and stream contact behaviour. A urine sample was collected and screened for the presence of S. haematobium ova using reagent strips, filtration and microscopy. The overall prevalence of S. haematobium infection was 22.8% (95% CL: 19.27-26.73) with geometric mean egg load of 18.74 (range: 1-1600) per 10ml of urine. Younger age group (15 - 20years) (OR: 5.13; 95% CL: 1.35-19.42), male (OR: 2.60 3.07; 95% CL: 1.54-4.40) and awareness of UGS (OR: 1.73; 95% CL: 1.02-2.95) were associated with higher odds of exposure to infection. Significantly higher intensity of infection was seen in males, singles and in the age group 15-30 years. It is worth noting that males carried out more activities which entailed longer duration in streams. CONCLUSION/SIGNIFICANCE: The prevalence obtained shows that Tiko is a moderate-risk area for UGS with underlying morbidity-inducing infection intensity. The severity of the infection is more in males. Awareness of the disease is not enough to protect these communities from infection, but provision of public infrastructures and health education will limit contact with infested water and thus curtail the infection. There is an urgent need to involve all age groups in control programs.
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Esquistossomose Urinária/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Camarões/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Esquistossomose Urinária/etiologia , Esquistossomose Urinária/transmissão , Caracteres Sexuais , Adulto JovemRESUMO
Background: In the Mount Cameroon area, maternal anemia remains a major public health concern. We hypothesized that nutrient inadequacy may account for the level of anemia in pregnancy. Thus, this study examined the relative effect of dietary diversity on maternal anemia in the study area. Methods: A total of 1,014 consenting pregnant women were enrolled in this cross-sectional study. Information on socio-demographic, antenatal characteristics, malaria and anemia control measures were documented. Dietary diversity (DD) was evaluated using the 24-h recall method and hemoglobin (Hb) levels (g/dl) measured using a portable Hb meter. Malaria parasitaemia was diagnosed by blood microscopy. Anemia status was trimester specific. Logistic regression analysis was used determine predictors of maternal anemia. Results: Among the pregnant women enrolled, the mean DD score was 3.5±0.8 SD and only 10.4% had adequate dietary diversity. Anemia prevalence was 40.9%. Majority of the women consumed starchy staples (99.3%) while least consumed foods were dairy (4.5%), eggs (8.3%), fruits and vegetable (vitamin A-rich) (8.6%). A significant lower prevalence of anemia was associated with intake of dairy (P < 0.001), animal protein (P = 0.006), vitamin A-rich fruits and vegetables (P < 0.001). Furthermore, mean Hb levels were higher (P < 0.001) among women with diverse diets (12.39 ± 1.34) than in those with less diverse diets (10.85 ± 1.33). Predictors of anemia were as follows: study setting [Odd Ratio (OR) = 1.4, 95% CI: 1.07-1.94], occupation (OR = 1.9, 95% CI: 1.16-3.43), number of clinic visits (OR = 1.9, 95% CI: 1.27-2.91), trimester of pregnancy (OR = 3.2, 95% CI: 1.45-7.38), malaria parasitaemia (OR = 1.8, 95% CI: 1.33-2.68), out of home eating (OR = 1.4, 95% CI: 1.03-2.13), and DD (OR = 9.8, 95% CI: 4.56-20.80). The attributable risk of anemia due to dietary diversity was 82.9%. Conclusion: In the study area, DD is a major risk factor for maternal anemia. This finding underscores the importance of content specific nutrition education during clinic visits to improve intake of protein and iron-rich food in anemia prevention.
RESUMO
BACKGROUND: The health of school-aged children (SAC) is often compromised by malaria parasitaemia (MP), soil-transmitted helminths (STH), and malnutrition in the tropics. The aim of this study was to determine the prevalence and influence of MP, STH and malnutrition on haemoglobin (Hb) levels as well as identify its predictors. METHODS: This cross-sectional study was carried out in SAC (4-14 years) in Owe, Mpundu and Meanja villages in Muyuka, Southwest Cameroon. Hb concentration was measured using a URIT-12 Hb meter while MP and STH were determined by Giemsa staining of blood films and Kato-Katz technique respectively. Anthropometric measures (weight, height and mid upper arm circumference (MUAC)) of malnutrition (z-scores of <-2 standard deviations below mean) were obtained by standard methods. Categorical and continuous variables were compared appropriately, and multiple linear regression model was used to determine predictors of Hb level. RESULTS: The prevalence of MP, STH, anaemia and malnutrition in the 401 SAC examined were 33.9%, 2.2%, 75.3% and 24.4% respectively. The prevalence of MP varied significantly with locality (P = 0.031). Stunting occurred commonly (23.7%) and was significantly higher in males (28.6%), children 11-14 years old (38.3%) and those of Meanja locality (47.4%) than their counterparts. Significantly higher prevalence of anaemia was observed in children of Meanja (89.5%) and those both MP positive and malnourished (86.2%). Moderate anaemia occurred commonly (60.6%) and children ≤6 years old had significantly (P = 0.034) higher prevalence (75.0%). Mean Hb level varied significantly (P = 0.004) with age and those ≤6 years old infected with MP had significantly (P = 0.022) lower values. Significant predictors of Hb levels were the MUAC (P <0.001) and the MP status (P = 0.035). Based on the Hb level (>11g/dL) and the absence of MP, STH and malnutrition, 13.7% of the SAC were considered as healthy. CONCLUSIONS: The health of a majority of SAC is compromised by malaria, helminthiasis, malnutrition and other conditions not investigated. Anaemia is of major public health concern hence, intervention programmes that integrate malaria control with improvement of educational levels especially on proper nutrition and health care practices are desirable.
Assuntos
Helmintos/fisiologia , Hemoglobinas/metabolismo , Malária/sangue , Malária/epidemiologia , Desnutrição/sangue , Desnutrição/epidemiologia , Solo/parasitologia , Adolescente , Animais , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Instituições Acadêmicas/estatística & dados numéricosRESUMO
Urine reagent strip used in detecting microhaematuria has been recommended in pregnancy for diagnosis of urogenital schistosomiasis (UGS) during routine antenatal care (ANC). This study evaluated its sensitivity, specificity, and predictive values in the diagnosis of maternal UGS using filtration method as a reference test. We also assessed the variation in its performance in the diagnosis of UGS using multiple-sample collection. A total of 93 pregnant women reporting for first ANC clinic visit at any of the three functional health care centres (Munyenge Integrated Health Centre, Banga Annex Health Centre, and Trans African Health Centre) were enrolled and followed up for three consecutive monthly visits. Urine samples were observed microscopically for S. haematobium egg using urine filtration and screened for microhaematuria and proteinuria using urine reagent strips. Twenty-two (23.7%) out of the 93 women were diagnosed for UGS, all of whom showed S. haematobium egg excretion during all three visits. There was a significant difference (p < 0.001) between the prevalence of S. haematobium infection and the prevalence of microhaematuria. The intensity of infection was significantly higher in microhaematuria-positive women compared with microhaematuria-negative cases. Sensitivity of reagent strip ranged from 54.5 to 59.1%, while specificity was above 98.0% (range: 98.6-100%). The measure of agreement between urine filtration and reagent strip method was substantial (0.61-0.8) irrespective of different sampling periods. Urine reagent strip is a moderately sensitive method in the detection of UGS and will most likely identify women with high egg load burden. Proper diagnosis of schistosomiasis during pregnancy is recommended.