Malaria Knowledge-Base and Prevalence of Parasitaemia in Asymptomatic Adults in the Forest Zone of Ghana.

PURPOSE: To determine the levels of knowledge, awareness and perception of malaria, and to determine the infection status among asymptomatic adults in selected districts. METHODS: This descriptive, cross-sectional study recruited 849 participants from seven districts in the malaria meso-endemic forest zone of Ghana. Questionnaires were administered to elicit responses from asymptomatic adults on malaria awareness, knowledge and insecticide-treated net (ITN) usage. Capillary blood samples were taken from study subjects for malaria Rapid Diagnostic Test (RDT) and microscopy. Descriptive statistics was used to analyse quantitative and qualitative data. RESULTS: Ninety-eight percent of participants were aware of malaria, 94.0% owned ITNs but only 35.5% consistently used them. Also, 56.7% correctly associated malaria with mosquitoes and 54.5% identified stagnant water as the breeding site. Twelve percent (12.2%) and 13.1% of the subjects tested positive for malaria via RDT and microscopy, respectively. Of the 111 confirmed malaria cases, 107 had Plasmodium falciparum infections, two had Plasmodium ovale infections and there were two Plasmodium falciparum-Plasmodium ovale mixed infections. CONCLUSION: Awareness and knowledge of malaria was satisfactory but this did not translate into mosquito avoidance behaviour due to deep-seated perceptions and myths. With the prevalence of asymptomatic parasitaemia observed, this reservoir of infection could be dislodged with appropriate health education targeted at women in the rural communities.

Parasitaemia estimation and prediction of hepatocellular dysfunction among Ghanaian children with acute malaria using haemoglobin levels.

Malaria is an important global health disease which puts individuals, particularly children, at a greater risk of mortality. Plasmodium falciparum is distinguished from the rest of the Plasmodia by its high level of parasitaemia. They infect liver cells (hepatocytes), and multiply into merozoites and rupture liver cells in the process, prior to infection of red blood cells. This study sought to estimate the extent to which P. falciparum parasitaemia correlates with hepatocellular dysfunction among Ghanaian children suffering from acute malaria in three malaria endemic districts in Ashanti Region and to predict liver dysfunction from the estimation of haemoglobin (HB) levels. A prospective uncontrolled before- and after study was conducted among under five years children with acute malaria (n = 300) and a control group (n = 20) within the same age brackets. The serum activities of liver enzymes such as aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyl transferase (GGT) were measured in patients and control subjects. The study observed an inverse relationship between mean HB and parasitaemia (mean HB level of 10.34 ± 0.14 versus parasitaemia <10,000 parasites/µL as against 8.06 ± 0.16 versus parasitaemia ≥10,000 parasites/µL). The mean levels of AST, ALT, ALP and GGT were higher (p < 0.0001) in the serum of the infected children before treatment compared with post treatment. Moreover, the receiver operating characteristics (ROC) curve was applied to establish that HB level at 10.9 g/dL predicted liver dysfunction with the area under the curve (AUC) being 0.75 ± 0.03 (P < 0.0001). The parasitaemia estimation and prediction of hepatocellular dysfunction in Ghanaian children with acute malaria could be done via HB levels.