AID  Vol.8 No.2 , June 2018
Determination of Effect of Home-Based Oral Chloroquine Treatment on Haematological Indices of P. falciparum Malaria in Children under 5 Years in Jos Metropolis
ABSTRACT
Background: The incidence of P. falciparum malaria is characterized by high rates of morbidity and mortality in under 5 children; a trend reportedly prevalent in tropical and subtropical countries including Nigeria, and recently observed in Jos metropolis, has to date defied all constructive, preventive and drug therapy intervention measures and consequently continues to constitute a serious public health problem in this most vulnerable group. Objective: The aim of this study was to determine certain haematological indicators of malaria parasite infection; their role in the clinical manifestation of P. falciparum malaria and effect of first line oral chloroquine treatment in children under 5 years attending Jos University Teaching hospital and OLA Hospital in Jos metropolis. Method: This is a cross-sectional study of 93 malaria and non-malaria children, age 1 - 59 months attending Jos University Teaching Hospital (JUTH), Jos and OLA hospital, Jos, North Central Nigeria. Malaria diagnosis was carried out using microscopical examination of Leishman’s stained thick and thin blood films and complete blood count was done using Beckman Coulter Analyzer. Results: The mean percentage lymphocyte value of chloroquine treated children (39.28% ± 7.45%) was significantly lower than the control (66.38% ± 2.27%). The mean granulocyte value of chloroquine treated children (51.07% ± 6.40%) was significantly higher than the control (26.69% ± 2.43%). Red Blood Cell (RBC) counts (4.01 ± 0.21 × 106/μL), Haemoglobin concentration (9.60 ± 0.51 g/dl) and Haematocrit (30.97% ± 1.43%) of chloroquine treated children were significantly higher than corresponding values in untreated malarious children, but not significantly different from values obtained in non-malaria control children. The RBC counts (2.92 ± 0.39 × 106/μL), Haemoglobin concentration (7.23 ± 1.01 g/dl) and Haematocrit (23.70% ± 3.37%) obtained for untreated malarious children were significantly lower than corresponding values in the non-malarious control children. Conclusion: The pattern of the results obtained in this study suggests that home-based, first-line oral chloroquine treatment 24 hours prior hospital admission decreases the lymphocytes production and elevated production of granulocytes with attendant consequences on their biological functions. The chloroquine treatment seems to protect the red blood cells against the destructive effect of malaria. The haemoglobin concentration of 7.23 ± 1.01 g/dl obtained in untreated malaria children when combined with results of red blood cells; differential analysis indicates a mild, normocytic, normochromic anaemia due to haemolysis. This study demonstrates the beneficial effects of first aid, home-based oral chloroquine use. Rational use of chloroquine needs to be re-evaluated and encouraged in this group of children.
Cite this paper
Olomu, S. , Abraham, U. and Hassan, G. (2018) Determination of Effect of Home-Based Oral Chloroquine Treatment on Haematological Indices of P. falciparum Malaria in Children under 5 Years in Jos Metropolis. Advances in Infectious Diseases, 8, 70-81. doi: 10.4236/aid.2018.82009.
References
[1]   National Population Commission (NPC) [Nigeria], National Malaria Control Programme (NMCP) [Nigeria], and The International Classification of functioning, Disabilty and Health [ICF International] (2012) Nigeria Malaria Indicator Survey (MIS) 2010. Malaria Indicator Survey 2010 Final Report: NPC, NMCP, & ICF International, Abuja, Nigeria, 2-4.

[2]   Bryce, J., Black, R.E. and Morris, S.S. (2003) Where & Why Are 10 Million Children Dying Every Year? Lancet, 361, 2226-2234.
https://doi.org/10.1016/S0140-6736(03)13779-8

[3]   Bryce, J., Boschi-Pinto, C., Shibuya, K. and Black, R.E. (2005) The WHO Child Health Epidemiology Reference Group. WHO Estimates of the Causes of Death in Children. Lancet, 365, 1147-1152.
https://doi.org/10.1016/S0140-6736(05)71877-8

[4]   World Health Organization (2005) Global Malaria Situation: The World Malaria Report 2005. World Health Organisation, Geneva, 5-17.

[5]   Houetol, D., D’Hoore, W., Ouendo, E.M., Charlier, D. and Deccache, A. (2007) Malaria Control among Children under Five in Sub-Saharan Africa: The Role of Empowerment & Parents’ Participation besides the Clinical Strategies. Rural and Remote Health, 7, 840.

[6]   Jaffar, S., Van Hensbroek, M.B., Palmer, A., Schneider, G. and Greenwood, B. (1997) Predictors of a Fatal Outcome Following Childhood Cerebral Malaria. American Journal of Tropical Medicine and Hygiene, 57, 20-24.
https://doi.org/10.4269/ajtmh.1997.57.20

[7]   Alilio, M.S., Kitua, A., Njunwa, K., Medina, M., Rønn, A.M. and Mhina, J. (2004) Malaria Control at the District Level in Africa: The Case of the Muheza District in North-Eastern Tanzania. American Journal of Tropical Medicine & Hygiene, 71, 205-213.

[8]   Yamey, G. (2004) Roll Back Malaria: A Failing Global Health Campaign. British Medical Journal, 328, 1086-1087.
https://doi.org/10.1136/bmj.328.7448.1086

[9]   Mwenesi, H. (2005) Social Science Research in Malaria Prevention, Management & Control in the Last Two Decades: An Overview. Acta Tropica, 95, 292-297.
https://doi.org/10.1016/j.actatropica.2005.06.004

[10]   Daboer, J.C., Chingle, M.P. and Ogbonna, C. (2010) Malaria Parasitaemia & Household Use of Insecticide Treated Bed Nets: A Cross-Sectional Survey of Under-Fives in Jos, Nigeria. Nigerian Medical Journal, 51, 5-9.

[11]   Yilgwan, C.S., Hyacinth, H.I. and Oguche, S. (2011) Factors Associated with Decreased Survival from Neonatal Malaria Infection in Jos, North Central Nigeria. Nigeria Journal of Medicine, 20, 349-354.

[12]   Bello, D.A., Tagurum, Y.O., Afolaranmi, T.O., Chirdan, O.O. and Zoakah, A.I. (2013) Knowledge and Pattern of Malaria Case Management among Primary Health-Care Workers in Jos. Journal of Medicine in the Tropics, 15, 91-95.
https://doi.org/10.4103/2276-7096.123578

[13]   Noland, G.S., Graves, P.M., Sallau, A., Eigege, A., Emukah, E., Patterson, A.E., Ajiji, J., Okorofor, I., Oji, O.U., Umar, M., Alphonsus, K., Damen, J., Ngondi, J., Ozaki, M., Cromwell, E., Obiezu, J., Eneiramo, S., Okoro, C., McClintic-Doyle, R., Oresanya, O., Miri, E., Emerson, P.M. and Richards, F.O. (2014) Malaria Prevalence, Anemia and Baseline Intervention Coverage Prior to Mass Net Distributions in Abia & Plateau States, Nigeria. BioMed Central Infectious Diseases, 14, 168.
https://doi.org/10.1186/1471-2334-14-168

[14]   Richards, F.O., Emukah, E., Graves, P.M., Nkwocha, O., Nwankwo, L., Rakers, L., Mosher, A., Patterson, A., Ozaki, M., Nwoke, B.E., Ukaga, C.N., Njoku, C., Nwodu, K., Obasi, A. and Miri, E.S. (2013) Community-Wide Distribution of Long-Lasting Insecticidal Nets Can Halt Transmission of Lymphatic Filariasis in Southeastern Nigeria. American Journal of Tropical Medicine & Hygiene, 89, 578-587.
https://doi.org/10.4269/ajtmh.12-0775

[15]   Okoli, C. and Solomon, M. (2014) Prevalence of Hospital-Based Malaria among Children in Jos, North Central Nigeria. British Journal of Medicine and Medical Research, 4, 3231-3237.
https://doi.org/10.9734/BJMMR/2014/8068

[16]   Plowe, C.V. (2005) Antimalarial Drug Resistance in Africa: Strategies for Monitoring & Deterrence. Current Topics in Microbiology & Immunology, 295, 55-79.
https://doi.org/10.1007/3-540-29088-5_3

[17]   Uhlemann, A.C. and Krishna, S. (2005) Antimalarial Multi-Drug Resistance in Asia: Mechanisms & Assessment. Current Topics in Microbiology and Immunology, 295, 39-53.
https://doi.org/10.1007/3-540-29088-5_2

[18]   Kublin, J.G., Cortese, J.F., Njunju, E.M., Mukadam, R.A.G., Wirima, J.J., Kazembe, P.N., Djimdé, A.A., Kouriba, B., Taylor, T.E. and Plowe, C.V. (2003) Reemergence of Chloroquine-Sensitive Plasmodium falciparum Malaria after Cessation of Chloroquine Use in Malawi. The Journal of Infectious Diseases, 187, 1870-1875.
https://doi.org/10.1086/375419

[19]   Kiarie, W.C., Wangai, L., Agola, E., Francis, T., Kimani, F.T. and Charity Hungu, C. (2015) Chloroquine Sensitivity: Diminished Prevalence of Chloroquine-Resistant Gene Marker pfcrt-76 13 Years after Cessation of Chloroquine Use in Msambweni, Kenya. Malaria Journal, 14, 328.
https://doi.org/10.1186/s12936-015-0850-9

[20]   Dacie, S.J.V. and Lewis, S.M. (1994) Reference Ranges & Normal Values. In: Practical Hematology. 8th Edition, Churchill Livingstone, UK.

[21]   Student Health Center Manuals (2013) Complete Blood Count (CBC).
http://shs-manual.ucsc.edu/policy/complete-blood-count-cbc

[22]   Bygbjerg, I.C. and Flachs, H. (1986) Effect of Chloroquine on Humanlymphocyte Proliferation. Transactions of Royal Society of Tropical Medicine & Hygiene, 80, 231-235.
https://doi.org/10.1016/0035-9203(86)90021-0

[23]   Landewé, R.B., Miltenburg, A.M., Verdonk, M.J., Verweij, C.L., Breedveld, F.C., Daha, M.R. and Dijkmans, B.A. (1995) Chloroquine Inhibits T Cell Proliferation by Interfering with IL-2 Production and Responsiveness. Clinical and Experimental Immunology, 102, 144-151.
https://doi.org/10.1111/j.1365-2249.1995.tb06648.x

[24]   Facer, C.A. (1994) Hematological Aspects of Malaria. In Infection and Hematology, Butterworth Heineman Ltd., Oxford, 259-294.

[25]   Perrin, L.H., Mackey, L.J. and Miescher, P.A. (1982) The Hematology of Malaria in Man. Seminars in Hematology, 19, 70-82.

[26]   Kremsner, P.G., Winkler, S., Wildling, E., Prada, J., Bienzle, U., Graninger, W. and Nussler, A.K. (1996) High Plasma Levels of Nitirogen Oxides Are Associated with Severe Disease and Correlate with Rapid Parasitological & Clinical Cure in Plasmodum falciparum Malaria. Transactions of the Royal Society of Tropical Medicine & Hygiene, 90, 44-47.
https://doi.org/10.1016/S0035-9203(96)90476-9

[27]   Jandl, J.H. (1996) Hemolytic Anemia Caused by Infection of Red Cells. In: Blood, 2nd Edition, Little Brown and Company, New York, 473-501.

[28]   Beales, P.F. (1997) Anemia in Malaria Control: A Practical Approach. Annals of Tropical Medical Parasitology, 91, 713-718.
https://doi.org/10.1080/00034983.1997.11813194

[29]   Das, B.S. (1999) Immunopathogenesis of Anaemia in Malaria. Journal of Parasitic Disease, 23, 71-76.

[30]   Layla, A.M.B., Ahmed, A.M., Ahmed, A.B. and Mirghani, A.A. (2002) Malaria: Hematological Aspects. Annals of Saudi Medicine, 22, 372-376.
https://doi.org/10.5144/0256-4947.2002.372

 
 
Top