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Biomedical Research

Onchocerciasis and plasmodiasis: concurrent infection in Garaha-Dutse community, Adamawa State Nigeria

Author(s): S.N. Rebecca, D.O. Akinboye and A.A. Abdulazeez

Vol. 19, No. 2 (2008-05 - 2008-08)

S.N. Rebecca1, D.O. Akinboye2 and A.A. Abdulazeez1

1Department of Biological Sciences, Federal University of Technology Yola, Adamawa State, Nigeria
2University of Ibadan, Ibadan Nigeria.

Keywords: Co-infection, Prevalence, Onchocerciasis, Plasmodiasis

Accepted May 07 2008

Abstract

The study examined co-infection between onchocerciasis and malarial infection in Garaha-Dutse, Nigeria. A community based prevalence rate of Onchocerca. volvulus and malarial parasites was carried out among 214 subjects randomly selected in the village. An approval by the State Ministry of Health and Hong Local Government Area was received before the commencement of the study. Physical examination, parasitslogical analysis of peripheral blood samples for malaria parasites and examination of skinsnip for microfilarae of Onchocerca volvulus was conducted on the sampled population. Structured interview was also conducted on the subjects for demographic information and to establish any history of fever among them. On the overall 15.8% onchocerciasis and 28.0% plasmodiasis were recorded as single infections while 8.4% concurrent infection was also observed.

Statistical analysis showed a significant association between the prevalence of onchocerciasis and malarial infection (P<0.05). Assessing the recovery rates of examination techniques, Microscopic examination recorded prevalence rate of 5.1% for onchocerciasis and 15.9% for plasmodiasis where as synadromic approach gave it as 10.7% and 12.1% respectively. Examining the distribution of the infections by age, progressive increase in prevalence of onchocerciasis was observed as the age increases while plasmodiasis rate did not follow any regular pattern. Statistically, there was no significant difference in the distribution of infections by age (P>0.05) and also by gender (P>0.05) Finally the prevalence of onchocerciasis was highest among the farmers (28.8%), malarial infection the highest among the fishermen (47.7%) while the highest concomitant infection rate was observed (18.2%) among the farmers.

Introduction

Onchocerciasis and Plasmodiasis are common human parastic infections in Africa with serious public health importance [1,2] while Onchocerciasis causes high mor-bidity rate ranging from ocular, through dermatologic to systemic conditions [3] among the affected population, malaria is known for its high mortality rate especially among the children under five years and pregnant women [4,5]. Out of the estimated 18 million people infected with Onchocerca. volvulus globally, over 80% live in Africa [6,7] while 3.3 million of the global estimate reside in Nigeria [8]. Similarly, about 90% of the world malaria cases are recorded in Africa [9,10].

Clinical manifestation of the infections had been associated with the degree of body immunity and frequency of exposure to the insect vector [11]. In Nigeria, onchocerciasis had been documented in almost all the states of the federation with exception of Lagos, Rivers and Akwa-Ibom State [12,13]. In a study earlier conducted, Egbert and his co-researchers [3] reported a co-infection between onchocerciasis and another disease condition. In this side of the globe however, there has been a paucity of published data on the concurrent infection between Onchocerca.volvulus and Plasmodium species. This study therefore attempts to determine the prevalence of the human parasitic infections in this locality with the aim of assessing the frequency of mixed infection between them.

Subjects and Methods

Study Area and Population

The study was conducted in Garaha – Dutse community in the Hong Local Government Area (L.G.A.) of Adamawa State, Nigeria. The village is situated within Dugwada district which lies on latitude 100 20′ N 100 30′ N and longitude 120 40′ E to 120 50′E. The climate of the area is marked with typical savanna vegetation characterized by distinct dry and rainy seasons. The village is transverses by many streams and fast flowing rivers that enhance the breeding of both Simulium damnosum and Anopheles Mosquitoes the insect vectors of Onchocerci-asis and plasmodiasis respectively. Farming and fishing are the major occupation of the inhabitants of the rural community.

After an initial orientation, mobilization and sensitization, enlightenment lectures on the benefits of the study were delivered. Subjects who volunteered to participate in the study were assembled in the chief’s compound. Two hundred and fourteen (214) subjects aged 11-70 years, were randomly selected for examination in the study.

Prior to the commencement of the research, an approval by the State Ministry of Health and Hong L.G.A. Health Authority was received. The informed consent of all the participants, village head and word leaders was also sought. Physical Examination of the subjects Ocular examination of the subjects was carried out to determine any impairment of vision, partial or total blindness due to Onchocerca. volvulus. This was followed by visual examination and palpation of skin for the presence of nodules, skin rashes, scaly skin or depigmentation and any other clinical manifestations of Onchocerca. volvulus infection. Bodies pyrexia and febrile condition was also noted. To obtain demographic information and any history of fever, structured interview was also conducted on the subjects.

Parasitological Examination

Pheripheral blood samples were employed in this study. Two capillary tubes of blood were collected from the fingertip of each subject. Prior to the collection, the fingertips of the subjects were sterilized with cotton wool swabs soaked in methylated spirit and sterile disposable lancets were used through out for the collection. Thick films were made in duplicates from each blood sample on greesefree slides, allowed to dry and stained by Geimsa technique as described by Cheesbrough [14] Stained blood films were examined under x 100 objective lens of a microscope with the aid of immersion oil, for any stage of malaria parasites.

Screening for the presence of dermal microfilaria of Onchocerca. volvulus was carried out using the standard skin Snip technique in which biopsy punch was used to take the skin snips from right iliac crest and right calf of each subject, weighed separately and dropped in microlitre plates containing four drops of physiological saline solution. This enables the microfilariae to emerge within 24 hours of incubation at room temperature. The preparation was then examined for the presence of microfilarine under x 40 objectives lens of the microscope, and recorded as positive or negative.

Data obtained were analysed with SPSS soft ware of Computer. Percentages were used to express the prevalence of both parasites while Chi-square test was used to analyse the difference in prevalence of the infections by age and by gender at 95% confidence level. Also correlation and regression statistical tool was employed to determine the association between the distribution of both infections.

Results

Overall prevalence rates of Onchocerciasis and malarial infection assessed by syndromic and microscopic examination are as shown in table 1. Out of the 214 subjects examined in the study, 43.8% (94/214) were infected with at least one of the parasites, representing 15.8% (34/214) onchocerciasis and 28.0% (60/214) malarial infection. In addition 8.4% (18/214) concomitant infection of both parasites was recovered from the infected subject. Assessing the recovery rates of the examination techniques employed, 10.7% (23/214), 12.1% (26/214), and 5.6% (12/ 214) were recorded positive for Onchocerca volvulus, malaria and concurrent infections respectively by syndromic approach whereas 5.2% (11/214), 15.9% (34/214) and 2.8%v (6/214) were recorded by parasitological technique respectively for the same set of parasitic infections

Table 2 shows the distribution of Onchocerca. volvulus and malarial infections in relation to age and gender. In the mono-infection category, 51-60 years age bracket re-corded the highest prevalence of Onchocerca. volvulus infection 33.3% (10/34) followed by age group 61-70 years with the prevalence of 26.7% (4/15) while the least 1.9% (1/51) was recorded within 11-20 years age group. Similarly, the highest 39.2% (20/51) and least 0.0% prevalence of malarial infection were respectively recorded among 11-20 years and 61-70 years age brackets. Also the highest rate of co-infection 30.0% (12/40) was recorded within 31-40 years age group where as no con-current infection was recorded among the subjects within 61-70 years age bracket.

Statistical analysis by chi-square however showed no significant difference in the distribution of infections with respect to age (P>0.05). Assessing the frequency of the infections by gender, higher prevalence of onchocerciasis 17.8% (19/107) and plasmodiasis 29.0% (31/107) were recorded among females than in their male counterparts where as the prevalence of mixed infection was higher among the males 9.3% (10/107) than the females 7.5% (8/107). Statistically, there was no significant difference in the distribution of infections by gender (P>0.05).

Data in table 3 shows the prevalence of onchocerciasis and malarial infection in relation to occupations of the sampled population. Of the total subjects examined for the parasites, farmers recorded the highest rate of Onchocerca. volvulus infection 28.8% (19/66), followed by fishermen with 14.5% (7/48) while the least 2.4% (1/41) was recorded among the dependants.

Similarly, the highest frequency of malaria infection was recorded among fishermen 47.9% (23/48),closely followed by the prevalence among the traders 45.2% (14/31) and the least among the dependants with 7.3% (3/41). However, the difference in prevalence of infection by occupation is not statistically significant (P>0.05).

Table 1: Overall prevalence of onchocerciasis and plasmodiasis in the Study Area

Examination techniques O. vol-
vulus
posi-
tive (%)
Malaria
Positive (%)
Co-infection(%)
O. vol
vulus
+ malaria
Syndromic 23 (10.7) 26 (12.1) 12 (5.6)
Microscopic 11 (5.1) 34 (15.9) 6 (2.8)
Overall 34 (15.8) 60 (28.0) 18 (8.4)

Table 2: Prevalence of O.volvulus and malaria infections in relation to age and gender

Age group (year) Number Examined Single
infection (%)
O. volvulus
malaria
Concurrent
infection (%)
Uninfected (%)
11-20 51 1 (1.9) 20 (29.2) 1(1.9) 30 (58.8)
21-30 47 5 (11.1) 0 (0.0) 16 (34.0) 26 (53.3)
31-40 40 7 (17.5) 12 (30.0) 5 (15.0) 21 (52.5)
41-50 31 7 (21.2) 8 (24.2) 4 (12.1) 16 (51.6)
51-60 30 10 (33.2) 4 (13.4) 4 (13.4) 16 (53.3)
61-70 15 4 (26.7) 0 (0) 0 (0) 11 (73.3)
Total 214 34 (15.8) 60 (28.0) 18 (8.4) 120 (56.2)

(We regret that Table 3 is unavailable)

Discussion

The results in this research revealed a worrisome con-comitant infection between Onchocerca. volvulus and malaria infection. It is worthy of note that 19.0% of the total infected subjects had mixed infection, representing 8.4% of the entire sampled population.

Statistically, a significant association exists between the prevalence of Onchocerca. volvulus and the frequency of malaria infection (P<0.05). The association in the distribution of both infections could probably be traced to lower level of immunity of the sampled population. It could also be due to high prevalence, high infectivity rate and increased vec-toral capacity of the insect vectors which increases their biting rates and increased infection of the subjects.

This study therefore suggests further research work on the prevalence rates and vectoral capacities of Simulium damnosum and female anopheles mosquitoes in this locality. Also, studies on biochemical, haematological and immunological changes in subjects with concurrent infection of Onchocerca volvulus and plasmodiasis are recommended. Although some previous studies [15,16] had reported a significantly higher onchocerciasis among males than their female counterparts, this study showed no significant difference in infection prevalence by gender (P>0.05).The reason for the present finding could probably be attributed to equal degree of exposure to Simulium damnosum and equal level of immunity of the subjects. Our results however agree with some previous findings [17,18,19].

Age-related prevalence of Onchocerca volvulus infection increased progressively with age among the sampled population. This could be due to early acquisition of the infection at child hood which undergoes development with time. However, the present result is in consonance with earlier studies [16,20]. Conversely, the distribution of malaria infection in this study did not follow any par-ticular pattern with respect to age. The result also shows no significant difference in the prevalence of onchocerciasis and malaria infection in relation to sex (P>0.05). This observation is in agreement with some past findings [21,22] in Nnewi and Owerri with similar observation.

Judging the prevalence of the infection from the occupational point of view, the prevalence rate of Onchocerca volvulus (15.8%) and malaria (28.0%) parasite are higher among farmers and fishermen than the other occupations in the study area. The finding is not surprising because the nature of daily activities of these groups of people often demands removal of some parts of their clothing for adequate airation after stressful work or to prevent the clothing from being soaked in water when fishing. All these behavioural activities exposed their body to the insect vectors.

Comparing syndromic technique with parasitological examination for determining the frequency of the infections, higher rate of infections was recovered by the former (23.2%) than the later (15.8%). Going by physical examination alone, the study area could have been wrongly assessed as a mesoendemic zone instead of the correct hypoendemic status that does not necessarily require mass intervention. Meanwhile, previous reports [23,24] had documented that parasitological examination technique is more reliable than physical method for parasite detection before the need for mass intervention.

In conclusion, although the world health organization [25] had earlier recommended mass treatment with livermectin for twelve years for people in hyperendemic and mesoendemic zones to teduce the morbidity caused by onchocerciasis, the 15.8% prevalence rate recorded in this study is of hypeondemic status and therefore does not call for mass treatment; instead only the affected people should be treated. Also effective health education, provision of social amenities and health facilities to prevent further spread of the infection is advocated. Further studies to assess the impact of treatment on the prevalence of mixed infection due to both parasites are suggested.

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Correspondence to:

S.N. Rebecca
FUTY, Nigeria
e-mail: rebnap2006( at ) yahoo.com

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