ABSTRACT
Hypoglycaemia
prevalence among Plasmodium falciparum infected women attending
antenatal clinics in Nsukka Local Government Area of Enugu State, Nigeria was
undertaken. The study objective was to assess the prevalence of hypoglycaemia
and P. falciparum infection among pregnant women in the study area. A
cross-sectional epidemiological survey was conducted among the pregnant women,
who attended antenatal clinics in the study Local Government Area between
January and September, 2015. A total of 375 randomly selected pregnant women
were assessed for P. falciparum infection and hypoglycaemia from the
development centres in the study area. Plasmodium falciparum malaria
infection was determined using Malaria Pf antigen detection kit. The
blood glucose levels of the subjects were estimated using One Touch UltraSmart Blood
Glucose Monitoring System. The obstetric, demographic, clinical and management
data of the pregnant women were also determined using a well-structured
questionnaire. Results obtained showed that 292 (77.9%) pregnant women had
primary diagnosis of P. falciparum infection and 39 (13.4%) of the
infected pregnant women were hypoglycaemic. The highest prevalence for P.
falciparum was observed among age group 30-34 years old, primigravidae and
second trimester pregnancy. Generally, prevalence of hypoglycaemic infected
subjects showed significant difference (P<0.05) when compared with their
non-infected counterpart. The study showed no significant correlation between
hypoglycaemia and positive infection status; rather hypoglycaemia occurrence
was associated with markers of impaired quality of life and disruption in the
maintenance of glucose supply. However, considering the endemicity of malaria
in Nigeria, the mortality rate across families, and the severity of malaria
infection in pregnancy, early detection and prompt treatment of malaria,
especially among pregnant women with hypoglycaemia are needed. In conclusion,
glucose metabolism during malaria infection is multifactorial. Therefore,
recognition of hypoglycaemia risk factors, blood glucose monitoring, selection
of appropriate regimens, education programs for health care professionals and
at risk patients are the major issues for maintaining good glycemic control,
minimize the risk of hypoglycaemia, and prevent long-term complications. The
present study recommends that simple, rapid and reliable laboratory tests at
health centres be readily available to help in diagnosis, prevention and
management of hypoglycaemia complications.
TABLE OF CONTENTS
Title page
Table of contents
List of tables
List of figures
Abstract
CHAPTER ONE: INTRODUCTION AND LITERATURE REVIEW
1.1 Introduction
1.1.1 Study Justification
1.1.2 Study Significance
1.1.3 Objectives of the Study
1.2 Literature Review
1.2.1 Malaria Burden
1.2.2 Hypoglycaemia Burden
1.2.3 Glucose and Malaria
1.2.4 Malaria and Pregnancy
1.2.5 Hypoglycaemia and Pregnancy
1.2.6 Antenatal Services Knowledge and Attitude
CHAPTER TWO: MATERIALS AND METHODS
2.1 Study Area
2.2 Ethical Clearance
2.3 Study Design
2.4 Collection of Blood for Malaria and Glucose Test
2.5 Statistical Analysis
CHAPTER THREE: RESULTS
3.1 Obstetric and Demographic Characteristics of the Study Population
3.2 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area
3.3 Prevalence of Blood Glucose Levels and P. falciparum Infection among Pregnant
Women in Nsukka Central
3.4 Prevalence of Blood Glucose Levels and P. falciparum Infection among Pregnant
Women in Nsukka East
3.5 Prevalence of Blood Glucose Levels and P. falciparum Infection among Pregnant
Women in Nsukka West
3.6 Prevalence of Blood Glucose Levels among P.falciparum Infected Pregnant
Women in the Study Area Stratified by Location
3.7 Prevalence of Blood Glucose Levels among P. falciparum Non-infected
Pregnant Women in the Study Area Stratified by Location
3.8 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Age
3.9 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Trimester
3.10 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Parity
3.11 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Educational Level
3.12 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Occupation
3.13 General Prevalence of Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area Stratified by Residence
3.14 Unhealthy Predisposing Factors to Hypoglycaemia and P. falciparum Infection
among the Pregnant Women in the Study Area
3.15 Correlation between Blood Glucose Levels and P. falciparum Infection among
Pregnant Women in the Study Area
3.16 Ethno-management Practices on Hypoglycaemia and P. falciparum Infection
among the Pregnant Women in the Study Area
3.17 Knowledge and Attitude of the Pregnant Women towards Antenatal Services in the Study Area
CHAPTER FOUR: DISCUSSION AND CONCLUSION
4.1 Discussion
4.2 Conclusion and Recommendation
REFERENCES
APPENDICES
CHAPTER ONE
INTRODUCTION AND LITERATURE REVIEW
1.1 Introduction
Malaria is an old disease whose name is derived from the Italian (mal-aria) or “bad air” and it was also known as Roman fever, ague, marsh fever, periodic fever, paludism (Martin, 2003). There were numerous, sometimes bizarre theories on how malaria was transmitted until 1898 when Dr Ronald Ross discovered that the female Anopheles mosquito was actually responsible for transmitting malaria parasite. This discovery revolutionized malaria control, which had hitherto often been haphazard or based purely on treating the patient by killing the malaria parasites (Phillips, 2001; Cheesbrough, 2006). Malaria probably originated in Africa and accompanied human migration to the Mediterranean shores, India and Southeast Asia. In the past it used to be common in the marshy areas around Rome. As malaria is a disease mostly of tropical and subtropical areas, it is particularly prevalent in sub-Saharan Africa, but also common throughout other tropical regions of China, India, Southeast Asia, South and Central America (Cheesbrough, 2006). Nigeria’s quest for effective control of malaria began well before the WHO global malaria eradication period between 1955 and 1968 (Gilles et al., 2007). From 1955, however, a more focused egalitarian attempt at evolving strategic plans and interventions resulted in pre-eradication pilot studies such as the Kankiya District Project and the establishment of a division in Ministry of Health to deal with the mosquito and malaria problem. The National Malaria Control Committee (NMCC) was set up in 1975 with the set mandate to reduce the malaria burden by 25%. It produced a five year plan of action that terminated in 1980; however, it recorded only modest achievements. It took another 8 years before progress was made when a major health system reform was carried out in 1988, with the adoption of a Health Policy for the country. Within this Policy, malaria was to be eradicated using the concept of Primary Health Care. The Ministry of Health subsequently prepared guidelines for malaria control in 1989. Government finally came out with a National Malarial Control Plan of Action 1996. Past and present malaria control programme plan achieved limited success in eradicating the scourge. In spite of this, the malaria situation has steadily worsened and currently it is estimated that malaria accounts for 65 percent of all diseases reported in Nigeria health facilities and that 42% of pregnant women are diagnosed with malaria and affects the birth weight of infants (Akanbi et al., 2009).
Severe underreporting by patients and insufficient worldwide surveillance hampers epidemiological studies on the toll of malaria. Despite gross underreporting, the majority of cases and deaths are estimated to occur in sub-Saharan Africa, especially in children under 5 years of age (Sturchler, 1989; Snowet al., 1999; Brinkmann and Brinkmann, 1991). The World Health
The vector for malaria parasite is the female anopheles mosquito (Cheesbrough, 1998). Malaria transmission can be achieved by three known ways: vector transmission (Anderson et al., 1981), blood transfusion (Strickland, 1991) and congenital transmission (Ezechukwu et al., 2004). Malaria parasite interferes with three organs in the body, namely the brain, kidney and liver (Edington, 1967).
In all malaria-endemic countries in Africa, 25-40% (average 30%) of all outpatient clinic visits is for malaria (with most diagnosis made clinically). In these same countries, between 20% and 50% of all hospital admissions are a consequence of malaria. With high case-fatality rates due to late presentation, inadequate management, and unavailability or stock-outs of effective drugs, malaria is also a major contribution to deaths among hospital inpatients. This high burden may in fact be partly a result of misdiagnoses, since many facilities lack laboratory capacity and it is often difficult clinically to distinguish malaria from other infectious diseases. Nonetheless malaria is responsible for a high proportion of public health expenditure on curative treatment, and substantial reductions in malaria incidence would free up available health resources and facilities and health workers’ time, to tackle other health problems. Poor people are at increased risk both of becoming infected with malaria and of becoming infected more frequently. Child mortality rates are known to be higher in poorer households and malaria is responsible for a substantial proportion of these deaths.
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