Epidemiological, hematological and biochemical features in complicated (severe) and uncomplicated malaria infection in Ghanaian children

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June, 2018
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Malaria, a common parasitic infection, can progress from uncomplicated, possibly asymptomatic, to complicated/severe cases, characterised by a wide range of symptoms, depending on the pathophysiology of the disease. Due to the presence of Fe2+ of heme, arising from hemoglobin, oxidant stress is believed to drive the pathophysiology. Therefore, this study was carried out to investigate the levels of oxidative stress, derangements in hematological parameters and the distinctive features of pediatric complicated malaria in the study area. To provide an epidemiological background, a survey in which views of 80 healthcare personnel were sought on the various features of severe falciparum malaria, using a structured questionnaire, whilst vitamin C and malondialdehyde (MDA) were targeted as ideal markers for the oxidative stress investigation. Subjects were recruited from hospitals in the Kumasi Metropolis. As a cross-sectional study, 17 complicated malaria subjects, 51 uncomplicated malaria subjects and 15 non-parasitemic subjects were recruited into the oxidative stress aspect of the study. The hematological parameters of the subjects were also assessed using their full blood counts. In uncomplicated malaria, increased hemoglobin (HGB) levels were significantly associated with increased levels of mean corpuscular volume (MCV) (r=0.404, p=0.009), mean corpuscular hemoglobin (MCH) (r=0.581, p<0.0001) and mean corpuscular hemoglobin concentration (MCHC) (p=0.413, p=0.007). Red blood cell (RBC) levels were also found to be significantly associated with increased levels of hematocrit (HCT) (r=0.897, p<0.0001) and decreased levels of MCV (r=-0.764, p<0.0001) and MCHC (r=-0.731, p<0.0001). Among the complicated malaria cases, there was a positive significant correlation between HGB and RBC (r=0.628, p=0.007), HCT (r=0.640, p=0.006) and PLT (r=0.573, p=0.041). RBC positively correlated with HCT (r=0.652, p=0.005) and negative correlated with MCV (r=-0.717, p=0.001) and MCH (r=-0.607, p=0.010). Malaria disease progression was found to increase MDA levels and decrease ascorbate concentration. In conclusion, this research showed changes in the selected hematological and biochemical parameters studied with prostration and hyperpyrexia reported as the most distinctive features of complicated malaria in the study area. Severity of malaria brought extreme changes in the parameters studied.
This dissertation is presented to the Department of Biochemistry and Biotechnology, in partial fulfilment of the requirements for the award of Master of Philosophy Degree in Biochemistry.