Prevalence Of Malaria And Intestinal Helminth Co-Infection In Children Presenting With Anaemia In Freetown, Sierra Leone

Abstract

Background: Anemia is a major health problem in Sub-Saharan Africa (which includes Sierra Leone), and its cause is frequently multifactorial. In many regions of Sub-Saharan Africa, intestinal helminth infections especially hookworm infection overlaps geographically with plasmodium falciparum malaria, resulting in an increased burden of anemia. Severe anemia is associated with significant morbidity (such as impaired cognitive function) and mortality in children. Knowledge of the burden of malaria and intestinal helminth co-infection and their contribution to anemia in children, would be valuable to develop strategies for reduction of these parasitic infections in children. Objective: To determine the prevalence of malaria and intestinal helminth co-infection in children 1-5 years of age, presenting with anemia at Ola During Children’s Hospital (ODCH) in Freetown, Sierra Leone. Method: This study was a hospital-based descriptive cross-sectional study, carried out from 1st September 2015 to 31st October 2015, at the ODCH in Freetown, Sierra Leone. A sample size of 264 children aged 1 to 5 years were studied. Consecutive sampling method was used, where every next patient who presented at ODCH within the study period and meets the inclusion criteria were enrolled into the study. Demographic data, socio-economic data, Hemoglobin levels, blood slide for malaria parasites, and stool for ova, cyst and protozoa, were collected to determine the burden of malaria and intestinal helminth co-infection in children with anemia. Data obtained from the study was analyzed using descriptive statistics, where discrete variables were summarized using frequencies and percentages; continuous variables were summarized using measures of central tendency such as mean, median, mode and standard deviation; while measures of association were analyzed using chi square 10 (categorical variables) and non-parametric test (continuous variables). Data was presented in the form of tables, graphs, and narratives. Results: Out of 264 children studied, 59.8% were males and 40.2% were females. The mean age of the children studied was 2.6 years (SD 2.2), and their mean hemoglobin concentration was 6.9 g/dl (SD 1.6). Children with malaria- helminth co-infection were 55, 96 had malaria infection only, and 35 had intestinal helminth infection only. Plasmodium falciparum was the only malaria specie found in the study subjects. The commonest helminth found was ancylostoma duodenale, followed by trichuris trichuria, and ascaris lumbricoides. Lowest hemoglobin concentration was recorded in children with malaria and hookworm co-infection (mean Hb= 5.0 g/dl; SD 1.2). Low family income, children not sleeping under insecticide treated nets, and the use of pit latrines for sewage disposal, were found to be significantly associated with malaria- helminth co-infection. Conclusions: There is a high prevalence of malaria and intestinal helminth co-infection (20.8%) in children aged 1 to 5 years, presenting with anemia at the Ola During Children’s Hospital in Freetown, Sierra Leone. Low socio-economic status was significantly associated with malaria- helminth co-infection. Recommendations: Children aged less than 5 years with Hb levels less than 9g/dl, should be offered testing for intestinal helminthes as well as malaria parasites, at presentation in ODCH. There is still further need for health education on the benefits of children sleeping under insecticide treated bed nets, and better sewage disposal and sanitary practices