Abstract

BACKGROUND: Malaria and Hepatitis B are two epidemic diseases in developing countries. People within these vast communities are at high risk of both infections. Each of these diseases contribute to a high mortality if not diagnosed and treated early as they have an effect on the liver function. The aim of this study was to investigate the prevalence of malaria and hepatitis b co-infection and to see the effects on liver enzymes in patients attending the Buea Regional Hospital.

METHODS: This study was carried out between February and April 2024 whereby venous blood was collected from 134 participants. Malaria test, serological test for HBsAg and ALAT, ASAT were carried out, using Microscopy, Rapid diagnostic test and spectrophotometer. Data was obtained and inputed into MS Excel and statistical analysis was done using SPSS.

RESULT: Out of the 134 patients, the prevalence of malaria, HBV and co- infection were 25(26.1%), 19(14.2%), 11(8.2%) respectively. Participants within the age 16-25  38(28.4%) were the most populated.

The levels of ALAT and ASAT were seen to have a higher prevalence during co-infection as compared to mono-infections. However mosquito nets, anti-malarial prophylaxis and unprotected sexual contact had no association to the prevalence of malaria and hepatitis b co-infection as compared to vaccination which had an association p˂0.05.

CONCLUSION: The prevalence malaria and hepatitis B co-infection was high in this study. Malaria was more prevalent than hepatitis B. Proper blood screening of malaria, hepatitis b and ALAT and ASAT is needed to identify those with chronic infections as to get treatment and avoid transmission.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria and Hepatitis B virus infections are endemic in most parts of Cameroon and Sub-Saharan Africa. Malaria is one of the most devastating infectious diseases of humans. It is problematic clinically and economically as it prevails in Africa mostly in poorer countries and regions, strongly hindering socioeconomic development [1].

For millions of years, invertebrates and malaria parasites have coexisted and to date, malaria remains the most important human parasitic disease. The causative agents of malaria are unicellular parasites belonging to the genus Plasmodium and described throughout history by various species; Plasmodium falciparum ,Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium  knowlesi which is a monkey parasites in the tropical forest of South-East-Asia. P falciparuim is the deadliest malaria parasite and most prevalent in Africa.[2] P vivax is more dominant out of sub Saharan Africa.

The presence of malaria has shown to be a risk factor contributing to the prevalence of other infections as malaria alone accounts for 229 million cases of malaria world wide and 409000 deaths in Africa [3].Malaria is still a major health threat in Cameroon with the whole country exposed to the risk of transmission.[4].Progress has been made but malaria infection remains prevalent with a higher number of suspected cases in health facilities being 3.3 to 3.7 million per year.

Hepatitis B is a viral infection that affects the liver leading to a life threatening infection putting people at high risk of liver cancer. [5] It is known to have infected about 2million people in the globe with some being asymptomatic. In Cameroon, hepatitis b is endemic, and the prevalence rates are significant. HBsAg prevalence according to a study conducted in Cameroon, the prevalence of HBsAg positivity among the general population was estimated to be around 10.8%. Higher rates were found in some regions like the Far North Region with 19.3%[4].Some risk factors of for HBV infection include contact with contaminated blood, and other fluids, body piercing, indiscriminate percutaneous drug use. The presence of malaria and hepatitis B co-infection is usually predominant in areas where both infections are endemic as mono-infection. Malaria and HBV are known to share some of their developmental stages in the liver [6].

Co-infection of Malaria and HBV happen to be both endemic and these two infectious diseases have a stages in the liver, which may cause liver damage .The liver stage of malaria parasite due to hepatocyte damages and in HBV infection as it is the main organ of attack which can lead to a health risks, particularly concerning liver function as both diseases can individually impact liver enzymes and liver health. These enzymes which are known to be influenced by Malaria and Hepatitis B include Alanine transaminase (ALT), Asparate transaminase (AST) and Alkaline phosphatase. Which reflect liver function and potential severe liver pathology [7].

1.2 Rationale

Malaria and Hepatitis B are two major public concerns in Cameroon. Co-infections with these two pathogens can have severe consequences including morbidity, mortality. And according to WHO in 2019 there were 228million cases of malaria and 257 million people chronically infected with hepatitis B worldwide. The co-infection of malaria and hepatitis B can have significant effects on liver enzymes. Hepatitis B causes chronic liver infection which leads to cirrhosis and malaria on the other hand can cause liver damage and co-infection causes abnormal liver enzymes such as ALT and AST.

The Understanding of the this study  is to systematically evaluate the prevalence and clinical impact of malaria and hepatitis B co-infection focusing on the influence of co infection dynamics on liver enzymes among individuals in the Regional Hospital  Buea as this research is said to not have been carried out in Cameroon. And also for developing health interventions optimizing disease manage and ultimately improving health outcome for affected individuals.

1.3 Research Questions

1. What is the Prevalence of malaria and Hepatitis B co-infection in Regional Hospital Buea?
2. How do liver Enzymes differ between individuals with Malaria, and hepatitis b and those with co-infection and the level?
3. What factors are associated with patients with malaria and hepatitis B co-infection in Regional Hospital Buea?

Check out: Medical Laboratory Project Topics with Materials