Abstract

Co-endemicity of malaria and hepatitis B virus (HBV) present a major threat to public health and Cameroon is endemic for these two disorders. Co-habitation of both infections in an individual might have significant clinical and public health implications.

Hence the present study will be undertaken to determine the prevalence of malaria and HBV co-infection among pregnant women attending Buea Regional Hospital, South West Region Cameroon.

It was a cross-sectional study, carried out using 110 consenting pregnant women. Malaria and HBV were to be detected using RDT while hepatitis will be with the aid of a hepatitis strip. For malaria, 74 were positive giving an overall prevalence of 67.3%.

Hepatitis B, 47 were positive with a prevalence of 42.7% and for their coinfection 37 were positive with an overall prevalence of 33.6%. Prevalence of malaria Hepatitis B and their coinfection with respect to gender was highest in females with the prevalence of 80%, 91.4%, and 91.4% respectively.

The most important predisposing factor for malaria was stagnant water around the house with a prevalence of 88.8% while the most important predisposing factor for Hepatitis B was using contaminated objects with a prevalence of 37.5%%.

CHAPTER ONE

INTRODUCTION

Background of the Study

Co-infection is the process in which a host becomes infected with multiple pathogens simultaneously (Abah et al., 2019). It is of vital health significance since there is an interface of pathogenic species within the host and an example of such coinfection is hepatitis B virus (HBV) and malaria coinfection (Abah et al., 2019).

Malaria has been considered the king of parasitic diseases due to its ability to resist host cell response, resist drugs and ability of its vector to resist chemicals and biological control methods (WHO, 2013). This parasitic disease is transmitted by a vector; the female Anopheles mosquito (CDC, 2016).

The malaria parasites found to be most prevalent in man and around the world are: Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae and Plasmodium knowlesi with P. falciparium posing the highest threat to humans. These five have been known to cause various forms of malaria ranging from benign tertian malaria (by P. vivax), malignant tertian malaria (by P. falciparum), quartan malaria (by P. malaria) and ovale malaria (by P. ovale) (Chiodini et al., 2003).

Malaria and hepatitis B coinfection pose a great hazardous and serious health issue in underdeveloped nations such as Cameroon. These infections are most prevalent in tropical and sub-Saharan African nations and are both major threats to prevent to preventive medicine.

Co-infection prevails in areas and region where either infection is prevalent or endemic as a result of their existence in the same geographical area (Chiodini et al., 2003).

Plasmodium falciparum can invade red cells of all ages, enabling high levels of parasitemia to develop. The parasitic index (number of parasitized RBCs/total number of RBCs) at times can be greater than 50% in very severe conditions (Bhalla et al., 2006).

The risk of severe malaria is highest among non-immune individuals, children less than five years old, and pregnant women. Clearance of a large number of parasitized red cells by the spleen and rupture of parasitized RBCs to release merozoites can lead to severe anemia and hyperbilirubinemia (Bhalla et al., 2006).

1. falciparum has a unique characteristic in which the parasite matures within red blood cells and induces the formation of sticky knobs on the surface of the erythrocytes (Oh et al., 1997; Newbold et al., 1999). These knobs bind to receptors on endothelial cells in capillaries and venules. Infected red cells also stick to uninfected red cells and form rosettes which clog microcirculation. Ultimately, secondary liver cell dysfunction occurs due to resultant ischemia which affects microcirculation (Bhalla et al., 2006).

Most people suffer from uncomplicated malaria with only fever as a symptom, besides the presence of malaria parasites in their blood. Many adults in endemic countries will encounter asymptomatic malaria, in which the infection is rapidly cleared by the host’s immunological responses directed against the P. falciparum-infected RBC.

However only repeated P. falciparum infections give protection against the disease with sterile anti-parasite immunity rarely achieved (Liehl and Mota, 2012; Spence and Langhorne, 2012; Portugal et al., 2013; Riley and Stewart, 2013).

Hepatitis is liver inflammation which is a broad term for a spectrum of liver dysfunctions caused by viral agents, bacteria, metabolic syndromes, vascular disorders, drugs, or toxic substances (Jessica, 2013).

As hepatocytes are attacked and infiltrated by the hepatitis B virus, they appear to have a “ground glass” look under histological examination due to the HBsAg infiltrating the cell’s cytoplasm which differentiates hepatitis B from other forms of hepatitis (Jessica, 2013). Because hepatocytes are continually proliferating, the virus is constantly being shed into the blood which contributes to chronic infection (Jessica, 2013; Gasim et al., 2015).

Malaria endemic foci are often affected by other infectious agents which may contribute to the clinical episodes of the disease (Boraschi et al., 2008). Hepatitis B virus is one of such infectious agents that coexist with P. falciparum in most endemic areas. Malaria and hepatitis B virus are co-endemic throughout tropical and Sub-Saharan Africa and both present major threats to public health (Mazie, 2002; Jeya, 2010; Paulyn, 2010; WHO, 2011).

Co-infection may occur in areas where both infections are endemic as a result of their geographical coincidence (Andrade, 2011; Freimanis, 2012). These two infections live some of their developmental stages within the liver and hepatocytes damaged by HBV infection may cause poor liver handling of malaria parasites (Thurz, 1995; Paulyn, 2010) thus culminating in increased morbidity, since both infectious agents make use of host liver cells for intracellular multiplication. Hepatitis B virus induces direct or immunologically mediated interactions in concurrent infections which may potentially escalate or inhibit the progression of both infections (Klein et al., 2011).

Statement of Problem

Malaria and HBV coinfection occur throughout Southeast Asia, Africa, and Tropical America (Oyeyemi and Amugo, 2015). Both diseases represent key threats to public health. Malaria prevalence of over 60.6% has been reported in Northern Cameroon (Salwa et al, 2016).

Malaria infection during pregnancy can have adverse effects on both mother and fetus, including maternal anemia, fetal loss, premature delivery, intrauterine growth retardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death. (Oyeyemi et al., 2015).

It is a particular problem for women in their first and second pregnancies and for women who are HIV-positive.

Malaria and HBV are two of the most prevalent and important infectious diseases worldwide with a potential cause of immunosuppression caused by HBV being a debilitating liver disease that might exacerbate malaria in endemic regions.

Previous surveys of co-infection (malaria) have shown the prevalence of 4.5% and 6.6% in both Kumba and Limbe in Cameroon, (Oyeyemi et al., 2015). While there is no information on the co-infection of these two diseases in Buea, Cameroon. This necessitates this work to be carried out.

Objectives

Main objective

To determine the prevalence of malaria and HBV co-infection among pregnant women attending BUEA Regional Hospital, South West, Cameroon.

Specific objectives

1. To determine the overall prevalence of HBV and their co-infection.
2. To determine the prevalence of malaria, HBV, and their co-infection with respect to age, and marital status.
3. To determine the prevalence of malaria and HBV with respect to their predisposing factors.

Research Questions

Main question

What is the prevalence of malaria and Hepatitis B co-infection among pregnant women attending Buea Regional Hospital, South West Region Cameroon?

Specific questions

1. What are the overall prevalence of malaria, HBV, and their co-infection?
2. What is the prevalence of malaria, HBV, and their co-infection among pregnant women with respect to age, and marital status?
3. What is the prevalence of malaria and HBV with respect to their predisposing factors?