Demographic Profile of Participants
Four hundred and sixty two (462) participants, consisting of 136 males and 326 females, were screened for Plasmodium falciparum malaria in this study. Of this population, 70 were microscopically positive for Plasmodium falciparum (Table 2), corresponding to a prevalence of 15.2%. The female participants were predominantly positive (70%) while males constituted 30% positives.
Of the 70 participants microscopically confirmed positive for Plasmodium falciparum, 65.7% were participants below 17 years of age while the adult participants aged 18 years and above constituted 34.3%. Overall, the median age of the participants was 21 years.
The seventy (70) age-matched controls on the other hand, were microscopically confirmed negative. The median age for the healthy controls was 21 years [Table 1].
Table 1: Demographic profile of study population.
93(20.1 %) subjects had a positive RDT test for diagnostic method and 70(15.2 %) had a positive malaria test for microscopic gold diagnostic standard [Figure 2].
Table 2. Malaria parasite density of participants
Malaria Density Distribution
Of the 462 participants tested, 70 (15.2%) were microscopically positive for malaria, 21(30%) were male and 49(70%) were female. There was a significant difference between male and female participants' (p<0.01) geometric mean parasite density (GMPD). Similarly, the results showed a statistical difference, p<0.01 between the age groups tested, with the highest GMPD in subjects under 5 years of age (P<0. 01) compared with those over the age of 5 [Table 2].
Fig. 2 Showing parasite density (Trophozoites) in the blood smear [A] & [B].
Table 3: Prevalence of malaria in relation to BMI status of participants
BMI status of participants in relation to malaria prevalence
Subject with low body mass index [BMI] <18 kg/m2 showed a very high prevalence of (46.8%), compared to those with Normal [BMI] 18.5-24.9 (kg/m2) with a prevalence of (27.3%). The overweight and obese subjects with a Body mass index of [BMI] 25.0 – 29.9 [kg/m2] and [BMI] >30) (kg/m2) showed a prevalence of (12.6%) and (13.4%). [Table 3] respectively.
Table 4: Relationship between BMI Status and malaria parasitemia.
X2= 4.521, df= 6, p=0.607 (p>0.05)
Relationship between BMI Status and Malaria Parasitemia (Microscopy)
In this study [Table 4], the underweight infected participants had a higher parasite load of 68.6% with a parasitemia level of < 100/μl, while those with normal BMI had a parasite density load of 31.4% with parasitemia levels of 1,000<100,000. The overweight and obese had a parasitemia level of
< 1,000≥10,000≥100,000 with a parasite load of 2.9% and 8.6% [p>0.01] respectively.
Table 5. Evaluation of malaria Parasite density in relation to cytokine levels of participants.
There were predominance cytokine immune responses among all screened and evaluated participants. TNF-α Showed (1.98 ± .015) lower preponderance compared to IFN-γ (2.46 ± .05) and IL-10 (2.21 ± .054). [Table 6]. Subjects who were grossly infected with Plasmodium falciparum showed an elevated pro and anti-inflammatory immune responses compared to individuals who tested negative to malaria parasite. [Table 5]. There was a significance difference between infected and non-infected individuals (p<0.01).
Fig. 3. Cytokine levels of participants infected with Plasmodium falciparum in comparison with the healthy controls.
Table 6. Cytokine levels of participants infected with Plasmodium falciparum in comparison with the healthy controls
The parasite density of malaria showed different elevated levels of pro and anti- inflammatory cytokines among the infected individuals. TNF-α (pg/ml) levels [1.7668 ± 0.4412] were highest in individuals with ≥100,000 malaria parasite density compared to <1,000[1.3760±0.858] and ≥10,000 [1.5758±0.6849] individuals. IFN-γ (ng/ml) levels were lowest in individuals with<1,000[1.2500 ± 0.9029] parasite density and highest in participants with ≥10,000 and ≥100,000 [1.8500 ± 0.0764] and [1.933 ± 0.2108] parasite density. An elevated level of IL-10 (pg/ml) was observed in subjects with ≥100,000 [2.000 ± 0.5774] parasite density compared to ≥10,000 [1.5833 ± 0.1028] and <1,000[1.5714 ± 0.1373], IL-10 cytokines elevation levels were highest compared to all levels of cytokines investigated. There was a significant difference [p<0.01] between malaria parasite density and cytokine elevated levels in the infected subjects [Table 6].