Haematological Characteristics of Patients with Malaria Parasitaemia in selected Hospitals in Uli , Ihiala Local Government Area , Anambra State

n humans, malaria is known to be caused by four species of Plasmodium which include; Plasmodium falciparium, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax and Plasmodium knowelsi. Among all these, Plasmodium falciparum is the most prevalent with about 80% infection and is responsible for 90% death from malaria infection (Trampuz et al., 2003). Malaria has been one of the most prevalent of human infections in the Tropics. The severity and duration of its attack in endemic areas depend on many factors which include the nutritional status of the host, virulence of the infecting strain, immunity of the infected host, age, occupation and environmental factors (Orago et al, 2001).


INTRODUCTION
n humans, malaria is known to be caused by four species of Plasmodium which include; Plasmodium falciparium, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax and Plasmodium knowelsi.Among all these, Plasmodium falciparum is the most prevalent with about 80% infection and is responsible for 90% death from malaria infection (Trampuz et al., 2003).Malaria has been one of the most prevalent of human infections in the Tropics.The severity and duration of its attack in endemic areas depend on many factors which include the nutritional status of the host, virulence of the infecting strain, immunity of the infected host, age, occupation and environmental factors (Orago et al, 2001).
According to World Health Organization (WHO, 1996), malaria is one of the most prevalent human infections and over 40% of the world population live in malaria endemic areas.It has been found to cause cognitive impairments especially in children (Boivin, 2002) and severe brain damage (Idro, 2003).The relationship between plasmodium and red blood cells is of dual effects in which the parasite modifies the composition and antigenicity of the red blood cells (Eneanya, 1996).Epidemiological studies have shown that red blood cells containing altered haemoglobin and lacking certain antigenic determinants at their surface confer resistance to malaria (Miller et al, 2003).However, alteration of various haematological parameters has been observed in patients with malaria (Flemming, 2002).This study tends to explore some haematological characteristics of individuals infected by malaria in Uli community.

Study Population and Blood Sample Collection
The population of study which involved 250 persons was drawn from patients who presented themselves for treatment at the hospitals; Victory medical centre, Ken Joe hospital, and Ezinne Maternity.They were classified among the ages of 0 -44 years and > 45 which represented both children, students and adults.
With the assistance of the hospital management, venous blood was collected from the consented patients.This was done using dry sterile syringe and needle and dropped into EDTA bottles labelled for each patient.The uninfected patients were used as control.

ABO blood group
This was determined using Anti sera kit containing Anti A, B and D reagents.There were white tiles, plastic stirrer.A drop of each patient blood was put on three different portions of the tile and anti-sera was dropped differently on the drops of blood.The content of each portion was thoroughly mixed with the stirrer, this was tilted side by side and agglutination was looked for after 2-3 minutes.The blood groups A, B, AB, and O were identified based on the observed agglutination with the anti-sera.

Genotype determination
The test involve electrophoretic tank, white tile, cellulose acetate paper, buffer solution, distilled water.A drop of each patient's blood was placed on different portions of the tile, and a drop of the control(AS).Each drop blood was lysed with distilled water.Exactly 100ml of buffer solution was poured into the electrophoretic tank.The blood samples and control were applied on the cellulose acetate paper using applicator, this was placed in the electrophoretic tank and connected to power supply.

Packed cell volume estimation
Capillary tubes were dipped into EDTA bottles containing each patient's blood sample and were allowed to be three quarters full.The tubes were flamed and sealed, and placed in haematocrit centrifuge and spanned for 10 minutes.The packed cell volume was read from haematocrit reader.This was measured by the length of the column of the packed red cells divided by the length of the whole column of blood (cells and plasma), multiplied by 100%.

Blood examination
Each blood sample was mixed thoroughly and gently.A drop of each was placed on clean sterile glass slide and spread to make even thick smear.This was stained using field stain A and B accordingly.This was examined using oil immersion at x100 objective.

Identification of Malaria Parasite
This was based on morphological features of stained smears, the pink dots in red blood cells as Schauffner's dot in P vivax and scanty Maurer's dot in P.falciparum (Olubunmi, 2013)

RESULTS
Two hundred and fifty people within the study area were screened for malaria parasitaemia, 174(69.6%were positive.In the zone representation which is according to hospitals, A had 45(18.0%),zone B 84(33.6%) and zone C had 45(18.0%).Considering their sex in terms of level of infection, males were 98(39.2%)and females 76(30.4%)Table 1.

DISCUSSION
The overall prevalence of malaria infection in the study area is 69.6% as shown in table 1.This is relatively low when compared with 100% infection by Eneanya (1996) in the work on severe falciparum malaria infection.The level of infection in the location can be attributed to the nature of the environment and the period of the study.In the sex related malaria infection, it was more in the males (39.2%) than in females (30.4%).In the age level of infection 0 -14years group were higher in males as well as in females with14.8%and 10.0% infection rates respectively.This confirms high level of malaria infection among children than in adults (Clair, 1997).
The intensity of malaria infection was related to packed cell volume (Table 3).Individuals with +++ infection had lower packed cell volume (38) when compared to those with just + (56.7) and ++ (45.1).High parasite intensity leads to anaemia and thus low packed cell volume (Trampuz, 2005) and this is common in children (Orago et al, 2001).Adults may have low packed cell volume which could be as a result of age related factors.
The ABO group infections varied as was observed in the study area.The highest infected blood group was O(40.0%) and the least AB(3.4%).This could in line with the report by Peter (2000), that some polymorphic human genes are involved in resistance of host to species of malaria infection.Moreso, the genotype of an individual's blood has influence in malaria infection.The result obtained showed that individuals with AA were more susceptible to malaria infection followed by AS and the least is SS (Table 4).The susceptibility the haemoglobin type could be based on its structure and nutrient content for the multiplication and maturation of erythrocytic schizonts coupled with the rich oxygen content which is lacking in SS (Peters, 2000).

CONCLUSION
It has been observed that malaria infection has serious effect on blood characteristics which will affect the general wellbeing of an infected person.The complexity in its influence cannot be ruled out for this has resulted to debility and mortality mostly among infants and elderly.This however calls for serious move for its prevention and possible control by all sectors and adopting whatever measures that are spelled out by specialists in the area for its elimination.