CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Malaria is a life-threatening parasitic disease transmitted through the bite of

a female anopheles’ mosquito (W.H.O (2003)). It is a disease that can be
treated in just 48 hours, yet it can cause fetal complication if the diagnosis
and treatment are delayed (kakkilaya, B.s (2003)). It affects both male and
female but with higher prevalence among males and in the month of
September (Ahmed T Hussain et al., 2013). Pregnancy has been seen as a
period marked by profound change in a woman’s electrolyte level (Zavalza
Gomez, A.B et al., 2008). The ability to regulate nutrient and balance
electrolyte during this period is critical to the health of the mother and the
growing foetus (Mayne, D.P et al., 1994). Pregnant women and children
under five years are the most vulnerable to the adverse consequences of
malaria. This is so because pregnant women and children do not always
receive the necessary prevention and treatments they need, and this
contributes to the extremely high numbers of maternal and infant malaria
related deaths. It is worst in rural areas where effective health care is
farfetched. More so, people living in poorer locations are also more
susceptible to malaria as they often live in houses that offer little protection
against mosquitoes. Anaemia on the other hand is one of the commonest
resultant manifestations or complication in pregnancy arising from the
leakage of potassium from intracellular space to extracellular space leading
to hyperkalaemia.
 In addition to water balance, these electrolytes play an important role in

maintenance of pH, regulation of heat and muscle function, electron transfer

reactions as well as serving as cofactor for enzymes (Mattys, B. et al., 2008).

In pregnant women erythrocyte infected with the mature form of the malaria

parasite, plasmodium falciparum, the cytosolic concentration of sodium ion

is increased and that of potassium is decreased (Dworak, J.A et al., 1975).

In separate studies it was observed that malaria is often associated with

abnormalities of fluids, electrolyte, and acid-base balance, since electrolyte

has been shown to be highly indispensable in water homeostasis which is

fundamental to the survival of all organisms (Idoniji BO et al., 2011). In

view of this it is imperative to assess the electrolyte status of pregnant

women with malaria, its severity and provide a plat form for effective

management regimen for patients in such condition.

1.2 Statement of the problem

There may have been previous researches in this subject. This work gives

further explanations and analysis in serum electrolytes/urea/creatinine in

pregnant women with malaria parasites

1.3 Objectives of the study

 This prospective study aims to investigate the impact of malaria parasitic

infection on serum electrolytes, urea, and creatinine levels in pregnant

women.

The objectives of this work is:

1. To understand the impact of serum electrolytes/urea/creatinine in pregnant

women with malaria parasites

2. To understand the relationship between serum electrolytes/urea/creatinine

and public health of pregnant women with malaria parasites

1.4 Research questions

1. What is the impact of serum electrolytes/urea/creatinine in pregnant

women with malaria parasites

2. What is the relationship between serum electrolytes/urea/creatinine and

public health of pregnant women with malaria parasites

1.5 Research hypothesis

H0: There is no relationship between serum electrolytes/urea/creatinine and

public health of pregnant women with malaria parasites

H1: There is a relationship between serum electrolytes/urea/creatinine and

public health of pregnant women with malaria parasites

1.6 Significance of the Study

 This research will contribute valuable information to the understanding of

the physiological impact of malaria infection on pregnant women. The

findings will aid in the development of targeted interventions to mitigate the

adverse effects of malaria during pregnancy, ultimately improving maternal

and fatal health outcomes.

CHAPTER THREE
METHODOLOGY

3.1 Subject Selection

The study subjects will be made up of sixty (60) confirmed pregnant women

with malaria recruited from the antenatal unit, FMC in Jalingo Metropolis. The

subject will be divided into two group based on age. The age ranges; 20 – 30

years, 30 – 40 years. Thirty apparently healthy age-match pregnant women

will be used as controls.

3.2 Inclusion Criteria

All test subjects will be confirmed pregnant with malaria.

3.3 Exclusion Criteria

 Subjects with abnormal electrolyte imbalance will be excluded from the control

group of the study.

3.4 Statistical Analysis

Data from the study will be analysed separately using paired t-test at 95%

confidence interval and analysis will be done using the statistical package of

social sciences (SPSS).

3.5 Obtaining subject’s personal data

Consent will be obtained from the pregnant women before the project

commencement. Their names, age will be recorded in the questionnaire.

3.6 Determination of Subject’s Weight

The subject will be instructed to stand erect on the weighing balance and the

weight reading is recorded on the questionnaires.

3.7 Determination of the Blood Pressure

The electronic blood pressure monitor will be operated electronically, reading,

the systolic and diastolic blood pressure on the screen. The subject will be

allowed to sit relaxed on the sit with the hand resting straight on the leg. The
 blood pressure pad will be wrapped round the upper part of the hand and

pressure will be applied electronically to obtain the blood pressure which will

be recorded on the questionnaire.

3.8 Sample Collection and Preparation

The specimen bottles will be used for each subject. Anticoagulant bottles

containing K3 EDTA for malaria parasite test and anticoagulant bottle

containing lithium heparin for electrolyte assay. The subject will be allowed to

sit and the tourniquet will be applied with the subject’s fist clenched. Blood

samples will be collected by clean venepuncture from the antecubital fossa

using the “vacutainer” into already labelled bottles, without undue pressure to

the arm. The samples will be mixed by gentle inversion. The samples in the K3

EDTA anticoagulant bottle will be tested for malaria parasite, after staining

their thick blood films with Giemsa stain, while those sample in lithium heparin

bottle will be centrifuged at 3000 pm for 5 minutes to obtain the plasma. The

plasma will be separated into sterile plain bottles and analysed within 4 hours.

3.9 Method of Determination of Malaria Parasite

The malaria parasite density will be determined by examining a thick blood

film stained by Giemsa method (Randox).

3.10 Procedure
 Immediately before use, the Giemsa stain will be diluted to 1 in 10 in buffered

water pH 7.2. The slide will be face down in a staining rack for immersion in a

staining trough. Thick film will be thoroughly dried. This was necessary to

prevent fine particles of stain being deposited on the film(s). The diluted stain

will be poured into the shallow tray or staining trough and stained for 30

minutes. The stain will be washed from the staining container using clean

water. The back of each slide will be cleaned and placed in a draining rack to

air dry. The slide will be examined microscopically using x40 and x100

objective

3.11 Classification of the Degree of Parasitaemia

The malaria parasite density will be graded by the semi-quantitative method

recommended by the WHO plus system.

i) 1 – 10 parasite per 100 hpf -------- (+)

ii) 11 – 100 parasite per 100 hpf -------- (++)

iii) 100 – 1000 parasite per hpf -------- (+++)

iv) 1000 parasite per hpf -------- (++++)

3.12 Estimation of Electrolyte

The electrolytes will be measured by potentiometric process known based on

the use of ion selective electrode, EasyLyte-400 (Genesis Diagnostics).