Dataset Information

Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study.

ABSTRACT: OBJECTIVE:Plasmodium falciparum is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between P. falciparum infection and seizure control in children with a unique epilepsy type, the nodding syndrome. DESIGN:This cross-sectional study was nested in an ongoing trial 'Doxycycline for the treatment of nodding syndrome (NCT02850913)'. We hypothesised that, in patients with epilepsy, infection by P. falciparum, including asymptomatic infections, increases the risk of seizures and impairs seizure control. SETTING AND PARTICIPANTS:Participants were Ugandan children with nodding syndrome, age ?8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density. OUTCOMES:The primary outcome was the number of seizures in the past month (30 days). RESULTS:A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0-4.0) and it was 4.0 (2.0-7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0-7.3) and 6.0 (IQR 4.0-10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002. CONCLUSION:In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.

SUBMITTER: Ogwang R

PROVIDER: S-EPMC6196862 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study.

Ogwang Rodney R Anguzu Ronald R Akun Pamela P Ningwa Albert A Kayongo Edward E Marsh Kevin K Newton Charles R J C CRJC Idro Richard R

BMJ open 20181018 10

<h4>Objective</h4><i>Plasmodium falciparum</i> is epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship between <i>P. falciparum</i> infection and seizure control in children with a unique epilepsy type, the nodding syndrome.<h4>Design</h4>This cross-secti ...[more]

PMID: 30341136

Similar Datasets

Project description:ObjectivesNodding syndrome (NS) is a poorly understood neurological disorder affecting thousands of children in Africa. In March 2012, we introduced a treatment intervention that aimed to provide symptomatic relief. This intervention included sodium valproate for seizures, management of behaviour and emotional difficulties, nutritional therapy and physical rehabilitation. We assessed the clinical and functional outcomes of this intervention after 12 months of implementation.DesignThis was a cross-sectional study of a cohort of patients with NS receiving the specified intervention. We abstracted preintervention features from records and compared these with the current clinical status. We performed similar assessments on a cohort of patients with other convulsive epilepsies (OCE) and compared the outcomes of the two groups.ParticipantsParticipants were patients with WHO-defined NS and patients with OCE attending the same centres.Outcome measuresThe primary outcome was the proportion of patients with seizure freedom (≥1 month without seizures). Secondary outcome measures included a reduction in seizure frequency, resolution of behaviour and emotional difficulties, and independence in basic self-care.ResultsPatients with NS had had a longer duration of symptoms (median 5 (IQR 3, 6) years) compared with those with OCE (4 (IQR 2, 6) years), p<0.001. The intervention resulted in marked improvements in both groups; compared to the preintervention state, 121/484 (25%) patients with NS achieved seizure freedom and there was a >70% reduction in seizure frequency; behaviour and emotional difficulties resolved in 194/327 (59%) patients; 193/484 (40%) patients had enrolled in school including 17.7% who had earlier withdrawn due to severe seizures, and over 80% had achieved independence in basic self-care. These improvements were, however, less than that in patients with OCE of whom 243/476 (51.1%) patients were seizure free and in whom the seizure frequency had reduced by 86%.ConclusionsUgandan children with NS show substantial clinical and functional improvements with symptomatic treatments suggesting that NS is probably a reversible encephalopathy.

Project description:BackgroundMalaria, malnutrition and anaemia are major causes of morbidity and mortality in African children. The interplay between these conditions is complex and limited data exist on factors associated with these conditions among infants born to HIV-uninfected and infected women.MethodsTwo hundred HIV-exposed (HIV-uninfected infants born to HIV-infected mothers) and 400 HIV-unexposed infants were recruited from an area of high malaria transmission in rural Uganda. A cross-sectional survey was performed at enrolment to measure the prevalence of malaria parasitaemia, measures of malnutrition (z-scores <2 standard deviations below mean) and anaemia (haemoglobin <8 gm/dL). Multivariate logistic regression was used to measure associations between these conditions and risk factors of interest including household demographics, malaria prevention practices, breastfeeding practices, household structure and wealth index.ResultsThe prevalence of malaria parasitaemia was 20%. Factors protective against parasitaemia included female gender (OR = 0.66, p = 0.047), mother's age (OR = 0.81 per five-year increase, p = 0.01), reported bed net use (OR = 0.63, p = 0.03) and living in a well-constructed house (OR = 0.25, p = 0.01). Although HIV-unexposed infants had a higher risk of parasitaemia compared to HIV-exposed infants (24% vs 14%, p = 0.004), there was no significant association between HIV-exposure status and parasitaemia after controlling for the use of malaria preventative measures including bed net use and trimethoprim-sulphamethoxazole prophylaxis. The prevalence of stunting, underweight, and wasting were 10%, 7%, and 3%, respectively. HIV-exposed infants had a higher odds of stunting (OR = 2.23, p = 0.005), underweight (OR = 1.73, p = 0.09) and wasting (OR = 3.29, p = 0.02). The prevalence of anaemia was 12%. Risk factors for anaemia included older infant age (OR = 2.05 per one month increase, p = 0.003) and having malaria parasitaemia (OR = 5.74, p < 0.001).ConclusionsCompared to HIV-unexposed infants, HIV-exposed infants had a higher use of malaria preventative measures and lower odds of malaria parasitaemia. Having a better constructed house was also protective against malaria parasitaemia. HIV-exposure was the primary risk factor for measures of malnutrition. The primary risk factor for anaemia was malaria parasitaemia. These findings suggest the need to better target existing interventions for malaria, malnutrition and anaemia as well as the need to explore further the mechanisms behind the observed associations.

Project description:BackgroundGlobal efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia.MethodsA population of about 5000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every 4 months and treated positive cases with Artemisinin-based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases.ResultsMTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1795/4941) in July 2017 to 32.9% (1303/3966) in July 2018 (p = 0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1043/1984) in July 2017 to 47.5% (820/1728) in July 2018 (p = 0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR = 0.76, CI = 0.67, 0.85 p ≤ 0.001).ConclusionThis study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation.Trial registrationNCT04167566, Date 14/11/2019. Retrospective registration.

Project description:Although asymptomatic malaria cases are reservoirs of malaria parasites, there is limited evidence on the burden and nurturing factors in malaria endemic areas during dry season. Thus, this study aims to determine the prevalence of asymptomatic malaria infection and nurturing factors in endemic areas of Ethiopia during dry season.A community based cross-sectional study was conducted in malaria endemic areas in Ethiopia. Six villages with a total of 1,366 households from three malaria endemic regions of Ethiopia were selected by stratified random sampling method. One asymptomatic member of the household was randomly selected from each household. A structured questionnaire was used to collect data on socio-demographic and other factors. Finger prick blood samples for malaria rapid diagnostic test (RDT) and blood film were collected and examined. Multivariable logistic regression model was used to determine the nurturing factors with asymptomatic malaria infection. The prevalence of asymptomatic malaria infection was 7.7% with both blood film microscopic examination and malaria RDT. Plasmodium falciparum was the predominantly observed type of malaria species (48.0%). The presence of bodies of water around the households (adjusted odds ratio (AOR = 5.4; 95% CI (2.7 ─ 9.7); p < 0.000), infrequent indoor residual spray (IRS) applied four to six months ago (AOR = 3.5; 95% CI (1.0─11.6); p = 0.045) and more than six months (AOR = 5.2; 95% CI (1.3─20.5); p = 0.019) and personal protection measure for malaria prevention (LLIN, repellent and clothing) (AOR = 0.41; 95% CI (0.2 ─ 0.9); p = 0.028) were associated significantly with asymptomatic malaria infection. The prevalence of asymptomatic malaria infection during dry season was considerable. Strong interventions that target stagnant bodies of water, infrequent household IRS spray and personal protection measure for malaria prevention is required to decrease asymptomatic malaria infection during dry season.

Project description:Treatment of the sub-clinical reservoir of malaria, which may maintain transmission, could be an important component of elimination strategies. The reliable detection of asymptomatic infections with low levels of parasitaemia requires high-volume quantitative polymerase chain reaction (uPCR), which is impractical to conduct on a large scale. It is unknown to what extent sub-clinical parasitaemias originate from recent or older clinical episodes. This study explored the association between clinical history of malaria and subsequent sub-clinical parasitaemia.In June 2013 a cross-sectional survey was conducted in three villages in Pailin, western Cambodia. Demographic and epidemiological data and blood samples were collected. Blood was tested for malaria by high-volume qPCR. Positive samples were analysed by nested PCR to determine the Plasmodium species. To identify previous episodes of malaria, case records were collected from village malaria workers and local health facilities and linked to study participants.Among 1343 participants, 40/122 (32.8 %) with a history of clinical malaria were parasitaemic during the cross-sectional survey, compared to 172/1221 (14.1 %) without this history (p < 0.001). Among the 212 parasitaemic participants in the survey, 40 (18.9 %) had a history of clinical malaria, compared to 87 out of 1131 (7.7 %) parasite-negative participants; p < 0.001, adjusted OR 3.3 (95 % CI; 2.1-5.1). A history of Plasmodium vivax was associated with sub-clinical P. vivax parasitaemia in the survey (p < 0.001), but this association was not seen with Plasmodium falciparum (p = 0.253); only three participants had both P. falciparum parasites in the survey and a clinical history of P. falciparum.A clinical episode of vivax malaria was associated with subsequent sub-clinical parasitaemia. Treatment of P. vivax with artemisinin-based combination therapy without primaquine often resulted in recurrent episodes. Targeting individuals with a history of clinical malaria will be insufficient to eliminate the sub-clinical reservoir as they constitute a minority of parasitaemias.

Project description:BackgroundThe increase in detections of Plasmodium vivax infection in Duffy-negative individuals in Africa has challenged the dogma establishing the unique P. vivax Duffy Binding Protein-Duffy antigen receptor for chemokines (PvDBP-DARC) pathway used by P. vivax merozoites to invade reticulocytes. Information on the impact of Duffy antigen polymorphisms on the epidemiology of P. vivax malaria remains elusive. The objective of this study was to determine the distribution of asexual parasitaemia of P. vivax according to the Duffy antigen polymorphisms in Ethiopia.MethodsDNA was extracted from dried blood spots (DBS) collected from prospectively recruited 138 P. vivax-infected patients from health centres. The identification and estimation of P. vivax asexual parasitaemia were performed by microscopic examination and quantitative real-time polymerase chain reaction (PCR). Duffy genotyping was conducted by DNA sequencing in a total of 138 P.vivax infected samples.ResultsThe proportion of Duffy-negatives (FY*BES/FY*BES) in P. vivax infected patients was 2.9% (4/138). Duffy genotype FY*B/FY*BES (48.6%) was the most common, followed by FY*A/FY*BES genotype (25.4%). In one patient, the FY*02 W.01/FY*02 N.01 genotype conferring a weak expression of the Fyb antigen was observed. All P.vivax infected Duffy-negative patients showed low asexual parasitaemia (≤ 110 parasites/µL). The median P. vivax parasitaemia in Duffy-negative patients (53 parasites/µL) was significantly lower than those found in homozygous and heterozygous individuals (P < 0.0001).ConclusionPlasmodium vivax in Duffy-negative patients shows invariably low asexual parasitaemia. This finding suggests that the pathway used by P. vivax to invade Duffy-negative reticulocytes is much less efficient than that used in Duffy-positives. Moreover, the low asexual parasitaemia observed in Duffy-negative individuals could constitute an 'undetected silent reservoir', thus likely delaying the elimination of vivax malaria in Ethiopia.

Project description:BackgroundAsymptomatic malaria and helminths coinfection occurs mainly in the tropics and subtropics where poverty and sanitary practice favor its high prevalence. In the tropics, where malaria is endemic, helminths also thrive resulting in coinfection. This study aimed to access the prevalence of asymptomatic malaria and helminths coinfection and its contribution for anemia in primary school children of Gedeo Zone, Southern Ethiopia. Methodology. This was a cross-sectional study conducted among 413 primary school children from February to April 2020. Finger-prick blood samples were used to determine asymptomatic malaria and hemoglobin concentrations. Stool samples were collected and processed through formalin-ether concentration techniques to detect the presence of intestinal helminths. Data were double entered into Epi Data version 3.1 software and exported to SPSS version 20 for analysis. Pearson's chi-square and correlation analysis were performed as part of the statistical analyses.ResultA total of 413 primary school children aged 6 to 16 years (mean age ± SD: 10.7 ± 2.64years) were enrolled in the study. 159 (38.5%) of school children were infected with at least one of the parasitic diseases. The overall prevalence of asymptomatic malaria and intestinal helminths was 46 (11.1%) and 113 (27.3%) respectively. Asymptomatic malaria and helminths coinfection was 29 (7%). Total of 39.1% of asymptomatic malaria-infected school children were anemic, which is statistically significant (P < 0.05). 15.9% of helminths-infected school children were anemic, not statistically significant (P > 0.05). The prevalence of anemia was 12 (41.3%) among coinfected students, which is statistically significant (P < 0.005).ConclusionAsymptomatic malaria and helminths coinfection affects the health status of considerable number of primary school children in the study area. Therefore, simultaneous combat against the two parasitic infections is crucial to improve health of the school children.

Dataset Information

Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study.

Publications

Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets