Ngwa Ambe Fabrice, Nsongmayi Ekwi Damian, Bobga Tanyi Pride, Tita Bih Vanessa, Nyeme Judith Ngong, Mbuh Nyanjoh Eugine
Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon.
Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Cameroon.
Parasite Epidemiol Control. 2024 Nov 1;27:e00390. doi: 10.1016/j.parepi.2024.e00390. eCollection 2024 Nov.
One of the major causes of morbidity and death in children is malaria, and HIV infection and other factors may make the situation worse. This study aimed to assess the prevalence of malaria parasitemia among HIV-infected children under 15 years in the Bonassama Health District, Douala, Cameroon, and investigate its association with CD4 cell counts, viral load, and haematological parameters.
The study was a cross-sectional study involving 287 HIV-infected children <15 years and convenient sampling was used to enrol participants. A semi-structured questionnaire was used to obtain the characteristics of the participants from the caregivers. Venous blood was collected; blood films were made and stained using Giemsa for parasite detection. Full blood count, CD4 level and viral load were measured using a haematology auto-analyzer, pima counter and genexpert, respectively. Data were analysed using SPSS, and the chi-square test was used to assess the association. Predisposing factors to malaria were evaluated using multivariable logistic regression, and a < 0.05 was considered significant.
The overall prevalence of malaria and anaemia was 31.01 % and 25.44 %, respectively. Malaria prevalence was significantly higher in children <5 years (42.68 %, < 0.001), those presented with fever (40.70 %, = 0.047), children not on antiretroviral therapy (ART) (28.6 %, = 0.02) and cotrimoxazole (28.6 %, p = 0.02). Children <5 years (AOR = 1.81, 95 % 1.19-2.75), those between 5 and 9 years (AOR = 1.61, 95 % CI 1.11-2.48), children not on ART(AOR = 2.2, 95 % 1.03-4.74) and Cotrimoxazole (AOR = 9.08, 95 % 2.33-43.46), febrile children (AOR = 1.72, 95 % 1.01-2.11), children with viral load >3000 copies/μL(AOR = 2.933, 95 % 1.36-6.49), and CD4 count <200cells/ μL (AOR = 3.09, 95 % 2.08-4.6) were factors associated with malaria parasitemia among HIV-infected children. Haemoglobin levels ( = 0.0016), White Blood Cells ( = 0.002), Red Blood Cells ( < 0.001), neutrophils count ( < 0.001), and platelet counts ( = 0.0164) were significantly lowered among malaria/HIV children compared to HIV-infected children.
The study concludes that HIV-infected children under 5 years, especially those not on ART or cotrimoxazole, are at a significantly higher risk for malaria and related haematological issues. This underscores the necessity for targeted malaria screening and treatment in this vulnerable group. Public health strategies should prioritize enhancing access to ART and cotrimoxazole to mitigate these risks and improve overall health outcomes.
疟疾是儿童发病和死亡的主要原因之一，而艾滋病毒感染及其他因素可能使情况恶化。本研究旨在评估喀麦隆杜阿拉博纳萨马卫生区15岁以下艾滋病毒感染儿童的疟原虫血症患病率，并调查其与CD4细胞计数、病毒载量和血液学参数的关联。
本研究为横断面研究，涉及287名15岁以下的艾滋病毒感染儿童，采用方便抽样法招募参与者。使用半结构化问卷从照顾者处获取参与者的特征。采集静脉血；制作血涂片并用吉姆萨染色以检测寄生虫。分别使用血液学自动分析仪、皮马计数器和基因专家检测全血细胞计数、CD4水平和病毒载量。使用SPSS分析数据，采用卡方检验评估关联。使用多变量逻辑回归评估疟疾的易感因素，P<0.05被认为具有统计学意义。
疟疾和贫血的总体患病率分别为31.01%和25.44%。5岁以下儿童（42.68%，P<0.001）、发热儿童（40.70%，P=0.047）、未接受抗逆转录病毒治疗（ART）的儿童（28.6%，P=0.02）和未服用复方新诺明的儿童（28.6%，P=0.02）的疟疾患病率显著更高。5岁以下儿童（调整后比值比[AOR]=1.81，95%可信区间[CI]1.19 - 2.75）、5至9岁儿童（AOR=1.61，95%CI 1.11 - 2.48）、未接受ART的儿童（AOR=2.2，95%CI 1.03 - 4.74）和未服用复方新诺明的儿童（AOR=9.08，95%CI 2.33 - 43.46）、发热儿童（AOR=1.72，95%CI 1.01 - 2.11）、病毒载量>3000拷贝/μL的儿童（AOR=2.933，95%CI 1.36 - 6.49）以及CD4计数<200细胞/μL的儿童（AOR=3.09，95%CI 2.08 - 4.6）是艾滋病毒感染儿童中与疟原虫血症相关的因素。与艾滋病毒感染儿童相比，疟疾/艾滋病毒儿童的血红蛋白水平（P=0.0016）、白细胞（P=0.002）、红细胞（P<0.001）、中性粒细胞计数（P<0.001）和血小板计数（P=0.0164）显著降低。
该研究得出结论，5岁以下的艾滋病毒感染儿童，尤其是未接受ART或复方新诺明治疗的儿童，患疟疾及相关血液学问题的风险显著更高。这突出了对这一弱势群体进行针对性疟疾筛查和治疗的必要性。公共卫生策略应优先提高ART和复方新诺明的可及性，以降低这些风险并改善整体健康结果。
