Malaria-Schistosomiasis mansoni Co-morbidities and the Possible Reciprocal Effects on the Parasitological, Clinical and Immunological Outcomes in Finchaa Sugar Estate, Western Ethiopia

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Addis Ababa University


In Ethiopia where malaria parasite and Schistosoma mansoni infections are coendemic, the general population is quite vulnerable both to malaria and Schistosoma mansoni infections singly and concomitantly. However, data about the prevalence of malaria- Schistosoma mansoni co-infection and their reciprocal parasitological, clinical and immunological effects are lacking.The aim of this study was to assess the reciprocal effects of malaria- Schistosoma mansoni co-infections with emphasis on parasitological, clinical and immunological interactions.A community based cross sectional study was conducted in Finchaa Sugar Estate, western Ethiopia. Blood samples were collected by finger pricking and thick and thin smears stained with Giemsa. Fresh stool samples were collected and processed by the Kato-Katz method. Haemoglobin level was determined using a portable spectrophotometer. Plasma was collected for cytokine assay and measurements of selected cytokines were performed using luminex IS 100 instrument. Schistosomal periportal and portal liver fibroses were determined by using the ultrasound assessment method. SPSS statistical software version 20 was used and Pvalue <0.05 was reported as statistically significant.The overall prevalence of parasite infections were: malaria (28.15%), Schistosoma mansoni (27.90%), malaria- Schistosoma mansoni co-infections (12.10%) and other intestinal helminths (11.85%).Among the total of 810 study participants, 452 (55.81%) harbored at least one parasitic infection and 358 (44.20%) had none of the investigated parasitic infections. Malaria parasite density increased with increasing infection intensity of S. mansoni and also S. mansoni parasite densities increased with increasing malaria parasite infection intensities. Malaria-Schistosoma mansoni co-infection was a significant factor for decrease in haemoglobin levels when compared with mono-infections.Malaria related anaemia was higher in children (6.22%) followed by adult women (4.42%) and adult men (3.27%), with a significant difference (P<0.05).Increased risk of anaemia was significantly associated with malaria (P=0.001), Schistosoma mansoni (P=0.002) and malaria- Schistosoma mansoni co-infection (P=0.000).Among the three groups of infections, the levels of IL-10 and IL-4 were higher in the co-infected individuals than in III the mono-infected.The overall prevalence of PPF was 17.71% and it was detected in 107 schistosomiasis mansoni patients of whom 54.21%, 42.06% and 3.74% had mild, moderate and severe PPF, respectively. PPF was associated with intensity of S. mansoni infection, being higher in individuals with moderate to heavy infection compared to those with light infections.The prevalence of PPF was higher in males than in females and as the age of infected individuals increased, PPF prevalence also increased.S.mansoni infection (P=0.000) and malaria- Schistosoma mansoni co-infection (P=0.002) were identified as significant risk factors for PPF among the study participants.Malaria-Schistosoma mansoni co-infected individuals with definite PPF had relatively higher levels of IL-10 and IL-4 when compared to co-infected individuals without PPF.In conclusion, the findings of this study showed that P. falciparum and S. mansoni co-infection reciprocally increase parasite densities, infection intensities, anaemia, anti-inflammatory cytokine (IL-10) and the degree of PPF.The study has provided an additional parasitological, clinical and immunological data on the adverse reciprocal effects of P. falciparum and S. mansoni co-infection , and could serve as a guide in designing, developing and implementing intervention strategies to mitigate comorbidity due to co-infection among the high risk groups, under the Ethiopian health services condition and other endemic areas in Africa. Key words: Anaemia, co-infections, co-morbidity, cytokine, Finchaa Sugar Estate, haemoglobin, periportal fibrosis, P.falciparum, P. vivax, Schistosoma mansoni, Ethiopia



Anaemia, co-infections, o-morbidity, cytokine, Finchaa Sugar Estate, haemoglobin, periportal fibrosis, P.falciparum,, P. vivax, Schistosoma mansoni, Ethiopia