Malaria and Typhoid Fever Infection Rates in Pregnant Women

Malaria and Typhoid Fever Infection Rates in Pregnant Women Plasmodium falciparum and Salmonella typhiCo- infection Among Pregnant Women in Abakaliki, Ebonyi State Nigeria. Okonkwo, E. C., Nwele, D. E., Nworie, O., Agumah, N. B., Orji, J. O.and1Nwuzo, A. C.   Abstract Malaria and typhoid fever are both endemic in the tropics and pregnant women constitute one of the high risk groups. This study was carried out to determine the rate of malaria-typhoid co-infection in pregnant women attending antenatal clinics in Federal Teaching Hospital, Abakaliki, Ebonyi State Nigeria. About120 volunteer pregnant women were recruited during routine antenatal. Malaria infection was determined by qualitative immunodiagnostic assay and confirmed by microscopic examination of thick and thin giemsa stained slides.Typhoid infection was determined by Widalagglutination method and confirmed by stool culture. Out of 120 pregnant women studied, 49 (40.8%) were positive for malaria parasite and equally had significant titre of salmonella antibiotics. Of the 120 stool samples cultured 29 (24.2%) were positive for salmonella. Thus, the overall rate of malaria-typhoid co-infection was 12.5% by both Widalagglutination and stool culture methods. The co-infection of malaria and ty phoid in pregnancy has a profound effect on adverse pregnancy outcome. Weadvocate for routine screening and treatment of infected pregnant women. Keywords: Co-infection, Malaria and Typhoid, Pregnant Women, Ebony State, Nigeria INTRODUCTION Malaria and typhoid fever (caused by plasmodium falciparum and salmonellaspp respectively) are both diseases of public health importance which are endemic in both tropical and subtropical countries including Nigeria. The association between typhoid and malaria was first described in medical literature in the middle of the 19th century by the United States Army and was erroneously called â€Å"typho-malaria fever† (Smith, 2002). Recent studies in Africa seem to corroborate the relationship between malaria and typhoid fever (Ammahetal., 2009). It is noteworthy that the socio-economic and environmental condition that tend to sustain high prevalence of malaria in endemic areas also favour the transmission of salmonellatyphi, the causative agent of typhoid fever. (Prasannaetal., 2011) The World Health organization has estimated that in 1995, 219 million cases of malaria were documented with about 1.2 million deaths (Brabin 1983). Malaria infection often presents with head ache, fever, shivering, arthralgia (joint pain), vomiting, hemolytic anaemia, jaundice, hemoglobinuria and retinal damage (Brabin, 1983; Gills etal., 1999). Complications of malaria involve respiratory distress, which occurs in up to 25% of adults and 40% of children. Acute Respiratory Distress Syndrome (ARDS) may develop in 5-25% in adults and up to 29% of pregnant women, although it is rare in young children (Isibor, et. al., 2011). Pregnant women are especially vulnerable to malaria infection. In Sub-Sahara Africa, maternal malaria is associated with up to 200,000 estimated infant deaths yearly (Isiboretal., 2011). Typhoid fever is considered a particular risk in pregnancy because of reduced peristaltic activity in the gastro-intestinal and biliary tracts and increased prevalence of biliary â€Å"sludge† (Bashyametal., 2007). Materials and method Area The study was carried out at the antenatal clinic, Federal Teaching Hospital, Abakaliki, Ebonyi State. Study population The study involved pregnant women who had fever by the time of their visit to the hospital. Sample collection Intravenous blood sample (5ml) was collected from each participant. The samples were stored in refrigerator after collection and were processed within six hours. Stool samples were also collected from participants using sterile universal containers. Determination of malaria infection This was carried out using antigen Rapid Test Device method as well as Giemsa stained thick and thin blood smear for microscopic detection of P. Falciparum. Both procedures were carried out as described by Cheesbrough, (2002). Widal test Widal agglutination test was performed on all malaria positive blood samples using commercial antigen suspension and the procedure was as described by the manufacturer. Also stool culture was done to further confirm S. Typhi. 10ml of selenite- F broth was added to 3g of the stool sample and mixed vigorously, and then incubated at 37oc for 24hours. Thereafter, a loopful of the sample was inoculated onto salmonella-stigella agar medium and incubated at 370c for 24 hours to get discreet colonies (Lactose fermenters were confirmed by pink colonies on SSA). The colonies were Gram stained and further subjected to biochemical analysis. Results Out of the 120 pregnant women at their different stages of pregnancy that participated in this present study, 49 (40.9%) were positive for malaria, while 29(24.2) tested positive for S. typhi. Malaria infection was highest during the first trimester (16.7%) while S. typhi was more prevalent during the third trimester. The overall malaria and typhoid fever co-infection showed a prevalence of 12.5% (see table 1). Table 1: prevalence of P. falciparum and S. typhi among women in different stages of pregnancy Stages of pregnancy N0 examined P. falciparum S. typhi Co-infection 1st trimester 40 20(16.7%) 8(6.7%) 5(4.2%) 2nd trimester 30 11(9.2%) 6(5%) 4(3.3%) 3rd trimester 50 18(15%) 15(12.5%) 6(5%) Total 120 49(40.9%) 29(24.2%) 15(12.5%) Table 2 and 3 below shows the comparative methods employed during this study. Both RDT and Microscopy methods were considered desirable as they gave positive result P. falciparumat all stages. Similarly, both widal test and culture methods gave confirmatory positive results for S. typhi. Table 2 comparative test for malaria using rapid diagnostic test and microscopy. Stage of pregnancy RDT (%) Microscopy (%) Number examined 1st 20(16.7) 20(16.7) 40 2nd 11(9.2) 11(9.2) 30 3rd 18(15) 18(15) 50 Total 49(40.9) 49(40.9) 120 Table 3 comparative Test for S. typhi by the widal and culture methods stages of pregnancy Widal (%) Stool culture (%) Number examined 1st 8(6.7) 8(6.7) 40 2nd 6(5) 6(5) 30 3rd 15(12.5) 15(12.5) 50 Total 29(24.2) 29(24.2) 120 Discussion Malaria and its co-infection with typhoid fever is a major public health problem in pregnant women in Nigeria. The malaria prevalence rate of 40.9% observed in the present study suggests high endemicity and transmission of malaria parasite. The high prevalence suggests increased susceptibility of pregnant women to malaria infection often due to induced immunosuppression (Ndukaetal., 206). The high prevalence could also be attributed to lack of adequate preventive measures being adopted by the pregnant women. Pregnant women in their first trimester were more infected with malaria as recorded in this study and this was in line with the earlier findings of Ukibeetal., (2008). This could attributedto the absence of medical facility or the inability of the pregnant women to register for antenatal on time. The prevalence of malaria-typhoid co-infection among the pregnant women attending antenatal clinic in this study was 12.5%. This is comparable to previous reports (Akinyemietal., 2007; Prasanna, 2011). The observed prevalence suggests that typhoid fever is a common co-infection in malaria infected women in this part of the country. The reduction of cellular and humoral immunity which occurs in pregnancy renders pregnant women susceptible to other infections including typhoid fever (Scholarpurka, etal., 2000). Malaria infected pregnant women are said to be more prone to typhoid fever because of the increased heamolysis in malaria which is said to increase the availability of iron in the tissue especially the liver and salmonella species are believed to thrive more in iron rich tissues (Kaye and Hook, 2003). It is pertinent to note that both typhoid and malaria in pregnant women present with management problems since most drugs used in the treatment of both diseases are contra-indicate d in pregnancy. Also both diseases have been associated with pregnancy outcomes such as premature deliveries, spontaneous abortions, low birth weight and intra-uterine foetal deaths (Nasemetal., 2008). The transmission of P. falciparium and S. Typhi is affected by environmental factors such as poor environmental sanitation, poor housing and inadequate safe water supply. This could be reason for the high prevalence since majority of the pregnant women were rural dwellers. Te use of insecticide treated net, safe water supply and personal hygiene as well as early registration for antenatal clinic of pregnant women are advocated. Reference Akinyemi,K.O, Bamiro, B.S and Coker, H,O (2007). Salmonellosis in Lagos, Nigeria. Incidence of Plasmodium falciparum malaria associated co- infection, patterns of antimicrobial resistance and emergence of induced susceptibility to fluoroquinolines. Journalof Health Popul Nuttri, 25: 351-358. Bashyam, H. (2007).Surviving malaria, dying of typhoid.J.Exp Med.204 (12): 2774. Brabin, B. J. (1983). An analysis of malaria in pregnancy in Africa.Bull WHO, 61:1005-1016. Cheesbrough, M. (2002). District Laboratory practice in tropical countries. Part1. Cambridge press, London.Pp.211-214. Gills, H. M., Lawson, J. B., Silbelos, M., Voller, A.And Allan, N. (1999).Malaria, anaemia, and pregnancy.Ann.Tropparasitolol. 63: 245-263. Isibor, J. O., Igun, E., Okodua, M., Akhite, A. O. and Isibor, E. (2011).Co-infection with malaria parasite and salmonella typhi in patients in Benin City, Nigeria.Ann Biol Res. 2(2): 361-365. Kaye, D. and Hook, E.W. (2003).The influence of heamolysis or blood loss on susceptibility to infection.Journal of immunology. 91: 65-75. Khan, M. A., Mekan, S. F., Abbas, Z.And Smego, R. A. (2005).Concurrent malaria and enteric fever in Pakistan.Singapore. Med J. 46: 625-628. Nasem, S. Anwar, S.and Ihsanullah, M. (2008). Outcome and complications of malaria in pregnancy.Gomal J med Sci; 6(2): 98-101. Nduka, F.O.,Egbu, A., Okafor, C. and Naogo, V.O. (2006).Prevalence of malaria parasite.Inter J trop Med. pub Health. 2(1): 1-11. Prasanna, P. (2011). Co-infection of typhoid and malaria.J Med. Lab Diag. 2 (3) 22 -26. Scholarpurka, S. C., Mahajar, R.C., Gupta, A.N. and Wangoo, A. (2000).Cellular immunity in pregnant and non-pregnant women with malaria infection.Asia Oceania J ObseGyncol. 16: 27-32. Smith, D.C. (2002). The rise and fall of typhomalaria fever.J Hist Med Allied sci. 37:182-220. Ukibe, S.N., Mbanugo, J.J. and Ukibe, N.R. (2008). Prevalence of malaria and increasing spleen rate in children aged 0-13 years in Awka South Local Government area of Anambra state, Nigeria J Environ Health, 5(2): 64-69.

Beowulf’s Confidence Essay

Beowulf was written in the earliest age of English poetry. Back in the Anglo-Saxon times, in order to make a name for themselves, warriors had to fight in battles. They believe that you should fight until death with absolutely no retreating. Beowulf, a young Geatish warrior, comes to Hrothgar’s kingdom to return a favor to him. While Beowulf is there, he fights in two battles; the battle with Grendel and the battle with Grendel’s mother. Much later in the poem, he fights in his third battle, defeating the dragon harming his country. Beowulf’s confidence decreases as each battle occurs. In Beowulf’s battle with Grendel, Beowulf is extremely confident. This confidence is very apparent in his attitude. When he first comes to Hrothgar’s court, he tells him that he had â€Å"firm resolve when [he] set to sea† (Beowulf 22). This confidence is also apparent in Beowulf’s preparation. He chooses to abandon his armor and weapons in the fight. He very dramatically â€Å"[strips] from his shoulders the byrny of steel, / [doffs] helmet from head† (23). Beowulf has a huge advantage on Grendel because he is very strong. He is so strong that the people of his country say that his handgrip is equivalent to that of â€Å"thirty men’s strength† (15). Beowulf’s confidence is extremely evident as he prepares to fight Grendel. Beowulf prepares differently in the fight with Grendel’s mother because he is not as confident as he was in the first battle. Beowulf’s attitude while talking to Hrothgar is less confident due to the fact he is not sure of how the battle will end. He has Hrothgar pledge to â€Å"Protect [his] kinsmen, [his] trusty comrades, / If battle take [him]† (48). Beowulf also shows his confidence lessening by deciding to use armor and weapons in the battle. To prepare for the battle, he â€Å"[dons] his armor† (47) with â€Å"A gleaming helmet† (47) and â€Å"the sword the herald of Hrothgar loaned† (47). Beowulf is still somewhat strong compared to his last battle. When Grendel’s mother â€Å"[grapples] and [grasps] the warrior / With horror grip† (48, 49) and tries to â€Å"tear through the tempered mail / With her savage fingers† (49), she cannot harm him. Beowulf’s confidence is not as apparent in the second battle with Grendel’s mother. Beowulf’s confidence continues to decrease as the battle with the dragon occurs. Beowulf’s attitude was extremely negative. His heart â€Å"[is] heavy with anguish† (75). Beowulf’s confidence level is so low that he has special armor prepared for him. The king â€Å"bade work him of iron a wondrous shield, / Knowing full well that wood could not serve him / Nor linden defend him† (75) against the dragon. Beowulf’s strength has drastically changed since the beginning of the first battle. Rather than having the grip of â€Å"thirty men’s strength† (15), Beowulf â€Å"[trusts] the strength / Of his single might† (82). Beowulf shows little to no confidence in the battle with the dragon. Beowulf’s confidence lessens as each battle approaches. He goes from being a great, bold warrior with much confidence, to an old, fragile king with very little confidence. Beowulf comes to a point of weakness where he can no longer defend for himself and needs help from fellow warriors, like Wiglef. His confidence adjusted so extremely that he goes into the last battle expecting a not so good outcome. At the end of the battle with the dragon, Beowulf passes away, with his weakness and little confidence being a huge factor.

Literature and It’s Relevance in Modern Times Essay

Before the importance of literature is discussed we must ask ourselves: â€Å"What is literature?† Many individuals that are asked that question will often give a complex answer for it seems to be a complex word. Some of the answers may include â€Å"it involves reading† or â€Å"it’s when you write†. These are both true, but when you actually think about it, literature is so much more than that, especially with how often we use it in our day-to-day lives; we speak it, we observe it, we use it in science, etc. Ever since the beginning of time, literature has always been present among men. It has been useful to depict their feelings, thoughts, desires, tragedies, and history. Before the technological advancements and benefits that we use today for entertainment or learning existed, learning was in one way or another completely tied in with literature. As time progressed, mankind eventually found other ways to display their feelings, ideals or thoughts without the use of literature, but that doesn’t mean it’s still not important. The best overall way to describe literature today is that it is lost in transition with the rise of technology and other forms of popular entertainment. Literature is just as important as it always has been; it’s just not as popular and as it once was. It should still be a top priority for society, considering the first things we learn in school are how to read and write. In old times, when a child started attending school, the first things they learned were how to read and count. Nowadays, that hasn’t seemed to change; methods might be different, but literature makes its presence known to us even when we are young and is a great asset to developing other skills needed to be successful later in life. In a recent study undertaken by Literary Research and Instruction, the observed second-grade teacher Mae Graham used â€Å"class readings to foster engagement and student-initiated talk with open discussions†¦.emphasizing the power of dialogue in providing a space for students to meaningfully use language.† (Worthy 308). Literature is just as important and meaningful in our lives from the very first time we begin to use it. From the days of elementary school to college, there is reading and writing involved. Even if one doesn’t realize it, literature is present almost everywhere, but it’s just hiding in plain sight. It can be located in items such as digital environments, films, graphic novels, and comic books. Movie and the famous lines within them are derived from literature, comic books and graphic novels may have pictures, but there are words to go along with the plot, and even when you use take a photo, pictures can be worth a thousand words. Any individual that believes they don’t experience enough literature in their lives needs to realize that books and essays are not its only limitations. When you attend a play, such as Hamlet, you are experiencing literature. If you read a Batman comic book, you’re taking in literature. If you go to the theatres and watch a Harry Potter movie, literature is related to the film at hand. If you take a picture of a typical downtown setting, literature is helping tell the story from what the viewer’s eyes can see. Literature does exist everywhere, but it doesn’t influence individuals as much as it did in the past. In order to understand how important literature is in modern times, we must also understand how it has taken a huge drop in terms of daily importance. Before TV, internet, video games, and other advancements in society were developed, the only forms of entertainment were as such, but not limited to; storytelling, reading, and plays. Many of them were mainly told, written, or performed to so that the audience could use their imagination and let it run wild to interpret the meaning. In modern society, if one doesn’t understand the story, play or text at all, they just look up the answer on the internet. There isn’t anything wrong with this strategy, but over time, one eventually becomes dependent on the â€Å"newer† resources over the oldest and most genuine resource; the brain. Literature is present in films, especially the ones made after novels and book but nowadays, it’s easier and more fun to watch the film rather than to read the book. If you were to ask someone if they would prefer to watch the film â€Å"Troy† starring Brad Pitt as Achilles or reading Homer’s â€Å"The Iliad†, nine times out of ten they will respond with the movie instantly. Not because they prefer movies over reading, but in actuality the movie just seems more entertaining and the movie requires less strain on the brain. Back then, the epic surrounding this tale was read and analyzed by individuals all over the world for were very entertained by it. Today, all someone has to do is just look at Sparknotes or Cliff-notes to trick themselves into thinking they truly understand the story or the message the author is trying to convey. By using these sources, you are not making your own opinion what the story means, but rather just borrowing it from someone who actually analyzed the story in-depth. With the way things are going, literature will soon be a thing of the past and irrelevant to the future. All that will matter is if someone has internet handy to look up a theme or analyze a plot that they can’t muster their brain to figure out. So why does literature still matter? Well it is very important in the sense of not being able to grasp it while at a very young age will result in irrelevance to an individual in later life. Recent research in England suggested that little explicit attention has been paid, either in research or policy documentation, to why literature still has a clear role to play in English education. In the study, teachers themselves were looked at along with their reading habits to see if that had any reflection on how the students were grasping literature and reading. Students that were interviewed on the matter at hand said they have reasons for reading in the first place such as entertaining themselves, to imagine, feel and reflect (Cliff Hodges 60, 67). The mind is so fresh at a very young age and it is very hungry for knowledge. If we feed the right materials to the young throughout the world, they will have so many opportunities ahead of them to succeed. By denying the young individual the chance to use their thought to interpret or imagine what is occurring as they read will only limit the extent of their abilities as they go on with their lives. Many may think that technology and the newer styles of teaching are â€Å"easier† for the youth, but in actuality, we are going to make it harder for them later in life. Anglo-Indian novelist Salman Rushdie once said â€Å"Literature is where I go to explore the highest and lowest places in human society and in the human spirit, where I hope to find not absolute truth but the truth of the tale, of the imagination and of the heart.†(Introduction to World Literature). Without literature, there would be no imagination or heart to what we do in our daily lives. Literature has been present since the beginning of time, and although it is being driven out by the new advancements in technology, we must do our best to preserve the older traditions that help make us better at thinking and understanding. Literature is all around us in our everyday lives, and even though we sometimes can’t see it, it is involved either directly or indirectly with what we do. It is still very important, particularly in the education field. Teaching young individuals to read and write is the biggest part of the foundation being laid out for the house of their future. Math and science might be at top priority right now in the learning environment, but even math and science involve writing and reading. Literature is still important, with its only downside being its decline in popularity. Sources Cliff Hodges, Gabrielle. â€Å"Reasons for Reading: Why Literature Matters.† Literacy: UKLA. 44.2 (2012): 60,67. EBSCO:Host. Web. 3 Feb. 2013 http://web.ebscohost.com.libezproxy.tamu.edu:2048/ehost/pdfviewer/pdfviewer?sid=8211ba49-180a-4590-9183-1f76a451f34b@sessionmgr11&vid=12&hid=25>. â€Å"Introduction to World Literature.† Invitation to World Literature. Annenberg Foundation, n.d. Web. 2 Feb 2013. . Worthy, Jo, Katharine Chamberlain, et al. â€Å"The Importance of Read-Aloud and Dialogue in an Era of Narrowed Curriculum: An Examination of Literature Discussions in a Second-Grade Classroom.† Literacy Research and Instruction. (2012): 308-310. EBSCO:Host. Web. 2 Feb. 2013. http://web.ebscohost.com.libezproxy.tamu.edu:2048/ehost/detail?vid=9&sid=8211ba49-180a459091831f76a451f34b%40sessionmgr11&hid=25&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d

The Importance Of The Civil War - Free Essay Example

Sample details Pages: 2 Words: 723 Downloads: 7 Date added: 2019/05/18 Category History Essay Level High school Tags: Civil War Essay War Essay Did you like this example? The Civil War is one of the most crucial events that shaped the course of American history, and its outcome had a significant impact on the development of the country that is today the United States of America as we know it. We could have been a divided nation where slavery would have still been something we encountered in our everyday lives. The importance of the Civil War cannot be stressed enough the victims and losses suffered due to the War will have meaning only if we acknowledge that our freedom and social justice today has a lot to do with the events that occurred during the War.. Don’t waste time! Our writers will create an original "The Importance Of The Civil War" essay for you Create order The conflict between the North and South called the Civil War started because of the many social, economic and political differences between the two separated regions. Both North and South agreed upon the fact that slavery was the immediate cause of the war, although many other aspects may be considered as relevant in the matter. The North and the South were otherwise differentiated as the Union and the Confederates. In 1793 the cotton gin was invented a machine used to remove seeds from cotton. This sped up the entire production process, resulting in a higher demand for workforce, which at that time mainly consisted of slaves. It is estimated that roughly four million slaves lived and worked in the Southern economy. About two million of them worked in the cotton fields while the rest worked in homes, on construction sites, mines, as lumberjacks, or in transportation. While the South had an agriculturally oriented economy, the North was rather industrial. Compared to the South, they had five times the factories and generally a bigger population, more than double the South population. Immigrant workers were also common, which only strengthened their economy society evolved in the North as people of different cultures and classes were used to working together as equals. Conflicts in the South between the individual states kept them from being truly unified and standing strong against their oppone nt. An industrial economy is also much more stable than an agricultural one, since it does not depend on its environment. This was also an important factor leading to the win of the North. This also implies that the North was much faster and more effective in producing the goods, including firearms, needed to win a war. Even in an agricultural sense, taking advantage of mechanisation led up to better production in the North, which shows the obvious ressource superiority. After the Siege of Vicksburg, Mississippi in 1863, the North gained control of the entire Mississippi river, which weakened the South even further. Since New Orleans was already defeated, any import or export to the South was difficult. Since the production was already bad, this could already be considered as the definite beginning of the end for the South. Another significant loss was at the Battle of Gettysburg during that same year that gave even more advantage to the North.Not long after Atlanta was captured the main railroad center of the South transportation was next to impossible, bringing the victory even closer to the Union. Politically, a relevant event that actually took place during the war itself were the elections between Abraham Lincoln and George McClellan Lincoln won, since he had a much stronger opinion on the war (wanting to end it), unlike his opponent. One can consider this win as the crown of the Norths triumph. Lincoln proposed the Emancipation Proclamation in order to legalize black men joining the the army and navy on the Union side, which prevented Great Britain joining the Confederacy. Looking back, it seems very obvious that the North had deciding advantages. This was nevertheless a result of many decisions and interactions between the two sides today we mostly look at the Union as ?the good guys since the results of the Civil War brought equality, justice, and freedom to the people. This would probably be a completely different story if the South had won the Civil War. Still, it is our duty to pay our respects to all the men who died for this cause and to always make sure we are looking at history objectively, trying to get the most out of the many difficult losses we suffer, regardless of which side suffered them.