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Wad Medani, Sudan

Hassan S.E.H.,Federal Ministry of Health | Haggaz A.E.D.,University of Geizera | Mohammed-Elhassan E.B.,Commission for Biotechnology and Genetic Engineering National Center for Research | Malik E.M.,Ministry of Health | Adam I.,University of Khartoum
Diagnostic Pathology | Year: 2011

Background: Accuracy of diagnosis is the core for malaria control. Although microscopy is the gold standard in malaria diagnosis, its reliability is largely dependent on user skill. We compared performance of Cyscope®fluorescence microscope with the Giemsa stained light microscopy for the diagnosis of malaria among pregnant women at Medani Hospital in Central Sudan. The area is characterized by unstable malaria transmission.Methods: Socio-demographic characteristics and obstetrics history were gathered using pre-tested questionnaires. Blood samples were collected from febrile pregnant women who were referred as malaria case following initial diagnosis by general microscopist.Results: During the study period 128 febrile pregnant women presented at the hospital. Among them, Plasmodium falciparum malaria was detected in 82 (64.1%) and 80 (62.5%) by the Giemsa-stained light microscopy and the Cyscope®fluorescence microscope, respectively. The sensitivity of the Cyscope®fluorescence microscope was 97.6% (95% CI: 92.2%-99.6%). Out of 46 which were negative by Giemsa-stained light microscopy, 5 were positive by the Cyscope®fluorescence microscope. This is translated in specificity of 89.1% (95% CI: 77.5%-95.9%). The positive and negative predictive value of Cyscope®fluorescence microscope was 94.1% (95% CI: 87.4% -97.8%) and 95.3% (95% CI: 85.4% - 99.2%), respectively.Conclusion: This study has shown that Cyscope®fluorescence microscope is a reliable diagnostic, sensitive and specific in diagnosing P. falciparum malaria among pregnant women in this setting. Further studies are needed to determine effectiveness in diagnosing other Plasmodium species and to compare it with other diagnostic tools e.g. rapid diagnostic tests and PCR. © 2011 Hassan et al; licensee BioMed Central Ltd.

Elhassan E.M.,University of Geizera | Haggaz A.E.D.,University of Geizera | Magzoub M.M.,Kassala University | Adam I.,University of Khartoum
Asian Pacific Journal of Tropical Medicine | Year: 2010

Objective: To investigate the accuracy of malaria diagnosis among pregnant women admitted in Medani Maternity Hospital, Central Sudan during June-October 2009 and to investigate the antimalarials prescribed in this setting. Methods: Socio-demographic characteristics and obstetrics history were gathered using pre-tested questionnaires. The finger prick blood samples were collected from pregnant women who admitted as malaria case after an initial microscopic test done by general microscopists for malaria diagnosis. The antimalarial treatment prescribed by treating doctor was inquired for. Results: Only 21 (8.6%) out of 243 pregnant women admitted as malaria case after an initial microscopic test done by general microscopists for malaria were found to have blood film positive. There was no significant difference in the specificity of the microscopy accuracy between those who have been investigated in the private and governmental sector, 15/193 (8.2%) vs. 6/60(10%), (P >0.05). Quinine infusion was the prescribed drug in this setting. Conclusions: There is a very poor specificity of malaria microscopy in pregnant women admitted to Madani Maternity Hospital. Quinine was the drug received. Malaria control programme should interfere urgently to change this situation. © 2010.

Haggaz A.D.,University of Geizera | Elbashir L.M.,University of Khartoum | Adam G.K.,University of Gadarif | Rayis D.A.,University of Khartoum | Adam I.,University of Khartoum
Malaria Journal | Year: 2014

Background: Microscopic examination using Giemsa-stained thick blood films remains the reference standard for detection of malaria parasites and it is the only method that is widely and practically available for quantifying malaria parasite density. There are few published data (there was no study during pregnancy) investigating the parasite density (ratio of counted parasites within a given number of microscopic fields against counted white blood cells (WBCs) using actual number of WBCs. Methods. Parasitaemia was estimated using assumed WBCs (8,000), which was compared to parasitaemia calculated based on each woman's WBCs in 98 pregnant women with uncomplicated Plasmodium falciparum malaria at Medani Maternity Hospital, Central Sudan. Results: The geometric mean (SD) of the parasite count was 12,014.6 (9,766.5) and 7,870.8 (19,168.8) ring trophozoites /μl, P <0.001 using the actual and assumed (8,000) WBC count, respectively. The median (range) of the ratio between the two parasitaemias (using assumed/actual WBCs) was 1.5 (0.6-5), i e, parasitaemia calculated assuming WBCs equal to median (range) 1.5 (0.6-5) times higher than parasitaemia calculated using actual WBCs. There were 52 out of 98 patients (53%) with ratio between 0.5 and 1.5. For 21 patients (21%) this ratio was higher than 2, and for five patients (5%) it was higher than 3. Conclusion: The estimated parasite density using actual WBC counts was significantly lower than the parasite density estimated using assumed WBC counts. Therefore, it is recommended to use the patient's actual WBC count in the estimation of the parasite density. © 2014 Haggaz et al.; licensee BioMed Central Ltd.

Ali A.A.,Kassala University | Elhassan E.M.,University of Geizera | Magzoub M.M.,Kassala University | Elbashir M.I.,University of Khartoum | Adam I.,University of Khartoum
Parasites and Vectors | Year: 2011

Background: Pregnant women are more susceptible to severe Plasmodium falciparum malaria, which can lead to poor maternal and fetal outcomes. Few data exist on the epidemiology of severe P. falciparum malaria in pregnant women. A hospital-based study was carried out to assess the pattern of severe P. falciparum malaria among pregnant women at the Kassala and Medani maternity hospitals, which are located in areas of unstable malaria transmission, in eastern and central Sudan, respectively. Pre-tested questionnaires were used to gather socio-demographic, clinical and obstetrical data. Suitable tests were performed for clinical and biochemical investigations. Results: Among 222 pregnant women diagnosed with malaria at the two hospitals, 40 (18.0%) women at mean (SD) gestational age of 29.3 (6.7) weeks fulfilled one or more of the WHO criteria for severe P. falciparum malaria. These were hypoglycaemia (14; 35.5%), severe anaemia (12; 30%), hypotension (10; 25%), jaundice (9; 22.5%), cerebral malaria (6; 15%), repeated convulsions (4; 10%), hyperparasitaemia (4; 10.0%) and more than one manifestation (9; 22.5%). While the mean (SD) presenting temperature was significantly lower for women presenting with hypoglycaemia [38.2(0.6) versus 38.8(0.7) °C, P = 0.04], other clinical and biochemical characteristics were not significantly different among women with different manifestations of severe P. falciparum malaria. Conclusion: Preventive measures for pregnant women such as insecticide-treated bednets and chemoprophylaxis may be beneficial in areas of unstable malaria transmission. Early detection and prompt treatment of severe malaria, especially in pregnant women with hypoglycaemia, are needed. © 2011 Ali et al; licensee BioMed Central Ltd.

Bushra M.,University of Khartoum | Elhassan E.M.,University of Geizera | Bakheit K.H.,University of Khartoum | Adam I.I.,University of Khartoum
Biological Trace Element Research | Year: 2010

Anaemia is a widespread problem in many parts of the world especially in tropic areas. Among pregnant women, it has negative consequences on maternal and perinatal outcomes. A cross-sectional study was conducted to investigate the prevalence of anaemia, iron, zinc and copper deficiencies among pregnant women in Wad Medani hospital, central Sudan and to examine the relationship of these micronutrients with haemoglobin (Hb) levels. One hundred four (52.5%) out of 200 pregnant women had anaemia (Hb < 11 gm/dl) and 3 (1.5) % had severe anaemia (Hb < 7 gm/dl). Iron deficiency (S-ferritin < 15 μg/l), iron deficiency anaemia (<11 gm/dl and S-ferritin < 15 μg/l) were prevalent in 25 (12.5%) and 13 (6.5%) of these women, respectively. Ninety (45.0%) and eight (4.0%) of these women had zinc (<80 μg/ml) and copper (<80 μg/ml) deficiency, respectively. In 24 (12.0%) of these women, there were ≥2 deficiencies of these elements. S-copper was significantly lower in patients with anaemia. While age, parity, gestational age, ferritin, zinc and copper were not predictors for anaemia, women who practiced pica were at higher risk for anaemia (OR = 3.4, 95% CI = 1.4-7.9, P = 0.004). Gestational age was significantly inversely correlated with haemoglobin (r = 0.161, P = 0.03), S-ferritin (r = 0.285, P = 0.001) and S-zinc (r = 0.166, P = 0.02). Thus, dietary and supplement interventions are required to prevent and control anaemia in this setting. Further research is needed. © 2009 Springer Science+Business Media, LLC.

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