Assessment of Body Mass (Weight Loss/Gain) in a 14 Day Clinical and Parasitological Responses to Supervised Antimalarial Drug Combination Therapies in Abakaliki, Ebonyi State

alaria is a disease due to blood infection caused by Protozoa parasites of the genus Plasmodium (P.) which is transmitted through the bite of infected female Anopheles mosquito (Ani et al., 2015). The global incidence of malaria was estimated to be nearly 120 million clinical cases each year with nearly 300 million carrying the parasite (WHO, 2014). As presence of the parasite in the body builds up to the asexual erythrocyte Schizontal stage, the accompanying increase in body temperature induces urinary excretion of nitrogen increases predisposing to negative nitrogen balance (Vaughan et al., 2017). The result of this increased synthesis and catabolism of proteins is the loss of body tissue which becomes apparent when infections are severe and prolonged hence affecting the body mass (Najm et al., 2012). This further compromises host integrity by enhancing susceptibility to other infective pathogens, thus, deteriorates nutritional status due to increasing metabolic stress.


INTRODUCTION
alaria is a disease due to blood infection caused by Protozoa parasites of the genus Plasmodium (P.) which is transmitted through the bite of infected female Anopheles mosquito (Ani et al., 2015). The global incidence of malaria was estimated to be nearly 120 million clinical cases each year with nearly 300 million carrying the parasite (WHO, 2014). As presence of the parasite in the body builds up to the asexual erythrocyte Schizontal stage, the accompanying increase in body temperature induces urinary excretion of nitrogen increases predisposing to negative nitrogen balance (Vaughan et al., 2017). The result of this increased synthesis and catabolism of proteins is the loss of body tissue which becomes apparent when infections are severe and prolonged hence affecting the body mass (Najm et al., 2012). This further compromises host integrity by enhancing susceptibility to other infective pathogens, thus, deteriorates nutritional status due to increasing metabolic stress.
The increased risk of malaria parasitaemia in pregnant women and especially in primagravidae in areas of high malaria endemicity, compared with that of non-pregnant women was well described by Michael et al. (2013) and Peter et al. (2013).
According to Chukwuocha et al. (2012), maternal anaemia may also have a direct effect on placental functions, causing low birth weight (LBW). The birth weight deficits in association with placental malaria are also influenced M ABSTRACT Malaria has considerable potential for adversely influencing host nutrition. It can restrict food intake through anorexia while causing vomiting or diarrhea, it may interfere with the absorption of ingested food. This survey was however conducted to ascertain the impact of the Plasmodium falciparum malaria attack on the weight potentials of the sufferers treated with Diaminopyrimidines (Pyrimethamine) and Sulphonamides (Sulfadoxine) Out of 243 patients studied in Abakaliki, the age groups 10-19 (48.6%), 20-29 (30.0%), 30-39 (12.8%), 40-49 (5.8%), and 50-59 (2.9%) showed average weight loss/gain of ± 1.4, ±0.3, ± 0.6, and± 0.2 respectively for both males, and females. The corresponding weight loss/gain between D0-D7 showed 10 ≤ 20: D0-D2 ( . by parity being most marked in first-born children and also placental malaria is also associated with the birth of infants weighing less than 2.5kg (WHO, 2015).
Nonetheless, how placental malaria depresses infant birth weight is not fully understood. It may retard foetal nutrition by adversely influencing maternal nutrition or by diminishing the physiological efficiency of the placenta, thus causing the birth of a full term but underweight child. Alternatively, it may induce early labour and expulsion of the foetus before the latter has gained its optimal birth weight. Baby Center (2016), noted in West Africa skin fold thickness and weight for height to be lower in parturient women in association with placental infections and considered these differences indicative that malaria adversely influence nutrition thus affecting the general body mass of the sufferer. To this end, this study was undertaken to ascertain the effect of the malaria parasite infection on the body weight of the sufferers within fourteen days clinical and parasitological responses to supervised malaria treatment.

MATERIALS AND METHODS
The assessment methodology of this investigation was based on the fourteen (14) day clinical and parasitological response to supervised malaria treatment as structured by WHO (1990) and modified in 1991 by Centre for Disease Control (CDC). Standard treatment of potency tested Pyrimethamine and Sulphonamide drugs formulation (Fansidar and Maloxine) per kg of body weight were administered orally on day zero ("DO") blood films, body mass and over all clinical evaluation were conducted as shown below:

Blood Sample Collection
Venous blood was collected by venepuncture from randomly selected patients at the then Federal Medical Centre Abakaliki, Ebonyi state. Three milliliters (3ml) of blood was collected from each randomly selected patient and was dispensed into an Ethylene Diamine Tetra-acetic Acid (EDTA) bottle, gently and properly mixed and transported to the Haematology section of the hospital's laboratory.

Laboratory Analysis
Thick blood films were prepared, stained and examined following the method described by Cheessbrough (2005). Thick films were made and labeled on a clean glass slide as recommended by the World Health Organization (WHO) for Plasmodium falciparum species detection. The thick smears were then stained with 10% Giemsa stain for 10 minutes and then observed microscopically using oil immersion objective (Cheesbrough, 2005).

The two choice of drugs formulation for the study viz
Fansidar and Maloxine were administered orally, three tablets as a dose treatment as recommended by the manufacturer. The drugs were only given when the patient tested positive to malaria infections, while malaria negative persons were excluded from the study.

Evaluation
To successfully evaluate adverse drugs effects associated with drug therapy the following considerations were on each encounter with the patient: 3.4.1 Vomit: patients were observed at least 30 minutes after each treatment. At least each subsequent visit, the patient was asked whether he/she has vomited since the last visit? If the drugs was vomited or spit out, the estimated lost portion of the dose was readministered when vomiting tendency continued in some patients, they were excluded from the study.

3.4.2
Pruritus: pruritus for the purpose of the study was itching which occurs after the administration of the antimalarial drugs under study and which was not attributed to another medical condition or were evaluated and decisions made on whether to continue with drugs under study and possible anti-histamine to apply. Anti-histamine drugs of choice for the study were piriton and phenergen (promethazine).

3.4.3
Diarrhoea: Diarrhoea for the purpose of the study was defined as passage of more than three unformed stools in 24 hours period. The patients were asked at each day of activity about the occurrence of this condition during the previous 48 hours.

3.5
Activity and follow up Analysis.
The Assessment protocol of the research was based on the 14 day clinical and parasitological responses to supervised therapies as was developed by WHO (5,6) in 1990 modified by CDC (7,8) in 1991.

RESULTS AND DISCUSSION
In the maloxine treated patients (Table 4), "D2-D0" weight loss gave 0.6kg to 1.0kg difference as against weight gain of "D14-D7" which gave 0.3kg to 2.6kg. These findings agree with that of Chukwuocha et al (2012), Michael et al (2013), Brabin andPiper (1997), WHO, (2015) and Baby Centre (2016), where their respective findings concurred to the fact that malaria infection induces weight loss in patients which is regained as parasites cleared from the blood stream followed by nutritional sufficiency.