Liver injury in malaria infected patients in Douala-Cameroon and its association with poor medical practice

Abstract

Malaria is an endemic mosquito-borne disease in sub-Saharan regions, including Cameroon. Due to the obligatory hepatic stage of its pathogenic agents, malaria can induce liver damage if not properly treated. Hence, we assessed the impact of malaria infection on liver transaminases among febrile patients consulting at the Deido District Hospital, Douala-Cameroon, in regard to their attitude towards the practice of preventive measures, treatment, and management of malaria. Over 10 weeks, 150 febrile patients and 28 healthy individuals serving as the control group were enrolled and their blood samples screened for Plasmodium species by Giemsa Staining and liver injury evaluated by measuring the serum level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities. The socio-demographic characteristics of participants and their attitude towards the practice of preventive measures, treatment, and management of malaria were collected using a structured- questionnaire. Among tested febrile patients, 113 (75%) were malaria-positive. Females were more affected (65.5%) than males; the most affected age group were adults between 30-60 years (55.8%). A significant association (p˂0.05; relative risk [RR] = 1.424 or p˂0.05; RR = 1.947) was found between malaria infection and non-use of mosquito nets or insecticides, respectively. The serum level of ALT and AST activities in malaria-positive were significantly (p<0.05) increased, compared to healthy or malaria-negative individuals. Furthermore, transaminase activity was significantly (p<0.05) elevated in non-practitioners of preventive measures; and in patients who engaged in auto-medication or traditional medication, compared to those who sought treatment from health centers. Our findings demonstrated that non-practice of preventive measures, improper treatment and management of malaria infection can lead to an abnormal increase in serum level of transaminases which may reflect liver injury.