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1 University of Nigeria Virtual Library Serial No Author 1 Author 2 Author 3 Title Keywords Description Category Publisher Publication Date SHU, E.N OKONKWO, P.O OGBODO, S.O and IBEKWE, E Nutritional Status of Onchocerciaasis Patients II: An Investigation of Iron deficiency Anemia Onchocerciaasis, Nutritional Status Iron Metabolism Nutritional Status of Onchocerciaasis Patients II: An Investigation of Iron deficiency Anemia Medicine 1998 Signature

2 NUTRITIONAL STATUS OF ONCIJOCERCIASIS PATIENTS 11:, AN INVESTIGATION OF IRON DEFICIENCY ANAEMIA BY: *E,N. SHU; **S.O. OGBODO; ***E. IBEKWE & *P.O. OKONKWO a **Department of Pharmacology & Therapeutics, Department of Chemical~~athology, ***Department of Haematology & Immunology College of Medicine, University of Nigeria Teaching Hospital P.M. B. 0 I 129, Enugu Nigeria. I SUMMARY Anaemia due to iron deficiency was investigated 111 Seventy-three (73) onchocerciasis male patients (aged between 30 and 40 years) with modules and forty (40) age and sex matched control subjects from Amaetiti- Achi, Enugu, Nigeria. Haematological values (Haemoglobin- Hb and Hearnatocrit - PCV) and serum iron levels were established for the two groups of subjects using standard procedures, that is, cyanrnethaanoglobin for Hb, microhaematocrit for PCV and Colorimetric method for serum iron. The results obtained showed that the highest numbcr of paticnts atid control subjects had Hb levels bctwem 12.0 and 14.0 gdl-' and showed no significant diffcrcncc (PN.05) bctween thc two groups. The PCV v;rlucs wcrc cvcnly diskibuled nlso showing the samc patlcnl as in tlb valucs. Likcwisc thc mcan iron lcvcls of both patients and controls were not significantly different (P> 0.05). It is therefore concluded that unchocerciasis has no significant effect on the metabolism of iron. Kcy Words: Onc/~ocercinsis, Nu~ritional shtus, Iron metnbolism. Introduction: Onchocerciasis, a filarial disease caused by Onchocerca volvulus, is a socio-economic problem of considerable magnitude in many tropical African countries including Nigeria, with an cstimated seven million persons iafccted with Lhc Onchocerca volvulus (1). This disease manifests mainly by intense itching and ultimately, in many cascs, blindness due to millions of Onchocerca volvulus tnicrofilariac scattered throughout the body, World Health Organisation (WHO) initiated several community-based trials of ivennectin : a new antihelminthic with prolonged effect on microfilariae. Such was the case with Achi - a rainforest savanah mosaic area in South - eastern Nigeria Following the mass ivermectin chemotherapy of the disease in this community for five years ( ) it was suggested that most of the side effects of the drug in patients were as a result of poor diet (3). This was sugge$ve of nutritional deficiency in onchocerciasis patients. We investigated protein - calorie malnutrition as the first line of assessment of the nu,tritional status in olichocerciasis patients (4). Our results1 showed that infection with Onchocerca volvulus did not result in severe protein depletion despite the low daily protein consumption in the community. Anacmia which is a manifesption of an underlying disease (5) is a resultant of many cpnditions including iron deficiency. It is characterized pong other signs by muscular weakness, easy fatigability and irritability, dizziness or drowziness, headache, faintness blurred vision dyspnea and latei pallor brittlehairs and nails, smooth tongues, cheilosis and probable dysphagia 67). Anaemia die to iron deficiency is one of the most prevalent and potentially seriobs fms of malnutrition (8). So far, only the works of Wadsworth (9), Abbey and Abbey (10) and Shu and,okonkwo (4) are known to have investigated nutritional state of the host with respect to the intensity of the disease and none of them gave attention to the patient's iron status. In this report, we investigated for the first time anacmia due to iron deficiencv in onchocercisasis Correspondence Author: SHU, Department of Pharmacology & Therapeutics College ~..... Medicine, University of Nigeria Teaching Hospital, P.M. B. 0 / 1.29, Enup- Nigeria

3 Orient Journal of Medicine; March-December, 1998 Vol. 10 Nos. 1-4 SUBJECT AND METHODS. T Study Area and Subjects: The study area - Amaetiti-Achi, is located approximately 45km from Enugu in South - eastern Nigeria. Achi- a town about made up of 21 wards or communities with a population of about 25,000, indicated that each community was unique in thc scverity and infection pattern of onchocerciasis (9). The area is in forest savannah. Amaetiti is one of such communities. The major item of food eaten by the people in this arca is cassava. The overall pattern is cassava twice or thrice daily with essential ingredients of the meal beiig palm oil, salt and pepper, Meat, fish and milk are seldomly consumed and not more than once a day. Some other food items such as yam, beans, maize and rice are eaten occasionally. The study was undertaken on 73 male onchocerciasis patients with exactly three nodules at non-lymph node areas and 40 male control (noninfected) subjects. All 113 ( ) subjects were between the ages of 30 and 40 years and had lived in Amaetiti for at least 20 years prior to the time of this study. These subjects who had given informed consent were found to be free from malaria and other forms of intestinal helminth infections. Methods: Fivc (5) ~~iillilitrcs of vcnous blood wcrc willdraw from each subject; one millilitre of which was transfercd into a bottle with ethylene diamine tetracetic acid (EDTA) for haematological investigations while the rest of the blood was transfered into a dry test tube for serum iron determination. Skin snips were obtained from the right iliac crest and calf of each subject using a 2mm comeoscleal ptmch as previously described (9). The skin snips were placed in normal saline in wells of microlitre plates incubated at room temperature for 24 hours and examined for microfilariae using an inverted Zeiss microscope. Patients whose skin snips were negative for microfilariae and the control subjects (without nodules) with skin snips positive for microfilariae were excluded from thc study. Hacrnatological values were established for the subjccls using Lhc cyanmcthncmoglobin mclhod for hacmoglobin and the microhaemalocrit method for hacmatocrit (10). Serum iron determination was by a colorimetric method previously described (11). The sludent's t-test was used to compare findings whcre necessary and results were considered insignificcnl when RESULTS ' Figure I represents the distribution of hearnoglobin.(hb) in both patients and control subjects. Generally, higher percentage of patients (69.8%) and control subjects (65.0%) were within the reference range of Hb (12gdL" and above), and &t highest percentage of the patients (60.2%) and the control subjects ( 529 fell within the range gdL-'Hb. While 12.5% c the control subjects had.hb levels between 15.0 and 17.0gdL-', only 9.6% of the patients was within that range. None of the subjects had Hb level greater that 17.0gdL-'. Figure 2 Summarizes the distribution of PCV i. both patients and controls. The greatest percentage, patients (63.1%) and control subjects (60.0%) had PC' values between 35% and 45% - which falls within thc reference range for PCV. Generally, in every PCV rang (<24%, 25-29%, 30-34%, 35-45%, >45Y0), thl percentage of patients was comparable to' that of thr controls. For instance, while 5.0% of cbntrols had PC' above 45%' 4.1% of patients had the same range. Als, there was no sigmficant difference (b0.05) in the meal. PCV values between the patients (38 g0.0ph). Serum iron levels in both patients (114.3 k 25.: ugdl1) and controls ( ug&' ) were withi. reference range and there was no significant differem b0.05) between their ineans. '01 Figure: 1 Figure 1: Haemoglobin (Hb) distribution in Patients and control subjects.

4 Orient Journal of Medicine; March-December, 1998 Vol. 10 Nos. 1-4 Figure: 2 < >45 Pcv (%) Figure 2: Packed Cell Volume (PCV) distribution in patients and control subjects. * abnormally low levels which was likely due to anaemia. Though the studies of other, workers (12,13,4) did not include the measurement by PCV in the populations studied, the PCV values obtained in this study did not show any significant difference (P>0.05) between the patients and the control eatiat~ subjects. bwever, they agreed with' the previous. published figures from healthy Nigerians (14,15,16).* A slightly higher but non-significant (P'0.05) mean value of serum iron 'in control subjects than in patients was observed in this study. The result could not be readily compared with any from onchocerciasis patients as none, to the best of our knowledge, existed. However, our results were significantly (BO.O 1) higher than those of blood donors in Nigeria (17). Since non-significant differences (B0.05) existed between the mean PCV values (of each range) and mean serum iron levels of onchbcerciasis' patients and controls, and the highest percentage of subjects (patients and controls) had haemoglobin levels between 12.0 and 14.0gdL-', it can thus be concluded that the disease has no effect on the metabolism of iron. Further research is strongly advocated in other nutritional deficiencies. Escussion Apart fiom the works of Wadsworth (12), Abbey and Abbey (13), and Shu and Okonkwo (4), no othcr known works exist on nutritional state of onchocerciasis patients with regard to the intensity of the disease. Abbey and Abbey (13) did not clearly show the nutritional state of these patients in the population sampled. These workers then advocated further REFERENCES: investigations in a population with high prevalence rate 1. Edungbola L.D.: Onchocerciasis control in of this disease. Already, we investigated protein - calorie Nigeria. Parasitology Today 1991 ; maluntrition in these patients (4). Our results showed that even though protein consumption of the locality 2. Meyers WM, Neafie RC and Coonor DH: was low, infection with,onchocerca Volvulus did not Onchocerciasis. Inversion of deep organs by result in severe protein depletion. In the community Onchocerca Volvulus. Am J. Trop Med Hyg studied, which is known to be hyperendemic for 1977; 26 (4): onchocerciasis (9), the common complaints of the dwellers are muscular weakness, easy fatigability, 3. Chijioke C P and Okonkwo P.O. Adverse dizziness and headache which are the hallmarks of events following mass ivermectin therapy for anaemia (6,7). onchocerciasis. Trans Roy Soc Trop Med Hyg In this study, we investigated iron deficiency (1992); 86: anaemia. The highest percentage of patients and controls had heaemoglobin levels between 12.0 and 4. Shu E.N. and Okonkwo P.O. Nutritional Status 14.OgdL1. Although the range was below that reported by Abbey and Abbey (13) in Iri, Kaduna, Nigeria, it was ' - of Onchocerciasis Patient. I: An investigation of protein - calorie malnutrition. Annals of stdl within the reference range. This lower range can be Trop Med Parasit (1998); 92: : attributed to some individual physiological variations 5. Hanis J.W. Iron lack anaemia in The Red cell. and probably difference in feeding patterns; moreover Iri Harvard University Press, Cambridge (1963). and Achi are in two different regions - Savannah and PP raicforest - Savannah mosaic regions respectively. 6. Brainerd H, Sheldon M. And Milton J.C. Blood Considering this range ( l4.ogc1) about 31-9% m Current Diagnosis and Treatment Blackwell of the subjects sampled in this study had low Scientific Publications, Oxford (1969). PP 286- hamoglobin levels. Only three persons (2.7%) had 308.

5 Y C Orient Journal of Medicine; March-December, 1998 Vol. 10 Nos ,,'. Wintrobe WN, Thorn G W, Adam RD, Bennet IV, Braunwald E, Isselbacher KJ, and Petersdorf RG. Pallor and Anaemia in Harrison's Principle of Internal Medicine. 6Lh edition. Mc Graw - Hill Book Company, New Vork (1971). PP Cohcn N. Vitamin A dcficicncy and ~hcyc. Medicine Digest (1989) 15: Okonkwo P.O.; Akpa A; lhekwaba A; Nwagbo D; Umeh R; Adibua S; Ezike V and Ogbuokiri J.E. Studies on onchocerciasis in forest savanah mosaic areas of Nigeria. I. Investigation in Gbaragu, Oji - River. Dacie J. V. And Lewis S.M. Practical haematology, 7tb edition Churchill Livingstone, London (1991) PP Varley H. Practical Clinical Biochemistry. 4th edition, ELBS Heineman Medical Books Ltd, London (1969). PP Wadsworth GR Onchocerciasis in Ziuie. Rodgen F.C. Pergamon, Oxford (1977). PP Abbey W N and Abbey SD. Onchocerciasis in Iri, Kaduna State, ' Nigeria: nutritional investigation. J. Med. Lab. Sci. (1992) 2: 1-6 Ukaejiofor E.O., Isaac - Soyede W.A. bnd Ipadeola A. ~ohnal haematological values in adult Nigerians. Nigerian Medical Journa: (1989); 9: Olakunlo 0, Kassimund Chuks and Ngozi N Blood Parameters in rural and urban Nigeria) Population, Nigerian Journal Parasitolog). (1982); 3: Araba AB. Survey of haematological variable.; in 600 healthy Nigerians. Nigerian Medic:%[ Journal (1976); 6: Usang E.A. Iron stores of, Nigerian bloc ci donors as assessed by serum fcn-il~n concentration. Central African Journal of Medicine (1990); 36: ', I. h.. (,I "., I., 1' 0.. '1, *: t? 1..d I t., ',,! r 4 \ I ' I.,.., 1, '1