Date of Award

2-5-2025

Thesis Type

Masters

Document Type

Dissertation

Divisions

Faculty of Medicine

Department

Department of Parasitology

Institution

Universiti Malaya

Abstract

Malaria and soil-transmitted helminth (STH) infections are prevalent in tropical and subtropical regions, where poverty and poor sanitation exacerbate their prevalence. In Malaysia, malaria and STH remain significant concerns in certain areas, but studies on their co-infection are limited. A cross-sectional study was conducted among indigenous communities in Malaysia to determine the prevalence, risk factors, and implications of malaria, STH, and their co-infection. Venous blood samples were collected from 635 participants (aged 1–91 years) and tested for malaria using microscopy and nested polymerase chain reaction assays, while stool samples were screened microscopically for the detection and quantification of STH eggs. Data on risk factors were collected using a pre-tested questionnaire. Venous blood samples were also used to determine haemoglobin concentrations for 228 participants. Anthropometric measurements were recorded for 169 children aged below 18 to assess malnutrition. Data were analysed using SPSS version 27.0. The overall prevalence of low-density malaria, STH, and their co-infection were 74 (11.7%), 419 (66.0%), and 43 (6.8%), respectively. The malaria species found include Plasmodium vivax (6.3%), Plasmodium cynomolgi (3.8%), Plasmodium knowlesi (3.5%), Plasmodium falciparum (1.3%), Plasmodium inui (0.5%), and Plasmodium malariae (0.2%). The prevalence of mixed-species malaria was 3.6%, with human-zoonotic malaria (P. vivax/P. knowlesi/P. cynomolgi) being the most common. Double malaria infections were the most prevalent (1.7%), followed by triple infections (1.4%) and quadruple infections (0.5%, 3/635). Meanwhile, the STH species identified were Trichuris trichiura (50.4%), Ascaris lumbricoides (32.4%), and hookworm (17.3%). Risk factor analyses for malaria identified females [Adjusted Odd Ratio (aOR) 2.15, 95% CI 1.26–3.68] and those with rudimentary education (aOR 2.31, 95% CI 1.24–4.34) as being at higher risk. For STH infections, individuals below 18 years old (aOR 2.80, 95% CI 1.89–4.14), those using piped water (aOR 1.67, 95% CI 1.04–2.70), and those practising open defaecation (aOR 1.87 , 95% CI 1.31–2.68) were at higher risk. Additionally, the risk factor analysis of malaria-STH co-infection revealed that those with education (OR 2.92, 95% CI 1.21–7.04) were also at higher risk of co-infection. Anaemia was observed in 33.3% of participants with low-density malaria and in 33.3% of participants with low-density malaria-STH co-infection. However, these associations were not statistically significant compared to the non-infected group (p = 0.954 and p = 0.218, respectively). In contrast, anaemia was significantly associated with STH infections (37.8%, p = 0.039), with moderate to high-intensity hookworm infection linked to lower mean haemoglobin levels (p = 0.019). Low-density malaria was significantly associated with lower weight-for-age (underweight) mean z-scores. A. lumbricoides and T. trichiura infections were linked to lower height-for-age (stunting) mean z-scores, potentially contributing to stunting. Moderate to high-intensity A. lumbricoides infection was significantly associated with lower weight-for-age mean z-scores. Malaria STH co-infection was observed in 5.0% (5) of malnourished children. This study contributes to the growing body of research on parasitic infections, anaemia, and child growth in the indigenous communities. These findings highlight the need for integrated control strategies addressing both STH and malaria, alongside interventions aimed at improving nutritional status in these communities.

Initial

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Additional Information

Dissertation (M.A.) – Faculty of Medicine, Universiti Malaya, 2025.

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