Relationship Between Anaemia, Glucose-6-phosphate Dehydrogenase Deficiency And Oxidative Stress Among Malaria Patients Visiting Esut Teaching Hosptial Enugu Nigeria

Proteins are the largest constituent of the cellular milieu and are frequent targets of oxidative damage (Stadtman, 2004). Protein oxidation can involve direct reaction with amino acids, cleavage of the polypeptide chain, and conversion of the protein to derivatives that are highly sensitive to proteolytic degradation. It has also been established that all of these protein modifications can be mediated by metal-catalyzed oxidation systems. All amino acid residues of proteins are potential targets for oxidation by HO· or by H2O2 in the presence of metal ions. For example, oxidation of tyrosine residues is damaging to the red blood cells, as this amino acid is converted to a 3,4-dihydroxyphenylanine derivative, which itself can undergo redox cycling to generate further ROS (Sugiura and Ichinose, 2011). 

Antioxidants are molecules that inhibit or quench free radical reactions and delay or inhibit cellular damage (Young et al., 2001). Though the antioxidant defenses are different from species to species, the presence of the antioxidant defense is universal. Antioxidants exists both in enzymatic and non-enzymatic forms in the intracellular and extracellular environment. . Enzymatic antioxidants work by breaking down and removing free radicals. The antioxidant enzymes convert dangerous oxidative products to hydrogen peroxide (H2O2) and then to water, in a multi-step process in presence of cofactors such as copper, zinc, manganese, and iron. Non-enzymatic antioxidants work by interrupting free radical chain reactions (Young et al.,2001).  

The antioxidants can also be categorized according to their size, the small-molecule antioxidants and large-molecule antioxidants. The small-molecule antioxidants neutralize the ROS in a process called radical scavenging and carry them away.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathological disease in humans. This disease is described as a widespread, heritable, X-chromosome linked abnormality (Reclose et al., 2000). It is estimated that it affects approximately 400 million people worldwide (Daloii et al., 2004). This disease is seen most frequently in approximately all of Africa, Asia, and the countries near the mediterranean Sea (Frank, 2005). G6PD enzyme was demonstrated to play an active role in survival of erythrocytes. It is known that in the pentose phosphate pathway of erythrocytes, glucose-6 phosphate dehydrogenase (G6PD) enzyme provides the production of NADPH and Glutathione (GSH). GSH, produced by pentose phosphate pathway can react with H2O2 and reduce it to H2O.  This prevents the generation of oxidative stress within red blood cells; oxidative stress can be induced in erythrocytes whose G6PD enzymes are deficient. In this situation, GSH is not produced and H2O2 is not reduced to H2O, leading to oxidative stress and hemolysis.

1.2 Justification / Need for study

The need for this study is to carefully ascertain whether G6pD deficiency has an impact on oxidative stress and malaria infection. To known if G6pD can promote malaria infection in patient. This study is equally designed to give information about the prevalence of G6PD and malaria infection among malaria patient in Enugu metropolis.

1.3 Statement of the problem

So many reasons have been attributed to susceptibility of G-6-PD deficient patients to malaria infection. Recall that the pentose phosphate pathway is essential in producing enough NADPH capable of reducing oxidized glutathione but when there is a default in the production of enough NADPH from PPP as the case may be in G-6-PD deficient patients, leading to a decrease in the level of reduced glutathione which leads to an increased in oxidative stress – a possible risk factor in the development of malaria infection will be complicated.

1.4 Aim of the study

This study was undertaken to evaluate the relationship between oxidative stress among malaria patients visiting Enugu State University Teaching Hospital, Parklane, Enugu Nigeria.

1.5   Objective of the study

1. To screen patients for malaria infection.

2. To assess anaemia in malaria patients. 

3. To assess G6PD deficiency in malaria patients.

4. To assess oxidative stress indices (lipid peroxidation and protein oxidation) in malaria patients.

1.6 Limitations of the study

Recruitment of participants into the study.