Socioeconomic Determinants of Malaria and Hepatitis Infections: Insights from the Federal Medical Center, Makurdi, North Central, Nigeria.

doi:10.21203/rs.3.rs-4996314/v1

Background: Malaria and hepatitis B and C are prevalent public health issues in Nigeria, significantly impacting health outcomes. The Federal Medical Center, Makurdi, serves as a key healthcare provider in the region, making it crucial to understand the prevalence and factors associated with these diseases within this setting. This study aims to evaluate the prevalence and risk factors of malaria and hepatitis B and C among patients at the Federal Medical Center, Makurdi.

Methodology: A cross-sectional study design was employed, involving the analysis of patient records and diagnostic data from the Federal Medical Center, Makurdi. Data on malaria and hepatitis B and C prevalence were collected from laboratory reports and patient interviews. Socioeconomic information, including income, education level, and healthcare access, was also gathered. Statistical analyses were performed to identify associations between disease prevalence and risk factors.

Results: The study identified a high prevalence of malaria and hepatitis B and C among the patient population. Socioeconomic factors such as lower income, inadequate education, and limited healthcare access were significantly associated with higher rates of these infections. Malaria prevalence was higher among individuals lacking access to insecticide-treated nets, while hepatitis infections were linked to inadequate blood transfusion safety and high-risk behaviors.

Discussion: The findings underscore the need for targeted public health interventions. Enhanced access to preventive measures, such as insecticide-treated nets and safer blood transfusion practices, alongside educational programs on disease prevention, are essential. Addressing socioeconomic disparities is crucial for effective disease control.

Conclusion: To mitigate the burden of malaria and hepatitis B and C at the Federal Medical Center, Makurdi, a multifaceted approach is required. Improving preventive measures, healthcare access, and addressing socioeconomic determinants will be vital in reducing disease prevalence and improving patient outcomes.

Malaria, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) infections remain critical public health challenges in sub-Saharan Africa, particularly in Nigeria. Malaria, caused by Plasmodium species, continues to be a leading cause of morbidity and mortality in regions with high transmission rates, such as Nigeria [1, 2]. Despite ongoing control efforts, including the distribution of insecticide-treated nets (ITNs) and the use of artemisinin-based combination therapies (ACTs), malaria prevalence remains alarmingly high. Socio-economic factors, such as poverty and limited access to healthcare, play significant roles in malaria transmission and control [3, 4].

Despite ongoing control efforts, the prevalence of malaria remains alarmingly high, with factors such as socio-economic status, access to healthcare, and behavioral practices playing pivotal roles in its transmission [4–7]. In regions like Nigeria, malaria persists due to several intertwined factors [8]. Socio-economic status significantly impacts the effectiveness of malaria prevention and control measures, with poorer communities often experiencing higher rates of infection due to limited access to healthcare and preventive resources [9].

Access to healthcare is crucial, as it determines the availability of diagnostics and treatment options. Inadequate healthcare infrastructure in many areas exacerbates the problem, leading to delays in diagnosis and treatment [3]. Behavioral practices also influence malaria transmission; for instance, inconsistent use of insecticide-treated nets (ITNs) and improper use of antimalarial medications contribute to ongoing high prevalence rates [10–14]. Addressing these factors requires comprehensive strategies that integrate socio-economic improvements, enhanced healthcare access, and effective behavioral interventions to combat malaria effectively [15–17].

Similarly, hepatitis B and C are major global health concerns, with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections leading to chronic liver diseases, including cirrhosis and hepatocellular carcinoma [18–21]. Sub-Saharan Africa bears a significant burden of these viral infections, with transmission frequently occurring through perinatal routes, unsafe injections, and other high-risk behaviors [22]. In Nigeria, the high prevalence of HBV and HCV is exacerbated by several factors, including limited access to vaccination, inadequate public awareness, and insufficient screening practices [23]. These challenges contribute to the persistence of these infections and underscore the need for improved public health interventions, including enhanced vaccination programs, increased public education, and more comprehensive screening and treatment strategies [24].

Studies have shown that socio-demographic factors such as age, sex, marital status, and income level significantly influence the prevalence of these infections. Moreover, the use of insecticide-treated nets (ITNs) and other preventive measures has been shown to reduce malaria transmission, yet challenges persist in ensuring consistent usage and addressing resistance issues [25–27]. Similarly, the association between hepatitis infection and risk factors such as alcohol consumption, blood transfusion, and previous hospitalizations underscores the need for comprehensive public health strategies to mitigate these risks [28–30].

This study aimed to investigate the prevalence of malaria, HBsAg, and HCV among patients attending the Federal Medical Centre, Makurdi, Nigeria, and to assess the influence of socio-demographic and behavioral factors on the distribution of these infections.

The specific objectives of the study were to determine the prevalence of malaria, HBsAg, and HCV according to sex, marital status, income level, age, and the use of insecticide-treated nets among patients in Makurdi; secondly, to examine the correlation between clinical manifestations and the prevalence of malaria, HBsAg, and HCV, thirdly, to identify significant risk factors associated with the prevalence of these infections, including socio-demographic and behavioral characteristics, and finally, to compare the findings with similar studies conducted in Nigeria and other West African countries, thereby contributing to the broader understanding of these public health challenges in the region. By addressing these objectives, the study seeks to provide valuable insights into the epidemiology of malaria, HBsAg, and HCV in Makurdi, contributing to the development of targeted public health interventions that can reduce the burden of these infections in Nigeria and beyond.

Study Area

This study was conducted at the Federal Medical Centre (FMC) in Makurdi, the capital city of Benue State, Nigeria. Makurdi is located in the North-Central region of Nigeria, an area characterized by a tropical climate with distinct wet and dry seasons. The city has a population that is predominantly agrarian, with significant health challenges, including high rates of infectious diseases such as malaria, hepatitis B, and hepatitis C.

Study Design

A cross-sectional descriptive study design was employed to assess the prevalence of malaria, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) among patients attending FMC, Makurdi. The study aimed to identify correlations between socio-demographic characteristics, clinical manifestations, and the prevalence of these infections.

Study Population

The study population consisted of patients attending FMC, Makurdi, over a specified period. A total of 248 patients were randomly selected and included in the study, representing a diverse demographic profile in terms of age, sex, marital status, income level, and clinical presentation.

Sample Size

Determination of Sample Size

The sample size was calculated using the formula:

[n = {Z^2 * P * q} / {d^2}

Where:

- n = desired sample size,

- Z = standard normal deviation, set at 1.96, corresponding to a 95% confidence level,

- P = estimated proportion of the target population with the characteristic of interest,

- q = 1 - P,

- d = degree of accuracy, set at 0.05.

This formula is derived from the method described by [31]. Based on a previous study conducted in Kano, Nigeria, which reported a prevalence rate of 25.5% for malaria and hepatitis [32], the sample size was calculated. The initial number of subjects required was estimated to be 200, and after accounting for a 10% attrition rate, the final sample size was adjusted to 248.

Using Fisher's sample size calculation method, the following parameters were used:

- Z = 1.96,

- P = 0.255 (based on local prevalence),

- d = 0.05.

The calculation yielded:

**[n = {(1.96)^2 * 0.255 *0.745}/{0.05^2} = {0.535}/{0.0025} = 224]**

With an additional 10% to account for potential dropouts (attrition rate is 10%):

[{Final Sample Size} = {224}/{0.9} = 248]

Inclusion and Exclusion Criteria

Inclusion Criteria: Patients who consented to participate in the study and were within the age range of 1 to above 81 years. Both inpatients and outpatients were considered, provided they presented with symptoms suggestive of malaria, HBsAg, or HCV infection.

Exclusion Criteria: Patients who did not provide consent, those with incomplete clinical records, and those who had received treatment for malaria, HBV, or HCV within the previous three months were excluded from the study.

Data Collection

Data were collected using a structured questionnaire administered by trained healthcare personnel. The questionnaire captured socio-demographic information (age, sex, marital status, income level), clinical manifestations, and risk factors for malaria, HBsAg, and HCV infection.

Blood samples were collected from each participant and tested for malaria using the rapid diagnostic test (RDT) method. The presence of HBsAg was detected using enzyme-linked immunosorbent assay (ELISA), while HCV antibodies were screened using third-generation ELISA kits.

Sample Collection

Blood samples were collected from individuals visiting the laboratory for diagnostic tests and exhibiting symptoms of malaria, hepatitis B, or hepatitis C. The study included a total of 248 from Federal Medical Center, Makurdi, comprising male and female adults as well as children. A questionnaire was administered to the adult participants to gather demographic information, risk factors, and clinical data related to the diseases under investigation.

Data Collection and Serological Examination

Blood Sample Collection

Approximately 5 ml of blood was collected from each participant via venipuncture using sterile disposable syringes. The blood samples were subjected to serological testing for malaria, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) using rapid diagnostic kits from Global, Germany. The study took place from July 2016 to December 2016, and all procedures were carried out in accordance with standard protocols and the manufacturers' guidelines [33, 34].

Malaria Testing Procedure

Blood samples (5 ml) were drawn intravenously with the assistance of a hospital phlebotomist and transferred into ethylenediaminetetraacetic acid (EDTA) bottles to prevent coagulation. Two blood films, one thick and one thin, were prepared on clean, dry glass slides and allowed to dry. The thin smear was fixed in methanol, and both smears were stained with 2% Giemsa solution [3].

The slides were examined under a microscope at 100x magnification using oil immersion. Independent assessments by two microscopists were conducted to ensure accuracy, with discrepancies resolved by a senior microscopist. Parasite density was calculated against 200 leukocytes, assuming a leukocyte count of 8,000 per microliter of blood [35]. Parasite density was classified as mild (<1,000 parasites/μl), moderate (1,000-9,999/μl), or severe (≥10,000/μl) based on the method described by Dawaki et al. (2016) [36].

For rapid diagnostic testing (RDT) of malaria, the CareStart test was used. After writing the sample number on the strip and cassette, 5 μl of whole blood was added to the "S" well, followed by 60 μl of assay buffer. The results were interpreted after 20 minutes.

Hepatitis B and C Virus Testing

For HBsAg and HCV testing, fingerstick whole blood was collected by puncturing the skin of the middle or ring finger with a sterile lancet after cleaning with an alcohol swab. The blood drops were placed on the "specimen pad" of the rapid test strips, followed by the addition of a drop of buffer solution. The results were read after 15 minutes. The appearance of two distinct colored lines indicated a positive result, while a single line in the control region indicated a negative result. The rapid test strips used had a sensitivity of 99.0% and specificity of 99.1%.

Hepatitis B Surface Antigen Testing Procedure

The HBsAg test strip was removed from its sealed foil packaging, and the sample number was written on the strip. Two drops of whole blood were added to the "sample pad" of the test strip, followed by one drop of buffer. The result was read after 15 minutes, with the presence of two colored bands indicating a positive result. A single band in the control area indicated a negative result, while the absence of a control band rendered the test invalid.

Hepatitis C Virus Testing Procedure

The HCV test followed a similar procedure. The strip was removed from the foil packaging, and the sample number was written on the strip. Two drops of whole blood were added to the "sample pad," followed by one drop of buffer. The result was read after 10 minutes, with two colored bands indicating a positive result, one band in the control area indicating a negative result, and no band in the control area indicating an invalid test.

Data Collection via Questionnaires

A semi-structured questionnaire was administered to all participants to collect demographic information such as age, sex, address, family size, marital status, ethnicity, educational status, and occupation. Additional medical information gathered included prophylactic measures, use of insecticides, history of tribal marks or tattoos, drug abuse, alcohol consumption, blood transfusion, previous hospitalization, surgery, and any administered prophylaxis.

Data Analysis

The collected data were analyzed using JASP version 0.18. Descriptive statistics, such as frequencies and percentages, were used to summarize the socio-demographic characteristics and prevalence rates. Chi-square tests were performed to assess the association between the prevalence of malaria, HBsAg, and HCV and various socio-demographic factors. Correlation analyses were conducted to determine the relationship between risk factors and infection prevalence. A p-value of less than 0.05 was considered statistically significant.

Table 1 shows the prevalence of malaria, Hepatitis B surface antigen (HBsAg), and Hepatitis C virus (HCV) among patients at the Federal Medical Centre, Makurdi, according to sex. A total of 248 patients were examined, consisting of 123 males and 125 females.

The prevalence of malaria among the examined patients was 52.4%. Of the 123 males, 71 (57.7%) tested positive for malaria, while 52 (42.3%) tested negative. Among the 125 females, 59 (47.2%) were positive, and 66 (52.8%) were negative for malaria. Although a higher proportion of males were positive for malaria compared to females, the difference was not statistically significant (X² = 2.753, df = 1, p = 0.097).

The overall prevalence of HBsAg among the patients was 6.9%. Specifically, 7 (5.7%) of the males tested positive for HBsAg, while 116 (94.3%) tested negative. Among females, 10 (8.0%) were positive, and 115 (92.0%) were negative for HBsAg. The difference in HBsAg positivity between males and females was not statistically significant (X² = 0.518, df = 1, p = 0.472).

For HCV, the prevalence was found to be 4.8% overall. In the male group, 6 (4.9%) tested positive, and 117 (95.1%) tested negative. Similarly, among females, 6 (4.8%) were positive, while 119 (95.2%) were negative. There was no significant difference in HCV positivity between males and females (X² = 0.01, df = 1, p = 0.977). Overall, the prevalence of malaria was higher in males compared to females, though not significantly so. The prevalence of both HBsAg and HCV was relatively low in this population, with no significant differences observed between sexes for either condition. These findings suggest that while malaria remains a prevalent concern, the burden of HBsAg and HCV is comparatively lower and equally distributed between males and females in this study population.

The prevalence of malaria according to marital status was evaluated among 248 patients at the Federal Medical Centre, Makurdi (Figure 2). The study population comprised 121 single individuals and 127 married individuals. Among the 121 single individuals examined, 65 (53.7%) tested positive for malaria, while 56 (46.3%) tested negative. This indicates that over half of the single individuals in this study were affected by malaria.

In the group of 127 married individuals, 65 (51.2%) were found to be positive for malaria, and 62 (48.8%) were negative. This shows that slightly more than half of the married individuals also tested positive for malaria. Overall, the total prevalence of malaria among the entire study population was 52.4%, with 130 individuals testing positive and 118 testing negative. When comparing the prevalence of malaria between single and married individuals, the difference was not statistically significant (X² = 0.60, df = 1, p = 0.689). This suggests that marital status does not have a significant influence on the likelihood of contracting malaria in this study population.

The analysis of malaria prevalence according to marital status revealed that both single and married individuals had similar rates of malaria infection, with no significant differences observed between the two groups. The findings suggest that marital status is not a determinant factor for malaria infection among the patients studied at the Federal Medical Centre, Makurdi.

The study further explored the prevalence of Hepatitis B surface antigen (HBsAg) and Hepatitis C virus (HCV) among 248 patients at the Federal Medical Centre, Makurdi, based on marital status. The study included 121 single and 127 married individuals.

Among the 121 single individuals, 9 (7.4%) tested positive for HBsAg, while 112 (92.6%) tested negative. In the married group, 8 (6.3%) were positive for HBsAg, and 119 (93.7%) were negative. The overall prevalence of HBsAg was 6.9%. Statistical analysis revealed no significant difference in HBsAg positivity between single and married individuals (X² = 0.126, df = 1, p = 0.723), suggesting that marital status does not significantly affect the likelihood of HBsAg infection in this population.

For HCV, 4 (3.3%) of the single individuals were positive, while 117 (96.7%) were negative. Among the married individuals, 8 (6.3%) tested positive, and 119 (93.7%) tested negative for HCV. The overall prevalence of HCV in the study population was 4.8%. The difference in HCV positivity between single and married individuals was not statistically significant (X² = 1.206, df = 1, p = 0.272), indicating that marital status does not have a significant impact on HCV infection rates.

The analysis of HBsAg and HCV prevalence according to marital status revealed that both single and married individuals exhibited similar rates of infection, with no significant differences observed between the two groups. These findings suggest that marital status is not a determining factor for HBsAg or HCV infection among the patients studied at the Federal Medical Centre, Makurdi.

Figure 4 shows us the prevalence of malaria among patients at the Federal Medical Centre, Makurdi, based on their income levels. Of the 248 patients examined, 224 patients were classified as low-income, 14 patients were categorized as middle-income, and no patients were categorized as high-income level.

Out of the 224 patients classified as low-income, 123 (52.6%) tested positive for malaria, while 111 (47.4%) tested negative. This indicates that slightly more than half of the low-income individuals in this study were affected by malaria.

Among the 14 patients categorized as middle-income, 7 (50.0%) were positive for malaria, and 7 (50.0%) were negative. This equal distribution suggests that malaria prevalence is significant even among middle-income individuals.

No patients were classified as high-income in this study; hence, no data is available for this category. The overall prevalence of malaria across the entire study population was 52.4%, with 130 individuals testing positive and 118 testing negative. The statistical analysis revealed no significant difference in malaria prevalence between the low and middle-income groups (X² = 0.035, df = 1, p = 0.852), suggesting that income level does not significantly influence the likelihood of contracting malaria in this study population.

The analysis of malaria prevalence according to income level indicates that both low and middle-income individuals had similar rates of malaria infection, with no statistically significant differences observed between the two groups. These findings suggest that income level is not a significant determinant of malaria infection among patients at the Federal Medical Centre, Makurdi.

According to Figure 5, the prevalence of Hepatitis B surface antigen (HBsAg) and Hepatitis C virus (HCV) were examined among patients at the Federal Medical Centre, Makurdi, according to income level. The study population comprised 234 low-income individuals and 14 middle-income individuals, with no patients categorized as high-income.

Among the 234 low-income individuals, 17 (7.3%) tested positive for HBsAg, while 217 (93.1%) tested negative. In the middle-income group, none of the 14 individuals tested positive for HBsAg, with all 14 (100%) testing negative. No individuals were categorized as high-income, so no data was available for this category. Statistical analysis showed no significant difference in HBsAg prevalence between the income levels (X² = 1.092, df = 2, p = 0.296), indicating that income level does not significantly affect the likelihood of HBsAg infection in this population.

For HCV, 9 (3.8%) of the low-income individuals were positive, while 225 (96.2%) were negative. In the middle-income group, 3 (21.4%) tested positive for HCV, and 11 (78.6%) tested negative. Again, no data was available for the high-income group. Statistical analysis revealed a significant difference in HCV prevalence between the income levels (X² = 8.869, df = 2, p = 0.003), suggesting that income level may have a significant impact on the likelihood of HCV infection, with middle-income individuals showing a higher prevalence compared to low-income individuals.

The analysis of HBsAg and HCV prevalence according to income level revealed that while HBsAg infection rates did not significantly differ between low and middle-income groups, HCV prevalence was significantly higher among middle-income individuals compared to low-income individuals. These findings suggest that income level may be a significant factor in the risk of HCV infection but not for HBsAg in the study population at the Federal Medical Centre, Makurdi. The absence of data for high-income individuals limits the conclusions that can be drawn about this group.

Table 1: Prevalence of Malaria and HBsAg According to Age in Federal Medical Centre, Makurdi

	Malaria	HBsAg
Age (Years)	Frequency (%)	Frequency (%)
1 – 12	13 (5.2%)	53 (21.4%)
13 – 25	69 (27.8%)	39 (15.7%)
26 – 40	88 (35.4%)	105 (42.3%)
41 – 65	66 (26.6%)	41 (16.5%)
66 – 80	10 (4.0%)	7 (2.8%)
Above 81	2 (0.8%)	3 (1.2%)
Total	248 (100%)	248 (100%)

This study also investigated the prevalence of malaria and Hepatitis B surface antigen (HBsAg) among 248 patients at the Federal Medical Centre, Makurdi, categorized by age groups. In table 1, the age groups examined were 1–12 years, 13–25 years, 26–40 years, 41–65 years, 66–80 years, and above 81 years.

The highest prevalence of malaria was observed in the 26–40 years age group, with 88 individuals (35.4%) testing positive. This was followed by the 13–25 years age group, where 69 individuals (27.8%) were positive, and the 41–65 years age group, with 66 individuals (26.6%) testing positive. The 1–12 years age group had 13 positive cases (5.2%), while the 66–80 years age group had 10 cases (4.0%). The lowest prevalence was in the above 81 years age group, with only 2 cases (0.8%). These findings indicate that malaria prevalence is highest among those aged 26–40 years and gradually decreases with age.

For HBsAg, the highest prevalence was observed in the 26–40 years age group, with 105 individuals (42.3%) testing positive. This was followed by the 1–12 years age group, with 53 cases (21.4%), and the 41–65 years age group, with 41 cases (16.5%). The 13–25 years age group had 39 positive cases (15.7%), while the 66–80 years age group had 7 cases (2.8%). The lowest prevalence was in the above 81 years age group, with 3 cases (1.2%). These findings suggest that HBsAg prevalence is also highest among those aged 26–40 years and decreases with age, similar to malaria.

The analysis of malaria and HBsAg prevalence according to age groups revealed that both infections are most prevalent in the 26–40 years age group and decrease with advancing age. These findings highlight the need for targeted interventions for malaria and HBsAg in younger and middle-aged populations, particularly those aged 26–40 years, at the Federal Medical Centre, Makurdi.

Table 2: Prevalence of Malaria by use of Insecticide treated Net in Federal Medical Centre, Makurdi

Insecticide net	Number examined (%)	Number positive (%)	Number negative (%)
Yes	190 (100)	89 (46.8)	101 (53.3)
No	58 (100)	41 (70.7)	17 (29.3)
Total	248 (100)	130 (52.4)	118 (47.6)

X² = 10.132, df=1; p>0.05 (p=0.01)

Table 2 reflects the prevalence of malaria among patients at the Federal Medical Centre, Makurdi, based on their use of insecticide-treated nets (ITNs). The total number of participants was 248, with 190 individuals reporting the use of ITNs and 58 individuals not using ITNs. Out of the 190 individuals who used insecticide-treated nets, 89 (46.8%) tested positive for malaria, while 101 (53.3%) tested negative. This indicates that nearly half of the ITN users were still affected by malaria, though a slight majority were protected.

Among the 58 individuals who did not use insecticide-treated nets, 41 (70.7%) tested positive for malaria, while only 17 (29.3%) tested negative. This suggests a much higher prevalence of malaria among those who did not use ITNs compared to those who did. Overall, 130 of the 248 individuals (52.4%) tested positive for malaria, while 118 (47.6%) tested negative. The statistical analysis revealed a significant difference in malaria prevalence between ITN users and non-users (X² = 10.132, df = 1, p = 0.01), indicating that the use of insecticide-treated nets significantly reduces the likelihood of contracting malaria.

The analysis of malaria prevalence according to the use of insecticide-treated nets shows that ITN use is associated with a significantly lower risk of malaria infection. The findings underscore the importance of promoting the use of ITNs as an effective preventive measure against malaria at the Federal Medical Centre, Makurdi.

Table 3: Prevalence of Malaria by Clinical Manifestation in Federal Medical Centre, Makurdi

Clinical manifestation	Number examined (%)	Number positive (%)	Number negative (%)
Fever	137 (100)	79 (57.7)	58 (42.3)
Headache	59 (100)	29 (49.2)	30 (50.8)
General body pain	18 (100)	8 (44.4)	10 (55.6)
Back pain	25 (100)	10 (40.0)	15 (60.0)
Hotness of the body	4 (100)	2 (50.0)	2 (50.0)
Persistent crying	1 (100)	0 (0.0)	1 (100)
Blurred vision	1 (100)	1 (100)	0 (0.0)
Stomach pain	2 (100)	0 (0.0)	2 (100)
Joint pain	1 (100)	1 (100)	0 (0.0)
Total	248 (100)	130 (52.5)	118 (47.6)

X² = 8.898, df=8; p>0.05 (p=0.351)

The prevalence of malaria among patients at the Federal Medical Centre, Makurdi, was also analyzed based on various clinical manifestations. Table 3 shows a total of 248 individuals were included in this analysis, with symptoms such as fever, headache, general body pain, back pain, hotness of the body, persistent crying, blurred vision, stomach pain, and joint pain being reported.

Of the 137 individuals who presented with fever, 79 (57.7%) tested positive for malaria, while 58 (42.3%) tested negative. Fever was the most common symptom associated with malaria. Among the 59 individuals reporting headaches, 29 (49.2%) tested positive for malaria, while 30 (50.8%) tested negative. This symptom showed a nearly equal distribution between positive and negative cases.

Of the 18 individuals with general body pain, 8 (44.4%) tested positive for malaria, while 10 (55.6%) tested negative. Among 25 individuals who reported back pain, 10 (40.0%) tested positive for malaria, while 15 (60.0%) tested negative. For the 4 individuals who experienced hotness of the body, 2 (50.0%) tested positive, and 2 (50.0%) tested negative, showing an equal distribution of results. Just an individual reported persistent crying, and this individual tested negative for malaria.

One individual experienced blurred vision and tested positive for malaria, resulting in a 100% positivity rate for this symptom. Out of the 2 individuals with stomach pain, both tested negative for malaria. The one individual with arthralgia reported tested positive for malaria. Overall, 130 of the 248 individuals (52.5%) tested positive for malaria, while 118 (47.6%) tested negative. The chi-square test for independence indicated that there was no statistically significant association between the type of clinical manifestation and the prevalence of malaria (X² = 8.898, df = 8, p = 0.351).

The analysis of malaria prevalence by clinical manifestation revealed that fever was the most common symptom among those who tested positive for malaria. However, the statistical analysis showed no significant association between specific clinical manifestations and the likelihood of testing positive for malaria. This suggests that while certain symptoms like fever are commonly associated with malaria, they are not definitive indicators of the disease, and malaria testing should be conducted regardless of the specific clinical presentation.

Table 4: Correlation analysis for Malaria, HBsAg, HCV patients and risks factors in FMC, Makurdi

	X1	X2	X3	X4	X5	X6	X7	X8	X9	X10	X11
X1	248
X2	0.34^x	1
X3	-0.112	-0.011	1
X4	-0.61	-0.029	-0.055	1
X5	-0.046	-0.0108	0.038	0.237^xx	1
X6	-0.113	-0.085	-0.066	0.180^xx	0.190^xx	1
X7	-0.108	-0.064	0.037	0.118	0.259^xx	0.168	1
X8	-0.104	-0.248^xx	-0.012	0.011	0.037	0.062	0.236^xx	1
X9	0.101^x	0.012	-0.202^xx	0.021	0.042	-0.138^x	-0.033	-0.033	1
X10	-0.004	0.066	0.037	0.048	-0.029	0.012	-0.046	-0.004	0.035	1
X11	0.039	-0.189^xx	0.080	0.048	0.144^xx	-0.012	0.188^xx	-0.138^x	0.049	0.061	1

Key:

X1= Clinical manifestation X7= Drug abuse

X2= Income level X8= Alcohol consumption

X3= Use of insecticide X9= Malaria

X4= Tattoo/Tribal marks X10= HBsAg

X5= Blood transfusion X11= HCV

X6= Previous hospitalization

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Table 4 revealed a correlation analysis which was conducted to assess the relationship between various risk factors and the prevalence of malaria, HBsAg, and HCV among patients at the Federal Medical Centre, Makurdi. The analysis included 248 participants and considered multiple factors, such as clinical manifestation, income level, use of insecticide-treated nets, tattoo/tribal marks, blood transfusion history, previous hospitalization, drug abuse, and alcohol consumption.

A weak positive correlation was found between clinical manifestation and income level (X2) (r = 0.34). Malaria (X9) was positively correlated with clinical manifestation (r = 0.101), significant at the 0.05 level (p < 0.05). Income level was negatively correlated with alcohol consumption (X8) (r = -0.248), which was significant at the 0.01 level (p < 0.01). Furthermore, a significant negative correlation was observed between income level and HCV (X11) (r = -0.189), also significant at the 0.01 level.

The use of insecticide-treated nets was negatively correlated with malaria (r = -0.202), indicating that individuals using insecticide-treated nets were less likely to test positive for malaria. This correlation was significant at the 0.01 level. A positive correlation was observed between tattoo/tribal marks and blood transfusion history (X5) (r = 0.237) and previous hospitalization (X6) (r = 0.180). Both correlations were significant at the 0.01 level. Blood transfusion history showed a significant positive correlation with previous hospitalization (r = 0.190, p < 0.01), drug abuse (X7) (r = 0.259, p < 0.01), and HCV (r = 0.144, p < 0.01).

Previous hospitalization was positively correlated with drug abuse (r = 0.168), although this correlation was not statistically significant. Alcohol consumption (X8) was also positively correlated with previous hospitalization (r = 0.236), significant at the 0.01 level. Drug abuse showed a significant positive correlation with alcohol consumption (r = 0.236, p < 0.01). Alcohol consumption was negatively correlated with HCV (r = -0.138), with this correlation being significant at the 0.05 level.

Finally, Malaria was positively correlated with clinical manifestation (r = 0.101, p < 0.05). However, it was negatively correlated with the use of insecticide-treated nets (r = -0.202, p < 0.01) and previous hospitalization (r = -0.138, p < 0.05). No significant correlations were observed between HBsAg and any of the other variables in the study. HCV was positively correlated with tattoo/tribal marks (r = 0.188) and blood transfusion history (r = 0.144), with both correlations being significant at the 0.01 level.

The correlation analysis highlights several significant associations between risk factors and the prevalence of malaria, HBsAg, and HCV. Notably, the use of insecticide-treated nets was significantly associated with a reduced prevalence of malaria, while income level and alcohol consumption were negatively correlated with HCV. These findings underscore the importance of understanding the multifaceted relationships between clinical and socio-economic factors in the management and prevention of these diseases.

The findings from the analysis of malaria, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) prevalence among patients at the Federal Medical Centre, Makurdi, provide valuable insights into the epidemiology of these diseases and the influence of socio-demographic factors and clinical manifestations on their distribution. Comparing these findings with similar studies conducted in other parts of Africa, particularly West Africa and Nigeria, reveals both consistencies and disparities, underscoring the importance of contextual factors such as socio-economic status, healthcare access, and public health interventions.

The study reveals a malaria prevalence of 52.4% among the patient population, with the highest prevalence observed in individuals aged 26–40 years (35.4%). For instance, a study in Ghana reported a similar high prevalence of 55.4% among outpatients [37]. The age-related pattern is in contrast with findings from other studies, where the youngest age group of children are frequently identified as high-risk due to their increased exposure [38–43]. The reason for the prevalence in this study might be due to increased exposure from outdoor activities and occupational risks.

Furthermore, different rates have been observed in different parts of Nigeria where malaria prevalence ranges from 35.7–82.72%, India (36.6%), and Malaysia (33.6%) Rwanda (22.8%), Kenya (28%), East Wollega Ethiopia (49.4%) and (21.2%), South Ethiopia (28.1%), North-Western Ethiopia (32.6%), and (29.0%). Study results from West Ethiopia (10.2%), South Ethiopia (6.1%), and North-West Ethiopia (7.3%), (3.5%) are significantly lower than those from East Shewa Ethiopia (20.5%),(25%), and Arba Minch South Ethiopia (22.1%), among various population groups [39, 44–54]. The study participants' varying geographic locations and climatic circumstances may be the cause of these variations. Based on the study's findings, which indicated that malaria remains a significant public health issue in many regions of the nation, measures for control and prevention of the disease can be developed to alleviate the ongoing suffering of the population.

Hepatitis B and C are major global health concerns, with HBV and HCV leading to chronic liver diseases such as cirrhosis and hepatocellular carcinoma [18, 55]. This study reports a higher prevalence of HBsAg (7.4%) among single individuals compared to married individuals (6.3%), though this difference was not statistically significant (p > 0.05). This finding is consistent with other studies suggesting that marital status does not significantly alter the risk of HBV or HCV infection [56–59]. However, in contrast, a study conducted in Burkina faso found a lower prevalence of HBV (14.95%) among single individuals compared to married individuals (15.52%) [60]. Another study conducted in Iran found out that the likelihood of contracting hepatitis B was 1.78 times higher among married individuals compared to those who were single [61]. This also aligned with the findings of Ghadir et al., (2012) [62] that highlighted marriage and heterosexual relationships as significant risk factors for hepatitis transmission. However, it is important to note that factors such as cultural practices and healthcare access may play a more critical role [55].

Income level emerged as a critical factor influencing disease prevalence in this study. High prevalence rates of malaria (52.6%) were observed among individuals in the low-income group, with no malaria cases reported in the high-income group. This finding is consistent with previous researches [4, 6–8]. Similarly, higher prevalence of HBsAg and HCV was found in the low-income group compared to the middle-income group (7.3% and 3.8%, respectively). This pattern reflects the association between lower socio-economic status and higher risk of infectious diseases due to poorer living conditions, limited healthcare access, and lower health literacy [21, 63–65].

Fever was identified as the most common symptom among malaria-positive individuals (57.7%), consistent with the literature identifying fever as the hallmark of malaria [66–68]. This finding aligns with reports from other malaria-endemic regions in Africa, such as in Tanzania, where fever is a prevalent symptom among malaria-positive individuals [69]. The use of insecticide-treated nets (ITNs) was found to significantly reduce malaria prevalence, with 46.8% of ITN users testing positive compared to 70.7% of non-users (p = 0.01). This reduction underscores the effectiveness of ITNs in malaria prevention, a finding supported by large-scale studies in different parts of Africa, [12, 70]. However, the high prevalence of malaria among ITN users suggests challenges related to consistent and correct usage, as well as potential insecticide resistance [71].

The correlation analysis reveals a significant negative correlation between income level and both alcohol consumption (r = -0.248, p < 0.01) and HCV prevalence (r = -0.189, p < 0.01), suggesting that lower income is associated with higher alcohol consumption and a higher risk of HCV infection. This aligns with research linking alcohol use with increased susceptibility to HCV, particularly among lower socio-economic groups [72–74]. Additionally, a significant positive correlation was observed between blood transfusion history and HCV prevalence (r = 0.144, p < 0.01), highlighting the risk of HCV transmission through blood transfusions, particularly in settings with inadequate blood screening protocols [28, 75–76]. The correlation between ITN use and malaria prevalence (r = -0.202, p < 0.01) confirms the protective role of ITNs [12, 70], while the associations between previous hospitalization, drug abuse, and alcohol consumption emphasize a cycle of risk factors that exacerbate disease burden.

The study’s findings have important public health implications. The high prevalence of malaria, particularly among lower socio-economic groups, highlights the need for targeted interventions addressing the underlying social determinants of health. Strategies such as improving access to ITNs, enhancing public health education on malaria prevention, and ensuring affordable healthcare services are crucial [68]. The significant associations between HCV and risk factors like blood transfusion history and alcohol consumption call for enhanced screening and preventive measures in healthcare settings, alongside efforts to reduce risky behaviors through education and support for individuals with substance abuse issues [53, 77]. Continuous monitoring and evaluation of preventive measures, including ITNs, are essential to address challenges such as insecticide resistance and ensure the effectiveness of malaria control efforts [12, 14, 25].

Limitations of the Study

Among the study's drawbacks was its reliance on self-reported data, which could be biased towards recollections. Furthermore, the study's cross-sectional design makes it more difficult to prove a link between risk factors and infection prevalence. Furthermore, as the testing was conducted without the use of sophisticated molecular techniques with a higher detection capability than light microscopy, such as loop-mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR), the study's findings could have been improved. Notwithstanding these drawbacks, the research offers insightful information about the prevalence of HCV, HBsAg, and malaria in Makurdi, Nigeria.

This study highlights the significant burden of malaria, HBsAg, and HCV among patients in Makurdi, Nigeria, with a strong correlation to socio-demographic and behavioral risk factors. The high prevalence of malaria, particularly among low-income individuals, underscores the need for targeted public health interventions that address the socio-economic determinants of health. The protective role of insecticide-treated nets (ITNs) is evident, yet challenges such as inconsistent usage and insecticide resistance call for sustained efforts in malaria control.

The correlation analysis reveals the complex interplay of factors influencing the prevalence of HCV, particularly the association with alcohol consumption and blood transfusion history. These findings emphasize the necessity for comprehensive public health strategies that address both behavioral risks and healthcare-related practices. Comparisons with similar studies across West Africa demonstrate that these health challenges are not unique to Makurdi but are prevalent across the region, highlighting the importance of regional collaboration in addressing these infectious diseases.

In conclusion, this study contributes to the understanding of malaria, HBsAg, and HCV epidemiology in Nigeria, with implications for broader public health strategies in West Africa. Efforts to improve healthcare access, enhance public health education, and strengthen disease prevention measures are critical to reducing the burden of these infectious diseases and improving health outcomes in the region.

Acknowledgements

The authors hereby acknowledge the role of the management in Federal Medical Center, (FMC) Makurdi, Benue State, for their support and facilitation of the data collection.

Contributions of the authors

Both authors_ Julius Kayode Ademoyegun (JKA), Stephen Olaide Aremu (SOA) participated in the design of the questionnaire, running the statistical analysis, data interpretation, writing most parts of the manuscript, drafting, and preparing the manuscript for submission. Both authors (JKA and SOA) contributed to the collection of data, entry of data, review of the literature, and statistical analysis. Both authors (JKA and SOA) revised all the statistical analyses and conceptualized the study design. All authors read and approved the final manuscript.

Funding

This study did not receive any specific grant from any funding institution.

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to privacy considerations of the participants but are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

Ethics approval was obtained from the research ethics committee of the Federal Medical Center, Makurdi, Benue State, Nigeria and the College of Biological Sciences, Joseph Sarwuan Tarka University Makurdi, Makurdi, Benue State, Nigeria, and administrative approval was obtained from the Federal Medical Center Health Management. The participants’ confidentiality was maintained by using code numbers rather than personal identifiers on the questionnaires. The aims of the study were explained to each participant before filling out the questionnaire. Written informed consent was obtained from all participants in the study. All measures were performed following the relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

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No competing interests reported.

Socioeconomic Determinants of Malaria and Hepatitis Infections: Insights from the Federal Medical Center, Makurdi, North Central, Nigeria.

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Abstract

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Introduction

Methodology