AASCIT Journal of Bioscience 2017; 3(6): 79-86 http://www.aascit.org/journal/bioscience ISSN: 2381-1250 (Print); ISSN: 2381-1269 (Online)

Prevalence of Malaria and Typhoid Fever Co-infection and the Haematological Profile of Patients Attending Hospitals in Wukari ,

Ubandoma Andefiki *, Awache Ibrahim, Ebuara Francis Ushie

Department of Microbiology, Faculty of Pure and Applied Sciences, Federal University Wukari, Wukari, Nigeria

Email address Keywords [email protected] (U. Andefiki), [email protected] (U. Andefiki) Malaria, *Corresponding author Typhoid Fever, Citation Co-infection, Ubandoma Andefiki, Awache Ibrahim, Ebuara Francis Ushie. Prevalence of Malaria and Typhoid Haematological Parameters, Fever Co-infection and the Haematological Profile of Patients Attending Hospitals in Wukari Patients, Taraba State, Nigeria. AASCIT Journal of Bioscience. Vol. 3, No. 6, 2017, pp. 79-86. Wukari Abstract This study on the prevalence of malaria and typhoid fever co-infection and the haematological profile of patients attending hospitals in Wukari Taraba State was Received: July 25, 2017 concluded in June, 2017. The aim was to determine the prevalence of malaria and Accepted: November 22, 2017 typhoid fever co-infection and their effects on blood parameters. It goes without saying, Published: December 23, 2017 that both malaria and typhoid fever are endemic in the tropical regions in which Nigeria is no exception. Veinous blood was used for the various analyses. Of the 100 patients examined, 88(88%) patients were positive for malaria and 64(64%) patients were positive for typhoid fever. Females were more infected with both malaria and typhoid fever (91% and 64.2% respectively) than males (84% and 63.6% respectively). However, the difference in the prevalence of infections between the genders were statistically insignificant (P >0.05). In the prevalence of co-infection, 56(56%) patients were co- infected. Of the 56 patients, 23(52.3%) were males and 33(58.9%) were females. Gender and age wise, males between age group 31 – 40years had the highest co-infection (75%) while females between age group 41 – 50years had the highest prevalence of co- morbidity. In the haematological analyses, this study showed that a reasonable percentage of malaria and typhoid fever infected patients were anaemic (25%), 5.4% had higher than normal leucocyte count, 21.4% with lymphocyte count lower than normal and 8.9% of the co-infected patients had monocyte count higher than the normal range.

1. Introduction Malaria and Typhoid infections have been associated with increasing poverty, deterioration in sanitation, poor public health services, compounded by increasing drug resistance of the two etiologic agents [1]. Owing to this high poverty rate, a large number of Wukari residents live in houses where there are no clean, safe drinking water and poor or no drainage system. Also, because both malaria and typhoid fever share similar predisposing factors (such as poverty, poor sanitation and public health services etc), and present in the same way, individuals in areas endemic for these infections are being put at a substantial risk of contracting both concurrently. The concurrent occurrence of both malaria and typhoid fever (malaria – typhoid AASCIT Journal of Bioscience 2017; 3(6): 79-86 80

co-infection) was first described in the Medical Literature in spread in environments where human feces or urine are able the middle of the 19th century and was named typhoid- to come into contact with food or drinking water. Careful malarial fever by the United State Army Doctor Joseph J. food preparation and washing of hands are crucial to prevent Woodward (1833 – 1884) in 1862. Typhoid – malaria fever typhoid. was found among young soldiers during the American Civil Changes in haematological parameters are likely to be War who were suffering from febrile illness that seemed to influenced by any disease condition including endemic be typhoid rather than a new species of disease [2]. diseases, such as malaria and typhoid fever, which can affect Malaria originates from Medieval Italian: mala aria human health with various clinical presentations. meaning "bad air"; the disease was formerly called ague or Haematological changes are some of the most common marsh fever due to its association with swamps and complications in these infections and they play a major role marshland [3]. The term first appeared in the English in their pathogenesis. These changes involve the major cell literature about 1829 [4]. It is a mosquito-borne infectious types such as red blood cells, leucocytes and thrombocytes. disease that affects man and other animals and is caused by The similarities in the predisposing factors to both malaria parasitic protozoans belonging to the Plasmodium species and typhoid fever infections and the similar signs and [5]. In humans, malaria is caused by P. falciparum , P. symptoms presented by both infections have propelled malariae , P. ovale , P. vivax and P. knowlesi [6]. P. falciparum researchers into investigating the co-infection of these traditionally accounts for the majority of deaths [7], recent diseases. Apparently, this present study may be useful to evidence suggests that P. vivax malaria is associated with individuals, medical practitioners, government policy makers potentially life-threatening conditions about as often as with and researchers. The findings from this research hopefully a diagnosis of P. falciparum infection [8]. will form the basis for further research while providing Malaria infection develops via two phases: one that baseline epidemiologic data for further studies. involves the liver (exoerythrocytic phase), and one that involves red blood cells, or erythrocytes (erythrocytic phase). 2. Materials and Method When an infected mosquito pierces a person's skin to take a blood meal, sporozoites in the mosquito's saliva enter the 2.1. Study Area bloodstream and migrate to the liver where they infect hepatocytes, multiplying asexually and asymptomatically for The study was carried out in Wukari Local Government a period of 8–30 days [9]. Mosquito parasite is therefore Area of Taraba State. Wukari Local Government Area is in relatively protected from attack by the body's immune system the Southern Senatorial District of Taraba State. Its because for most of its human life cycle it resides within the headquarter is in the town of Wukari on the A4 highway. The liver and blood cells and is relatively invisible to immune Donga River flows through the area and the Benue River surveillance. forms a boundary with Nasarawa State to the northwest. The The World Health Organization (WHO) estimates that in town is the base of the Wukari Federation, a traditional state. 2015 there were 214 million new cases of malaria resulting in It has an area of 4,308 km² and a population of 241,546 at the 438,000 deaths [5]. Others have estimated the number of 2006 census. cases at between 350 and 550 million for falciparum malaria The occupation of the inhabitants of the area is basically [10]. According to Layne (2007), malaria is presently farming. Although some are civil servants while others are endemic in a broad band around the equator, in areas of the involved in one form of trade or the other. Americas, many parts of Asia, and much of Africa; in Sub- 2.2. Study Population Saharan Africa, 85–90% of malaria fatalities occur. An estimate for 2009 reported that countries with the highest A total number of one hundred (100) patients (age ranged death rate per 100,000 of population were Ivory Coast 1 to 70 years) consisting of 75 patients from General Hospital (86.15), Angola (56.93) and Burkina Faso (50.66) [11]. and 25 patients from Bethel Hospital both in Wukari town, Typhoid fever is caused by the gram negative bacterium out of which 44 males and 56 females attending these Salmonella typhi , also known as Salmonella enterica hospitals were included in the study. These patients were serotype Typhi [12]. There are two main types of Typhi selected for the study as there were considered to be in a namely the ST1 and ST2 based on MLST subtyping scheme, better position to give accurate and reliable information which are currently widespread globally [13]. required for the study regarding the co-infection of malaria The bacterium that causes typhoid fever may be spread and typhoid within the metropolis. The researcher was through poor hygiene habits and public sanitation conditions, indifferent as to whether the patients were nationals or non and sometimes also by flying insects feeding on feces. Public nationals or has varying social classes or religion. education campaigns encouraging people to wash their hands after defecating and before handling food are an important 2.3. Sample Collection component in controlling spread of the disease. Sanitation Five milliliters (5ml) of blood sample was collected by and hygiene are important to prevent typhoid. Typhoid does venepuncture from each patient into not affect animals other than humans. Typhoid can only ethylenediaminetetracetic acid (EDTA) tubes by trained and 81 Ubandoma Andefiki et al. : Prevalence of Malaria and Typhoid Fever Co-infection and the Haematological Profile of Patients Attending Hospitals in Wukari Taraba State, Nigeria licensed medical laboratory technologists from the two antigen suspension reagents as follows: hospitals. No agglutination 1:20 2.4. Examination for Malaria Parasite Scanty agglutination 1:40 Slight agglutination 1:80 Thick blood films were made by using the end of a pipette Heavy agglutination 1:160 to apply a large drop of blood on the slide to produce a thick Very heavy agglutination 1:320 smear. An area of about 15 mm × 15 mm was covered by the film. 2.6.1. Estimation of Packed Cell Volume The blood films were air-dried and the slide placed on a (PCV) and Haemoglobin (Hb) horizontal position. Field stains A and B were used for The aim of the PCV test was to measure the volume of staining. The slides were placed face downwards on a slide packed red cells present in the blood. The principle of the rack. Immersion oil was added by the edge and it spread to PCV test is the ability of different blood components (red and cover an area of about that is equivalent to the diameter of white blood cells, and platelets) to pack together according to the film. Blood films were examined under ×100 objective their rate of sedimentation after centrifuging for 5minutes and malaria parasites recorded. The trophozoites, schizonts using the Haematocrit centrifuge. Similarly, Haemoglobin and gametocytes were looked for. A smear was considered was also estimated by Sahli's haemoglobinometer (acid negative for malaria parasites if no parasites were seen after haematin method). examining at least 100 microscopic fields [14]. 2.6.2. Total White Blood Cell (WBC) Count 2.5. Widal Test The total WBC count was determined by measuring 0.38ml of Turk’s solution using 1ml pipette into a clean This is a serological technique used to detect the presence cuvette in which 0.02ml (20µL) of blood sample was of Salmonella antibodies in the patient’s serum. Serum was measured using a micropipette and also added, mixed and obtained from 5ml of the patient’s venous blood. Quality incubated for 1hour. WBC count was read microscopically control was done to ascertain the effectiveness of the Widal by counting each of the cells as seen on the Hemocytometer kits. (Neubaer’s counting chamber). The agglutination test was performed on all blood samples by the rapid slide titration method using CJ Smart Widal 2.6.3. WBC Differential Count commercial antigen suspensions, for the somatic (O) and The identification of the different types of white blood flagella (H) antigens by adding one drop of the widal antigen cells was done. In identifying the numbers of different WBC, suspension to the reaction circles containing the patient’s a thin blood film was made, stained with Leishman stain, serum. The content of each circle was uniformly mixed over observed microscopically using the X100 objective and a the entire circle with separate mixing sticks. The slides were large number of WBC (at least 100) was counted. This gave gently rocked back and forth, and observed for agglutination the percentage of cells that are of each type. By multiplying for one minute. A positive widal test was considered for any the percentage by the total number of WBC, the absolute serum sample with antibody titre ≥ 1:160 to the O and H number of each type of WBC was obtained. Five (5) kinds of antigens of S. typhi. WBC were encountered viz; neutrophils, lymphocytes, monocytes, eosinophils, and basophils. 2.6. Identification

Positive samples were identified on the basis of 3. Result microscopy for malaria parasite and agglutination reaction for widal test. The following plus sign scheme was used to Table 1. Overall prevalence of Malaria using Field stains A and B, and report parasite numbers [14]: Typhoid fever using CJ Smart Widal reagent. Illness No. Examined No. Infected Percentage (%) 1 – 10 parasites per 100 high power fields + Malaria 100 88 88.0 11 – 100 parasites per 100 high power fields ++ Typhoid 100 64 64.0 1 – 10 parasites in every high power field +++ More than 10 parasites in every high power field ++++ In table 1 above, the overall prevalence of malaria and typhoid fever shows that 88(88%) and 64(64%) patients were The degree of agglutination in widal test was recorded in respectively infected. titres according to manufacturer’s instruction of CJ Smart Table 2. Malaria prevalence between genders of patients.

No. Infected with Malaria Sex No. Tested Expected Frequency Percentage positive (%) (observed frequency) Males 44 37 44 84.0 Females 56 51 44 91.0 Total 100 88 88 88 AASCIT Journal of Bioscience 2017; 3(6): 79-86 82

The distribution of malaria (Table 2 above) showed that of the 44 males examined, 37(84%) were positive and 51(91%) of the 56 females were positive for malaria.

Table 3. Typhoid fever prevalence between genders of patients.

No. Infected with Typhoid fever Sex No. Tested Expected Frequency Percentage positive (%) (observed frequency) Males 44 28 32 63.6 Females 56 36 32 64.2 Total 100 64 64 64.0

In table 3 above, 28(63.6%) males out of the 44 tested were positive for typhoid fever while 36(64.2%) female patients were typhoid positive.

Figure 1. Age Prevalence of Malaria and Typhoid fever among patients.

In Figure 1 above, the prevalence of malaria and typhoid and 5(100%) respectively, while the age group of 61 – fever among patients across different age groups is shown. 70years had the lowest malaria prevalence rate of 1(50%). Most patients were in the age group of 21 – 30years (38 Also, age group of 51 – 60years had the highest typhoid fever patients) and the least were in the age group of 61 – 70years prevalence rate of 4(80%) while age group 61 – 70years had with 2 patients. The age groups of 41 – 50years and 51 – the least typhoid fever prevalence rate of 1(50%). 60years had the highest malaria prevalence rate of 11(100%) Table 4. Frequency and Distribution of co-infection with malaria and typhoid fever between genders of patients.

Sex No. Tested No. infected with both Malaria and Typhoid fever Percentage positive (%) Males 44 23 52.3 Females 56 33 58.9 Total 100 56 56.0

According to table 4 above, of the 100 patients tested for malaria and typhoid fever co-infection, 56(56%) patients were concurrently infected with both malaria and typhoid. In terms of gender distribution, 23(52.3%) of the 44 males were co- infected while 33(58.9%) of the 56 female patients were co-infected with malaria and typhoid fever. 83 Ubandoma Andefiki et al. : Prevalence of Malaria and Typhoid Fever Co-infection and the Haematological Profile of Patients Attending Hospitals in Wukari Taraba State, Nigeria

Figure 2. Age prevalence of co-infection with malaria and typhoid fever between genders of patients.

The occurrence of co-infection among the different age and none of the patients had PCV above normal. 2(2.3%) groups with respect to their gender (Figure 2 above) showed patients had abnormally low leucocyte count (lower than that among the 23(52.3%) males co-infected, age group 31 – 3,500µL), 82(93.2%) patients had normal leucocyte count 40years had the highest prevalence rate of co-infection of (between 3,500µL and 10,500µL) while 4(4.5%) patients had 6(75%) while age group 51 – 60years had no co-infection. leucocyte count higher than normal (above 10,500µL). Out of the 33(58.9%) females co-infected with malaria and 1(1.1%) patient had neutrophil count lower than the normal typhoid fever, age group 41 – 50years had the highest range (less than 45%), 83(94.3%) patients had normal prevalence rate of co-infection of 5(83.3%) while age group neutrophil count (between 45% and 75%) and 4(4.5%) 61 – 70years had no co-infection. Overall, age groups 31 – showed neutrophil count above normal (greater than 75%). 40years and 41 – 50years (i.e 31 – 50years) were shown to be 17(19.3%) of the malaria positive patients had lymphocyte the most co-infected and age groups 51 – 60 years and 61 – count below the normal range of between 20 – 40%, 70years (i.e 51 – 70years) were the least infected with both 70(87.5%) had normal lymphocyte while 1(1.1%) patient had malaria and typhoid fever. lymphocyte count above normal. For monocyte count, 77(87.5%) patients had normal count (between 1% and 10%) Table 5. Haematological parameters among malaria infected patients. while 11(12.5%) patients had monocyte count higer than Frequency normal. No patient showed monocyte count below the Parameters Below normal Normal Above normal normal range. Eosinophil count was normal (count less than PCV/Hb 20(22.7%) 68(77.3%) 0(0%) 7%) for 81(92.0%) patients and above normal for 7(8.0%) Leucocyte 2(2.3%) 82(93.2%) 4(4.5%) patients. Lastly, 85(96.6%) patients had normal basophil Neutrophil 1(1.1%) 83(94.3%) 4(4.5%) Lymphocyte 17(19.3%) 70(79.5%) 1(1.1%) count (less than 3%) and 3(3.4%) patients had basophil count Monocyte 0(0%) 77(87.5%) 11(12.5%) above normal. Eosinophil 0(0%) 81(92.0%) 7(8.0%) Basophil 0(0%) 85(96.6%) 3(3.4%) Table 6. Haematological parameters among typhoid fever infected patients. Frequency Table 5 above shows the haematological parameters Parameters Below normal Normal Above normal among malaria infected patients in which 20(22.7%) of the PCV/Hb 14(21.9%) 50(78.1%) 0(0%) 88 infected patients had PCV/Hb lower than the normal Leucocyte 2(3.1%) 59(92.2%) 3(4.7%) range (considering PCV and haemoglobin threshold level for Neutrophil 1(1.6%) 61(95.3%) 2(3.1%) children is 33% and 11mg/dL respectively), 68(77.3%) Lymphocyte 12(18.8%) 50(78.1%) 2(3.1%) positive patients had normal PCVs (between 33% and 52% Monocyte 0(0%) 58(90.6%) 6(9.4%) Eosinophil 0(0%) 60(93.6%) 4(6.3%) depending on whether children, adult males or adult females) Basophil 0(0%) 64(100.0%) 0(0%) AASCIT Journal of Bioscience 2017; 3(6): 79-86 84

In table 6 above, the haematological parameters among normal. 12(18.8%) of the typhoid positive patients had typhoid fever positive patients show that 14(21.9%) of the 64 lymphocyte count below the normal range, 50(78.1%) had infected patients had PCV/Hb lower than normal, 50(78.1%) normal lymphocyte while 2(3.1%) patients had lymphocyte positive patients had normal PCVs and none of the patients count above normal. For monocyte count, 58(90.6%) patients had PCV above the normal range. 2(3.1%) patients had had normal count while 6(9.4%) patients had monocyte count abnormally low leucocyte count, 59(92.2%) patients had higher than normal. No patient showed monocyte count normal leucocyte count while 3(4.7%) patients had leucocyte below the normal range. Eosinophil count was normal for count higher than normal. 1(1.6%) patient had neutrophil 60(93.6%) patients and above normal for 4(6.3%) patients. count lower than normal, 61(95.3%) patients had normal All typhoid positive patients had normal basophil count. neutrophil count and 2(3.1%) showed neutrophil count above

Figure 3. Haematological parameters among malaria and typhoid fever co-infected patients.

Figure 3 shows the haematological parameters among malaria and typhoid fever had normal basophil count. malaria and typhoid fever co-infected patients. From the figure, 14(25.0%) of the 56 co-infected patients had PCV/Hb 4. Discussion lower than normal, 42(75.0%) co-infected patients had normal PCVs and none had PCV/Hb above the normal range. Of the 100 patients attending selected hospitals in Wukari 2(3.6%) patients infected with both malaria and typhoid fever in which 75 patients from General Hospital and 25 from had abnormally low leucocyte count, 51(90.0%) patients had Bethel Hospital were included in the study, 56(56%) were normal leucocyte count while 3(5.4%) patients had leucocyte females and 44(44%) males. Included patients were between count higher than normal. 1(1.8%) co-infected patient had the ages of 1 and 70 years with most of the patients being neutrophil count lower than normal, 53(94.6%) patients had youths (between the age of 18 and 35years). normal neutrophil count and 2(3.6%) had neutrophil count This study shows that the overall prevalence (88%) of above normal. 12(21.4%) of the co-infected patients had malaria in Wukari is high. The prevalence rate (64%) of lymphocyte count below the normal range, 43(76.8%) had typhoid fever as well as the co-morbidity (56%) of malaria normal lymphocyte while 1(1.8%) patient had lymphocyte and typhoid fever is also very high. The overall prevalence of count above normal. For monocyte count, 52(92.9%) patients malaria 88(88%) and typhoid 64(64%) were similar to the had normal count while 5(8.9%) patients had monocyte count figure obtained in (80.8% and 46.8% respectively) higher than normal. No patient showed monocyte count by Orok et al in 2016 [15]. Malaria prevalence rate in this below the normal range. Eosinophil count was normal for study was also similar to the value reported in Sierra Leone 52(92.9%) patients and above normal for 4(7.1%) co-infected (79.94%) but typhoid prevalence rate 64(64%) in this study patients. All the patients concurrently infected with both was relatively lower than the figure (83.5%) reported in the 85 Ubandoma Andefiki et al. : Prevalence of Malaria and Typhoid Fever Co-infection and the Haematological Profile of Patients Attending Hospitals in Wukari Taraba State, Nigeria same area [16]. group of 31 – 40years had the highest co-infection rate of The prevalence rate of malaria was higher in females 6(75%) while age group 51 – 60 years had no co-infection 51(91%) than males 37(84%), however, no significant (0%). This does not agree with the report of most other association existed statistically (P > 0.05). This occurrence researchers especially that of Orok et al in which the highest contrasts the result obtained in Calabar by Orok et al which co-infection rate (37.5%) was in the age group of 1 – showed that males (85.8%) are more infected than females 15years. In females, the age group 41 – 50years had the (76.6%). This may not be unconnected with the fact that highest co-infection rate (83.3%) of malaria and typhoid females seem to sweat more than males especially in a high fever while age group 61 – 70years had no co-infection. This temperature locality like Wukari and may often not like the was similar to the report of Mbah and Agu in Samaru in idea of sleeping under insecticide treated nets. which co-infection rate in female adults was 75%. Typhoid fever prevalence rate was also slightly greater in Overall, the very high prevalence rate of malaria in Wukari females 36(64.2%) than in males 28(63.6%), but was not as seen in this research may be as a result of consistent high statistically significant (P > 0.05). This prevalence rate temperature along with stagnant waters in which mosquito corresponds to that reported in Samaru by Mbah and Agu larvae readily mature, providing them with the environment [17] in which females had slightly higher prevalence rate of they need for continuous breeding. Similarly, the high typhoid fever (45.3%) than males (42.2%). This higher prevalence rate of typhoid fever could be as a result of lack frequency of typhoid fever in females may be due to the fact of access to clean water, proper sanitation systems, and that they are regularly engaged in household activities like proper health care facilities. cooking and washing with unsafe water. This study showed obvious changes in the haematological Considering the different age groups tested, it was seen parameters of patients infected with malaria. 20(22.7%) had that the age group of 41 – 50years and 51 – 60years with haemoglobin lower than the threshold 11mg/dL haemoglobin malaria prevalence rate of 11(100%) and 5(100%) level for children, a figure considerably lower than the 87.5% respectively basically contrasts with the popular view that reported by Shah et al at Ahmedabad in India [18]. However, age groups 0 – 10years and 11 – 20years are most infected. there was no significant difference between low haemoglobin However, it is worthy of acceptance that they are more in malaria-positive patients and that in malaria negative susceptible to the disease in areas of high transmission. patients (P > 0.05). Changes noticed in other haematological Naturally acquired immunity builds up in older adults parameters such as neutrophil and eosinophil count above following repeated exposure to malaria parasite and this normal (4.6%) and (8.0%) respectively as well as lymphocyte might have accounted for the least prevalence rate of 1(50%) count below normal (19.3%) cannot be completely attributed of patients between 61 – 70years of age. to malaria infection alone as other complications might be Age group 51 – 60years had the highest typhoid fever involved. 11(12.5%) of the patients had monocyte count prevalence rate of 4(80%) which corresponds to the report of higher than normal which seem to correspond to the popular Okore et al for residents of Obuda- Aba, Abia State which observation that malaria infection contributes to elevated showed that age group of 46 – 60years has the highest monocyte count. prevalence rate (48.33%) of typhoid fever. However, the least In this study, 14(21.9%) of typhoid fever positive patients typhoid prevalence rate of 1(50%) in age group 61 – 70years had lower PCV/Hb, a figure lower than that reported by as shown in this study contrasts the figure obtained by Orok Shilpa et al (34.48%) in Kalaburgi, India [19] but there was et al in which age group 46 – 60years (40.7%) had the least also no significant difference between low haemoglobin in prevalence rate. The higher prevalence rate in age group 51 – typhoid-positive patients and that in typhoid-negative 60years may be due to the fact that most people within this patients (P > 0.05). Leucocyte count was fairly normal in age group in Wukari are working class and usually choose to most of the patients positive for typhoid fever (92.2%), feed during working hours in restaurants proximal to their although showed higher counts compared to negative working places and it’s possible proper hygiene might not patients. Neutrophil count in typhoid positive patients was have been maintained or the food might not have been well mostly normal (95.3%) i.e in 61 of the 64 positive patients prepared. which agrees with the statement of Hoff brand et al 1996, The prevalence of malaria and typhoid co-infection (56%) that neutrophil count can only be abnormally elevated in in this study is higher than that reported by Mbah and Agu in complicated typhoid fever. Samaru in which the prevalence rate of co-infection was 14(25%) of malaria and typhoid fever co-infected patients 15.2%. The rate of co-infection in this study was also higher had anaemia (low PCV/Hb) and that figure is quite high than the value reported in Calabar by Orok et al in which the given that the precise mechanism underlying the association prevalence rate of malaria and typhoid fever co-morbidity between malaria and typhoid fever is still not fully was 28%. The rate of co-infection in this research was also understood though it has been shown that haemolysis, which higher in females (58.9%) than in males (52.3%). This is occurs in malaria, may predispose to typhoid fever [20]. somewhat not strange because females are more exposed to Lymphocyte count below normal range in co-infected mosquitoes and spend time in farms and markets where they patients (21.4%) is medically significant because the do their petty trades and therefore lack access to potable combined effects of the co-morbidity of malaria and typhoid water. In terms of age group cum gender, males in the age fever can result in the anomaly. Also, leucocyte count in co- AASCIT Journal of Bioscience 2017; 3(6): 79-86 86

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