H pylori-Negative MALT-Associated Extranodal Marginal Zone Lymphoma: A Comprehensive Case Report and Literature Review.

Extranodal marginal zone B-cell lymphoma (ENMZL) of mucosa-associated lymphoid tissue (MALT), a rare subtype of B-cell lymphoma, is typically associated with Helicobacter pylori (H pylori) infection, especially in gastric cases. However, this article presents 2 unique cases of H pylori-negative colonic ENMZL, challenging the conventional understanding of the disease. The first case involves an 80-year-old male diagnosed with Stage 1E ENMZL in the descending colon, and the second describes a 74-year-old male with sigmoid colon ENMZL. Both cases lacked H pylori infection, adding complexity to their management. Accompanying these case studies is a comprehensive literature review, delving into the epidemiology, pathology, clinical features, diagnosis, and treatment of H pylori-negative ENMZL, with a focus on gastrointestinal involvement. This review highlights the importance of considering H pylori-negative cases in ENMZL diagnosis and management, illustrating the need for further research and individualized treatment approaches in this uncommon lymphoma subtype.

Esophageal Stricture: An Uncommon Complication of Cervical Inlet Patch.

Esophageal heterotopic gastric mucosal patches (HGMP), also known as cervical inlet patches (CIP), is a rare but underdiagnosed condition characterized by the presence of salmon-colored, velvety mucosa located in the proximal esophagus, distal to the upper esophageal sphincter. The incidence of CIP ranges from 3% to 10% in adults, and its endoscopic appearance is characterized by a flat or slightly raised salmon-colored patch. In this case, we report a 78-year-old man who presented with symptoms of laryngopharyngeal reflux and dysphagia. An esophagogastroduodenoscopy showed a flat area of salmon-colored patch between 17 and 20 cm from the incisors, suggestive of a CIP complicated by stricture. The biopsy results showed an oxyntic-type mucosa lined with columnar cells consistent with an inlet patch. Esophageal dilation was done with a savory dilator with no resistance at 18 mm. The patient was placed on maintenance acid suppression therapy with proton-pump inhibitors and reported complete resolution of symptoms at the 1-month follow-up.

Clinical and Endoscopic Response to Anti-Tumor Necrosis Factor-Alpha Antibody Therapy in a Patient With Cronkhite-Canada Syndrome.

Cronkhite-Canada syndrome (CCS) is an acquired polyposis syndrome with gastrointestinal and extraintestinal manifestations. Given its rarity and lack of standard treatment, diagnosis and treatment are challenging. Steroid therapy and nutritional support are conventional treatments. There is no consensus on management of steroid-refractory cases. Here, we report the diagnosis and treatment course of a 54-year-old Asian male with CCS, whose initial treatment with prednisone 60 mg a day led to partial response and disease flare up during prednisone tapering. The use of infliximab and azathioprine led to promising remission of his symptoms.

Prevalence and Associated Risk Factors of Urinary Schistosomiasis among Primary School Pupils in the Jidawa and Zobiya Communities of Jigawa State, Nigeria.

Background: Urogenital schistosomiasis (UgS) is a parasitic disease caused by Schistosoma haematobium and can lead to chronic ill-health. Nigeria is endemic for schistosomiasis, but epidemiology of UgS has not been studied in most states. This study was conceived with the aim to contribute towards an accurate national picture of UgS in Nigeria. The prevalence of UgS and the associated risk factors were for the first time investigated among primary school pupils in Jidawa and Zobiya communities of the Dutse Local Government Area (LGAs) of Jigawa State, Nigeria. Method: Focus group discussions with teachers and parents were conducted. After obtaining written consent from parents, questionnaires were administered to pupils to obtain socio-demographic data and information on water contact activities. Urine samples (279) were collected and processed by the urine filtration technique to evaluate haematuria and the presence of S. haematobium eggs. Results: Prevalences of 65.7% (90/137) and 69.0% (98/142) were recorded in the Jidawa and Zobiya communities, respectively. In both communities, there was a significant association between gender and UgS: 63.3% of the infected pupils were males as compared to 36.7% females (χ2 = 5.42, p = 0.020). Grade 5 students had a significantly higher prevalence (χ2 = 17.919, p = 0.001) (80.0%) compared to those in grades 2, 3, 4, and 6 (63.8%, 66.7%, 61.5%, and 64.6%, respectively). Water contact activities showed that pupils involved in fishing, irrigation, and swimming were at greater risk of becoming infected in Jidawa and Zobiya, with odds ratios (risk factors) of 5.4 (0.994-28.862) and 4.1 (1.709-9.862), respectively (p = 0.05). Conclusion: Both the Jidawa and Zobiya communities of the Dutse LGAs of Jigawa State are hyperendemic for UgS. In collaboration with the State Ministry of Health, mass administration of praziquantel was carried out in the Jidawa and Zobiya communities after this study.

Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians.

BACKGROUND: Antimicrobial use plays a key role in development and spread of antimicrobial resistance. Following the global coronavirus disease 2019 (COVID-19) pandemic and the report of the first confirmed case in Nigeria, several states embarked on either a full or partial lockdown as a measure to prevent or curtail the spread of the virus with its attendant challenges. This survey was designed to provide a snapshot of public antimicrobial use and common perception related to antimicrobial use for COVID-19 related symptoms among Nigerian populace. METHODS: We developed and tested a 29-question electronic questionnaire with Google forms asking respondents about their antimicrobial use and perceptions regarding appropriate antimicrobial use for real or perceived symptoms during the outbreak period. Respondents aged 18 years and above were recruited through crowd sourcing and they received the link to the survey tool through emails and social media including WhatsApp, Twitter, Facebook, LinkedIn, and Instagram. All data analysis was performed using SPSS version 26.0. RESULTS: A total of 410 responses were received from the six geopolitical zones in Nigeria comprising 200 (48.8%) females and 210 (51.2%) males. Majority (62.9%) of the respondents had taken antimicrobials in the 3 months period preceding the survey, while less than half (46.8%) received prescription for it. Previous intake of antimicrobial for similar illness was a predictor of antimicrobial intake (OR: 0.55, 95%CI: 0.30-1.01). The most consumed antimicrobial was antimalarial drugs, specifically Artemisinin-based combination therapy (43.4%), followed by antibiotics [Ciprofloxacin (20.2%)]. CONCLUSION: There was high levels of antimicrobial use for COVID-19 related symptoms by the Nigerian public. This is likely to escalate the already high prevalence of antimicrobial use previously reported and may further fuel the emergence of antimicrobial resistance.

CONTEXTE: L'utilisation d'antimicrobiens joue un rôle clé dans le développement et la propagation de la résistance aux antimicrobiens. À la suite de la pandémie mondiale de coronavirus 2019 (COVID-19) et du rapport du premier cas confirmé au Nigéria, plusieurs États se sont engagés dans un verrouillage complet ou partiel en tant que mesure pour prévenir ou freiner la propagation du virus avec ses défis associés. Cette enquête a été conçue pour fournir un aperçu de l'utilisation publique des antimicrobiens et de la perception commune liée à l'utilisation des antimicrobiens pour les symptômes liés au COVID-19 parmi la population nigériane. MÉTHODES: Nous avons développé et testé un questionnaire électronique de 29 questions avec des formulaires Google interrogeant les répondants sur leur utilisation d'antimicrobiens et leurs perceptions concernant l'utilisation appropriée d'antimicrobiens pour les symptômes réels ou perçus pendant la période d'épidémie. Les répondants âgés de 18 ans et plus ont été recrutés via le crowdsourcing et ils ont reçu le lien vers l'outil d'enquête via des e-mails et des médias sociaux, notamment WhatsApp, Twitter, Facebook, LinkedIn et Instagram. Toutes les analyses de données ont été effectuées à l'aide de la version 26.0 de SPSS. RÉSULTATS: Un total de 410 réponses ont été reçues des six zones géopolitiques du Nigéria comprenant 200 (48,8%) femmes et 210 (51,2%) hommes. La majorité (62,9%) des répondants avaient pris des antimicrobiens au cours des 3 mois précédant l'enquête, tandis que moins de la moitié (46,8%) en avaient reçu une prescription. La prise antérieure d'antimicrobiens pour une maladie similaire était un prédicteur de l'ingestion d'antimicrobiens (OR: 0,55, IC à 95%: 0,30-1,01). L'antimicrobien le plus consommé était les antipaludiques, en particulier les associations thérapeutiques à base d'artémisinine (43,4%), suivis des antibiotiques [Ciprofloxacine (20,2%)]. CONCLUSION: Il y avait des niveaux élevés d'utilisation d'antimicrobiens pour les symptômes liés au COVID-19 par le public nigérian. Cela est susceptible d'augmenter la prévalence déjà élevée de l'utilisation d'antimicrobiens rapportée précédemment et peut encore alimenter l'émergence de la résistance aux antimicrobiens.

KNOWLEDGE, ATTITUDE AND PRACTICE OF NIGERIAN MEDICAL STUDENTS TOWARDS COMPLEMENTARY AND ALTERNATIVE MEDICINE IN COVID-19 MANAGEMENT.

OBJECTIVE: Complementary and alternative medicine (CAM) is commonly used, but many physicians have limited knowledge of CAM despite its widespread use. Therefore, this study sought to assess the knowledge, attitude, and practice of medical students on complementary and alternative medicine in the management of COVID-19. METHODOLOGY: A descriptive cross-sectional study was conducted among 150 medical students from three Federal Universities in South West, Nigeria. A self-administered semi-structured online Google Forms questionnaire was used to collect information. Chi-squared and Fisher's exact test was used to analyze the bivariate relationship between KAP status and sociodemographic characteristics. Spearman's correlation coefficient matrix was computed to determine the association between knowledge, attitude, CAM, age, and religiosity practice. RESULTS: The median age was 22 years (interquartile range: [IQR]: 21-23 years). Median self-rated score for religion was 4.00 (IQR: 3.00-4.25). Median knowledge score was 4.00 (IQR: 3.75-5.00), median attitude score 2.75 (IQR: 2.38-3.00) and median practice score 2.00 (IQR: 1.00-2.00). Thirty-seven respondents (24.7%) were considered to have poor knowledge about CAM use in COVID-19 while the rest (75.3%) had good knowledge. Thirty-eight (25.3%) had a poor attitude towards using CAM in COVID-19 and 112 (74.7%) had a good attitude. CONCLUSION: Medical students have good knowledge and a positive attitude towards CAM modalities as adjunct management for COVID-19. However, their practices do not reflect wide acceptability. There is a need for clinical trials on the efficacy of CAM as an adjunct treatment for COVID-19 to further inform its use.

Emergency Presentation of Groin Hernia: Severity and Outcomes of Treatment in a Nigerian Tertiary Hospital.

BACKGROUND AND OBJECTIVE: Complications arising from groin hernias carry significant risks that task the resources of the surgeon and patient and, whenever feasible, should be avoided. In the past, obstructed groin hernia was the most common cause of intestinal obstruction in many parts of tropical Africa, but the trend appears to be changing. The aim of this study was to determine the severity and operative outcomes of complicated groin hernias in our centre. DESIGN: Aseven-year retrospective study. SUBJECTS: Records of adult patients with groin hernias, managed surgically for complicated groin hernias from January 2012 to December 2018 were retrieved and evaluated. RESULTS: A total of 387 patients were evaluated representing 18.3% of the entire groin hernias repaired surgically during the study period. Inguinal hernias accounted for 88.4% while femoral hernias represented 11.6%. Majority (76.5%) resided in a rural area. Twenty six (6.7%) patients presented with bilateral hernias (all were inguinal), but none had complications in both groins simultaneously. Twenty-one (5.4%) patients had spontaneous reduction, and of these, 13 (61.9%) received mesh implants. Overall, 6.2% were incarcerated, 56.8% were obstructed while the remaining 37.0% were strangulated. The resection rate was 29.5% for emergency repairs; 60.2% of the resections were performed in those who delayed beyond 72hours before presentation. The overall morbidity and mortality rates were 40.7% and 10.4% respectively. CONCLUSION: Late presentation is very common among patients with complicated inguinal hernia in our centre. Subsequently, bowel resection, morbidity and mortality rates are increased in proportion to the length of delay and degree of bowel and systemic involvements.

YouTube™ as a Source of Instructional Videos on Bowel Preparation: a Content Analysis.

Instructional videos on bowel preparation have been shown to improve bowel preparation scores during colonoscopy. YouTube™ is one of the most frequently visited website on the internet and contains videos on bowel preparation. In an era where patients are increasingly turning to social media for guidance on their health, the content of these videos merits further investigation. We assessed the content of bowel preparation videos available on YouTube™ to determine the proportion of YouTube™ videos on bowel preparation that are high-content videos and the characteristics of these videos. YouTube™ videos were assessed for the following content: (1) definition of bowel preparation, (2) importance of bowel preparation, (3) instructions on home medications, (4) name of bowel cleansing agent (BCA), (5) instructions on when to start taking BCA, (6) instructions on volume and frequency of BCA intake, (7) diet instructions, (8) instructions on fluid intake, (9) adverse events associated with BCA, and (10) rectal effluent. Each content parameter was given 1 point for a total of 10 points. Videos with ≥5 points were considered by our group to be high-content videos. Videos with ≤4 points were considered low-content videos. Forty-nine (59 %) videos were low-content videos while 34 (41 %) were high-content videos. There was no association between number of views, number of comments, thumbs up, thumbs down or engagement score, and videos deemed high-content. Multiple regression analysis revealed bowel preparation videos on YouTube™ with length >4 minutes and non-patient authorship to be associated with high-content videos.

Disseminated herpes zoster ophthalmicus in an immunocompetent 8-year old boy.

Varicella results from a primary infection with the varicella virus while herpes zoster is caused by a reactivation of a latent infection. Dissemination of herpes zoster is uncommon in immunocompetent individuals. Reports of disseminated herpes zoster in children are even less common than in adults. An unusual case of disseminated herpes zoster ophthalmicus in an 8-year old immunocompetent black boy is presented. He had a previous primary Varicella zoster virus infection at three years of age. In the current report, he presented during an on-going chicken pox outbreak and survived with no significant complications. A breakthrough varicella virus re-infection or a reactivation is possible, both of which could present as zoster. This case emphasizes the need for prevention of varicella virus infection through universal childhood immunization and effective infection control strategies in health care settings.

Genetic Analysis and Molecular Identification of Virulence in Xanthomonas oryzae pv. oryzae Isolates.

Bacterial leaf blight (BLB) of rice is a very destructive disease worldwide and is caused by Xanthomonas oryzae pv. oryzae (Xoo). The aim of the present study was to examine if the Xoo virulence pathotypes obtained using phenotypic pathotyping could be confirmed using molecular approach. After screening of 60 Operon primers with genomic DNA of two Xoo isolates (virulent pathotype, Vr, and mildly virulent pathotype, MVr), 12 Operon primers that gave reproducible and useful genetic information were selected and used to analyze 50 Xoo isolates from 7 West African countries. Genetic analysis revealed two major Xoo virulence genotypes (Mta and Mtb) with Mta having two subgroups (Mta1 and Mta2). Mta1 (Vr1) subgroup genotype has occurrence in six countries and Mta2 (Vr2) in three countries while Mtb genotype characterized mildly virulence (MVr) Xoo isolates present in five countries. The study revealed possible linkage and correlation between phenotypic pathotyping and molecular typing of Xoo virulence. Xoo virulence genotypes were known to exist within country and there was evidence of Xoo pathogen migration between countries. Durable resistance rice cultivars would need to overcome both Mta and Mtb Xoo virulence genotypes in order to survive after their deployment into different rice ecologies in West Africa.

Analysis of nonformulary use of PPIs and excess drug cost in a Veterans Affairs population.

BACKGROUND: In the Veterans Affairs (VA) health care system, a formulary-based approach without beneficiary cost-share incentives is used to limit the pharmacy cost of proton pump inhibitors (PPIs). However, the effectiveness of this approach in reducing the cost of PPIs is unknown. OBJECTIVES: To (a) compare cost differences between the formulary PPI (generic omeprazole) and nonformulary PPIs and (b) evaluate reasons for nonformulary PPI use in order to identify opportunities to increase formulary drug use and discourage unnecessary use of nonformulary PPIs. METHODS: A list of patients with receipt of PPIs from July 1, 2008, through June 30, 2009, was obtained from the Loma Linda VA Healthcare System pharmacy. Subjects with receipt of at least 120 units (capsules or tablets) of any PPI in the study period were considered long-term users. Demographic information was collected. Pharmacy consult records were reviewed to identify reasons for nonformulary use and dosing regimen of the formulary PPI prior to the switch. Cost analysis was done based on the VA contract prices for the drugs at the time of the study. RESULTS: Of 58,605 unique patients seen in this VA health care system in the 12-month period from July 1, 2008, through June 30, 2009, 13,713 (23.4%) received a PPI, and of these, 10,483 (76.4%) received at least 120 PPI units and were defined as long-term users. Of the long-term users, 9,462 (90.3%) were on the formulary PPI generic omeprazole, and 1,021 were nonformulary PPI users. Use of nonformulary PPIs (esomeprazole, pantoprazole, lansoprazole, rabeprazole) accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI cost. This pattern resulted in $570,263 in excess spending (i.e., $570,263 would have been saved in the study period if the nonformulary PPI users had used the formulary drug). The most common reason for nonformulary long-term PPI use was persistent symptoms (n=901, 88.2%). Adverse reaction was cited by 111 (10.9%) of nonformulary PPI users, 33.3% (n=37) of whom reported diarrhea. Of those who switched to a nonformulary PPI due to persistent symptoms, 363 (40.3%) were on once-daily dosing prior to the switch; 379 (42.1%) were on twice-daily dosing; and 159 (17.6%) were transfers from other places in which prior dosing information was not available in the hospital pharmacy records. CONCLUSIONS: One-year PPI use prevalence was 23% in this VA population, and long-term use prevalence was 18%. Nonformulary PPI use accounted for 10.5% of the PPI units and 9.7% of the users but 57.3% of total PPI drug cost. Opportunities to reduce nonformulary PPI use in order to reduce overall expenditures on PPIs include verification of optimal formulary PPI use, titration to twice-daily dosing, and confirmation of adverse reaction as being attributable to PPI use.

Larvicidal efficacy of seed oils of Pterocarpus santalinoides and tropical Manihot species against Aedes aegypti and effects on aquatic fauna.

Botanical larvicides have featured prominently as alternative to synthetic chemical insecticides which are less degradable and toxic to non-target organisms. The larvicidal potentials of the seed oils of Pterocarpus santalinoides and Tropical Manihot species (TMS 30572) were investigated in the laboratory against larvae of Aedes aegypti. The seed oil of each plant was extracted using n-hexane and was graded into different concentrations; 30, 60, 90, 120 and 150 ppm. The toxicity of each of the concentrations was evaluated against 3rd instar larvae of A. aegypti and tadpoles (Buffo spp) as non target aquatic fauna. Both oils were toxic to the larvae though at higher concentrations (120 ppm and 150 ppm) after 24 hours of exposure. The oil of P. santalinoides was more toxic to the larvae (LC50 104.0 ppm and LC90 184.5 ppm) than oil of TMS (LC50 113.5 and LC90 201.2) but the difference in the lethal doses was not statistically significant (P > 0.05). However, mortality was not recorded at any of the graded concentrations in both oils against tadpoles. The results therefore suggest that the seed oils of both plants could be incorporated as botanical insecticides against mosquito vectors with high safety to non-target organisms.

Seasonal biting pattern of Simulium damnosum s.l and its implications on onchocerciasis treatment with ivermectin.

BACKGROUND: The current control strategy adopted by African Programme for Onchocerciasis Control (APOC) is the mass distribution of ivermectin in all endemic areas for between 12-15 years. One of the major obstacles of the strategy, is the ability of the fly to migrate long distances and this brings about the possibility of flies migrating from uncontrolled areas to controlled areas. OBJECTIVE: To assess the impact of annual ivermectin treatment of onchocerciasis and to ascertain the seasonality of transmission and its impact on the current control strategy in the forest zone around a dam in Southern Nigeria. METHODS: A 36 x 11-hour entomological survey was carried out in the study area. Simulium damnosum s.l were caught using two human baits from 07.00 hours-18.00 hours, three days of every month for 12 months according to the method of Walsh et al. The head, thorax and abdomen of each insect were dissected separately. Catches were made from dawn to dusk. RESULTS: Catches yielded a total of 2,807 female S. damnosum s.l. Higher mean biting rates (2,486 flies/man/year) occurred during the dry season. The mean monthly distribution of parous flies also showed distinct seasonality with preponderance of parous flies during the dry season (61.8%) as compared to the rainy season (38.6%). Flies harbouring developing and infective larvae were observed during the dry season in October and December when the monthly transmission potential recorded was 31 larvae/man/month. This dropped to 28 larvae/man/month and 25 larvae/man/month in January and February respectively. An annual transmission potential of 115 larvae/man/year was recorded. CONCLUSION: In spite of the ivermectin treatment in the area at the time of study, the transmission of Onchocerca volvulus continued unabated in the area with a higher transmission in the dry season than the rainy season. The distribution of ivermectin should be intensified through improved coverage while other control measures may be necessary during the dry season which is the peak of transmission in the area.

Knowledge and practices on malaria treatment measures among pregnant women in Abeokuta, Nigeria.

The knowledge and practices on malaria treatment measures were assessed among 1400 pregnant women in semi-urban and rural communities (Akomoje, Iberekodo, Osiele and Sabopapamaru) of Abeokuta, Nigeria in 2006. Data was collected using structured questionnaires and focus group discussions. The largest proportion (41%) of the respondents was in the age group 21-25years. About three quarters (74%) of the women were multigravids. Sixty-five percent of the women had between three to four episodes of malaria per year. According to the respondents, symptoms associated with malaria in pregnancy included abdominal pains and foetal weakness due to reduced kicks (53%), body pains and headaches (27%) and anaemia (20%). Sixty-eight percent of the pregnant women utilized herbs for treating symptoms associated with malaria due to its effectiveness and suitability and not due to financial constraint or lack of access to health facility. Though most women utilized herbs, 32% relied more on the use of antimalarials. Sulfadoxine-pyrimethamine was the preferred antimalarial during pregnancy at the 2nd and 3rd trimesters. Only 15% of the women were using insecticide treated mosquito nets for personal protection. The majority (77%) of respondents used nylon net to screen their windows off mosquitoes. Since malaria poses adverse effect on the mother and developing foetus, health education becomes very essential to the traditional birth attendants and the women who patronize them. Pregnant women who attend traditional birth homes should be encouraged to also attend orthodox antenatal clinics, in order to receive proper and adequate treatment against malaria for themselves and the foetus.

Sociocultural aspects of mass delivery of praziquantel in schistosomiasis control: the Abeokuta experience.

BACKGROUND: Schistosomiasis is a public health problem in Nigeria. Although there is an ongoing national program for its control, disease control programs in other countries have shown the need to understand the sociocultural aspects of disease transmission, prevention, and treatment in endemic communities before control efforts are undertaken. OBJECTIVE: To describe sociocultural factors that influence the distribution process of praziquantel for the mass treatment of schistosomiasis infection. METHODS: Data for the study were collected through focus group discussions held separately with adult males and females, male and female adolescents (13-19 years), and male and female children (5-12 years). In-depth interviews were similarly held with the drug distributors of praziquantel for mass treatment and with community/opinion leaders of six hyperendemic communities in Ogun State, Southwest Nigeria on mass treatment using praziquantel. These focus group discussions and in-depth interviews were held both before and following the drug distribution. The data were analyzed using the textual analysis program, Textbase Beta. RESULTS: Following a 3-week period of mass treatment in six communities, we observed an increased awareness of rivers/streams as a source of schistosomiasis. In addition, the communities reported overwhelming support for the mass treatment after receiving treatment. The reasons for this acceptance appear to include the perceived efficacy of praziquantel against the disease and its availability free of charge. The drug's distributors adhered to the originally specified systems-based protocol for mass treatment in only two of the six communities. The systems-based protocol adhered to strict distribution through primary health centers and schools. The four other communities used a community-based approach for mass treatment with praziquantel and attained greater coverage of treatment as a result. CONCLUSION: Obtaining community support and involvement before the implementation of mass treatment of schistosomiasis with praziquantel contributes to an effective treatment strategy for this disease. A detailed assessment of a community's health needs, before the initiation of the control efforts against endemic infections, should be undertaken.

Height as a substitute for weight for estimating praziquantel dosage.

The study evaluated height and weight measurements of 750 school children from five rural communities in western Nigeria. The measurements were taken by 12 trained community members designated as distributors in determining treatment dose with praziquantel for these children. A very strong correlation value, r=0.97, was obtained for the weight of treated children measured by the distributors and the research team. The distributors obtained a correlation coefficient value of r=0.87 on weight and height measurements, showing that height can be used by community distributors in lieu of weight for correct dose determination.

Identification of the forest strain of Onchocerca volvulus using the polymerase chain reaction technique.

Annual mass treatment with ivermectin for 12-15 years in endemic communities is the control strategy adopted by the African Programme for Onchocerciasis Control (APOC) for the control of onchocerciasis in Nigeria. This long-term treatment necessitates the use of Polymerase Chain Reaction (PCR) for the proper identification of the Onchocerca species and strains in endemic areas and also for monitoring recrudescence of infection in areas where infection has been controlled. This study, which forms part of a larger study on transmission of onchocerciasis identifies the Onchocerca volvulus strain in Ondo state using the Polymerase Chain Reaction (PCR) technique. Deoxyribonucleic acid (DNA) was extracted from the adult worm of Onchocerca parasite using the glass bead method of extraction. The repeated sequence family present in the genome of the parasite designated as 0-150bp was amplified by the polymerase chain reaction (PCR). The amplified parasites produced significant products visible as bands in a 2% agarose gel stained with ethidium bromide. Hybridization of the PCR products with specific DNA probe identified the products as forest strain of Onchocerca volvulus. The epidemiological implication of this is that there would be more of the skin lesions and low blindness rate in the area.

Effectiveness of different approaches to mass delivery of praziquantel among school-aged children in rural communities in Nigeria.

Schistosomiasis is hyperendemic in Nigeria. The national policy on schistosomiasis control has adopted praziquantel as the main drug of use in the control strategy aimed at reducing morbidity. However, the best delivery channel for praziquantel in schistosomiasis control in Nigeria is yet to be determined. This study assessed different channels for praziquantel delivery in a mass treatment effort. Three groups, each of two communities, were assigned to one of the following three channels: health facility (HF), school, and community for mass delivery of praziquantel to school-aged children. Distributors were trained on all aspects of praziquantel distribution and sufficient praziquantel tablets were provided for the drug distribution within 3 weeks following which an evaluation of the drug distribution by the different treatment channels was conducted. Overall, the community channel of delivery achieved the best coverage of 72.2% (range: 69-73%) compared to 44.3% (range: 39.5-62%) and 28.5% (range: 26.3-74.5%) for the HF and school channels, respectively. Community channel of praziquantel delivery as shown in this study ensures good coverage of both in and out-of-school children.

Endemicity of onchocerciasis in some local government areas of Niger state.

The established method of justifying the need for ivermectin delivery to a community is the use of Rapid Assessment Method (RAM). This method involves the clinical examination of 50 adult males, who have been resident in the community for at least five years, for onchocercal nodules and leopard skin. The values obtained for these indices will guide the classification of such a community as being hypoendemic, mesoendemic or hyperendemic. Those that fall within mesoendemic and hyperendemic category onchocerciasis qualify for ivermectin delivery. This study was carried out to determine the endemicity level of onchocerciasis in 74 communities of 8 Local Government Areas (LGAs) of Niger state to justify their inclusion or otherwise in the ongoing state wide mass treatment for onchocerciasis using ivermectin. The communities were selected using the Geographical Information System (GIS) data and following the World Health Organization (WHO) guideline for RAM. A total of 3000 subjects were examined comprising of 2395 (79.8%) males and 605 (20.2%) females. None of the LGAs, based on overall prevalence for nodules qualify for mass treatment with ivermectin. However the study identified communities within some of these LGAs that were mesoendemic for onchocerciasis and thus qualified for mass treatment with ivermectin.