Community referral for presumptive TB in Nigeria: a comparison of four models of active case finding.

BACKGROUND: Engagement of communities and civil society organizations is a critical part of the Post-2015 End TB Strategy. Since 2007, many models of community referral have been implemented to boost TB case detection in Nigeria. Yet clear insights into the comparative TB yield from particular approaches have been limited. METHODS: We compared four models of active case finding in three Nigerian states. Data on presumptive TB case referral by community workers (CWs), TB diagnoses among referred clients, active case finding model characteristics, and CWs compensation details for 2012 were obtained from implementers and CWs via interviews and log book review. Self-reported performance data were triangulated against routine surveillance data to assess concordance. Analysis focused on assessing the predictors of presumptive TB referral. RESULTS: CWs referred 4-22% of presumptive TB clients tested, and 4-24% of the total TB cases detected. The annual median referral per CW ranged widely among the models from 1 to 48 clients, with an overall average of 13.4 referrals per CW. The highest median referrals (48 per CW/yr) and mean TB diagnoses (7.1/yr) per CW (H =70.850, p < 0.001) was obtained by the model with training supervision, and $80/quarterly payments (Comprehensive Quotas-Oriented model). The model with irregularly supervised, trained, and compensated CWs contributed the least to TB case detection with a median of 13 referrals per CW/yr and mean of 0.53 TB diagnoses per CW/yr. Hours spent weekly on presumptive TB referral made the strongest unique contribution (Beta = 0.514, p < 0.001) to explaining presumptive TB referral after controlling for other variables. CONCLUSION: All community based TB case-finding projects studied referred a relative low number of symptomatic individuals. The study shows that incentivized referral, appropriate selection of CWs, supportive supervision, leveraged treatment support roles, and a responsive TB program to receive clients for testing were the key drivers of community TB case finding.

Malaria parasitaemia among febrile under-five children at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria.

Background: Malaria is an infectious disease caused by Plasmodium and transmitted by the bite of an infected female Anopheles mosquito. It continues to be a global challenge with about half of the world's population being at risk of the disease and under­5 children being the most vulnerable. Aims and Obejectives: To determine the prevalence of malaria parasitaemia and some associated symptoms among febrile under-five children presenting at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. Materials and Methods: A total of 200 children under the age of five years were recruited for the study. Data on socio-demographic characteristics and symptoms were collected through interviewer administered questionnaire. They were physically examine and blood sample was collected from each of them. The Blood smear was Giemsa stained and examined microscopically for malaria parasite. Result: There were 118 males and 82 females, giving a male: female ratio of 1.44:1. Their ages ranged from 3-59 months and the average age was 27+17.49 months. Those in the age range of 12-23 months and 24-35 months constitute the highest number (23%) each. Forty-seven (23.5%) came from the rural area while 153(76.5%) came from the urban area. Average number of days the subjects had fever before presentation were 3.78+1.95 days with a range of 1-30 0 days. Body temperature ranged from 35.9-40.4 C with average of 37.7+0.8oC. Forty (20%) were positive to microscopy. Those in the age range of 47-59 months have the highest prevalence of malaria. Parasite density ranged from 40-136,000/µL with a mean of 18,687.2+3360/µL. All the children who are positive by microcopy had Plasmodium falciparium as the specie causing malaria. Conclusion: Malaria parasitaemia among these under-5 children is 20%.

Intensity and clinical morbidities of tungiasis in an impoverished south-west Nigerian community.

Sand fleas infestation, Tunga penetrans, remains a neglected tropical disease of public-health concern in many countries. Tungiasis can lead to destruction of the feet causing serious discomfort and deformities. This study aim was to determine the intensity rate and clinical morbidities of tungiasis among the people living in Igbokoda, Ondo State, Nigeria. A community-based cross-sectional survey was conducted among households in three villages in Igbokoda. Hands and feet of selected household members were examined, while fleas on different floor types of houses were sampled by soil collection and extraction by tullgren funnel method. Sand fleas were equally sampled from legs of infested individuals by hand picking. Intensity was determined in terms of number of lesions and fleas in different floor-types. Tungiasis-associated morbidities was assessed using acute and chronic lesions severity scores. The study revealed that moderate infestation was observed in 173 infested individuals and severe infestation in 16 infested individuals. A total of 5293 lesions was observed out of which 3098 were viable. The flea burdens on sampled floors and legs were 127 and 146 fleas respectively occurring mostly in unpaved veranda and rooms (65 and 62 fleas respectively). Tungiasis lesions observed in males were more intense compared to females. Flea lesions and burdens with respect to age stratification and location were significant P < 0.0001. Difficulty in walking, pain upon pressure and deformation of the feet were the most common tungiasis-associated morbidity recorded. Also, tungiasis-associated morbidities, and flea number sampled on legs and on floor of environment were reportedly intense. Therefore, scaling up an appropriate and affordable intervention approach targeted at the fleas would serve as a relief to the scourge of tungiasis in Igbokoda community.

Evaluating the potentials of randomised integrated control trial on tungiasis in a South-western Nigerian community.

Considering the fact that new, safe and incorporable treatment alternatives to therapeutic prophylaxis for tungiasis are lacking and sometimes proving difficult, this present study evaluated the potentials of integrating control approach involving focal premise treatment using 5% emulsifiable concentrate of cypermethrin, and topical application of Piper guineense oil with personal protection. Of the 90 houses selected, their floors were classified into paved rooms & unpaved verandas, paved verandas & unpaved rooms, paved rooms & verandas, and unpaved rooms & verandas, and tested for the presence of sand fleas using the sweeping and beating as well as soil collection and extraction by tullgren funnel method before fumigation. A total of 100 individuals partitioned into four groups of 25 individuals each were assigned 3%, 5%, 10% and 15% of P. guineense oil irrespective of stages of embedded fleas. The mean of sand fleas decreased from 1.14, 0.07, 0.21, and 1.66 to 0.37, 0.02, 0.09 and 1.08 after two weeks of single spray compared to the untreated location (p <  0.001). Furthermore, the mean lesions of stage I reduced to 0 after 2 to 6 days of 3%, 5%, 10% and 15% ointment application, and stage II and III after 10 to 12 days of 10% and 15% application respectively. The difference between tungiasis stages and exposure time for P. guineense ointment was highly significant p = 0.007 and p = 0.0002. Notable reduction in severity score of acute and chronic tungiasis was observed thus indicating effectiveness of the topical ointment. Hexanolic oil extracts of P. guineense in 10% and 15% concentration would kill embedded sand flea and ameliorate the sufferings in endemic settings.

Assessing the potentials of two local topical ointments as affordable treatment against tungiasis infestation: A self-experimentation in Igbokoda, Nigeria.

Infestations caused by penetration of Tunga penetrans (Siphonaptera: Hectopsyllidae) in cutaneous sub-layers present morbidities and resulting mortalities if surgical treatment remains the obtainable. Considering the neglected nature of this infestation and the absence of marketable product, we report an observation on the use of grounded naphthalene in kerosene ointment, and powder of Piper guineense in coconut oil ointment as affordable treatment of embedded tungiasis flea in Igbokoda. A total of 80 individuals partitioned into two groups of 40 individuals each were assigned the locally made topical ointment irrespective of stages of tungiasis lesions. The mean of stage I, II and III tungiasis lesions treated with grounded naphthalene in kerosene ointment respectively decreased from 1.83, 3.42 and 3.89 to 0 after 5-6 days (p < .05). Also, the mean of stage I, II and III tungiasis lesions treated with grounded P. guineense ointment respectively decreased from 1.52, 3.10 and 5.00 to 0 after 6 to 7 days of treatment exposure (p < .05). Very high significant difference between stages and exposure days of participants assigned the two topical ointment was recorded p < .0001 and p = .0005 respectively. Naphthalene ointment and to a lesser extent P. guineense ointment is best to control and hinder development cycle of embedded fleas irrespective of infested part and stage of infection.

Saline cathartics and adsorptive capacity of activated charcoal for doxycycline.

The effects of sodium chloride and sodium citrate on the in vitro adsorption of doxycycline to activated charcoal have been studied. Solutions of doxycycline alone and doxycycline with 7.5 mg/ml cathartic solutions were vortex-mixed for 30 s with different quantities of activated charcoal, incubated for 30 min at 37 degrees C and analyzed for free doxycycline spectrophotometrically at 348 nm. Addition of NaCl had a significant (p<0.05) increase while sodium citrate produced a significant (p<0.05) decrease in the adsorption of doxycycline on activated charcoal. In all, the adsorption doxycycline on activated charcoal obeyed quantity-dependent kinetics.

Sub-chronic Hepatotoxicity of Anacardium occidentale (Anacardiaceae) Inner Stem Bark Extract in Rats.

The extracts of Anacardium occidentale have been used in the management of different cardiovascular disorders in Nigeria. These have necessitated the assessment of the toxicity of this plant extract in sub-chronic administration. The inner stem bark of Anacardium occidentale was extracted with 80 % methanol and quantitatively analysed for antinutrients and some heavy metals. The phytochemical compositions and acute toxicity of the extract were determined also. Toxicity profiles of the extract on some liver function parameters were evaluated following a sub-chronic oral administration at doses of 1.44 and 2.87 g/kg. The phytochemical screening of extract revealed the presence of high amount of tannins, moderate saponins and trace of free reducing sugars. The antinutrient levels were 5.75 % (tannins), 2.50 % (oxalates), 2.00 % (saponins), 0.25 % (phytate) and 0.03 % (cyanide). The quantity of iron detected from dried crude was 8.92 mg/100 g, while lead and cadmium were non-detectable. The extract had LD(50)of 2.154g/kg p.o. in mice. Sub-chronic administration of the extract significantly increased the serum levels of alanine aminotransaminase and aspartate aminotransaminase, which are indicative of liver damage. The serum levels of alkaline phosphatase and total protein of the treated animals were not significantly increased. The effects of sub-chronically administered extract on hepatocytes were minimal as the serum alkaline phosphatase; total bilirubin and total protein levels in treated animals were not significant (p< 0.05). Thus, sub-chronic administrations of Anacardium occidentale inner stem bark extract did not significantly (p< 0.05) depress the function of hepatocytes in Wistar rats.

Formulation and in vitro evaluation of a PEGylated microscopic lipospheres delivery system for ceftriaxone sodium.

The aim of this study was to formulate and evaluate in vitro, ceftriaxone sodium lipospheres dispersions for oral administration. Ceftriaxone sodium lipospheres were prepared by melt-emulsification using 30%w/w Phospholipon 90H in Softisan 154 as the lipid matrix containing increasing quantities of PEG 4000 (10, 20, 30, and 40%w/w). Characterization based on particle size, particle morphology, encapsulation efficiency, loading capacity and pH were carried out on the lipospheres. Microbiological studies of the ceftriaxone sodium-loaded lipospheres were performed using Escherichia coli as the model organism. In vitro permeation of ceftriaxone sodium from the lipospheres through artificial membrane (0.22 microm pore size) was carried out using Franz cell and simulated intestinal fluid (SIF) without pancreatin as acceptor medium. Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month (Maximum size = 64.76 +/- 3.81 microm). Microbiological studies indicated that lipospheres formulated with 20%w/w of PEG 4000 containing 2%w/w or 3%w/w of ceftriaxone sodium gave significantly (p < 0.05) higher inhibition zone diameter than those with 30%w/w or 40%w/w of PEG 4000. The result also indicated that lipospheres with 10%w/w PEG 4000 resulted in significantly higher encapsulation efficiency (p < 0.05) while those with 30%w/w gave the least, while the loading capacity values ranged from 3.22 mg of ceftriaxone sodium/100 mg of lipid to 6.36 mg of ceftriaxone sodium/100 mg of lipid. Permeation coefficient values varied and ranged from 8.55 x 10(-7) cm/s to 2.08 x 10(-6) cm/s depending on the concentration of PEG 4000. The result of this study gave insight that the issue of ceftriaxone stability in oral formulation could be adequately addressed by tactical engineering of lipid drug delivery systems such as lipospheres.