Onchocerciasis in Anambra State, Southeast Nigeria: clinical and psychological aspects and sustainability of community directed treatment with ivermectin (CDTI).

BACKGROUND: A cross-sectional study was performed to determine the psychological impact of onchocerciasis, and assess sustainability of the decade-old community directed treatment with ivermectin (CDTI) in Ayamelum Local Council, Anambra State, Southeast Nigeria. METHODS: Skin manifestations assessed using the rapid assessment method (RAM) in 894 subjects from 13 communities selected by multi-stage sampling were classified based on the anatomical sites affected. Focus group discussions and in-depth interviews were used to obtain information on the psychological impacts and sustainability of the CDTI programme. Qualitative data were summarised while quantitative data generated were analysed using charts and tables. RESULTS: Anatomical distribution showed a preponderance of onchodermatitis on the limbs (the most exposed parts of the body) and buttocks (an area considered 'private'), thus revealing some reasons for the psychological impacts of the skin disease and the psychosocial inclination of the victims. Itching (40%) and onchocercal skin manifestations (OSDs) (34.3%) were identified as the most troublesome signs and symptoms, while the most worrisome consequence of onchocerciasis was social seclusion (or stigmatisation) (34.3%). Focus group responses revealed the persistence of psychological impacts on the victims, affecting almost all facets of their lives. The CDTI programme has performed creditably well when assessed using the sustainability indicators, yet there are still challenges in the areas of coverage, monitoring, resources, and participation. A 'quick-win' was identified whereby the CDTI chain could be utilised to deliver other health interventions. CONCLUSION: It is recommended that onchocerciasis control programmes should include aspects that would address its psychosocial impacts and threats to the sustainability of the CDTI programme.

Association of low birth weight and placental malarial infection in Nigeria.

BACKGROUND: Malaria causes significant morbidity and mortality among pregnant women in Nigeria. However, the contribution of malaria infection to neonatal development is incompletely understood. Here we determined the prevalence of placental malarial infection in six communities in Anambra State, Nigeria, between 2005 and 2006, and compare these data to neonatal birth weight. METHODOLOGY: Blood samples were obtained from the placenta of 500 parturient mothers and examined for the presence of malaria parasites. Newborn birth weight was then compared with the malaria status of their mothers. RESULTS: Placental malarial infection was found in 322 of 500 mothers (64.4%). The prevalence of infection did not differ among the six different Nigerian communities (P = 0.978). Furthermore, there was no difference in infection rates between rural and urban areas (64.9% vs. 64.0%, respectively, P = 0.827). Interestingly, neonates born from mothers with placental malaria had lower birth weights than neonates born from uninfected mothers [2500 g (range 1900 g - 3200 g) vs. 3800 g (range 3200 g - 4700 g), P < 0.001]. Forty-five percent (145/322) of the newborns born from infected mothers were of low birth weight (defined as birth weight less than 2,500 g). CONCLUSION: Malaria infection during pregnancy is common in Nigeria and is likely associated with low newborn birth weight.