RESUMO
BACKGROUND: Nigeria suffers the world's largest malaria burden, with approximately 51 million cases and 207,000 deaths annually. As part of the country's aim to reduce by 50% malaria-related morbidity and mortality by 2013, it embarked on mass distribution of free long-lasting insecticidal nets (LLINs). METHODS: Prior to net distribution campaigns in Abia and Plateau States, Nigeria, a modified malaria indicator survey was conducted in September 2010 to determine baseline state-level estimates of Plasmodium prevalence, childhood anemia, indoor residual spraying (IRS) coverage and bednet ownership and utilization. RESULTS: Overall age-adjusted prevalence of Plasmodium infection by microscopy was similar between Abia (36.1%, 95% CI: 32.3%-40.1%; n = 2,936) and Plateau (36.6%, 95% CI: 31.3%-42.3%; n = 4,209), with prevalence highest among children 5-9 years. P. malariae accounted for 32.0% of infections in Abia, but only 1.4% of infections in Plateau. More than half of children ≤10 years were anemic, with anemia significantly higher in Abia (76.9%, 95% CI: 72.1%-81.0%) versus Plateau (57.1%, 95% CI: 50.6%-63.4%). Less than 1% of households in Abia (n = 1,305) or Plateau (n = 1,335) received IRS in the 12 months prior to survey. Household ownership of at least one bednet of any type was 10.1% (95% CI: 7.5%-13.4%) in Abia and 35.1% (95% CI: 29.2%-41.5%) in Plateau. Ownership of two or more bednets was 2.1% (95% CI: 1.2%-3.7%) in Abia and 14.5% (95% CI: 10.2%-20.3%) in Plateau. Overall reported net use the night before the survey among all individuals, children <5 years, and pregnant women was 3.4%, 6.0% and 5.7%, respectively in Abia and 14.7%, 19.1% and 21.0%, respectively in Plateau. Among households owning nets, 34.4% of children <5 years and 31.6% of pregnant women in Abia used a net, compared to 52.6% of children and 62.7% of pregnant women in Plateau. CONCLUSIONS: These results reveal high Plasmodium prevalence and childhood anemia in both states, low baseline coverage of IRS and LLINs, and sub-optimal net use-especially among age groups with highest observed malaria burden.
Assuntos
Anemia/epidemiologia , Malária/epidemiologia , Malária/prevenção & controle , Mosquiteiros , Adolescente , Adulto , Anemia/etiologia , Animais , Criança , Pré-Escolar , Culicidae/crescimento & desenvolvimento , Culicidae/parasitologia , Coleta de Dados , Características da Família , Feminino , Humanos , Insetos Vetores/crescimento & desenvolvimento , Insetos Vetores/parasitologia , Malária/complicações , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Controle de Mosquitos/métodos , Mosquiteiros/estatística & dados numéricos , Nigéria/epidemiologia , Plasmodium malariae/parasitologia , Gravidez , Prevalência , Adulto JovemRESUMO
Onchocerciasis causes severe morbidity in sub-Saharan Africa. Abia, Anambra, Enugu, and Imo states of Nigeria were historically classified meso- or hyperendemic and eligible for ivermectin mass drug administration (MDA). After ≥25 years of annual and biannual MDA, serological and entomological assessments were conducted to determine if Onchocerca volvulus transmission was interrupted. Dried blood spots collected in October 2020 from ≥3167 children 5-9 years old in each state were screened for O. volvulus-specific Ov16 antibody by enzyme-linked immunosorbent assay. Additionally, 52,187 Simulium damnosum heads (≥8845 per state) collected over 12 months between 2021 and 2022 were tested by pooled polymerase chain reaction (PCR) for O-150 DNA. Among seven seropositive children, four were found for follow-up skin snip PCR to confirm active infection. Three were negative and the fourth was excluded as he was visiting from an endemic state. The final seroprevalence estimates of each state had 95% upper confidence limits (UCL) < 0.1%. All fly pools were negative by O-150 PCR, giving a 95% UCL infective fly prevalence < 0.05% in each state. Each state therefore met the World Health Organization epidemiological and entomological criteria for stopping MDA effective January 2023. With 18.9 million residents eligible for MDA, this marked the largest global onchocerciasis stop-treatment decision to date.
RESUMO
In Nigeria, mass drug administration (MDA) for schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) has often been coordinated with other programs that receive greater external funding. As these programs reach stop MDA milestones, SCH and STH programs will likely need to transition implementation, or "mainstream," to domestic support. A mixed-methods study was conducted in four districts before (2021) and after (2022) mainstreaming to evaluate its impact on MDA coverage. Household surveys were done in 30 villages per district pre- and post-mainstreaming. All selected communities were eligible for STH treatment; around a third were eligible for SCH treatment. Mass drug administration was primarily conducted in schools. A total of 5,441 school-aged children were included in pre-mainstreaming and 5,789 were included in post-mainstreaming. Mass drug administration coverage was heterogeneous, but overall, mebendazole coverage declined nonsignificantly from 81% pre-mainstreaming to 76% post-mainstreaming (P = 0.09); praziquantel coverage declined significantly from 73% to 55% (P = 0.008). Coverage was significantly lower among unenrolled children or those reporting poor school attendance in nearly every survey. For the qualitative component, 173 interviews and 74 focus groups were conducted with diverse stakeholders. Respondents were deeply pessimistic about the future of MDA after mainstreaming and strongly supported a gradual transition to full government ownership. Participants formulated recommendations for effective mainstreaming: clear budget allocation by governments, robust and targeted training, trust building, and comprehensive advocacy. Although participants lacked confidence that SCH and STH programs could be sustained after reductions in external support, initial results indicate that MDA coverage can remain high 1 year into mainstreaming.
Assuntos
Anti-Helmínticos , Helmintíase , Administração Massiva de Medicamentos , Esquistossomose , Solo , Humanos , Nigéria/epidemiologia , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Helmintíase/tratamento farmacológico , Helmintíase/epidemiologia , Helmintíase/prevenção & controle , Criança , Solo/parasitologia , Anti-Helmínticos/uso terapêutico , Anti-Helmínticos/administração & dosagem , Feminino , Masculino , Adolescente , Praziquantel/uso terapêutico , Praziquantel/administração & dosagem , Mebendazol/uso terapêutico , Mebendazol/administração & dosagemRESUMO
Nigeria changed its goal for onchocerciasis from control to transmission elimination. Under the control program, ivermectin mass drug administration (MDA) focused only on hyper/meso-endemic local government areas (LGAs) identified by Rapid Epidemiological Mapping of Onchocerciasis as having ≥ 20% nodule rates. Because transmission is likely in some LGAs where nodule rates are < 20%, the new elimination paradigm requires MDA expansion. Determining which hypoendemic areas require MDA, termed onchocerciasis elimination mapping, is a major challenge. In 2016, we studied 19 ivermectin-naive hypoendemic LGAs in southern Nigeria that bordered LGAs under MDA. Fifty adults and 50 children (aged 5-10 years) were tested in 110 villages for onchocerciasis IgG4 antibody using an Ov16 rapid diagnostic test (RDT). A 10% subset of subjects provided a blood spot for confirmatory Ov16 ELISA. The mean prevalence of RDT positives was 0.5% in the 5,276 children tested (village range, 0.0-4.0%) versus 3.3% in 5,302 adults (village range, 0.0-58.0%). There was 99.3% agreement between the Ov16 RDT and ELISA. Six different MDA launch thresholds were applied to the RDT results based on different recommendations by the Nigeria Onchocerciasis Elimination Committee and the Onchocerciasis Technical Advisory Subgroup of the WHO. Mass drug administration targets for the same area varied tenfold by threshold chosen, from one LGA (population to be treated 221,935) to 13 LGAs (population 2,426,987). Because the Ov16 threshold selected will have considerable cost and resource implications, the decision to initiate MDA should incorporate entomological data demonstrating onchocerciasis transmission.
Assuntos
Oncocercose/epidemiologia , Adulto , Anticorpos Anti-Helmínticos/imunologia , Antiparasitários/uso terapêutico , Criança , Pré-Escolar , Erradicação de Doenças , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ivermectina/uso terapêutico , Governo Local , Loíase/epidemiologia , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Oncocercose/tratamento farmacológico , Oncocercose/prevenção & controle , Oncocercose/transmissão , PrevalênciaRESUMO
The western region of Edo state in southern Nigeria is highly endemic for onchocerciasis. Despite years of mass drug administration (MDA) with ivermectin (IVM), reports suggest persistently high prevalence of onchocerciasis, presumably because of poor coverage. In 2016, twice-per-year treatment with IVM (combined with albendazole for lymphatic filariasis in the first round where needed) began in five local government areas (LGAs) of Edo state. We undertook a multistage cluster survey within 3 months after each round of MDA to assess coverage. First-round coverage was poor: among 4,942 people of all ages interviewed from 145 clusters, coverage was 31.1% (95% confidence intervals [CI]: 24.1-38.0%). Most respondents were not offered medicines. To improve coverage in the second round, three LGAs were randomized to receive MDA through a "modified campaign" approach focused on improved supervision and monitoring. The other two LGAs continued with standard MDA as before. A similar survey was conducted after the second round, interviewing 3,362 people in 87 clusters across the five LGAs. Coverage was not statistically different from the first round (40.0% [95% CI: 31.0-49.0%]) and there was no significant difference between the groups (P = 0.7), although the standard MDA group showed improvement over round 1 (P < 0.01). The additional cost per treatment in the modified MDA was 1.6 times that of standard MDA. Compliance was excellent among those offered treatment. We concluded that poor mobilization, medicine distribution, and program penetration led to low coverage. These must be addressed to improve treatment coverage in Edo state.
Assuntos
Filariose Linfática/tratamento farmacológico , Filaricidas/administração & dosagem , Administração Massiva de Medicamentos/estatística & dados numéricos , Oncocercose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/administração & dosagem , Albendazol/economia , Criança , Erradicação de Doenças/estatística & dados numéricos , Esquema de Medicação , Quimioterapia Combinada , Filariose Linfática/epidemiologia , Feminino , Filaricidas/economia , Humanos , Ivermectina/administração & dosagem , Ivermectina/economia , Governo Local , Masculino , Administração Massiva de Medicamentos/economia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Oncocercose/epidemiologia , Prevalência , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Ivermectin treatment can cause central nervous system adverse events (CNS-AEs) in persons with very high-density Loa loa microfilaremia (≥ 30,000 mf/mL blood). Hypoendemic onchocerciasis areas where L. loa is endemic have been excluded from ivermectin mass drug administration programs (MDA) because of the concern for CNS AEs. The rapid assessment procedure for L. loa (RAPLOA) is a questionnaire survey to assess history of eye worm. If ≥ 40% of respondents report eye worm, this correlates with ≥ 2% prevalence of very high-density loiasis microfilaremia, posing an unacceptable risk of CNS-AEs after MDA. In 2016, we conducted a L. loa study in 110 ivermectin-naïve, suspected onchocerciasis hypoendemic villages in southern Nigeria. In previous RAPLOA surveys these villages had prevalences between 10% and 67%. We examined 10,605 residents using the LoaScope, a cell phone-based imaging device for rapidly determining the microfilaria (mf) density of L. loa infections. The mean L. loa village mf prevalence was 6.3% (range 0-29%) and the mean individual mf count among positives was 326 mf/mL. The maximum individual mf count was only 11,429 mf/mL, and among 2,748 persons sampled from the 28 villages with ≥ 40% RAPLOA, the ≥ 2% threshold of very high Loa mf density could be excluded with high statistical confidence (P < 0.01). These findings indicate that ivermectin MDA can be delivered in this area with extremely low risk of L. loa-related CNS-AEs. We also concluded that in Nigeria the RAPLOA survey methodology is not predictive of ≥ 2% prevalence of very high-density L. loa microfilaremia.
Assuntos
Doenças Endêmicas/estatística & dados numéricos , Loa/isolamento & purificação , Loíase/epidemiologia , Carga Parasitária , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Olho , Feminino , Filaricidas/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Loa/patogenicidade , Loíase/diagnóstico , Loíase/parasitologia , Masculino , Administração Massiva de Medicamentos/métodos , Nigéria/epidemiologia , Prevalência , População Rural , Inquéritos e QuestionáriosRESUMO
Millions of long-lasting insecticide treated nets (LLINs) have been distributed as part of the global malaria control strategy. LLIN ownership, however, does not necessarily guarantee use. Thus, even in the ideal setting in which universal coverage with LLINs has been achieved, maximal malaria protection will only be achieved if LLINs are used both correctly and consistently. This study investigated the factors associated with net use, independent of net ownership. Data were collected during a household survey conducted in Ebonyi State in southeastern Nigeria in November 2011 following a statewide mass LLIN distribution campaign and, in select locations, a community-based social behavior change (SBC) intervention. Logistic regression analyses, controlling for household bed net ownership, were conducted to examine the association between individual net use and various demographic, environmental, behavioral and social factors. The odds of net use increased among individuals who were exposed to tailored SBC in the context of a home visit (OR = 17.11; 95% CI 4.45-65.79) or who received greater degrees of social support from friends and family (ptrend < 0.001). Factors associated with decreased odds of net use included: increasing education level (ptrend = 0.020), increasing malaria knowledge level (ptrend = 0.022), and reporting any disadvantage of bed nets (OR = 0.39; 95% CI 0.23-0.78). The findings suggest that LLIN use is significantly influenced by social support and exposure to a malaria-related SBC home visit. The malaria community should thus further consider the importance of community outreach, interpersonal communication and social support on adoption of net use behaviors when designing future research and interventions.
Assuntos
Comportamento do Consumidor , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Malária Falciparum/prevenção & controle , Controle de Mosquitos/instrumentação , Comportamento Social , Adulto , Aniversários e Eventos Especiais , Participação da Comunidade , Características da Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Visita Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Nitrilas , Piretrinas , População Rural , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
We conducted a cohort study on impact of effects of eight years of annual ivermectin mass treatment administered in eight villages in Imo State, Nigeria. Physical and visual acuity examinations carried out in 462 persons in 1995, prior to the launching of mass drug administration with ivermectin, were compared with re-examinations of 411 (89%) of these same individuals in 2002. We found that gross visual impairment decreased from 16% to 1%, nodule prevalence decreased from 59% to 18%, and papular dermatitis was reduced from 15% to 2%. No change was seen in leopard skin rates (14%). The only incident lesions were three subjects from a single community having the appearance of new nodules (e.g., nodules not identified in the 1995 examinations). Differences in community coverage did not appear to influence the benefit from treatment of individual residents.
Assuntos
Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , NigériaRESUMO
Lymphatic filariasis (LF) in rural southeastern Nigeria is transmitted mainly by Anopheles spp. mosquitoes. Potential coinfection with Loa loa in this area has prevented use of ivermectin in the mass drug administration (MDA) strategy for LF elimination because of potential severe adverse L. loa-related reactions. This study determined if long-lasting insecticidal net (LLIN) distribution programs for malaria would interrupt LF transmission in such areas, without need for MDA. Monthly entomologic monitoring was conducted in sentinel villages before and after LLIN distribution to all households and all age groups (full coverage) in two districts, and to pregnant women and children less than five years of age in the other two districts. No change in human LF microfilaremia prevalence was observed, but mosquito studies showed a statistically significant decrease in LF infection and infectivity with full-coverage LLIN distribution. We conclude that LF transmission can be halted in southeastern Nigeria by full-coverage LLIN distribution, without MDA.
Assuntos
Filariose Linfática/prevenção & controle , Mosquiteiros Tratados com Inseticida , Controle de Mosquitos/instrumentação , Animais , Anopheles/parasitologia , Pré-Escolar , Características da Família , Feminino , Humanos , Inseticidas , Ivermectina/farmacologia , Estudos Longitudinais , Malária/prevenção & controle , Nigéria , Gravidez , População RuralRESUMO
Nigeria is highly endemic for infection with Schistosoma haematobium, which most commonly manifests itself with blood in urine. To monitor the impact of annual mass drug administration (MDA) with Praziquantel for S. haematobium in Delta State, Nigeria, cross-sectional hematuria surveys of school children were conducted in 8 sentinel villages (SVs) at baseline (n=240) and after two annual doses (n=402). We assessed the comparability of three assessments of hematuria (child's reported history, nurse visual diagnosis (NVD) and dipstick) to determine the need for mass treatment. Dipstick was considered to be the gold standard. Prior to treatment, history and NVD each identified only the 3 most highly prevalent SVs, and overall this represented just 37.5% of the 8 SVs in need of treatment. Following treatment, after dipstick prevalence decreased by 88.5% (p<0.001), and history and NVD identified only one of two villages still needing treatment. The study suggests that dipsticks should be the recommended method for launching and monitoring mass treatment for S. haematobium.
Assuntos
Anti-Helmínticos/administração & dosagem , Monitoramento de Medicamentos/métodos , Heme/análise , Praziquantel/administração & dosagem , Schistosoma haematobium/patogenicidade , Esquistossomose Urinária/tratamento farmacológico , Urina/química , Adolescente , Animais , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria , Prevalência , Schistosoma haematobium/efeitos dos fármacos , Esquistossomose Urinária/parasitologia , Instituições AcadêmicasRESUMO
Urinary schistosomiasis, which is one of the commonest forms of the parasitic disease is a major debilitating disease characterized by blood in urine. The main objective of the study reported here was to assess the knowledge, attitude/perception and practices of the people in Oshimili South and Ndokwa Northeast Local Government Areas of Delta State in Nigeria. A cross-sectional study of 400 randomly selected persons aged > or =15 years was undertaken using a uniform set of structured interview schedule administered by trained field assistants. This was supported with some qualitative data collected from in-depth interview with community leaders and school teachers as well as focus group discussions with community members. One-third of the people interviewed were aware of the schistosomiasis. For a majority however, the perceived causes of the disease included witchcraft and sexual or body contact with infected persons. For some of the respondents, the disease is not serious since it does not harm or prevent the victim from eating. In many cases the disease was not treated because of the belief that there is no effective cure for it and that it reoccurs after treatment. But perhaps more importantly, the infection is not treated because it is considered a normal growing up process, which the infected person outgrows. A very high proportion of people depended on the schistosomiasis-infected river for all the domestic needs even where there are alternative sources of water. People argued that the river/ stream give them purer water than the hand dug wells. Furthermore, swimming is a popular activity in the river during all seasons, irrespective of sex and age. In conclusion, the study has identified gaps in the knowledge of the cause and means of transmission, poor perception and management practices, which calls for systematic health education on schistosomiasis in the communities
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Esquistossomose , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Esquistossomose/epidemiologia , Esquistossomose/etiologia , Esquistossomose/prevenção & controle , Esquistossomose/transmissãoRESUMO
We evaluated the effect of annual ivermectin (IV) distribution for onchocerciasis on the prevalence of soil transmitted helminth (STH) infections in school-aged (SAC) and preschool-aged (PAC) children by comparing children in villages that had received treatment for 13 years to those from socioeconomically similar villages in untreated areas. We enrolled 1,031 SAC and 211 PAC for Kato Katz examinations. Treated areas had a lower prevalence of Ascaris (SAC: 3% versus 12%, P < 0.0001; PAC: 3% versus 10%, P < 0.051) and Trichuris (SAC: 6% versus 10%, P = 0.012; PAC: 1% versus 8%, P = 0.019), but not hookworm (SAC: 38% versus 42%, P = 0.20; PAC: 21% versus 27%, P = 0.30). The prevalence of Ascaris or Trichuris in treated areas was below the WHO threshold for mass antihelminthic treatment (MDA), but not for hookworm. We conclude that benzimidazole MDA in IV treatment areas is indicated to effectively control hookworm.
Assuntos
Antiparasitários/uso terapêutico , Helmintos/isolamento & purificação , Intestinos/parasitologia , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Adolescente , Animais , Criança , Pré-Escolar , Humanos , Ivermectina/farmacologia , PrevalênciaRESUMO
Africa's populous country, Nigeria, contains or contained more cases of dracunculiasis, onchocerciasis, lymphatic filariasis, and schistosomiasis than any other African nation and ranks or ranked first (dracunculiasis, onchocerciasis, schistosomiasis) or third (lymphatic filariasis) in the world for the same diseases. After beginning village-based interventions against dracunculiasis 20 years ago and confronting onchocerciasis a few years later, Nigeria has nearly eliminated dracunculiasis and has provided annual mass drug administration for onchocerciasis to over three quarters of that at-risk population for 7 years. With assistance from The Carter Center, Nigeria began treating lymphatic filariasis and schistosomiasis in two and three states, respectively, over the past decade, while conducting pioneering operational research as a basis for scaling up interventions against those diseases, for which much more remains to be done. This paper describes the status of Nigeria's struggles against these four neglected tropical diseases and discusses challenges and plans for the future.