Low ivermectin use among 5- to 6-year-old children: observations from door-to-door surveys in onchocerciasis-endemic regions in Africa.

During door-to-door surveys in onchocerciasis-endemic regions in Africa, the age-specific ivermectin coverage in 29 722 individuals was assessed. Children 5-6 y of age had significantly lower coverage compared with older participants. Insufficient ivermectin intake among young children could prolong onchocerciasis elimination prospects, as they may serve as human reservoirs of Onchocerca volvulus; moreover, it increases the risk of developing onchocerciasis-associated epilepsy (OAE). The causes of the low ivermectin coverage observed among children 5-6 y of age need to be explored. Integrating ivermectin distribution into chemoprophylaxis strategies for other neglected diseases could increase coverage in a cost-effective manner.

Perceptions on the use of insecticide treated nets in parts of the Imo River Basin, Nigeria: implications for preventing malaria in pregnancy.

This study aimed at assessing perceptions on use of ITNs in parts of the Imo River Basin, Nigeria and its implications in preventing malaria in pregnancy. Data was collected using focus group discussions, key informant interviews and structured questionnaires. Results showed high awareness on the benefits of ITNs. Factors affecting use of ITNs included its high cost, perceptions of chemicals used to treat them as having dangerous effects on pregnancy, low utilization of antenatal care, husband's lack of interest in malaria prevention and perceptions that adolescent girls are at low risk of getting malaria. The implications of these findings include demystifying the negative perceptions on the chemicals used for net treatment and subsidizing the cost of ITNs to increase access. These findings provide important lessons for malaria programmes that aim at increasing access to ITNs by pregnant women in developing countries.

The knowledge, attitude and practices of food handlers in food sanitation in a metropolis in south eastern Nigeria.

The spread of diseases through food is still a common problem which results in appreciable morbidity and occasional mortality. Food handlers play an important role in ensuring food safety throughout the chain of production, processing, storage and preparation. This study was designed to determine knowledge, attitude and practice of food handlers towards food-borne diseases and food safety. A total of 430 food handlers were randomly selected from Owerri Metropolis of Imo State Nigeria and interviewed using structured pretested questionnaire. Almost half (48.4%) of the respondents had poor knowledge of food sanitation. Multiple logistic regression showed type of premise [Odd Ratio (OR) = 4.0, 95% confidence interval (CI) = 1.8 - 7.5, P = 0.0004], educational level (OR = 0.4, 95% CI = 1.8 -7.4, P = 0.0003) and job status of food handlers (OR = 0.5, 95%, CI = 0.3 - 0.8, P = 0.0031) significantly influenced the score level of knowledge. There was no significant difference in attitude and practice between trained and untrained food handlers. Findings of this study may be important in planning health education intervention programs for food handlers in order to improve their knowledge, attitude and practice towards food borne diseases and food safety. This will help in reducing morbidity and mortality due to food-borne diseases.

Placental malaria in Owerri, Imo State, south-eastern Nigeria.

Malaria in pregnancy jeopardizes the outcome of pregnancy, affecting both the mother and the foetus. The prevalence of placental malaria in women, who routinely attended ante-natal clinics in Owerri, south-eastern Nigeria, was assessed using three hospitals between March 2004 and August 2005. Placental blood was collected in EDTA bottles from incisions made on cleaned basal plate of the placenta, within an hour of delivery. Blood collected was used to assess ABO blood group, haemoglobin level as well as malaria parasitaemia. Malaria parasitaemia was determined from thick and thin smears stained with Giemsa, while the haemoglobin level was measured using the cyanomethaemoglobin method. A total of 586 pregnant women were involved in this study with written consents. Malaria parasites were observed in 175 (29.9%) of the women on delivery. Of these women, 64 (36.6%) were anaemic. A significant relationship at P<0.05 variation, was observed between the prevalence of malaria parasites in the placenta and gravidity, age and blood group. The rate of occurrence of malaria parasitaemia, in the placenta of women who were on a weekly prophylaxis against malaria is alarming and calls for more serious efforts in the prevention of malaria especially in this vulnerable group.

The varied beneficial effects of ivermectin (Mectizan) treatment, as observed within onchocerciasis foci in south-eastern Nigeria.

In the treatment of humans, ivermectin (Mectizan((R))), a semi-synthetic macrocyclic lactone, is now primarily used as a rapid microfilaricide. The drug has several other benefits, however, and these have recently been investigated in five states in south-eastern Nigeria, where there have been mass treatments with ivermectin, for the control of Onchocerca volvulus, for more than 10 years. Between the January and December of 2005, 3125 adult onchocerciasis patients (each aged >/=20 years and known to have at least one clinical sign of onchocerciasis) were enlisted, clinically examined and interviewed. Relevant data were collected in the interviews, using a structured, pre-tested questionnaire, and in personal and focus-group discussions. Overall, 612 (19.6%) of the subjects reported that they had had nodules that had disappeared following repeated doses of ivermectin, although only 83.8% of the 612 attributed their nodule clearance to ivermectin (the other 16.2% being unsure of the cause). A larger percentage of the subjects (24.6%) reported that they had expelled intestinal helminths following the last round of ivermectin treatment (i.e. been dewormed). Other side-benefits reported in the study were improved vision (11.7% of subjects), reversal of secondary amenorrhea (4.5%), increased appetite (22.3%), reduction in arthritic or other musculo-skeletal pain (7.9%), reductions in the severity of body itching (18.5%) and skin rash (17.3%), darkening of leopard skin (6.6%), improved libido in men (6.6%), and clearance of head lice (4.5%). If, via health education, the local communities could be made more aware of the side-benefits of ivermectin treatment, the sustainability of the on-going programme of community-directed treatment with ivermectin (CDTI) in south-eastern Nigeria would probably be improved.

The use of herbs in malaria treatment in parts of Imo State, Nigeria.

Persistence of malaria symptoms after treatment with over the counter available antimalarial drugs has resulted in a gradual loss of faith in orthodox drugs. There is thus an increased tendency towards the use of herbs in the treatment of malaria in Imo State, Nigeria. In this study we report activities of two herbalists in the treatment of malaria as well as the effectiveness of the herbal treatment. The study covered two areas namely, Umuneke Ugiri in Isiala Mbano Local Government Area (LGA) and Odummara Obi-Orodo in Mbaitoli LGA of Imo State, Nigeria. A participant-observation technique was used. Finger prick blood samples were collected from patients who visited the herbalists complaining of malaria, and blood smears were stained with Field's B stain. Blood smears were taken again one-week post-treatment. A total of 75 patients from Umuneke Ugiri and 265 patients from Odumara Obi-Orodo were involved in the study. All the 75 patients (100%) from Umuneke Ugiri and 163 (61.51%) patients from Odummara Obi-Orodo were positive for malaria parasites. Only 13 (17.3%) patients from Umuneke Ugiri and 149 (56.23%) from Odummara Obi-Orodo returned for the post-treatment blood parasite analysis. From Umuneke Ugiri 4 (31%) were still positive for malaria parasite while 9 (69%) were negative. All 149 patients from Odummara Obi-Orodo were negative. This indicates that the herbal treatment was effective. However, there is need for further studies into the efficacy of herbal concoctions, their effective life span, as well as possible toxic effects.

Concomitant bacteria in the blood of malaria patients in Owerri, southeastern Nigeria.

The presence of concomitant bacteria was assessed in the blood of 125 malaria positive patients and 60 malaria negative controls, resident in Owerri, southeastern Nigeria. Blood samples were cultured in MacConkey, Chocolate and Blood agar, respectively using oxoid signal system after the manufacturer's instructions. Blood cultures of 44 (35.2%) of the 125 malaria positive patients had bacterial growth while none was observed in the blood cultures of malaria negative patients. The bacteria species identified included: Staphylococcus aureus 4 (3.2%), Escherichia coli 3 (2.4%) Salmonella typhi 25 (20%), Klebsiella pneumoniae 10 (2.4%) and Pseudomonas aeruginosa 2 (1.6%). The presence of concomitant bacteria in malaria-positive cases usually results in persistence of malaria-like symptoms after treatment with antimalarials and subsequently taken as resistance of the parasites to the particular drugs in question. The significance of concomitant bacteria in the management of malaria should be given priority.

Validation of reports of nodules dissolution after repeated ivermectin treatment of onchocerciasis in southeastern Nigeria.

OBJECTIVE: To ascertain the validity of the claims by villagers in endemic communities in southeastern Nigeria that repeated ivermectin treatment cause disappearance or dissolution of onchocercal nodules. DESIGN: From baseline epidemiological data, four communities (Amuro, Aku, Nzerem Ikpem and Awuchinimo) were randomly chosen as the study sites. A total of 324 adults (hitherto had onchocercal nodules), aged > or = 20 years from these communities were enlisted in the study. After clinical examination, each of the villager was interviewed with structured, pre-tested questionnaire. Also personal and focus group discussion was held. RESULTS: Sixty nine (21.30%) respondents; 16.67% from Amuro, 32.26% from Aku, 19.05% from Nzerem Ikpem and 15% from Awuchnimo claimed that their nodules gradually dissolved or disappeared. A significant (p < 0.05) proportion (82.61%) attributed this phenomenon to repeated doses of ivermectin; 4.35% claimed it was not due to ivermectin therapy while 13.04% were not sure of the cause. CONCLUSION: The results have opened challenges in our understanding of the role of ivermectin therapy in endemic communities and calls for further studies of nodule dissolution in other onchocerciasis endemic communities.