Persistence of onchocerciasis in villages in Enugu and Ogun states in Nigeria following many rounds of mass distribution of ivermectin.

BACKGROUND: Onchocerciasis is endemic in most local government areas (LGAs) in Enugu and Ogun states. Most meso- and hyper-endemic LGAs have received many rounds of ivermectin mass drug administration (MDA). This study aimed to determine the current prevalence of onchocerciasis in villages in Enugu and Ogun states that were formerly highly endemic and to assess progress toward elimination of the infection in areas believed to be at high risk for persistence. METHODS: Cross-sectional community surveys were conducted 8 to 12 months after the last round of MDA in 16 villages (6 in Enugu state and 10 in Ogun state) in individuals aged ≥ 18 years. Study participants were examined for the presence of palpable subcutaneous nodules. Skin snips from the posterior iliac crests were used to assess microfiladermia (Mf) prevalence and density. RESULTS: 643 subjects were palpated for nodules and 627 individuals (225 in Enugu state; 402 in Ogun state) provided skin snips. Nodule prevalence in the study villages ranged from 42 to 66.7% in Enugu state and from 0 to 25.0% in Ogun state. Mf prevalence in the Enugu and Ogun study villages ranged from 32 to 51.1% and 0 to 28.6%, respectively. Geometric mean skin Mf density in surveyed Enugu state villages ranged between 1 and 3.1 Mf/mg; these values were < 1 Mf/mg in all but one community in Ogun state villages. CONCLUSION: Results from this study show that onchocerciasis persists in adults in many villages in Enugu and Ogun states despite many prior rounds of ivermectin MDA. Prevalence was higher in villages surveyed in Enugu than in Ogun. Low Mf densities suggest the MDA program is working well to reduce disease, but more time will be required to reach the elimination goal.

Description of global innovative methods in developing the WHO Community Engagement Package.

OBJECTIVES: Development of a Community Engagement Package composed of (1) database of community engagement (CE) experiences from different contexts, (2) CE learning package of lessons and tools presented as online modules, and (3) CE workshop package for identifying CE experiences to enrich the CE database and ensure regular update of learning resources. The package aims to guide practitioners to promote local action and enhance skills for CE. SETTING AND PARTICIPANTS: The packages were co-created with diverse teams from WHO, Social Innovation in Health Initiative, UNICEF, community practitioners, and other partners providing synergistic contributions and bridging existing silos. METHODS: The design process of the package was anchored on CE principles. Literature search was performed using standardised search terms through global and regional databases. Interviews with CE practitioners were also conducted. RESULTS: A total of 356 cases were found to fit the inclusion criteria and proceeded to data extraction and thematic analysis. Themes were organised according to rationale, key points and insights, facilitators of CE and barriers to CE. Principles and standards of CE in various contexts served as a foundation for the CE learning package. The package comprises four modules organised by major themes such as mobilising communities, strengthening health systems, CE in health emergencies and CE as a driver for health equity. CONCLUSION: After pilot implementation, tools and resources were made available for training and continuous collection of novel CE lessons and experiences from diverse socio-geographical contexts.

Effects of intestinal parasitic infections on nutritional status of primary children in Imo State Nigeria.

INTRODUCTION: A cross-sectional study was conducted between the months of April to October 2015, to determine the effects of intestinal parasitic infections (IPIs) on nutritional status of school age children in Owerri and Orlu geographical zones, in Imo State, Nigeria. METHODS: Faecal samples were examined using Kato Katz method and formol-ether concentration techniques, while blood samples were examined using cyamethahaemoglobin method. Anthropometric indices were used as indicators of nutritional status, children whose Height-for-Age, Weight-for-Age and Weight-for-Height were <-2 standard deviation (SD) were classified as stunted, wasted, and underweight respectively. RESULTS: Total prevalence rate of 16.6% was recorded in the study areas with Ascaris lumbricoides (4.0%), Trichuris trichiura (0.6%), Hookworm (1.0%) Taenia sp (0.3%), Entaomeba histolytica (5.3%), Entamoeba coli (2.7%) and Giardia lambia (2.7) Majority (73.4%) of the children had light intensity. Anthropometric study results showed that 79(31.3%) of the children were malnourished. The prevalence of stunting, under-weight and wasting were higher in uninfected (86.1%, 90.0% and 10%) respectively than in infected children (13.9%, 10.0% and 0.0%) respectively, although not significant at p = 0.857, 0.587 and 0.368 respectively. Prevalence of anaemia was 17.4%, anaemia was insignificantly (p = 0.09) higher in infected (21.1%) than in uninfected (16.5%) children. Children that had co-infection recorded higher prevalence (2.2%) of severe anaemia. There was an association (p = 0.002) between anaemia and intensity of helminth infection. Malnutrition was insignificantly (p = 0.319) higher in children with heavy (100.0%) and moderate (75.0%) intensity of helminth infection than children that had light intensity (41.7%) of helminth infection. CONCLUSION: When compared with previous study, there were decline in the prevalence of intestinal parasitic infections and anaemia among school age children. Low intensity parasitemia with intestinal parasites had no significant effect on the malnutrition and haemoglobin profile of the children in the study areas. Therefore, improved sanitation and more deworming efforts should be intensified to ensure further decline in prevalence of intestinal parasitic infections.

Perception and utilization of public health services in Southeast Nigeria: Implication for health care in communities with different degrees of urbanization.

BACKGROUND: The relationship between people's perception and utilization of public health services was investigated. METHODS: A survey of 840 households across selected urban, peri urban and rural communities, in the Southeast of Nigeria, was conducted using the mixed methods approach. RESULTS: Of the nine (9) demographic variables, only the locality and status of the health system (strong or weak in terms of child immunization) was found to influence both the poor rating and utilization of public health services. Individuals from states with strong health system rated relatively higher and used public health services more (p < 0.001), than their counterparts from states with weak health care system. Similarly, those in the urban or peri-urban localities used public health services more (p = 0.013). The two perceptual variables significantly influence the rating and use of public health services. Those with a good perception of the quality of health service provided, rated and patronized them more (p < 0.001). Also, health centres that provide a high number of services enjoyed greater rating and patronage (p < 0.001 and p = 0.0524 respectively). The results of the structured questionnaire survey were confirmed by qualitative enquiry,based on in-depth interviews and focus group discussions. CONCLUSIONS: It will be necessary to create a more responsive atmosphere in the health facilities, with culturally-sensitive and friendly health workers, and provision of affordable drug to improve the perceptions of the primary health care system, for it to succeed in providing health services for all.

Host determinants of reinfection with schistosomes in humans: a systematic review and meta-analysis.

BACKGROUND: Schistosomiasis is still a major public health burden in the tropics and subtropics. Although there is an effective chemotherapy (Praziquantel) for this disease, reinfection occurs rapidly after mass drug administration (MDA). Because the entire population do not get reinfected at the same rate, it is possible that host factors may play a dominant role in determining resistance or susceptibility to reinfection with schistosomes. Here, we systematically reviewed and meta-analyzed studies that reported associations between reinfection with the principal human-infecting species (S. mansoni, S. japonicum and S. haematobium) and host socio-demographic, epidemiological, immunological and genetic factors. METHODOLOGY/PRINCIPAL FINDINGS: PubMed, Scopus, Google Scholar, Cochrane Review Library and African Journals Online public databases were searched in October 2013 to retrieve studies assessing association of host factors with reinfection with schistosomes. Meta-analysis was performed to generate pooled odds ratios and standardized mean differences as overall effect estimates for dichotomous and continuous variables, respectively. Quality assessment of included studies, heterogeneity between studies and publication bias were also assessed. Out of the initial 2739 records, 109 studies were included in the analyses, of which only 32 studies with 37 data sets were eligible for quantitative data synthesis. Among several host factors identified, strong positive association was found with age and pre-treatment intensity, and only slightly for gender. These factors are major determinants of exposure and disease transmission. Significant positive association was found with anti-SWA IgG4 level, and a negative overall effect for association with IgE levels. This reconfirmed the concept that IgE/IgG4 balance is a major determinant of protective immunity against schistosomiasis. Other identified determinants were reported by a small number of studies to enable interpretation. CONCLUSIONS: Our data contribute to the understanding of host-parasite interaction as it affects reinfection, and is a potential tool to guide planning and tailoring of community interventions to target high-risk groups.

Prospects of using Community Directed Intervention strategy in delivering health services among Fulani Nomads in Enugu State, Nigeria.

BACKGROUND: The Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads. STUDY DESIGN AND METHODS: This exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area. RESULTS: Like sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises. CONCLUSION: Given the definable organizational structure of the nomads in Enugu State and their desire for modern health intervention, it is feasible to test the CDI strategy for equitable healthcare delivery among nomads. They are willing and capable to participate actively in their own health programmes with minimal support from professional health workers.

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.

Onchocerciasis in Anambra State, Southeast Nigeria: endemicity and clinical manifestations.

BACKGROUND: A cross-sectional study was performed to determine the current endemicity of onchocerciasis in Ayamelum Local Council, Anambra State, Southeast Nigeria, where community-directed treatment with ivermectin has been implemented for over a decade. METHODS: An estimate of the endemicity of onchocerciasis was obtained using the rapid assessment method in 894 subjects from 13 communities selected by multistage sampling. Dermatological and ocular manifestations were analysed and classified using standard criteria. RESULTS: Onchocerca volvulus nodules were recorded in 86 (9.6 ± 1.9%) of the subjects, and 186 (20.8 ± 3.7%) had one or more of the various classes of onchocercal skin diseases (OSD). Prevalence was dependent on age (p = 0.001), but not on sex (p = 0.31). There was a total absence of symptoms in the youngest age group and a low prevalence among subjects in their second decade of life. Pearson's correlation showed a strong positive correlation between nodular rate and prevalence of chronic papular onchodermatitis (r = 0.943) and a poor correlation with acute papular onchodermatitis (r = 0.259). Age-dependent analysis of various classes of OSDs showed that the rate of acute papular onchodermatitis increased with age up to the third decade of life and decreased steadily thereafter, while the chronic forms of OSD increased with age for both sexes. Infection was dependent on occupation and proximity of the village to the vector breeding sites. CONCLUSIONS: Generally low prevalence in the population and absence of symptoms among the youngest age group emphasise the success of the intervention, but the persistent occurrence of acute disease may suggest a shortfall due to low coverage or non-compliance with the mass chemotherapeutic regimen.

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.

Ultrasonographic screening of urinary schistosomiasis infected patients in Agulu community, Anambra state, southeast Nigeria.

BACKGROUND: The pathology of Schistosoma haematobium infection in 60 infected primary school children in Agulu community, Anambra State, southeast Nigeria, with over 50 ova/10 ml urine was assessed. METHODS: The ultrasonographic examination was done using a sector scanner with convex probe. World Health Organisation method was used for classification and scoring of lesions. T-test and Coefficient of determination were used in analysis. RESULTS: The pathologic effects due to S. haematobuim identified among the study group included irregularity of the bladder wall (25%), thickening of the bladder wall (10%) and massing of the bladder wall (3.3%). About 4(6.7%) and 1(1.7%) of the patients had the right pelvis and left pelvis of their kidney moderately dilated respectively. Identified bladder wall lesions had 69 scores while kidney dilation had 30 scores. The number of individuals with lesions correlated with intensity of infection. Male pupils (65.2%) had more lesions than females (34.8%). The difference observed in lesion distribution among males and females was found to be significant (df = 6, p < 0.05). All bladder and kidney lesions responded favorably to treatment with praziquantel (40 mg/kg-body weight). CONCLUSION: Health education campaign including showing the community members evidence of damages to the organs (from the ultrasound pictures) will go a long way in the control and prevention of the disease in this community.

Family life and HIV/AIDS education (FLHE) in schools in Enugu State: baseline study of reproductive health issues among in-school adolescents in Enugu State.

We studied the sexual and reproductive health (SRH) knowledge and practices among junior secondary school grades 1 and 3 students Enugu State, preparatory to incorporating family life and HIV/AIDS education (FLHE) into the school curricula in the state. Results show that over 90% of the respondents were regularly involved in sexual activities. More than seventeen per cent (17.5%) indicated that they would definitely have sex in the next two years while 19.2% may have sex in the next two years. The students lacked proper knowledge of protection and knowledge scores on SRH issues was low especially among the urban dwellers (p < 0.001). Some respondents (64.4%) did not know if condoms prevent pregnancy. Some indicated that charms and herbs are effective ways of preventing pregnancy. Against this background, the opinion leaders and community members welcome the FLHE for improving youth knowledge on SRH issues and pledge their support for the programme.

Reproductive health knowledge and practices among junior secondary school grade one students in Enugu State: threat to achieving millennium development goals in Nigeria.

OBJECTIVE: This was designed to provide background information for the implementation of family life and HIV/AIDS education in post primary schools in the Enugu State. METHODS: A cross sectional survey of the reproductive health knowledge and practices of 412 junior secondary school pupils from 12 schools in Enugu State, Nigeria was undertaken using a uniform set of structured self-administered questionnaire. RESULTS: The results revealed that while the pupils demonstrated fair knowledge of human biology, they lacked knowledge of self-protective mechanisms as it related to sexual health. About (50%) of the participants reported that they have had sex, at the age of less than 11 years when they must have been in the primary school and most (89.3%) at age 11-14 years. Half (50.9%) of the respondents hold the belief that a girl would not get pregnant in her first sexual encounter. Statistically more of those who have ever had sex were betrayed this ignorance (p = 0.004). The boys were less certain about what constitutes the wrong ideas about reproductive health systems than the girls (p = 0.042). In the same vein, there was a difference (p < 0.0001) in the proportion of the rural residents, vis-a-vis their urban counterparts that could correctly identify the wrong ideas about human reproduction. CONCLUSION: This situation urgently calls for concerted efforts at addressing the poor reproductive health knowledge of these sexually active young people, for the millennium development goals (MDGs) target to be realized in Nigeria.