Economic burden of malaria illness on households versus that of all other illness episodes: a study in five malaria holo-endemic Nigerian communities.

We compared the financial and economic costs of malaria attack to that of a combination of other illness episodes on households in five malaria holo-endemic rural communities. The data was collected from household heads or their representatives using pre-tested interviewer-administered questionnaire. Information was collected on the amount of money household spent to treat both malaria and other illnesses respectively, together with the time lost due to both the groups of illnesses within 1 month prior to the interview. The findings showed that the cost of treating malaria illness accounted for 49.87% of curative health care costs incurred by the households. Average malaria expenditure was $1.84 per household per month, while it was $2.60 per month for the combination of other illness episodes. The average person-days lost due to malaria and the combination of other illnesses were almost equal. If the financial costs of treating malaria and other illnesses are combined, this cost will deplete 7.03% of the monthly average household income, with treatment of malaria illness alone depleting 2.91%. Thus, malaria is a big contributor to the economic burden of disease, in malaria holo-endemic communities. Community-effective malaria control programs are needed to reduce this burden on the households.

Renal amyloidosis following tuberculosis.

Amyloidosis, either primary or secondary, may be defined as a group of chronic infiltrative disorders that have in common a beta-pleated sheet configuration on X-ray diffraction examination, a fine fibrillar nonbranching appearance on electron microscopy and an apple-green birefringence when examined under polarised light after staining with Congo-red. Renal amyloidosis is a rare entity in the pediatric age group and is almost always secondary in nature, related to chronic infections and inflammatory conditions. It occurs 2-7 years after a chronic inflammatory process; however an onset as early as 9 months of life is known. The diagnosis of amyloidosis is suspected on the basis of clinical features and is established by obtaining an appropriate tissue biopsy and demonstrating amyloid with appropriate stains. All the tissues obtained must be stained with Congo-red stain which is the singlemost useful diagnostic test to define amyloidosis. In order to differentiate the primary from secondary variety, the deposits may be treated with potassium permanganate before Congo-red staining. In secondary amyloidosis, the green birefringence seen under polarized light is abolished. Therapeutic approaches include specific measures to reduce the amyloid deposition and general measures to relieve symptoms related to involvement of specific organs. The prognosis in renal amyloidosis is relatively poor, with a median survival of 9-13 months in primary amyloidosis complicated by renal involvement, and more than 50 months in secondary amyloidosis. We have reported a case of secondary amyloidosis following tuberculosis and have discussed the clinical features, diagnosis and management of amyloidosis.

Willingness to pay for the retreatment of mosquito nets with insecticide in four communities of south-eastern Nigeria.

OBJECTIVES: To determine the willingness to pay (WTP) for the retreatment of insecticide-treated nets (ITN) in four malaria holoendemic communities of Nigeria. METHODS: Contingent valuation method. The study tool was a pretested interviewer-administered questionnaire. Randomly selected households were the study units and household heads or their representatives were interviewed by locally trained interviewers. RESULTS: Most households were willing to pay for annual ITN retreatment in all four communities. The proportion of those willing to pay ranged from 79% to 91%. WTP amounts ranged from $0.05 to $5.26. The median from the aggregated data from the four communities was $0.21. Multivariate analysis showed that many explanatory variables were statistically significantly related to WTP for ITN retreatment. CONCLUSION: WTP for ITN retreatment exists. The difficulty lies in implementing this. One possibility would be a community-based ITN retreatment programme.

Preliminary in vitro toxicological evaluation of a series of 2-pyridylcarboxamidrazone candidate anti-tuberculosis compounds III.

We have evaluated the cytotoxicity of a series of novel anti-tubercular 2-pyridyl carboxamidrazones through incubation with human mononuclear leucocytes (MNL), with and without a rat microsomal metabolising system. Isoniazid (INH), the closest structurally related agent, was used as a positive control. Incubation of the 3-benzyloxy-benzylidene, dimethylpropyl-benzylidene and 4-phenyl-benzylidene with MNL showed no significant toxicity in comparison with either INH or DMSO vehicle control. However, the 4-N,N-dimethylamino-1-naphthylidene derivative exerted more than sevenfold greater toxicity compared with INH, while the 4-N,N-dimethylamino-1-naphthylidene, 2-benzyloxy-3-methoxy-benzylidene, 2-t-butylthio-benzylidene and 4-i-propyl-benzylidene derivatives showed toxicity which ranged from five to fourfold that of INH. In the presence of either rat microsomes with or without NADPH, the 3-benzyloxy-benzylidene, dimethylpropyl-benzylidene and 4-phenyl-benzylidene derivatives showed no metabolically-mediated cytotoxicity. The latter two derivatives showed a combination of low toxicity and considerabe efficacy against Mycobacteria tuberculosis in vitro and show promise for future development.

Hypothetical and actual willingness to pay for insecticide-treated nets in five Nigerian communities.

OBJECTIVES: To determine the hypothetical and actual willingness of households to pay (WTP) for insecticide-treated nets (ITNs), and compare these in areas with and without previous exposure to free ITNs. METHODOLOGY: The contingent valuation method was used to determine the willingness of the heads of 1908 randomly selected households from five communities in south-east Nigeria to pay for two sizes of ITNs. Two communities previously had free access to ITNs. Validity was assessed using multiple regression analyses, and by offering ITNs for sale to 200 randomly selected people drawn from the original sample. The data was collected between March and September 1998. FINDINGS: Most respondents were willing to pay for ITNs: Mbano (93.26%), Ugwogo (97.69%), Orba (83.24%), Alor-uno (95.37%), and Ibagwa-ani (87.34%). In multivariate analyses, WTP was significantly associated with the number of people living in a household, sex of the respondent, average yearly expenditure on gifts and the type of savings scheme (P < 0.05). Some of the residences were also statistically significant in the two models used, and those with prior exposure to free ITNs were negatively related to WTP. Seventy-six percent of those who were hypothetically willing to pay actually purchased them, and the WTP technique correctly predicted the choices of 80% of the respondents. CONCLUSION: There was good evidence that stated WTP could be translated into actual WTP. However, peoples' perception of affordability of the nets and its link to their WTP needs further exploration. The WTP technique is a potentially valid tool for market research in healthcare, as it was able to predict the direction of actual WTP for the ITNs. The hypothetical WTP amounts could be used as guide to know either the optimal price to charge for the ITNs or the level of subsidy to introduce.