Malaria and HIV co-infection and their effect on haemoglobin levels from three health-care institutions in Lagos, southwest Nigeria.

BACKGROUND: Malaria and human immunodeficiency virus (HIV) are two major infections with enormous public health consequence. Together, they are endemic in many developing countries with anaemia being the most frequent haematological consequence of the infections. OBJECTIVES: To determine the prevalence of malaria and HIV co-infection as well as anaemia among selected patients from three health-care institutions in Lagos, Nigeria. METHODS: A cross-sectional study of 1080 patients was carried out to determine the prevalence of malaria and HIV co-infection as well as anaemia. Blood sera from each of the patients were screened for malaria parasites, HIV-1 and HIV-2 using Giemsa stain, Cambridge Biotech Recombigen HIV-1/HIV-2 rapid device, respectively while haemoglobin estimation was performed using cyanmethemoglobin method. RESULTS: Our data showed that the total number of malaria infected patients were significantly higher in HIV sero-positive patients 47.7% (31/65) when compared with their HIV sero-negative counterparts 25.8% (262/1015) P = 0.047. The result also revealed that 25.8% (8/31) of the patients co-infected with malaria and HIV had anaemia as compared to 11.1% (29/262) infected with malaria alone. Multivariable logistic regression analysis showed that patients with dual infection of malaria and HIV were twice likely to be anaemic than those infected with malaria alone [adjusted OR 2.4, 95% CI, 1.3 to 2.7, P = 0.014]. CONCLUSIONS: Our data indicated a higher prevalence of malaria in HIV infected patients and also revealed that patients co-infected with malaria and HIV were more likely to be anaemic.

Effect of ivermectin on Trypanosoma brucei brucei in experimentally infected mice.

BACKGROUND & OBJECTIVES: Human and livestock African trypanosomiasis, otherwise known as sleeping sickness, is a neglected tropical disease of public health importance in west and central Africa. In view of the adverse side effects of the antitrypanosomal drugs, the relatively few side effects observed in ivermectin use, and because both onchocerciasis and typanosomiasis occur in overlapping foci in Africa, it would be desirable if the ivermectin that has been used successfully on onchocerciasis management could also be used in the control and treatment of trypanosomiasis. METHOD: In this study, prophylactic and therapeutic effects of ivermectin (Mectizan) were investigated in albino mice infected with a Nigerian strain of Trypanosoma brucei brucei. RESULTS: A 300 µg/ml/kg dose had the most effective impact because it showed the highest mean survival time of 12 days in both the treatment and prophylactic groups of mice. This dose also enhanced the defence capacity of the treated groups. It also had positive influence on the packed cell volume (PCV) and the state of anaemia in the trypanosome infected mice, hence, improving their survivability. INTERPRETATION & CONCLUSIONS: Our report indicates that using the 300 µg/ml/kg dose of ivermectin increases the mean survival period from 5 to 12 days. This suggests that ivermectin could be possibly used in the treatment of trypanosomiasis. Further studies will be required to show whether proper treatment may entail a single dose, as used in this study; an increased number of doses, or combinations with other drugs.

Allelic diversity of merozoite surface protein 2 gene of P falciparum among children in Osogbo, Nigeria.

The genetic diversity of Plasmodium falciparum (P falciparum) infections in humans is implicated in the pathogenesis of malaria. This study provides the first estimate of the genetic diversity and genotype multiplicity of Plasmodium falciparum infection in children with uncomplicated P falciparum malaria in Osogbo, Nigeria. One hundred and one isolates were used for analysis of parasite population polymorphism and genotyped by nested-PCR of merozoite surface protein 2 (MSP2) block 3. Amplicons were obtained for all the 101 genotyped samples in MSP2 PCR with 9 alleles varying in size between 300 and 800 base pair. Thirty-three (31.7%) samples had FC27 allele while 27 (26.7%) had 3D7 allele and 35 (34.7%) had mixed alleles (3D7+FC27). The Multiplicity of Infection (MOI) in the population was 1.6. Children in the age group of > 4-8 years had the highest number of different genotypes in their samples (1.8). The number of MSP2 bands per isolate was lower in the older age group (1.3) but the difference was not statistically significant. Children with parasite density range 5001-10 000 had the highest MOI of 2 while those with parasite density range 1000-5000 had the lowest of 1.5. In conclusion, the present study shows that the field isolates are highly diverse in respect of MSP2 and multiplicity of infection was neither age nor parasite density dependent in the study population.

Knowledge, attitude, perception of malaria and evaluation of malaria parasitaemia among pregnant women attending antenatal care clinic in metropolitan Lagos, Nigeria.

BACKGROUND & OBJECTIVES: Little information exists on the compliance of pregnant women to malaria management in malaria endemic countries. This study was designed to access knowledge, attitude, perception and home management of malaria among consenting pregnant women attending antenatal care (ANC) clinic. METHODS: In total, 350 pregnant women were randomly recruited during their ANC Clinic in Lagos. Structured questionnaires were administered in a two-stages research design; first during their early months of ANC visit and the second approximately 1-2 months before delivery. Information on occupation, parity, symptoms used to recognise malaria, treatment sources, control measures, knowledge factors, anti-vector measures, health-seeking practices, malaria parasitaemia and packed cell volume (PCV) were recorded. RESULTS: The results revealed that 78.9% of the pregnant women identified infected mosquitoes as the cause of malaria while 86% of the pregnant women identified stagnant water as its breeding sites. Knowledge of the benefit of insecticide-treated mosquito bednets was less prominent as most of the selected subjects decried its high market price. Our data also showed that educational programme targeted on potential mothers is beneficial. Overall, 27.4% (96/350) of the pregnant women had peripheral malaria infection with 88.5% (85/96) of the parasite positive women infected with Plasmodium falciparum and 11.5% (11/96) with P. malariae. PCV ranged from 20-40% (median 33.9%) with 25.7% (90/350) of the pregnant women being anaemic with PCV <33%. We found an association between malaria infection and occupation, and this association was not influenced by parity. INTERPRETATION & CONCLUSION: Our findings revealed that improvement in knowledge and education of women of child-bearing age has an influential impact on malaria control.

The roles, challenges and institutionalization of institutional review boards.

Researches involving human participants are expected to be conducted professionally to ensure that the research participants are protected from any likely harm. In this regard, the Institutional Review Board (IRB) of an institution plays a very important role in ensuring the safety and rights of research participants. Though most institutions have an IRB that approves research protocols, official policy that all research must be approved is yet to be institutionalized. In addition, training and re-training of members of IRBs is not given sufficient attention. While noting that the functionality of an IRB is hinged on an efficient secretariat that serves as the clearing house for protocols to be approved, some of our IRBs do not have a working secretariat with dedicated staff. Indeed, there are a number of challenges that are capable of undermining the role of the IRBs. Other challenges in the operationalization of IRBs include: poor mechanisms of monitoring of research, financial constraints, poor data archival systems, lack of a standard operational procedure and guidelines for submission and evaluation of protocols etc. As the IRBs are expected to play important roles in research involving human participants especially in clinical and vaccine trials, this paper highlights the role, challenges and requirements for the institutionalization of IRBs.

Cyclospora cayetanensis infection in Lagos, Nigeria.

Although reports of Cyclospora infection continue to increase globally, few cases have been reported from the African continent. We present 11 cases of cyclosporiasis detected from stool samples submitted to seven major hospital laboratories in Lagos, Nigeria between March 1999 and April 2000.

Adverse reactions following annual ivermectin treatment of onchocerciasis in Nigeria.

OBJECTIVES: This study aims to document and underscore the need to monitor adverse reactions following repeated ivermectin treatment under the current dispensation of the implementation of the Community-directed Treatment with Ivermectin (CDTI) Program. As communities are empowered to distribute ivermectin, monitoring of adverse reactions by health care professionals is important in achieving the onchocerciasis control objectives through mass ivermectin therapy. METHODS: Eight hundred and ninety subjects from 204 randomly selected households (based on cluster of households) were interviewed using structured questionnaires and in-depth interviews. Responses concerning the adverse effects of ivermectin at the first and sixth rounds were obtained using self-report and treatment records. RESULTS: Of the 890 individuals, 40.67% presented with adverse reactions at the first round of treatment (TX(1)). This was reduced to 15.06% at the sixth (TX(6)) round of treatment. Pains in joints were more frequently reported at TX(1) and TX(6), 22.7% and 8.5%, respectively. CONCLUSION: The relatively mild adverse reaction rates observed at TX(1) did not affect future participation in community treatment with ivermectin, due to adequate community mobilization with health education messages. The current CDTI program has a good chance of achieving the onchocerciasis control program's objectives in Shao, Kwara State, Nigeria.

Effect of repeated community-based ivermectin treatment on the intensity of onchocerciasis in Nigeria.

INTRODUCTION: Ivermectin (Mectizan) is an effective and well-tolerated microfilaricidal drug that has emerged as the drug of choice for large-scale treatment of onchocerciasis. Repeated doses of ivermectin is reported to lower the incidence of microfilardermia, while a single dose will markedly reduce skin microfilarial loads for up to 12 months with a transient fall in microfilarial level. AIM: The aim of the study was to evaluate the effect of repeated community-based ivermectin treatment on the intensity of onchocerciasis in 10 onchocerciasis-endemic communities of Lade District, Pategi Local Government Area of Kware State, Nigeria. METHODS: The participants, a cohort of 330 men from whom parasitologic pre-treatment data were collected before mass ivermectin distribution commenced in 1992, were evaluated just before the fifth round of annual ivermectin treatment in August-September 1996, and 12 months after the fifth round in August-September 1997. Two bloodless skin snips were obtained from participants' left and right iliac crests and incubated for 24 h in an 0.5 mL microfuge tube containing 0.2 mL normal saline, before microscopic examination and enumeration of microfilariae. The community microfilarial load (CMFL), the most sensitive parasitologic indicator, was computed. RESULTS: Following four rounds of repeated annual treatments of onchocerciasis with ivermectin in the 10 communities studied, varying degrees of reduction in CMFL were observed in six of the 10 communities. These reductions were significant in three of the six communities at the first evaluation carried out just before the fifth round of annual ivermectin treatment (p = or <0.05). There was an increase in the remaining four communities, mainly attributed to poor annual acceptance and compliance with annual ivermectin treatment due to the occurrence of severe adverse reactions and absenteeism. Post-treatment evaluation (12 months after the previous evaluation), just before the sixth round of annual ivermectin treatment was preceded by community mobilization (enlightenment on the usefulness of ivermectin an assurance on its safety), especially in the four affected communities. This brought about reductions in the CMFL in the four communities that were not previously affected. Although the CMFL of these four communities was reduced, the CMFL of three of the communities did not fall below the 1992 pre-treatment level but was below the level recorded 12 months earlier. One of these affected communities had its CMFL reduced below the 1992 pre-treatment CMFL. CONCLUSION: This study confirms the efficacy of ivermectin in the reduction of CMFL but exposes the danger of failing to monitor annual ivermectin treatment where community ivermectin-based control efforts are ongoing. The results obtained from this study are not as impressive as results reported from closely monitored scientific evaluations of ivermectin efficacy studies.

Community response to repeated annual ivermectin treatment of onchocerciasis in Nigeria.

The evaluation of repeated annual treatment with ivermectin in onchocerciasis-endemic communities using output indicators such as acceptance rate (AR) and community compliance rate (CCR) are invaluable tools for assessing community response to onchocerciasis control measures. These indicators were employed in evaluating the responses to annual ivermectin treatment in ten communities in Lade District, Kwara State, Nigeria, where annual ivermectin treatment had reached the fourth round in 1995. The mean AR in all of the communities at the first round of treatment (Tx1) was 95.18% while the mean for Tx1-Tx4 varied between the communities and ranged from 62.82% to 98.49%. The CCR also differed between the communities and ranged from 38.56% to 96.97%. Adverse reactions to ivermectin treatment at Tx1 brought about non-compliance in Lile (CCR of 38.46%), one of the communities studied. AR in Lile also decreased from 94.87% at Tx1 to 61.54% at Tx2, 53.85% at Tx3 and 41.03% at Tx4. (The commencement of community mobilization in defaulting communities after Tx4 restored the acceptance at the next round of annual treatment. The drop in participation in Lile due to adverse reactions would have been averted if annual ivermectin treatment were properly monitored. This study advocates the need for the continuous monitoring and evaluation of onchocerciasis-endemic communities currently receiving treatment, especially in the implementation of the Community-Directed Treatment with Ivermectin (CDTI) programme, so that feedback from the communities can permit proper intervention if necessary.

Cyclospora cayetanensis in stools submitted to hospitals in Lagos, Nigeria.

BACKGROUND: Cyclospora cayetanensis is an emerging human pathogen associated with gastrointestinal disease. The epidemiology and biology of the parasite are poorly understood, and numerous outbreaks of cyclosporiasis have been recorded from around the world since 1990, but the incidence of the parasite in Nigeria has not been described. DESIGN AND METHODS: A cross-sectional, laboratory-based study was conducted in Lagos-metropolis state in southwestern Nigeria. All stool samples submitted to the Microbiology and Parasitology Department between March 1999 and April 2000 were processed for the presence of Cyclospora cayetanensis. Data from each patient were obtained from health records and via questionnaires, including age, sex and reason for hospital visit. RESULTS: In total, 1109 stool samples were collected during the period of study. Eleven (0.99%) were confirmed to be positive for Cyclospora cayetanensis oocysts. Other parasites were also detected, including Cryptosporidium sp., Entamoeba sp., Ascaris, Trichuris, Strongyloides sp., and hookworm. CONCLUSIONS: Cyclospora cayetanensis is an infrequent but important cause of gastrointestinal disease in Lagos, Nigeria. This is the first report of Cyclospora infection in Nigeria and suggests that medical practitioners and laboratory scientists should be made more aware of the infection.

Effects of anti-protozoal drugs and histopathological studies on trypanosome species.

The trypanosomostatic and trypanosomicidal effects of four anti-protozoal drugs, namely halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine, on species of trypanosomes, viz. Trypanosoma brucei brucei (MBOS/NG/94/NITR) Bassa strain, T. congolense (MBOS/NG/93/NVRI) Zaria strain and T. brucei gambiense (MHOM/NG/92/NITR) Abraka strain, were investigated. In vitro and in vivo studies on these drugs vis-a-vis the parasites were carried out. The histopathological changes in organs and tissues of experimentally infected rats were also studied. Results from the in vitro studies indicated that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine appeared to be effective trypanosomicidal agents against T. brucei brucei (Bassa strain), T. congolense (Zaria strain) and T. brucei gambiense (Abraka strain). The in vivo studies showed that these drugs were sub-curative by prolonging the survival period of the trypanosome-infected rats, but not necessarily curing the infection. Histopathological findings indicated inflammatory reactions characterised by infiltration to variable degrees in the majority of tissues, mostly in the lungs and liver. The most consistent lesions were interstitial pneumonia, multifocal necrosis and oedema. Pathological findings showed the T. brucei brucei and T. brucei gambiense strains studied to be both intravascular and extravascular parasites. These results suggest that halofantrine hydrochloride, chloroquine phosphate, benzoylmetronidazole and pyrimethamine could be used as supportive, suppressive and/or synergistic/additive drugs in the treatment of African trypanosomiasis. Their effects on species of trypanosomes have been studied and are reported for the first time.

Prevalence of trichomonas vaginalis in patients with vaginal discharge in Lagos, Nigeria.

Trichomonas vaginalis is the most prevalent, non-viral sexually transmitted infection worldwide and probably the most commonly treatable in Africa and worldwide. The purpose of this study was to determine the prevalence of T. vaginalis among women with vaginal discharge attending a gynaecologic clinic in Lagos and to identify the common characteristics of the vaginal discharge in T Vaginalis. High vaginal swabs were taken from consenting adults with vaginal discharge. The quantity, colour and odour of the discharge were noted. Amine (10% KOH) test and pH were determined. Wet-mount microscopy Giemsa staining and culture in Oxoid (R) Trichomonas Medium were performed on each swab. A total of 200 patients were examined. One hundred and forty-nine (74.5%) had T. vaginalis. There was no statistically significant association between age, marital status, parity, number of sexual partners and prevalence of T vaginalis. The colour of the discharge was white in 104 (69.8%), yellow in 30 (20.1), clear in 15 (10.1%). None was frothy or greenish. The discharge was heavy in 50 (33.6%) and malodorous in 51 (34.2%). The pH range was 4-7 and 42 (28.2%) normal pH of4. In 47 (31.5%) the amine test was negative. The prevalence of T vaginalis among women with vaginal discharge is high. Women complaining of vaginal discharge should be thoroughly screened for T. vaginalis using all available methods.

Zoonotic infections in Nigeria: overview from a medical perspective.

Infections of domestic and wild animals that are transmitted directly or by an arthropod vector to humans are a major cause of morbidity and mortality worldwide and particularly in Nigeria. With a population of over 100 million and the need for improved health care delivery, Nigerians are at considerable risk considering the seriousness of these infections. Zoonotic infections that are endemic in Nigeria include tuberculosis, trypanosomiasis, toxoplasmosis, taeniasis, rabies, lassa fever and yellow fever. Zoonotic food-borne infections (caused by Campylobacter, Salmonella and Escherichia coli O157:H7) and cryptosporidiosis are emerging. Sporadic cases such as strongyloidiasis, ascariasis, leptospirosis, scabies, pentastomiasis and African histoplasmosis have been reported. There is a need to determine the prevalence of tick-borne zoonoses. Prevention and control of zoonoses in humans is by vaccination, treatment and health education. As a first measure to improve control, the link between veterinary and medical officers, which is presently very weak, needs to be strengthened. Furthermore, regional multidisciplinary approaches to the control of zoonotic infections should be adopted in West Africa, which take into consideration the huge inter-border traffic.

Disinfectant/antiparasitic activities of Jatropha curcas.

OBJECTIVE: To investigate the disinfectant/antiparasitic activities of Jatropha curcas as a first step in providing a cheap, readily available disinfectant and malaria vector control agent. DESIGN: Bacteriological and parasitologic tests were carried out on laboratory bench surfaces using the sap and crushed leaves of Jatropha curcas. Four rectangular areas labelled A, B, C and D were first swabbed and streaked onto McConkey and Nutrient agar plates. Section A was treated with "Hibiscrub", D with exterma germcloth, B and C with full strength sap and leaf extracts respectively. Effect of the sap was also tested on helminth ova, vector control on mosquito eggs and toxic effects of the sap on mice. SETTING: The study was carried out in the medical microbiology laboratory of the College of Medicine, University of Lagos, Lagos. RESULTS: Observation showed that the sap extracted germicidal actions on the growth of common bacteria of Staphylococcus, Bacillus and Micrococcus species on contact and retained such effects on treated laboratory bench surface for close to six hours after initial application. Ova of Ascaris Lumbricoides and Necator americanus incubated in 50% and 100 concentrations of the sap at room temperature showed either no evidence of embryonation after 21 days in the case of A. Lumbricoides, negation of hatchability in hookworm, or complete distortion in both. The sap also exhibited strong inhibitory effect on normal larval growth of mosquito, but was highly toxic to mice when administered through oral or intraperitoneal routes. CONCLUSION: J. curcas would provide a very cheap, readily available disinfectant and malaria vector control agent and should be commercially exploited.

Reduced prevalence of onchocerciasis following mass treatment with ivermectin.

The effect of four years of cummulative annual treatment with ivermectin just before the fifth round of dosing with the drug was studied in six endemic communities where pretreatment data had been collected in 1992. Significant reductions in prevalence of microfilaridermics (PMF), skin microfilarial density (MFD) and community microfilarial load (CMFL) was recorded. Remarkable reductions in PMF were recorded in Gbodongi (53.0%), Ndanako (80.1%) and others. In all the communities, the infection was reduced to a hypo endemic status except for Gbodongi. This was corroborated by the increase in amicrofilaridermics. CMFL was reduced in Gbodongi by 64.2%, Lata (53.1%) and the least in Bongi (11.0%). Reduction in clinical manifestations were variable.

Adoptive transfer of immunity induced with chloroquine attenuated Plasmodium yoelii nigeriensis from immune to immunologically naive mice.

Immunity was induced in albino mice using Chloroquine-attenuated Plasmodium yoelii nigeriensis which had been maintained under drug pressure in 4 passages. Attempts were made to adoptively transfer immunity from the immune to immunologically naive mice by means of serum, spleen and thoracic duct extracts. None of them conferred complete immunity on the recipients but some protection was gained. This was evident from the prolongation of both the pre-patent periods of the infection and the survival periods of the host mice. The best protection conferred by the different extracts was seen in groups that received 0.4 ml serum, 0.9 ml spleen and 1.2 ml thoracic duct extracts whose survival periods lasted 23, 21 and 15 days respectively as compared to 9 days for the controls.

Induced immunity to Plasmodium yoelli nigeriensis in albino mice by antigenic mice organs.

Antigenic materials prepared from parasite infected and non-infected tissue (blood), organs (spleen, liver, lung) and whole mouse burnt with or without Aframomum melegmeta (Alligator Pepper) were tested whether they could elicit immune response to Plasmodium yoelli nigeriensis in albino mice. This investigation is in line with the practice of traditional medicine in the western part of Nigeria where burnt herbal preparation are introduced into patient through body cuts known as "Gbere" for protection and therapy against infection. Results from the study unexpectedly showed that immune response was elicited against malaria parasite by the uninfected antigenic material prepared from spleen and whole mouse. Aframomum melegmeta on its own lysed the red blood cells and played a doubtful role in inducing immunity.