Compliance With Guidelines on Seasonal Malaria Chemoprevention in Kwara State, Northcentral Nigeria.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is an effective strategy for reducing malaria morbidity and mortality in children aged 3-59 months in areas with seasonal malaria transmission. Sulphadoxine-pyrimethamine plus amodiaquine is given to an eligible child at monthly intervals during the peak malaria transmission season. The aim of this study was to determine the level of compliance with SMC guidelines by community drug distributors during SMC implementation in Kwara State. METHOD: Caregivers of eligible children from six Local Government Areas were interviewed using a structured questionnaire on the KoboCollect app downloaded on hand-held android devices. The questionnaire was composed of questions on caregiver's demographics, SMC drug administration, and adherence to SMC protocol. RESULTS: A total of 1,314 caregivers were interviewed, most of them were female 1076 (81.9%), married 1200 (91.3%) and literate 795 (60.5%). The mean SMC coverage for the 4 cycles was 1183(88.5%). SMC information was received by 1166 (88.7%) of caregivers. Most of the caregivers 1166 (88.7%) heard about SMC. Overall, SPAQ administration was directly observed in most cases 1169 (91.5%), second dose was given 1226 (96.0%) and drugs were fully ingested 1140(89.3%). Poor compliance was observed in home visits by lead mothers 988 (77.4%). The report of adverse drug reactions was low 132 (10.3% [95% CI: 8.8-12.3%]), the commonest being severe vomiting 50 (37.9%). There were significant (P<0.05) variations in SMC implementation across the 6 LGAs in virtually all the performance indicators. SPAQ administration to over-age children was low 128 (10.0%). CONCLUSION: Overall, the compliance with SMC implementation guidelines in Kwara state was good though significant differences in performance were observed across the six LGAs. Home visits by lead mothers were generally poor. The self-reported coverage of SMC by caregivers was commendable.

CONTEXTE: La chimioprévention saisonnière du paludisme (CSP) est une stratégie efficace pour réduire la morbidité et la mortalité liées au paludisme chez les enfants âgés de 3 à 59 mois dans les zones à transmission saisonnière du paludisme. La sulfadoxine-pyriméthamine associée à l'amodiaquine est administrée à un enfant éligible à intervalles mensuels pendant la saison de transmission maximale du paludisme. L'objectif de cette étude était de déterminer le niveau de conformité aux directives de la CSP par les distributeurs de médicaments communautaires lors de la mise en œuvre de la CSP dans l'État de Kwara. MÉTHODE: Les aidants des enfants éligibles de six zones de gouvernement local ont été interrogés à l'aide d'un questionnaire structuré sur l'application KoboCollect sur des appareils android portables. Le questionnaire comprenait des questions sur les caractéristiques démographiques des aidants, l'administration des médicaments de la CSP et l'adhésion au protocole de la CSP. RÉSULTATS: Au total, 1 314 aidants ont été interrogés, la plupart étaient des femmes 1 076 (81,9 %), mariées 1 200 (91,3 %) et alphabétisées 795 (60,5 %). La couverture moyenne de la CSP pour les 4 cycles était de 1 183 (88,5 %). La plupart des aidants 1 166 (88,7 %) avaient entendu parler de la CSP. Dans l'ensemble, la première administration de SPAQ a été observée directement dans la plupart des cas 1 169 (91,5 %), la deuxième dose a été administrée par 1 226 (96,0 %) aidants et les médicaments ont été entièrement ingérés sans cracher partiellement ou totalement par 1 140 (89,3 %) enfants. Une mauvaise conformité a été observée lors des visites à domicile par les mères responsables 988 (77,4 %). Le signalement des réactions indésirables aux médicaments était faible 132 (10,3 % [IC à 95 % : 8,8-12,3 %]), la plus courante étant les vomissements sévères 50 (37,9 %). Des variations significatives (P<0,05) dans la mise en œuvre de la CSP ont été observées dans les 6 LGAs pour pratiquement tous les indicateurs de performance. L'administration de SPAQ aux enfants plus âgés était faible 128 (10,0 %). CONCLUSION: Dans l'ensemble, la conformité aux directives de mise en œuvre de la CSP dans l'État de Kwara était bonne bien que des différences significatives dans les performances aient été observées dans les six LGAs. Les visites à domicile par les mères responsables étaient généralement mauvaises. La couverture autodéclarée de la CSP par les aidants était louable. MOTS-CLÉS: Chimioprévention saisonnière du paludisme, SPAQ, Conformité, Enfants, Centre-nord du Nigeria, Saison des pluies.

Polymorphism and virulence factors in the pathogenesis of amoebiasis

Amoebiasis is one of the world's most prevalent infectious diseases of developing world. E. histolytica and E. dispar are two morphologically identical but genetically distinct species. Infection with E. histolytica may be symptomatic and asymptomatic. E. dispar is non-pathogenic. Both innate and acquired immune responses limit amoebic infection while different strains of E. histolytica and its virulence have been described and virulence factors of E. histolytica such as cysteine proteinases; Gal/GalNAc-inhibitable lectin and ameobapore are known to be involved in E.histolytica pathogenesis. Proteolytic enzymes and cysteine proteases facilitate tissue invasion while Gal/GalNAc-inhibitable lectin aids adherence and amoebapores are involved in lysis of target cells. Three new strains of E. histolytica (Rahman; HK-9; and 200: NIH) have been described as well as the previously known strain (HM 1 IMSS). This review highlights the newly described strains and virulent factors involved in the pathogenesis of E. histolytica

Factors that facilitate infant survival in a low socio-economic community in Lagos State, Nigeria

Infants are delicate, relying mostly on caregivers for their survival. Their survival is plagued by diseases, poverty, behavioural habits and cultural beliefs of the caregivers in the developing countries. For strategies to improve infant survival, the health seeking behaviour and home care practices of caregivers during infant illness episodes were studied. A total of 742 caregivers in 5 out of 11 health districts of Ajeromi/Ifelodun Local Government areas of Lagos State whose infants were ill four weeks preceding the survey were interviewed using a semi-structured questionnaire. Sixty-two (8.4%) of the interviewed lost their infants; 51.6% of children who died did so in hospitals, 35.5% at home and 12.9% at unspecified places. The notable causes of death were malaria (22.6%), acute respiratory infections (14.5%) and diarrhea (12.9%). Majority of the caregivers (60.0%) whose infants died did not seek external help until 24hrs or more after onset of illness signs. Infant's tendency to survive an illness episode was significantly dependent on full term delivery (P<0.01); birth weight (P<0.01); treatment sources (P<0.05) and infant feeding methods (P<0.05). Appropriate antenatal care and infant feeding practices including exclusive breast feeding, early recognition of danger signs and timely health seeking will significantly improve child survival in Nigeria

Diagnostic methods for typhoid fever in Nigeria.

In this study, 65 patients are screened for Salmonella typhi by conventional culture and the Widal test. In addition, the patients undergo full blood count are screened for malaria parasites. Of the 65 patients, 50 report febrile conditions, while the remaining 15 are used as a control population. In the febrile group, 13 (26%) were positive for S. typhi, while in the control group only one (7%) was positive for S. typhi. Overall, 36 (64.3%) patients had malaria parasites. Patients with a higher O antibody titre (> or = 1 in 80) by Widal test were found to have consumed both tap water and pure water. More females (10/14; mean age: 33) had typhoid fever as a result of S. typhi infection, the majority of which were isolated from stool samples (57%). Nine of the isolates were also positive for malaria parasites, seven of which were in the trophozoite stage. Plasmodium falciparum was the predominant parasite (78%), the remainder being P. malariae. The majority of patients (12/14) with typhoid fever had normal PCV values. In conclusion, it is recommended that tests for the diagnosis of typhoid fever in Nigeria should include malaria parasites, S. typhi culture from faecal samples, and the Widal test.

Effect of chlorpheniramine on the pharmacokinetics of and response to chloroquine of Nigerian children with falciparum malaria.

Chlorpheniramine (CP), a histamine H1-receptor antagonist, enhances the efficacy of chloroquine (CQ) in acute uncomplicated falciparum malaria. The effects of this combination therapy on the pharmacokinetic disposition of CQ is, however, unpredictable. A standard treatment with 25 mg CQ base per kg bodyweight was orally administered over 3 days, alone or in combination with CP, to 17 semi-immune Nigerian children with Plasmodium falciparum parasitaemia attending hospital in Lagos, Nigeria, and observed for 28 days. Whole-blood CQ concentrations were monitored 14 times during the follow-up by high-performance liquid chromatography analysis of blood dried on filter paper. Parasitaemia was determined on thick blood films stained with Giemsa, and treatment failures were established following the WHO classification for CQ resistance. Our pharmacokinetic data showed that the peak whole-blood CQ concentration was significantly increased (P < 0.05) by CP administration, and the time to achieve the peak was reduced in the presence of CP. The area under the first-moment drug-concentration-time curve was also significantly increased (P < 0.05) by CP administration. Treatment with CQ-CP combination resulted in a shorter parasite clearance time (2.0 +/- 0.5 days) and a higher cure rate (87.5%) compared to treatment with CQ alone (3.5 +/- 0.5 days; 66.7%). Our data suggest that CP enhanced the efficacy of CQ against resistant P. falciparum in acute uncomplicated malaria by increasing the uptake/concentration of CQ in resistant parasites.