Knowledge and practices on malaria treatment measures among pregnant women in Abeokuta, Nigeria.

The knowledge and practices on malaria treatment measures were assessed among 1400 pregnant women in semi-urban and rural communities (Akomoje, Iberekodo, Osiele and Sabopapamaru) of Abeokuta, Nigeria in 2006. Data was collected using structured questionnaires and focus group discussions. The largest proportion (41%) of the respondents was in the age group 21-25years. About three quarters (74%) of the women were multigravids. Sixty-five percent of the women had between three to four episodes of malaria per year. According to the respondents, symptoms associated with malaria in pregnancy included abdominal pains and foetal weakness due to reduced kicks (53%), body pains and headaches (27%) and anaemia (20%). Sixty-eight percent of the pregnant women utilized herbs for treating symptoms associated with malaria due to its effectiveness and suitability and not due to financial constraint or lack of access to health facility. Though most women utilized herbs, 32% relied more on the use of antimalarials. Sulfadoxine-pyrimethamine was the preferred antimalarial during pregnancy at the 2nd and 3rd trimesters. Only 15% of the women were using insecticide treated mosquito nets for personal protection. The majority (77%) of respondents used nylon net to screen their windows off mosquitoes. Since malaria poses adverse effect on the mother and developing foetus, health education becomes very essential to the traditional birth attendants and the women who patronize them. Pregnant women who attend traditional birth homes should be encouraged to also attend orthodox antenatal clinics, in order to receive proper and adequate treatment against malaria for themselves and the foetus.

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.

The validity of haematuria in the community diagnosis of urinary schistosomiasis infections.

The validity and reliability of haematuria when used as screening criteria in community diagnosis of urinary schistosomiasis is presented. Between May and July, 1998, 1173 persons were screened for haematuria and examined for the presence of eggs of Schistosoma haematobium in their urine from all participating households in the Ozitem area of Bende Local Government Area, Abia State, Nigeria. Haematuria showed a sensitivity rate of 41.0% and specificity of 82.0% when used to identify cases of urinary schistosomiasis. Some factors that influenced the validity of haematuria as a diagnostic criterion are discussed. The use of haematuria amongst subjects in the first twenty years of their life is recommended.

The prevalence, intensity and clinical manifestations of Onchocerca volvulus infection in Toro local government area of Bauchi State, Nigeria.

Between January and October 1994, a study of the prevalence, intensity and clinical manifestations of onchocerciasis in nine communities of Toro local government area of Bauchi State, Nigeria was undertaken using the skin-snip method. Of the 1117 inhabitants examined, 188 (16.8%) were positive for microfilariae of Onchocerca volvulus. The prevalence of onchocerciasis was significantly higher (P < 0.05) among males than females, in subjects 21 years of age and above than in those in the first two decades of life, in nomads, farmers, hunters and fishermen than smiths and traders. Intensity of infection was light, not exceeding a geometric mean of 5.3 microfilaria per 2 mm skin bite. Preponderance of positive cases below 20 years presented no chronic signs. Conversely, persons above 20 years had higher microfilaria counts which coincides with the period when most clinical signs manifest. Microfilarial-rate and -density in relation to age were closely associated (r = 0.75, P < 0.001). The need for a sustained mass distribution of Mectizan in these communities is highlighted.

Control of onchocerciasis in Nzerem-Ikpem, Nigeria: baseline prevalence and mass distribution of ivermectin.

Data from a survey of endemicity of human onchocerciasis and subsequent mass distribution of ivermectin to control this disease in 9 villages of the Nzerem-Ikpem community in the Imo River basin of Nigeria are presented. Of the 1126 persons examined, 46.2% were positive for skin microfilarial, 29.2% for leopard skin, 34.2% for palpable subcutaneous nodules and 14.8% for various types of onchodermatitis. Ivermectin was distributed to a total of 1934 persons living in 233 households. The treatment coverage rate was 51%. 12.8% of those treated reported various mild reactions to the microfilaricide. Implications for community participation and long term sustenance of mass distribution programs are discussed.

A survey of predilection sites and degree of disability associated with guineaworm (Dracunculus medinensis).

Of the 1,200 people surveyed for dracontiasis in Ribi and Kanje villages in Awe Local Government Area of Plateau State, Nigeria, 982 (82%) were infected. Most infections (98%) involved the lower limb. Worms emerging from the umbilicus, groin, palm, wrist, and upper arm were also encountered. Of the 982 infected persons 206 (21%) were totally incapacitated, 193 (20%) were seriously disabled, and 431 (44%) suffered mild incapacity, while 152 (16%) were unaffected. Of the 5 species of cyclopoid copepods found in their main water source, only Thermocyclops nigerianus and Mesocyclops aequatorialis harboured guineaworm larvae.

Studies on filariasis in Bauchi State, Nigeria. 1. Endemicity of human onchocerciasis in Ningi Local Government Area.

The endemicity of human onchocerciasis was assessed in eight rural, at-risk communities in Ningi Local Government Area, Bauchi State, Nigeria, between July 1990 and March 1991. Of the 1536 subjects skin-snipped, 334 (21.7%) were positive for Onchocerca volvulus microfilariae. Surprisingly, there was a significant inverse relationship between prevalence and mean microfilarial load (r = -0.608; P < 0.05). Males were more likely to be infected than females (P < 0.01) and cattle rearers (71.0% infected), farmers (49.8%) and fishermen (40.0%) had significantly higher prevalences than students/schoolchildren, housewives or traders (P < 0.001). Pruritus and itchy eyes were recorded in all age groups and appeared in much younger subjects than any other manifestations of the infection. Prevalence and onchocercal blindness were linearly related to intensity of infection. The epidemiological significance of these findings, in terms of a future community-wide programme of long-term chemoprophylaxis with Mectizan, is highlighted.

Reversal of amenorrhoea after Mectizan treatment.

Plausible reversal of secondary amenorrhoea in three women infected with onchocerciasis after Mectizan treatment in Imo State, Nigeria, is presented. The women aged 30, 28, and 32 years with drastic reduction in mean microfilaria scores had reversed amenorrhoea 8, 13 and 10 days post Mectizan treatment, respectively. They had typical manifestation of onchocerciasis including nodules, pruritic rash, body itching and musculo-skeletal pains. The manifestations eased off 4 days post treatment. The plausible link between loss of fertility due to premature menopause in women and onchocerciasis is discussed.

Studies on filariasis in Bauchi State, Nigeria. II. The prevalence of human filariasis in Darazo Local Government area.

In an eleven months study of eleven communities of Darazo Local Government Area of Bauchi state, northern Nigeria, 293 (21.7) of 1,349 persons examined harboured various filarial parasites. Of the sampled population, 18%, 1.9%, 1.6%, 0.5% and 0.2% had microfilariae of Onchocerca volvulus, Wuchereria bancrofti, Mansonella perstans, M. streptocerca and Loa loa respectively. Of the 637 females examined, 90 (14.1%) were infected, while 203 (23.5%) of 712 males sampled had filarial infections. The high rate in males was significant (P < 0.001). O. volvulus mf-rate increased gradually from the first decade to the seventh decade of life but declined thereafter. Prevalence of bancroftian filariasis was consistently lower in females of reproductive age, while the distribution of various filarial parasites varied significantly among age groups and communities (P < 0.05). Fishermen (42.9%), farmers (42.4%) and cattle rearers (40.9%) were the most affected occupational categories. Control strategies are highlighted.

A case of probable transplacental transmission of Wuchereria bancrofti microfilariae.

A case of transplacental transmission of Wuchereria bancrofti microfilariae is reported in endemic are of Bauchi State, Nigeria. The diagnosis was based on the history of illness, clinical symptoms, age of the child and presence of sheathed microfilariae of nocturnal periodic form of W. bancrofti in the peripheral blood films. Also the night blood sample collected from the child's mother revealed mf of W. bancrofti in addition to the unilateral elephantiasis of the hindlimb. The implication of this observation is stressed.

Studies on filariasis in Bauchi State, Nigeria. V. The distribution and prevalence of mansonellosis with special reference to clinical signs.

A survey on mansonellosis was carried out in Bauchi State of Nigeria between January 1990 and March 1992. Of the 5,640 inhabitants examined, 24 (0.4%) were positive for Mansonella streptocerca microfilariae. Microfilaria rate and mf density increased gradually with host age. While infection and sex are independent, mansonellosis was significantly lower in subjects within the first three decades of life than in those above 31 years (P < 0.05). Clinical signs observed include pruritus, rash, inguinal adenopathy and occasional dizziness. Skin biopsies taken from the shoulder gave the highest frequency of positive skin snip.

The status of human filariasis in north-western zone of Bauchi State, Nigeria.

In a nine-months epidemiological study to assess the status of human filariasis in north-western zone of Bauchi State, Nigeria, 3.5% prevalence was recorded in 8 communities. Of the 1536 persons examined, 54 were microfilaremic for three blood-dwelling filarial parasites. 22 (1.4%) were positive for Mansonella perstans, 10 (0.7%) and 22 (1.4%) had Loa loa and Wuchereria bancrofti respectively. W. bancrofti showed low microfilaremia in females of reproductive age with high degree of heterogeneity among communities. Most infected persons (81.5%) had counts less than 11 mf/20 mm3 of peripheral blood. Pruritus appeared much earlier in life while hydrocoele, limb and scrotal elephantiasis occurred much later in the population (> or = 40 years). Except in L. loa infections, mf-rate and mean mf-density increased with advancing host age (r = 0.713, P < 0.01). Fishermen, nomads and farmers had significantly higher infection rates (P < 0.05) than other occupational categories. Suggestions on the disease intervention involving treatment, prevention and vector control are highlighted.

Observations on the epidemiology of human taeniasis amongst the Goemai tribe of northern Nigeria.

A study on the epidemiology of human taeniasis amongst the Goemai tribe of Kwande rural community of Qua'an Pan Local Government Area carried out between January and June, 1991 is reported. 115 or 11.5% of the 1,000 persons examined were infected. Of the 614 males and 386 females examined, 77 (12.5%) and 38 (9.9%) respectively had infections. No significant difference in prevalence rates was recorded between the sexes and age groups. Infection was significantly higher (P < 0.05) among farmers than other occupational categories, and in those eating half roasted/cooked meat than in persons eating well-cooked meat. Other epidemiological factors relating to type of toilet facilities used as well as some socio-cultural and traditional beliefs of Goemai people which encourage host-parasite contact and their implications for public health are discussed. Suggestions are made for the control of human taeniasis in the community.