Intimate Partner Violence and Risk Factors among Women during the COVID-19 Movement Restriction in Nigeria: An Online Survey.

BACKGROUND: The rapid spread of the SARS-CoV-2 infection in the absence of treatment or the presence of vaccines is forcing nations to respond with strong preventive measures ranging from mitigation, containment, and in extreme cases, quarantines. While these measures are a useful measure of infection control, they can lead to significant social, economic, and psychological consequences. This study sought to establish the prevalence and risk factors of intimate partner violence during the COVID-19 movement restriction in Nigeria among girls and women. METHODS: An online-based questionnaire survey using Google Forms was conducted over four weeks among girls and women aged 15 years and above. Data analysis was performed using SPSS version 20, and logistic regression was used to determine risk factors for IPV experience during the lockdown. RESULTS: Overall, 32.8% of respondents reported ever experiencing IPV, and 42.5% experienced IPV during the lockdown. Verbal (35.1%) and psychological (24.1%) violence were the commonest forms of violence in the study. There was considerable overlap between the various forms of IPV in the study. Age less than 35 years (aOR = 1.3; CI = 1.2 - 1.4), resident in the northeast region (aOR=1.6; CI=1.41.9), alcohol (aOR=1.3;CI=1.2-1.5) and substance (aOR = 1.5; CI = 1.3 - 1.8) use, average family monthly income < $100 (aOR = 1.4;CI=1.2 - 1.5), daily or weekly income (aOR = 2.7; CI = 2.5-3.1) had an increased association with IPV during the lockdown, residency in the southeast region had lower odds of experiencing IPV (aOR=.0.5; CI = 0.3-0.8). CONCLUSION: The reported lockdown prevalence of IPV was 42.8%, with verbal and psychological violence being the most prevalent form of IPV. Age less than 35 years, resident in northeast and southeast, use of alcohol or substances, average family monthly income < $100, and partner being a daily-weekly earner was associated with IPV experience. Policymakers in the future should consider the consequences, including IPV, before issuing such an order.

CONTEXTE: La propagation rapide de l'infection par le CoV-2 du SRAS en l'absence de traitement ou présence de vaccins oblige les nations à réagir par des mesures préventives fortes allant de l'atténuation à l'endiguement et, dans les cas extrêmes, à la mise en quarantaine. Bien que ces mesures soient utiles pour contrôler l'infection, elles peuvent avoir des conséquences sociales, économiques et psychologiques importantes. Cette étude visait à établir la prévalence et les facteurs de risque de la violence exercée par le partenaire intime au cours de la restriction de mouvement du COVID-19 au Nigeria, chez les filles et les femmes. MÉTHODES: Une enquête par questionnaire en ligne utilisant google form a été menée pendant quatre semaines auprès de filles et de femmes âgées de 15 ans et plus. L'analyse des données a été réalisée à l'aide de la version 20 de SPSS et une régression logistique a été utilisée pour déterminer les facteurs de risque de violence conjugale pendant la période de restriction. RÉSULTATS: Dans l'ensemble, 32,8 % des personnes interrogées ont déclaré avoir déjà subi des VPI, et 42,5 % ont subi des VPI pendant l'enfermement. La violence verbale (35,1 %) et la violence psychologique (24,1 %) étaient les formes de violence les plus courantes dans l'étude. Il y avait un chevauchement considérable entre les différentes formes de VPI dans l'étude. L'âge inférieur à 35 ans (aOR=1,3 ; CI= 1,2 - 1,4), la résidence dans la région nord-est (aOR=1,6; CI=1,4-1,9), la consommation d'alcool (aOR=1,3; CI=1,2 - 1,5) et de substances (aOR=1,5 ; CI = 1,3 - 1,8), le revenu mensuel moyen de la famille < 100 $ (aOR=1. 4 ; IC = 1,2 - 1,5), le revenu quotidien ou hebdomadaire (aOR = 2,7 ; IC = 2,5-3,1) était davantage associé à la VPI pendant le lockdown, la résidence dans la région du sud-est avait moins de chances d'être victime de VPI (aOR = 0,0,5 ; IC = 0,3-0,8). CONCLUSION: La prévalence de la VPI pendant le lockdown était de 42,8 %, la violence verbale et psychologique étant la forme de VPI la plus répandue. L'âge inférieur à 35 and, le fait de résider dans le nord-est et le sud-est, la consommation d'alcool ou de substances, le revenu mensuel moyen de la famille inférieur à 100 dollars et le fait que le partenaire gagne sa vie toutes les semaines étaient associés à l'expérience de la VPI. À l'avenir, les décideurs politiques devraient prendre en compte les conséquences, y compris la VPI, avant d'émettre un tel ordre. Mots-clés: Violence entre partenaires intimes, COVID-19, Lockdowns, Nigeria, Violence fondée sur le genre.

Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians.

BACKGROUND: Antimicrobial use plays a key role in development and spread of antimicrobial resistance. Following the global coronavirus disease 2019 (COVID-19) pandemic and the report of the first confirmed case in Nigeria, several states embarked on either a full or partial lockdown as a measure to prevent or curtail the spread of the virus with its attendant challenges. This survey was designed to provide a snapshot of public antimicrobial use and common perception related to antimicrobial use for COVID-19 related symptoms among Nigerian populace. METHODS: We developed and tested a 29-question electronic questionnaire with Google forms asking respondents about their antimicrobial use and perceptions regarding appropriate antimicrobial use for real or perceived symptoms during the outbreak period. Respondents aged 18 years and above were recruited through crowd sourcing and they received the link to the survey tool through emails and social media including WhatsApp, Twitter, Facebook, LinkedIn, and Instagram. All data analysis was performed using SPSS version 26.0. RESULTS: A total of 410 responses were received from the six geopolitical zones in Nigeria comprising 200 (48.8%) females and 210 (51.2%) males. Majority (62.9%) of the respondents had taken antimicrobials in the 3 months period preceding the survey, while less than half (46.8%) received prescription for it. Previous intake of antimicrobial for similar illness was a predictor of antimicrobial intake (OR: 0.55, 95%CI: 0.30-1.01). The most consumed antimicrobial was antimalarial drugs, specifically Artemisinin-based combination therapy (43.4%), followed by antibiotics [Ciprofloxacin (20.2%)]. CONCLUSION: There was high levels of antimicrobial use for COVID-19 related symptoms by the Nigerian public. This is likely to escalate the already high prevalence of antimicrobial use previously reported and may further fuel the emergence of antimicrobial resistance.

CONTEXTE: L'utilisation d'antimicrobiens joue un rôle clé dans le développement et la propagation de la résistance aux antimicrobiens. À la suite de la pandémie mondiale de coronavirus 2019 (COVID-19) et du rapport du premier cas confirmé au Nigéria, plusieurs États se sont engagés dans un verrouillage complet ou partiel en tant que mesure pour prévenir ou freiner la propagation du virus avec ses défis associés. Cette enquête a été conçue pour fournir un aperçu de l'utilisation publique des antimicrobiens et de la perception commune liée à l'utilisation des antimicrobiens pour les symptômes liés au COVID-19 parmi la population nigériane. MÉTHODES: Nous avons développé et testé un questionnaire électronique de 29 questions avec des formulaires Google interrogeant les répondants sur leur utilisation d'antimicrobiens et leurs perceptions concernant l'utilisation appropriée d'antimicrobiens pour les symptômes réels ou perçus pendant la période d'épidémie. Les répondants âgés de 18 ans et plus ont été recrutés via le crowdsourcing et ils ont reçu le lien vers l'outil d'enquête via des e-mails et des médias sociaux, notamment WhatsApp, Twitter, Facebook, LinkedIn et Instagram. Toutes les analyses de données ont été effectuées à l'aide de la version 26.0 de SPSS. RÉSULTATS: Un total de 410 réponses ont été reçues des six zones géopolitiques du Nigéria comprenant 200 (48,8%) femmes et 210 (51,2%) hommes. La majorité (62,9%) des répondants avaient pris des antimicrobiens au cours des 3 mois précédant l'enquête, tandis que moins de la moitié (46,8%) en avaient reçu une prescription. La prise antérieure d'antimicrobiens pour une maladie similaire était un prédicteur de l'ingestion d'antimicrobiens (OR: 0,55, IC à 95%: 0,30-1,01). L'antimicrobien le plus consommé était les antipaludiques, en particulier les associations thérapeutiques à base d'artémisinine (43,4%), suivis des antibiotiques [Ciprofloxacine (20,2%)]. CONCLUSION: Il y avait des niveaux élevés d'utilisation d'antimicrobiens pour les symptômes liés au COVID-19 par le public nigérian. Cela est susceptible d'augmenter la prévalence déjà élevée de l'utilisation d'antimicrobiens rapportée précédemment et peut encore alimenter l'émergence de la résistance aux antimicrobiens.

Prevalence and Clinical Characteristics of Coronavirus Disease 2019 Seen at a Testing Centre in Lagos Nigeria.

BACKGROUND: The SARS-CoV-2 infection continues to ravage the global community since it was declared a pandemic. The socio-demographic and clinical characteristics defining the disease are mainly from Europe and Asia. The disease symptomatology is similar to the prevalent diseases in our environment, this could result in the delay in prompt identification and appropriate management of suspected cases toward combating community transmission. This study evaluates the prevalence, socio-demographic and clinical characteristics of positive cases of COVID -19. METHODS: This was a retrospective cohort study. Data on the socio-demographic, clinical characteristics and the results of the SARS-CoV-2 test of participants at the Nigerian Institute of Medical Research [NIMR] Modified Drive-through Centre for COVID-19 test sample collection over two months [24th February 2020- 27th April 2020] were retrieved from the electronic medical records (EMR). Data obtained were analyzed using SPSS version 22.0. RESULTS: A total number of 481 clients were evaluated in this review. The prevalence of SARS-CoV-2 infection in the population was 14.6%. The mean age of the positive cases was 42.2 [±15.9] years. The common symptoms reported by the positive cases were fever (40.0%), cough (32.9%), sore throat (17.1%) and running nose (15.7%). Fever depicted statistical significance with positive cases with the majority being of mild to moderate clinical severity. CONCLUSION: The prevalence of SARS-CoV-2 infection among this cohort was 14.6% with a male preponderance. Fever and sore throat were the variables that predicted SARS CoV-2 infection among our cohort.

The burden of anaemia and associated factors in HIV positive Nigerian women.

BACKGROUND: Anaemia is the most common complication of pregnancy and a predictor of poor maternal and foetal outcomes. HIV infection is now recognized as one of the major contributors to anaemia in pregnancy. It is therefore important to determine the burden and risk factors of anaemia in maternal HIV infection in others to plan effective prevention strategies as well as optimize management outcomes. OBJECTIVE: To determine the prevalence and risk factors of anaemia in pregnant HIV positive Nigerians. METHODS: The prevalence and possible risk factors of anaemia were investigated in HIV positive pregnant Nigerian women at a large HIV treatment clinic in southwestern Nigeria using a cross-sectional design between January 2006 and December 2011. RESULTS: Nine hundred and eighty-five (42.5 %) women of 2,318 HIV positive pregnant women seen during the period were anaemic by WHO standard defined by haemoglobin <11 g/dl. Majority were of mild to moderate severity (97.9 %). Short inter birth interval (p = 0.002), presence of opportunistic infections (OIs), (p = 0.001), use of zidovudine containing regimen (p = 0.0005) and CD4 cell count <200 cells/mm(3) (p = 0.001) were found to be independently associated with anaemia in HIV positive pregnant women after controlling for confounding variables. CONCLUSION: Anaemia was found to be high at 42.5 % among the HIV positive women studied and was found to be independently associated with short inter birth interval, presence of OIs, advanced HIV disease and use of zidovudine containing HAART regimen.

Immunological and virological response to haart in HIV-1 patients co-infected with hepatitis B and C viruses.

BACKGROUND: Among the countries highly endemic for viral hepatitis, Nigeria is found. Information on how triple infected persons (HIV, HBV, and HCV) fare on HAART in the country is lacking. Laboratory based investigation was carried out to assess the virological and immunological parameters of HIV-1 infected patients co-infected with Hepatitis B and C, accessing care at the Nigerian Institute of Medical Research. It was a case controlled study. OBJECTIVES: The study aimed to compare the laboratory data of HIV-HBV-HCV patients seen between 2006 and 2009 with HIV-1 monoinfected patients in the same period, on HAART according to the national guideline and followed up for 12 months. METHODS: Detection of Hepatitis B surface Antigen (HBsAg) and Hepatitis C Virus Antibody (HCVAb) were assayed using ELISA techniques (Bio Rad and DIA PRO respectively). The CD4 and HIV viral load were determined using the Cyflow Counter/Kits (Partec) and the Amplicor HIV-1 Monitor Test V1.5 (Roche) techniques respectively. RESULTS: Forty-one (0.4%) of the 10,214 HIV-1 patients seen during the period were co-infected with both HBV and HCV. Over the 12 month-period, median HIV-1 viral load and CD4 count reduced and increased respectively (12,205-200 RNA copies/mL; 210-430 cells/mL from baseline - 12th month), and for the HIV-1 monoinfected patients (36,794-200 RNA copies/mL [p=0.5485] and 206-347 cells/mL [p=0.7703] from baseline - 12th month). CONCLUSION: There seems to be no significant influence of hepatitis B and C in HIV infection on HAART judging by the CD4 and viral load profiles which were similar in the two groups.

Prevalence of abnormal cervical smears among patients with HIV in Lagos, Nigeria.

BACKGROUND: There are over four million people living with HIV/AIDS in Nigeria. Cervical cancer is the most common genital cancer in Nigeria. There are many reports on the association of HIV with increased risk of cervical dysplasia. OBJECTIVE: To determine the prevalence of abormal cervical smears in Nigerian women who are HIV positive in Lagos. METHODS: Cervical smears were taken from 233 HIV positive women and 235 HIV negative women who attended the HIV clinic and the family planning clinic respectively of the Lagos University Teaching Hospital during the period January-April 2004. Proportions were compared with the X2 test. RESULTS: Data were complete for analysis in 227 of HIV positive and 228 of HIV negative women. Mean (SD) ages of HIV positive and HIV negative patients were respectively 35.2 (9.81) and 34.5 (7.37) years. Prevalence of squamous intraepithelial lesion (SIL) was higher in those who were HIV positive than in those who were HIV negative, 10.9% vs 4.3% (X2, 7.04; p=0.00798). Prevalence of high grade SIL was higher in HIV positive than HIV negative subjects, 7.9% vs 2.6% (X2, 6.38; p=0.0115). There was no significant difference in the prevalence of inflammatory smears, 15.7% in HIV positive vs 16.2% in HIV negative. CONCLUSION: Prevalence of cervical dysplasia is high in women who harbour HIV.

Knowledge and practices of traditional birth attendants in prenatal services in Lagos State, Nigeria.

A questionnaire-based study was conducted on 189 Traditional Birth Attendants (TBAs) on their knowledge and practices in prenatal services. Only 86 (45.5%) of them associated cessation of menstrual period with pregnancy while others use mystic power 46 (24.3%), early morning sickness, pallor of conjunctiva and reaction to herbs 56 (29.6%) to detect pregnancy. Fundal height n=76 (40.2%), palpation n=82 (43.4%), special soaps and soups n=52 (27.5%) and special devices n=8 (4.2%) are used to determine stages of pregnancy. Foetal health status is determined by regular foetal movements n=95 (50.3%), mystic power n=15 (8%), soap n=2 (1.1%), special concoction 9 (4.8%), health status of mother n=67 (35.4%) and foetal heart beat n=24 (12.7%). Ninety seven (51.3%) of them used herbal treatment, 77 (40.7%) used incantations, 189 (100%) used special soaps as their main methods of delivery, while only 18 (9.5%) of respondents refer difficult cases to hospitals. Instruments used for separating cord were blade 123 (65.1%) and scissors 40 (21.1%). Symptoms recognized by the TBAs as signs of complications in pregnancy were dizziness, swollen feet, pallor, tiredness, absent foetal movement, loss of appetite, heaviness, pain in back/stomach/side, weight loss, vomiting, bleeding, fever/malaria, head ache, bad dream, premature or delayed labour. Although some of them recognized some danger signs in pregnancy and labour, only very few would refer difficult cases for emergency obstetric interventions. Clear protocols for management and referral, which are necessary for improved maternal survival, should be provided through regular training of the TBAs.

Aetiological agents of vaginitis in Nigerian women.

This study focuses on the identification of aetiological agents of vaginitis in Nigerian women. Study subjects are drawn from patients presenting with lower abdominal pain, vaginal discharge and itching at the gynaecology clinic of Lagos University Teaching Hospital and at the Clinical Centre of the Nigerian Institute of Medical Research, Yaba, Lagos, between January 2001 and July 2002. A total of 250 patients gave informed consent to participate in the study. The patients also had pre- and post-test human immunodeficiency virus (HIV) counselling. Each patient completed a questionnaire in order to provide biographical data, past clinical history and socio-economic background information. A cervical swab (CS) and a high-vaginal swab (HVS) were obtained from each patient. Swab samples were examined for pH and under light microscopy by Gram's stain and as wet preparations in 10% potassium hydroxide. Subsequently, samples were cultured on appropriate media at optimal conditions and a drug sensitivity profile for all isolates was determined by standard methods. Blood samples were screened and confirmed for HIV antibodies. Bacterial, fungal and parasitic pathogens were identified or isolated in samples from 241 (96.4%) of the women. Bacterial agents (Neisseria, Streptococcus and Staphylococcus species) were predominant in 128 (51.2%) patients, followed by fungi in 108 (43.2%) and parasites (Trichomonas vaginalis) in five (2.0%). Sensitivity to ciprofloxacin was seen in 40% of Staphylococcus species and in 90% of Neisseria species. Positive HIV serology was seen in 25 (10%) of the 250 women studied, 20 (80%) of which had concurrent microbial infections. Overall, a broad spectrum of microbial agents were shown to be responsible for vaginitis in the group of patients studied.

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.

Tuberculosis masquerading as 'constant malaria'.

Four hundred adults aged 20-60 years, (200 females and 200 males) were studied. All the subjects were residing in the urban areas of Lagos, Nigeria. Thirteen percent claimed they were having "constant malaria" (> 8 times per year), 5% (20) claimed to have cough mostly during the cold period, 2.5% (10) produced mucoid sputum, 2.5% unproductive cough, 13% were AFB smear positive, 1.5% had positive chest X-ray for pulmonary Tuberculosis (PTB), 1.5% were HIV positive and 50% were mantoux positive (> 10 mm induration). All who complained of "constant malaria" were AFB positive. Malaria parasite density was lower in those who complained of "constant malaria" than those who did not complain (P = 0.003). The complaint of frequent malaria attack decreased after Antituberculosis therapy for 6 months. This study revealed that in a malaria and tuberculosis endemic region, early stage of tuberculosis can masquerade as "constant malaria". Therefore any such complaint should be fully investigated.

Serum ferritin and other haematological measurements in apparently healthy children with malaria parasitaemia in Lagos, Nigeria.

One hundred apparently normal nursery and primary school children aged between 2 to 12 years from private schools, in Lagos Nigeria were studied. From this study the mean ferritin levels for children aged 2-5 years, and 6-12 years were 112 +/- 48 micrograms/l, and 119 +/- 38 micrograms/l respectively. Mean haematocrit values were 37.6 +/- 2.2%, and 37.5 +/- 2.6%, while mean haemoglobin levels were 126 +/- 9 g/l 127 +/- 7.9 g/l (2-5 years and 6-12 years respectively). The mean values for MCV, MCH, MCHC were 92 +/- 8.6 fl, 27.6 +/- 3.0 pg, 338.0 +/- 15.0 g/l and 93.5 +/- 9.0 fl, 28.7 +/- 2.5 pg, 332.0 +/- 17.0 g/l (2-5 years and 6-12 years respectively). All haematological parameters measured were similar in both malaria parasitaemia positive and negative subjects, except ferritin level which was significantly higher in subjects with malaria parasitaemia (p < 0.05). There was positive correlation between ferritin concentration and malaria density (r = 0.85, p < 0.05). From the above findings, it would be concluded that, ferritin estimation without examination for malaria parasitaemia in a malarious region like Nigeria is not reliable. It is also concluded that with the high mean ferritin level obtained in this study for normal children on balanced diet, routine iron supplementation may not be necessary for this group of children in Nigeria.

HIV association with conventional STDS (sexual transmitted diseases) in Lagos State, Nigeria.

The study examined a possible association between HIV infection and conventional sexually transmitted diseases (STDS) in a population of 700 patients seen in some hospitals and clinics in Lagos State between November 1997 and December 1999. The patients were drawn mainly from LUTH and Jolad hospitals in Lagos State. In these hospitals, patients who presented with symptoms of STDS were screened clinically and microbiologically for agents of STDS and HIV antibodies. Screening was carried out using conventional methods. A total of 150 (21.5%) were found positive for various STDS while 550 (78.5%) were negative Also, 109 (15.8%) were sero-positive for HIV while 591 (84.4%) were sero-negative. The frequency of STDS diagnosed were, Treponema pallidum, 38(25.3%), Neisseria gonorrhoea 3(2.0%), Chlamydia trachomatis 26(17.3), Hepatitis B virus 60(40.0%) Staphylococcus aureaus, 20 (13.3%) and Candida albicans 3(2.0%). Data showed that Syphillis was the most prevalent STDS diagnosed while Calbicans and N. gonorrhoea are the least. Amongst the 150 (21.5%) patients positive with STDS, 82(54.65%) were found to be positive for HIV antibodies. The remaining 68(45.3%) patients were negative for HIV. The difference in sero-prevalence on the true group of patients rates was significant. The higher rate in the STDS patients strongly suggest some association between HIV infections andSTDS amongst the patients studied p = 0.05. It was also recorded that HIV-1 infection is four times more prevalent than HIV-2 in these patients.

Current clinical presentation of malaria in Enugu, Nigeria.

This study examined the malaria situation in a malarial endemic area of Nigeria. Structured questionnaire was applied to 300 doctors practising in Enugu urban, Nigeria and confirmation of the clinical diagnosis by laboratory technique was done using 468 patients. The result shows a high prevalence of Plasmodium falciparum infection (96.4% in children, 87.0% in adults). Malaria positivity rate was 51.9% in children and 42.8% in adults. Fever, vomiting and anorexia were the commonest malaria symptoms in children, while headache, fever, chills and rigors were the commonest malaria symptoms in adults. The diagnostic practice of the doctors was clinical. Fever, vomiting and cough were found to be more associated with malaria parasitaemia in children, while in adults fever was found to be more associated with malaria parasitaemia. Chloroquine and sulphadoxine-pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria.

Establishment of reference values of CD4 and CD8 lymphocyte subsets in healthy Nigerian adults.

A total of 2,570 apparently healthy human immunodeficiency virus-negative adults from the six geopolitical zones in the country were enrolled in our study in 2006. The samples were assayed using the Cyflow technique. Data were analyzed using the Statistical Package for Social Scientists (SPSS). The majority (64%) of the participants had CD4 counts within the range of 501 to 1,000 cells/microl. The reference range for CD4 was 365 to 1,571 cells/microl, while the reference range for CD8 was 145 to 884 cells/microl.

Limitations to Access and Use of Antiretroviral Therapy (ART) Among HIV Positive Persons in Lagos, Nigeria.

The study was designed to examine the knowledge and perception of HIV positive persons about the antiretroviral therapy (ART) program and to determine their ability to pay for ART and the treatment of other opportunistic infections in Nigeria. This is aimed at identifying factors that may impede effective delivery and utilization of ART in the country. One hundred and twenty-five HIV positive persons seeking ART at the Nigerian Institute of Medical Research (NIMR) clinic, Lagos, were studied using questionnaires. Respondents' average monthly income was N11,253.00 (US$90.00). Almost 26% (25.6%) were unwilling to seek ART at the nearest hospital because of fear of stigmatization. While 9% wanted the therapy for free, the majority was willing to pay N500.00 (US$4.00) per month. The average affordable price based on the subjects' assessment was N905.00 (US$7.24), while the median was N500.00 (US$4.00) per month. Eighty-eight percent believed ART would prolong their lives. The ART drugs need to be affordable and building on the positive perceptions of ART is imperative.

Serum ferritin and other haematological measurements in apparently healthy adults with malaria parasitaemia in Lagos, Nigeria.

We studied 300 apparently healthy residents of Lagos aged 16-57 years. Their mean ferritin levels were 99.6 +/- 50.5 microg/l (men aged 20-57) and 66.5 +/- 44 microg/l (women aged 20-53) in aparasitaemic individuals. In parasitaemic subjects, mean ferritin levels were 133.1 +/- 48.3 microg/l (men aged 20-56) and 114.8 +/- 51.1 microg/l (women aged 16-50). Mean haematocrit values for aparasitaemic males were 45.7 +/- 5.6% and 37.9 +/- 5% for females, while mean haemoglobin levels were 153.2 +/- 1.5 microg/l and 124 +/- 3 microg/l, respectively. The mean values for MCV (mean corpuscular volume), MCH (mean corpuscular haemoglobin), MCHC (mean corpuscular haemoglobin concentration) were 101.7 +/- 8fl, 30.6 +/- 2.2 pg, 335 +/- 0.4 g/l and 99.8 +/- 10.1fl, 29.1 +/- 6.5 pg, 335 +/- 6 g/l. Serum iron levels were 34.2 +/- 5 micromol/l and 29.5 +/- 77 micromol/l. All haematological parameters measured were similar in both malaria parasitaemia positive and negative subjects, except ferritin level which was significantly higher in parasitaemic individuals (P < 0.05). Ferritin concentration and malaria density (r = 0.76 in males, r = 0.74 in females, P < 0.05) were positively correlated. Ferritin levels of subjects infected with Plasmodium falciparum were significantly higher than of those infected with P. malariae (P < 0.05). Hence ferritin estimation without examination for malaria parasitaemia in a malaria-endemic region such as Nigeria is not reliable. Asymptomatic malaria parasitaemia increases the ferritin level. Considering the mean ferritin level we found in normal subjects on a balanced diet, routine iron supplementation may not be necessary in the treatment of malaria-induced anaemia in Nigeria.