Prevalence of Molecular Markers of Plasmodium Falciparum Resistance to Proguanil and Pyrimethamine in Children with Haemoglobin Phenotypes SS and AA in Benin City, Nigeria.

BACKGROUND: Chemoprophylaxis against Plasmodium falciparum (Pf) is advocated in children with sickle cell anaemia (SCA). Among them, antifolates: proguanil and pyrimethamine had replaced initial chemoprophylactic drugs because of widespread resistance. In recent past, efficacy of these antifolates has also come under scrutiny due to increasing level of drug resistance. Specific point mutations on Plasmodium falciparum dihydrofolate reductase gene (pfdhfr) have been linked with resistance to proguanil and pyrimethamine and they can be used as markers in monitoring prevalence and level of resistance to the drugs. OBJECTIVES: To determine the prevalence of molecular markers of Plasmodium falciparum resistance to proguanil and pyrimethamine in children with SCA. METHODS: A total of 146 Plasmodium falciparum isolates (71 from children with SCA and 75 from those with Haemoglobin AA: HbAA) were evaluated for point mutations and mutant haplotypes on the pfdhfr gene using nested polymerase chain reaction amplification followed by direct sequencing. RESULTS: The triple (S108N+N51I+C59N) mutant haplotype was present in 100.0% and 96.0% of samples from children with SCA and HbAA respectively. S108T, A16V and 1164L mutationswere not present in both groups. CONCLUSION: High prevalence of triple mutant haplotype mediates significant resistance to pyrimethamine and implies that pyrimethamine resistance is fixed in the study locale. However, the absence of pfdhfr S108T and A16V mutations, which indicate specific resistance to proguanil but not to pyrimethamine, suggests that proguanil is still useful even in the face of pyrimethamine resistance. The threat of proguanil resistance is however real due to high prevalence of the triple mutant pfdhfr haplotype.

CONTEXTE: La chimioprophylaxie contre Plasmodium falciparum (Pf) est préconisée chez les enfants atteints de drépanocytose. (DCA). Parmi eux, les antifoliques : proguanil et pyriméthamine ont remplacé les médicaments chimioprophylactiques initiaux en raison d'une résistance généralisée. Ces derniers temps, l'efficacité de ces antifoliques a également été remise en question en raison de l'augmentation de la résistance aux médicaments. Des mutations ponctuelles spécifiques sur le dihydrofolate de Plasmodium falciparum dihydrofolate réductase (pfdhfr) ont été associées à la résistance au proguanil et à l'antifongiqueet elles peuvent être comme marqueurs pour surveiller la prévalence et le niveau de la résistance à ces médicaments. OBJECTIFS: Déterminer la prévalence des marqueurs moléculaires de la résistance de Plasmodium falciparum au proguanil et à la pyriméthamine chez les enfants atteints d'ACS. MÉTHODES: Un total de 146 isolats de Plasmodium falciparum (71 falciparum (71 provenant d'enfants atteints d'ACS et 75 d'enfants présentant une hémoglobine AA : HbAA) ont été évalués pour détecter des mutations ponctuelles et des haplotypes mutants sur le gène pfdhfr en utilisant une amplification en chaîne par réaction en chaîne par polymérase nichée suivie d'un séquençage direct. RÉSULTATS: L'haplotype mutant triple (S108N+N51I+C59N) était présent chez 100,0 % et 96 % des patients.était présent dans 100,0 % et 96,0 % des échantillons provenant d'enfants atteints de SCA et HbAA respectivement. Les mutations S108T, A16V et 1164L n'étaient pas présentes dans les deux groupes. CONCLUSION: La prévalence élevée de l'haplotype triple mutant est à l'origine d'une résistance significative à la pyriméthamine et à l'HbA une résistance significative à la pyriméthamine et implique que la résistance à la pyriméthamine est fixe dans le groupe pyriméthamine et implique que la résistance à la pyriméthamine est fixe dans la région étudiée. Cependant, l'absence des mutations S108T et A16V de pfdhfr, qui indiquent une résistance une résistance spécifique au proguanil mais pas à la pyriméthamine, suggère que le proguanil reste utile même en cas de résistance à la pyriméthamine résistance à la pyriméthamine. La menace de la résistance au proguanil est cependant réelle en raison de la prévalence élevée de l'haplotype triple mutant pfdhfr haplotype.

Splenic enlargement and abdominal scarifications in childhood malaria: beliefs, practices and their possible roles in management as seen in Benin City, Nigeria.

AIMS AND OBJECTIVES: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. To evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control. This was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaires in a cross-sectional and descriptive study. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26-30 years. (Range, 18 - 56 years) Respondents were mainly Binis, Esan, and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood", 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (chi(2) = 40.0, p< 0.005), women over 40 years of age (chi(2) = 13.5, p < 0.05) and Esan/Bini ethnic groups (chi(2) = 15.6, p < 0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%; neighbours, 25.1%; and friends/colleagues, 16.7%. CONCLUSION: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.

Splenic enlargement and abdominal scarification in childhood malaria. Beliefs, practices and their possible roles in management in Benin City, Nigeria.

BACKGROUND: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. AIMS AND OBJECTIVES: This was a cross-sectional and descriptive study to evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control; It was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaire. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26 - 30 years (Range, 18 - 56 years) Respondents were mainly Binis Esan and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood" 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (X2 = 40.0, p<0.005), women over 40 years of age (X2 = 13.5, p< 0.05) and Esan/Bini ethnic groups (X2 = 15.6, p <0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%, neighbours, 25.1%; and friends/colleagues, 16.7% CONCLUSION/RECOMMENDATIONS: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.

Home management of febrile convulsion in an African population: a comparison of urban and rural mothers' knowledge attitude and practice.

To determine the knowledge, attitude and practice (KAP) of home management of febrile convulsion (FC), by mothers in the community, focus group discussions (FGD) were conducted in two communities, Uselu (urban) and Evbuomodu village (rural), both in Edo State, Southern Nigeria. The study was conducted between December 2000 and February 2001. Our findings show that 71% of urban mothers compared to 25% of rural mothers attributed the cause of FC to fever (chi(2)=24.17: p<0.001). Seventy-five percent of mothers from rural community and 28.6% of urban mothers attributed the cause to witchcraft and/or evil spirits. Twenty-five percent of rural mothers also attributed abnormality of the spleen as a cause of FC. All the mothers, both urban and rural, were not directly involved in the management of the convulsive episode due to panic and confusion. Ninety-two percent of urban and all the rural mothers permitted the use of traditional medicine while 7.1% of urban mothers employed prayers during convulsion. Twenty percent of urban and twenty-two percent of rural mothers use urine (human and or cow's) for treating FC at home. Other home remedies include kerosene, fuel and crude oil. Mass enlightenment campaign for the community, especially the rural, against use of harmful traditional remedies to treat FC at home is strongly advised.

Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian children.

Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36 month(s), admitted to the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital, Benin city, Nigeria, during July 1993-June 1996, were reviewed to document the relationship between dehydration and malaria parasitaemia. There was a significant association between severity of dehydration and malaria parasitaemia (p < 0.0001). Association of parasitaemia (p < 0.006) with dehydration (p < 0.0001) was significantly more marked in patients with acute watery diarrhoea than in those with persistent and bloody diarrhoea. Parasitaemia was demonstrated in 50.5% of those not initially suspected to have malaria. Parasitaemia was also significantly associated with fever (p < 0.001) and fever coexisting with vomiting (p < 0.01). The prevalence of malaria-associated diarrhoea was 61.7%. More infants (75.6%) than older children had diarrhoea. It was concluded that the prevalence of malaria-associated diarrhoea was high and that children with dehydration are more likely to manifest malaria parasitaemia.

Prevalence and antimicrobial sensitivity pattern in urinary tract infection in febrile under-5s at a children's emergency unit in Nigeria.

The prevalence of urinary tract infection (UTI) in 300 consecutively admitted, febrile, preschool children with and without a focus of infection was evaluated to determine the contribution of UTI to febrile illnesses. Uncentrifuged urine was evaluated by culture and microscopy. The prevalence of UTI was 9% and was significantly higher in girls than in boys. It was also significantly higher when urine infection had been clinically suspected than in those with other diagnoses. Temperature >41 degrees C and abdominal pain were significantly associated with UTI. Other features significantly associated with UTI were fever of at least 7 days duration, a peak evaluation temperature >or=38.3 degrees C and a white blood cell count >10/mm(3). Escherichia coli, Klebsiella pneumonia and Staphylococcus aureus were the only organisms isolated and they all showed high in vitro sensitivity to clavulanic acid-potentiated amoxycillin, gentamicin and ceftriaxone but were poorly sensitive to co-trimoxazole.