Medication errors are preventable causes of patient harm with significant contributions to adverse drug events but they remain understudied in Nigeria. To estimate the prevalence of self-reported medication errors among health... more
Medication errors are preventable causes of patient harm with significant contributions to adverse drug events but they remain understudied in Nigeria. To estimate the prevalence of self-reported medication errors among health professionals and examine their knowledge of medication errors with the hope of identifying appropriate measures to promote medication safety. A cross sectional survey among doctors, pharmacists and nurses in 10 tertiary hospitals. Information was obtained using a self-administered structured questionnaire. Correct responses evaluating the knowledge of prescription, dispensing and administration errors were scored one mark each and the composite scores computed. Appropriate statistics were applied to summarize and establish the relationship between variables at 5% level of significance using SPSS 17.0. A total of 2,386 professionals participated in the study (46.3% nurses, 44.9% doctors, 8.8% pharmacists).The prevalence of self-reported medication errors was 4...
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ABSTRACT
The purpose of this study was to explore the cultural context of HIV patients' experience of stigma. Participants were recruited through HIV support networks in Southwestern Nigeria. 23 women and men participated in a 90 minutes... more
The purpose of this study was to explore the cultural context of HIV patients' experience of stigma. Participants were recruited through HIV support networks in Southwestern Nigeria. 23 women and men participated in a 90 minutes in-depth interviews and focus group discussion which were audio-taped. Without using the word stigma', interviews and discussions were guided by four questions exploring participants' reaction to HIV diagnosis; challenges experienced; changes made (positive and negative); and family, friends and community members reaction to their HIV status. Participants' age ranged from 22 to 58 with an average of 2.5 years since clinical diagnosis of HIV/AIDS. All participants were receiving ARV through the PEPFAR program. Using content analysis, three major themes emerged: life before ARV, life after ARV, and strategies used in ARV adherence. All participants self-reported high adherence to ARV medications out of "fear of looking sickly and people su...
Attributable Fraction Estimates for Malaria in Pregnant Women in Southwest Nigeria Malaria in pregnancy remains a public health problem. It is beneficial to characterize the clinical presentation of malaria based on clinical complaints in... more
Attributable Fraction Estimates for Malaria in Pregnant Women in Southwest Nigeria Malaria in pregnancy remains a public health problem. It is beneficial to characterize the clinical presentation of malaria based on clinical complaints in pregnant women living in endemic areas and estimate the proportion of any sign/symptoms attributable to malaria which is important in the evaluation of the adequacy of case management. Hence, in this study, we characterized the clinical presentation of malaria based on complaints in pregnant women living in endemic areas and estimated the proportion of an episode of any sign/symptoms attributable to malaria (MAF) by modeling the relationship between quantitative P. falciparum parasitemia and clinical illness.
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A descriptive cross sectional survey using an interviewer-administered questionnaire was carried out among 700 caregivers whose children had fever during the previous two weeks. The aim was to determine the community effectiveness of... more
A descriptive cross sectional survey using an interviewer-administered questionnaire was carried out among 700 caregivers whose children had fever during the previous two weeks. The aim was to determine the community effectiveness of malaria treatment using arthemeter-lumefantrine (AL) among under-5-year-olds in a rural community in southwestern Nigeria. A total of 353 (50.9%) children received AL. About half of these children (49%) were said to have been treated within 24 hours of onset of symptoms; 44% took the drug for the stipulated period of time; 42% received the correct dosage; and only 4% received all the treatment steps. With a drug efficacy of 100%, AL achieved a community effectiveness of 4%. The greatest effort in the home management of malaria strategy should be in reducing delay in treatment and improving dosage and duration of treatment.
Research Interests: Malaria, Nigeria, Medicine, Humans, Young Adult, and 14 moreCaregivers, Adult, Antimalarials, Community Networks, Combination drug therapy, Rural Community, Artemisinin, Cross Sectional Studies, Child preschool, Lumefantrine, Health Services Accessibility, Rural Population, Artemisinin based combination therapy, and Outcome Assessment Health Care
Using a structured questionnaire, surveys were conducted in 55 of 123 primary and secondary healthcare facilities in 4 selected local government areas in Southwestern Nigeria. Heads of healthcare facilities (HCFs) surveyed include nurses... more
Using a structured questionnaire, surveys were conducted in 55 of 123 primary and secondary healthcare facilities in 4 selected local government areas in Southwestern Nigeria. Heads of healthcare facilities (HCFs) surveyed include nurses (41.8%), medical officers (21.8%) and community extension workers (21.8%). Twenty five (45.5%) HCFs run special clinics for children. About one fifth (20.3%) of staff had received continuing education on management of malaria. Forty seven (85%) HCFs possessed and used national guidelines for management of malaria. Although 48.9% of HCFs had microscopes, fewer had microscope slides, lancets and Giemsa stain which are also required items for definitive diagnosis of malaria. Healthcare workers were not well informed on some aspects in the management of malaria. Selected healthcare workers from various categories attended a workshop where they were trained to correct inadequate knowledge, attitude and practice in the management of malaria. These workers...
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Many childhood febrile illnesses are treated at home prior to presentation. This study gathered information on treatment practices of caregivers for febrile illnesses in an urban area. A Cross sectional survey of consenting guardians of... more
Many childhood febrile illnesses are treated at home prior to presentation. This study gathered information on treatment practices of caregivers for febrile illnesses in an urban area. A Cross sectional survey of consenting guardians of 535 consecutive febrile children under 10 years presenting at General Outpatients' (GOP) Clinic. University College Hospital. Ibadan was carried out. Thick blood smears were examined for malaria parasite. The mean (SD) age of the febrile children was 3.2 (2.8) years. Nineteen (17.5%) children were brought within 24 hours of noticing fever. Malaria was presumed to be the diagnosis by 217 (40.6%) respondents: 247 (46.2%) did not know the cause of fever. Most. 469 (87.7%) respondents gave drugs bought from chemists/pharmacy shops before presentation at the GOP. Paracetamol 1380 (81.0%)] and chloroquine [171 (36.5%)] were the most commonly used drugs. Twenty-six (15.2%) respondents used chloroquine correctly. One hundred and ninety-nine of 476 childr...
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Impairment of physical and mental development has been identified as deleterious effects of helminthic infection. As a result, there have been concerted efforts to control this group of diseases especially among children who are most... more
Impairment of physical and mental development has been identified as deleterious effects of helminthic infection. As a result, there have been concerted efforts to control this group of diseases especially among children who are most vulnerable. However, knowing the prevalence of multiple infections will strengthen or otherwise justify the use of broad spectrum antihelminthics in the prophylaxis and treatment of intestinal helminthes among children. This study was carried out in a farming community with no tarred access road, electricity or pipe-borne water. The diagnosis of intestinal helminthes was by Kato-Katz thick smear examination technique. One hundred and seventy stool samples from 88 male and 82 female children were examined. The mean age of the children was 8 +/- 1.6years. One hundred and sixteen of 170 (68.2%) of the study volunteers had one intestinal helminthic infection or the other. Co-infection by more than one helminth was not uncommon and this occurred in 49.1% of ...
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In the course of evaluating the contribution of phytomedicine to possible drug discovery of antimalarial drugs, an ethnomedical survey of specialized children traditional clinics was done. In the observational multi center study, efficacy... more
In the course of evaluating the contribution of phytomedicine to possible drug discovery of antimalarial drugs, an ethnomedical survey of specialized children traditional clinics was done. In the observational multi center study, efficacy of eight different herbal remedies, each consisting of 3-8 ingredients and administered by herbalists were investigated in clients enrolled in the six traditional clinics in Oyo (urban center) and Otu (rural center) of Oyo State, Nigeria. The clients, aged between six months and fifteen years with clinical symptoms of malaria were enrolled in the clinics of the herbalists, as their usual practice. Oral informed consents were obtained from their parents or guardians. Microscopic diagnosis of malaria infection was used to evaluate parasitaemia and validate efficacy of herbal remedies. Results of the analysis showed that, of the 163 clients of the herbalists, only 62 (30 from Oyo, 32 from Otu) had microscopically confirmed P. falciparum infection. Onl...
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This study was designed to assess the relative reliability of microscopy, the dipstick technique based on the detection of Plasmodium falciparum-specific histidine rich protein II (HRPII) (Parasight-F) and PCR assays in diagnosing... more
This study was designed to assess the relative reliability of microscopy, the dipstick technique based on the detection of Plasmodium falciparum-specific histidine rich protein II (HRPII) (Parasight-F) and PCR assays in diagnosing falciparum malaria infections in Nigerian children. The prevalence of P. falciparum infections in enrolled patients was 100% by microscopy. Parasite density ranged from 329 to 81,194 parasites/microL of blood, with a geometric mean parasite density of 5168 parasites/microL of blood. The sensitivity of the HRPII based dipstick, PCR and microscopy were 80%, 92% and 100% respectively. A false negative rate of 20% was observed with Parasight-F as compared with microscopy. The parasitemia in patients with false negative Parasight-F tests ranged from 319 to 54,680 parasites/microL of blood. Detailed PCR analysis of Isolates obtained from five out of the eight patients who exhibited a negative Parasight-F test, showed that the average numbers of P. falciparum clo...
Research Interests: Microscopy, Malaria, Nigeria, Medicine, Humans, and 15 moreChild, Pubmed, Animals, Polymerase Chain Reaction, Infant, Proteins, Plasmodium falciparum, Genetic Polymorphism, Reproducibility of Results, Protozoan Proteins, Sensitivity and Specificity, Merozoite surface protein 1, Child preschool, Malaria Falciparum, and Outcome Assessment Health Care
Efficacy and safety of combinations ofChloroquine (CQ) and doses of Promethazine (PR) against CQ resistant Plasmodium berghei infections in gravid mice was evaluated. Parasites were cleared faster in mice treated with CQ combined with... more
Efficacy and safety of combinations ofChloroquine (CQ) and doses of Promethazine (PR) against CQ resistant Plasmodium berghei infections in gravid mice was evaluated. Parasites were cleared faster in mice treated with CQ combined with doses of PR ranging from 20mg/kg to 50mg/kg (3.4 +/- 0.5 to 2.7 +/- 0.7) compared with CQ alone (4.7 +/- 0.8) (P<0.5). Parturition resulting in live pups in animals treated with CQ and 20mg/ kg and 30mg/kg of PR (81%) was significantly higher than in animals treated with CQ alone (44%) or saline (13%). Mean birth weight of pups delivered by infected gravid animals treated with CQ and 30mg/kg or 40mg/kg of PR (1.51 +/- 0.16 or 1.56 +/- 0.16) was significantly higher than animals treated with CQ alone (1.33 +/- 0.13) (P=0.00004, 0.0014 respectively). No gross malformations were observed in pups delivered by infected or non-infected animals treated with the combinations of chloroquine and Promethazine.
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A 15-year-old male presented on three occasions with fever, aggressive behaviour, poor sleep and mixed affective and schizophreniform symptoms in association with falciparum malaria. The symptoms resolved promptly following anti-malarial... more
A 15-year-old male presented on three occasions with fever, aggressive behaviour, poor sleep and mixed affective and schizophreniform symptoms in association with falciparum malaria. The symptoms resolved promptly following anti-malarial treatment. Prophylaxis with proguanil prevented recurrence of the illness.
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The attitudes of 193 healthcare workers (Nurses (35.7%), auxiliary nurses (35.7%), followed by community health officers (26.4%)) in 55 primary and secondary healthcare facilities to home management of malaria were evaluated in four local... more
The attitudes of 193 healthcare workers (Nurses (35.7%), auxiliary nurses (35.7%), followed by community health officers (26.4%)) in 55 primary and secondary healthcare facilities to home management of malaria were evaluated in four local government areas in Southwestern Nigeria. Results showed that mothers and patent medicine sellers were perceived as offering useful services in home management of malaria by giving first aid and selling antimalarial drugs, respectively. Although 79% of respondents expressed the opinion that mothers are the most appropriate to give first line management to children suffering from malaria, 56% were also of the view that such children should receive definitive treatment in a formal health care facility. Furthermore, 45% of the respondents felt that only formal healthcare workers should treat children who have malaria irrespective of the location of the treatment because mothers, patent medicine sellers, and traditional healers have not been formally trained. Healthcare workers were willing to train mothers and patent medicine sellers on effective management of childhood malaria, but were not favorably disposed toward collaboration with traditional healers in the home management of malaria. There is an urgent need for formal healthcare workers to seek better understanding of traditional healers&amp;amp;amp;amp;#39; practices as well as their cooperation for improved home management of childhood malaria among indigenous groups.
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Patent medicine sellers (PMS) play an important role in supplying the medication needs of the community particularly antimalaria. A situational analysis of the role of PMS in home management of malaria was carried out in four rural local... more
Patent medicine sellers (PMS) play an important role in supplying the medication needs of the community particularly antimalaria. A situational analysis of the role of PMS in home management of malaria was carried out in four rural local government areas in Southwestern Nigeria using both cross sectional and observational study methods. The results showed that patent medicine stores constituted 76.2% of the medicine shops in the areas. The PMS provided not only drugs but also consultation services. Malaria constituted the commonest fever for which drugs were purchased. The most commonly mentioned drug best for malaria was the 4 aminoquinolone. Many (55.4%) of the PMS have received some form of training on malaria treatment. However, this was carried out in many instances (41.9%) by the shop owners to the apprentice PMS or shopkeepers. Health personnel were mentioned as trainers by only 27% of the PMS. The use of guidelines provided by PMS was infrequent and only 13.8% could produce ...
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This study was carried out in two rural communities: Kaani and Boue, in Khana Local Government Area (LGA) and, in one urban community, Eleme, in Eleme LGA, all in Rivers State, South-South Nigeria. The investigations involved in-depth... more
This study was carried out in two rural communities: Kaani and Boue, in Khana Local Government Area (LGA) and, in one urban community, Eleme, in Eleme LGA, all in Rivers State, South-South Nigeria. The investigations involved in-depth interviews conducted with 104 health care givers comprising indigenous healers: herbalists, sellers of herbal remedies and community elders. Information was obtained on types of fevers (febrile illnesses) treated, symptoms and methods of establishing illnesses, and traditional herbs used in the prevention and treatment of febrile illnesses. On types of febrile illnesses treated, respondents presented the following: malaria (78.8%), typhoid (23.1%), yellow fever (21.2%), high fever (19.2 %), convulsion (15.4%), and pregnancy fever (2.9%). Other illnesses treated were yellow eyes (4.8%) headache (11.5%), waist pain (14.4%), and joint pains, (8.7%). Respondents determined whether a person had fever by the following: physical examination (85.4 %), listening to patients' complaints (9.4 %), through divination and inspiration (9.4 %), while others (0.2 %) were not quite explicit on their methods of diagnoses. On the treatment of febrile illnesses, respondents used herb teas (88.5%), herb powders (42.3%), incantation (3.3 %), and performance of sacrifice (4.8%) or use of special fluids (27.9%). Majority of the respondents, in describing the best herbal medicines for the treatment of febrile illnesses, 62.5 % said that dogonyaro ( Azadiracta indica ) was the best medicine. Other responses were: lemon grass ( Cymbopogon citratys , 51.9 %), mango ( Mangifera indica ) bark (29.8 %); lime ( Citrus limetta ) juice (30.0 %), paw paw ( Carica papaya ) leaf/fruit (20.2 %); guava ( Psidium guajava ) leaf (18.3 %), akpagbogoro ( Salacia nitida ), 7.7 %, plantain ( Musa sapientum ) sucker (6.7 %), Lipton tea (3.8 %) and scent leaf ( Ocimum gratissimum ), 1.9%. Keywords : Malaria, fever, febrile illness, herbal remedies, Nigeria West African Journal of Pharmacology and Drug Research Vol. 21 (1&2) 2005: pp. 48-54
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SummaryBackground Increasing drug resistance in Plasmodium falciparum has necessitated renewed search for cheap, effective alternatives to commonly available antimalarials, chloroquine and pyrimethamine–sulphadoxine, for the treatment of... more
SummaryBackground Increasing drug resistance in Plasmodium falciparum has necessitated renewed search for cheap, effective alternatives to commonly available antimalarials, chloroquine and pyrimethamine–sulphadoxine, for the treatment of malaria in Africa. Probenecid, an inhibitor of organic anion transporters and multiresistance‐associated proteins, can chemosensitize P. falciparum to pyrimethamine and sulphadoxine in vitro, but the clinical significance is unclear. We assessed the safety, treatment efficacy, and effects on gametocyte carriage of adding probenecid to pyrimethamine–sulphadoxine.Methods We evaluated 151 children aged 12 years or younger who had uncomplicated P. falciparum malaria. Patients were randomly assigned pyrimethamine–sulphadoxine (25 mg/kg of the sulphadoxine component) or pyrimethamine–sulphadoxine as above plus probenecid 20–25 mg/kg of bodyweight in two divided doses daily for 3 days. The primary endpoints were parasitological cure rates on days 14 and ...
Research Interests: Pharmacology, Malaria, Drug interactions, Treatment Outcome, Medicine, and 15 moreHumans, Child, Female, Male, Infant, Pyrimethamine, Sulfadoxine, Public health systems and services research, Plasmodium falciparum, Antimalarials, Combination drug therapy, Acute Disease, Child preschool, Malaria Falciparum, and Drug combinations
The cardiac effects of halofantrine were assessed in 42 children with acute symptomatic uncomplicated Plasmodium falciparum malaria by electrocardiographic (ECG) and clinical monitoring over a period of 14 d. The children were treated... more
The cardiac effects of halofantrine were assessed in 42 children with acute symptomatic uncomplicated Plasmodium falciparum malaria by electrocardiographic (ECG) and clinical monitoring over a period of 14 d. The children were treated with oral halofantrine 8 mg/kg body weight every 6 h for 3 doses. There was significant prolongation of the P-R interval (compared with the pre-treatment value) only at 8 h after drug administration. However, first degree auriculoventricular (AV) block occurred in 2 children at 8 h or 8 and 48 h, and second degree AV block in another child at 48 h. There was significant prolongation of the Q-Tc interval at 8, 16, 24, 48 and 72 h after treatment; the proportions of children with Q-Tc interval &gt; 0.44 s were also significantly higher at all these times except 72 h. Rhythm disturbance was rare. There was no significant ECG change at 168 or 336 h. Despite the ECG abnormalities, there was no clinical symptom. These findings indicate that, in children, the currently recommended dose of halofantrine for the treatment of falciparum malaria may produce serious cardiac side effects.
Research Interests: Microbiology, Medical Microbiology, Malaria, Nigeria, Medicine, and 15 moreElectrocardiography, Prospective studies, Humans, Child, Infant, Public health systems and services research, Plasmodium falciparum, Antimalarials, Physical examination, Body Weight, Recommended Dose, Heart Diseases, Heart Block, Child preschool, and Malaria Falciparum
Research Interests: Pharmacology, Microbiology, Medical Microbiology, Malaria, Medicine, and 15 moreHumans, Child, Animals, Drug Resistance, Infant, Public health systems and services research, Plasmodium falciparum, Antimalarials, Combination drug therapy, Chloroquine, Pruritus, Acute Disease, Child preschool, Adverse effect, and Malaria Falciparum
Research Interests: Microbiology, Medical Microbiology, Malaria, Nigeria, Medicine, and 15 moreHumans, Child, Internal Medicine, Female, Male, Infant, Anemia, Public health systems and services research, Plasmodium falciparum, Antimalarials, Combination drug therapy, Chloroquine, Acute Disease, Child preschool, and Malaria Falciparum
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The antimalarial and antioxidant activities of methanolic extract of Nigella sativa seeds (MENS) were investigated against established malaria infection in vivo using Swiss albino mice. The antimalarial activity of the extract against... more
The antimalarial and antioxidant activities of methanolic extract of Nigella sativa seeds (MENS) were investigated against established malaria infection in vivo using Swiss albino mice. The antimalarial activity of the extract against Plasmodium yoelli nigeriensis (P. yoelli) was assessed using the Rane test procedure. Chloroquine (CQ)-treated group served as positive control. The extract, at a dose of 1.25 g/kg body weight significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) suppressed P. yoelli infection in the mice by 94%, while CQ, the reference drug, produced 86% suppression when compared to the untreated group after the fifth day of treatment. P. yoelli infection caused a significant (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) increase in the levels of red cell and hepatic malondialdehyde (MDA), an index of lipid peroxidation (LPO) in the mice. Serum and hepatic LPO levels were increased by 71% and 113%, respectively, in the untreated infected mice. Furthermore, P. yoelli infection caused a significant (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) decrease in the activities of superoxide dismutase, catalase, glutathione-S-transferase and the level of reduced glutathione in tissues of the mice. Treatment with MENS significantly (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) attenuated the serum and hepatic MDA levels in P. yoelli-infected mice. In addition, MENS restored the activities of red cell antioxidant enzymes in the infected mice to near normal. Moreover, MENS was found to be more effective than CQ in parasite clearance and, in the restoration of altered biochemical indices by P. yoelli infection. These results suggest that N. sativa seeds have strong antioxidant property and, may be a good phytotherapeutic agent against Plasmodium infection in malaria.
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Reactive oxygen species are mediators of tissue injury and are involved in malaria infection. In this study, the status of red cell and hepatic oxidative stress and antioxidant defence indices were investigated during Plasmodium yoelii... more
Reactive oxygen species are mediators of tissue injury and are involved in malaria infection. In this study, the status of red cell and hepatic oxidative stress and antioxidant defence indices were investigated during Plasmodium yoelii nigeriensis (P. yoelii) infection, and treatment with chloroquine (CQ), methylene blue (MB) or artemether (ART) in mice. P. yoelii infection caused a significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) increase in oxidative stress as evidenced by the elevated level of malondialdehyde. This was followed by a significant decrease (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) in hepatic antioxidant defence indices, viz. reduced glutathione (GSH) and glutathione-S-transferase (GST). Also, the red cell catalase activity was significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) lower in malaria infection, while there was no significant difference (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05) in the superoxide dismutase (SOD) activity of infected mice when compared to untreated normal. Treatment of infected mice with the three antimalarials showed that the drugs suppressed the parasitaemia in the order CQ &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; ART &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; MB. CQ, MB and ART treatment of infected mice caused a significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) increase in the levels of hepatic GSH and GST. Specifically, CQ, MB and ART increased the levels of hepatic GSH by 108, 124 and 98 %, respectively, at day 6. Also, ART treatment of infected mice significantly (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) elevated the red cell SOD level by 200 % at day 3. Taken together, the findings suggest that the antimalarial effect of CQ, MB and ART countered the P. yoelii-induced oxidative stress leading to the elevation of enzymatic and non-enzymatic antioxidants in the host system.
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Increasing resistance to sulfadoxine-pyrimethamine is leading to a decline in its effectiveness. We aimed to assess the safety profile of chlorproguanil-dapsone (CD), and to compare the safety and efficacy of this drug with that of... more
Increasing resistance to sulfadoxine-pyrimethamine is leading to a decline in its effectiveness. We aimed to assess the safety profile of chlorproguanil-dapsone (CD), and to compare the safety and efficacy of this drug with that of sulfadoxine-pyrimethamine (SP) as treatment for uncomplicated falciparum malaria. We undertook a double-blind, randomised trial in 1850 consecutively recruited children with uncomplicated falciparum malaria, pooling data from five African countries. Analyses were based on all randomised patients with available data. CD was significantly more efficacious than SP (odds ratio 3.1 [95% CI 2.0-4.8]); 1313 patients (96%) given CD and 306 (89%) given SP achieved acceptable clinical and parasitological response by day 14. Adverse events were reported in 46% and 50% of patients randomised to CD and SP, respectively (treatment difference -4.4%, [95% CI -10.1 to 1.3]). Haemoglobin in the CD group was significantly lower than in the SP group at day 7, a difference of -4 g/L (95% CI -6 to -2). Mean day 14 haemoglobin (measured only for the small number of patients whose day 7 data caused concern) was 94 g/L (92-96) and 97 g/L (92-102) after CD and SP, respectively. Glucose-6-phosphate dehydrogenase deficient patients on CD had greater odds than those on SP of having a fall of 20 g/dL or more in haemoglobin when baseline temperature was high. Methaemoglobinaemia was seen in the CD group (n=320, mean 0.4% [95% CI 0.4-0.4]) before treatment, 4.2% (95% CI 3.8-4.6) (n=301) at day 3, and 0.6% (0.6-0.7) (n=300) at day 7). CD had greater efficacy than SP in Africa and was well tolerated. Haematological adverse effects were more common with CD than with SP and were reversible. CD is a useful alternative where SP is failing due to resistance.
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SummaryA safe and efficient method for obtaining blood smears for the diagnosis of placental malaria infection is required in order to reduce the risks associated with direct blood contact. We describe a simple and safe method of needle... more
SummaryA safe and efficient method for obtaining blood smears for the diagnosis of placental malaria infection is required in order to reduce the risks associated with direct blood contact. We describe a simple and safe method of needle aspiration of the placenta for the diagnosis of placental malaria infection. The method was compared with the conventional incision method in 60 consecutive placentae obtained at term. The quality of the blood smear prepared with the methods were similar. There was a significant correlation between parasite counts from samples prepared with both the incision and aspiration methods. Altman-Bland analysis of the counts revealed narrow limits of agreement with an insignificant bias. The method is useful for obtaining blood smears from the placenta for the diagnosis of placental malaria infection and reducing contact with potential pathogens in blood.
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ABSTRACT Summary Seventy-three placentae and 73 newborn babies were examined from 72 consecutive parturient Nigerian women at term. Ten of the placentae had ring forms of Plasmodium falciparum only, 17 placentae had ring forms and... more
ABSTRACT Summary Seventy-three placentae and 73 newborn babies were examined from 72 consecutive parturient Nigerian women at term. Ten of the placentae had ring forms of Plasmodium falciparum only, 17 placentae had ring forms and schizonts, and two placentae had only schizonts. Pigment granules alone was present in two placentae, and pigment granules in combination with ring forms and/or schizonts were seen in 10 placentae. There was seasonal variation in both maternal and placental parasite infection. There was also a positive correlation between peripheral and placental parasite density. First-born babies of primigravidae with infected placentae weighed less and had body lengths lower than those of first-born babies with non-infected placentae but the difference was not statistically significant. Their weights and lengths were also significantly less than those of babies of multigravidae with infected placentae. Peripheral parasitaemia was present in 16 of 73 (21 per cent) newborn babies. Parasite density in the newborn babies was low (8–159 asexual forms per (μ blood) and only one newborn baby was symptomatic within 24 hours of birth. Infected newborn babies weighed less than non-infected newborn babies but the difference was not statistically significant. Despite peripheral and/or placental parasitaemia in 25 of the parturient women, only 5 (20 per cent) had symptoms in the one week preceding presentation. Maternal weekly pyrimethamine prophylaxis appears not to confer protection against infection.
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A subject that has received less discussion but is potentially even more important is the requirement that any drugs proven effective in the trial be made available to the host population after the trial.3 There seems to be general... more
A subject that has received less discussion but is potentially even more important is the requirement that any drugs proven effective in the trial be made available to the host population after the trial.3 There seems to be general agreement that &amp;amp;amp;amp;amp;amp;quot;reasonable avail-ability&amp;amp;amp;amp;amp;amp;quot; is necessary ...
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The correlation of P. falciparum lactate dehydrogenase (pLDH) activities and patent infections was evaluated for monitoring therapeutic responses and drug resistance in 70 patients with microscopically confirmed P. falciparum malaria in... more
The correlation of P. falciparum lactate dehydrogenase (pLDH) activities and patent infections was evaluated for monitoring therapeutic responses and drug resistance in 70 patients with microscopically confirmed P. falciparum malaria in Nigeria. Each patient was treated with standard dosages of artemether (53 patients), chloroquine (7 patients), sulfadoxine-pyrimethamine (6 patients), or halofantrine (4 patients). Response of infection to treatment was monitored by microscopic examination of thick and thin blood smears, clinical symptoms, and levels of pLDH activities in blood products. pLDH activity was determined using an antibody capture technique and 3-acetyl pyridine adenine dinucleotide developed to enhance sensitivity of the enzyme detection. All patients treated with artemether were cured while 5 patients treated with chloroquine, 1 treated with sulfadoxine-pyrimethamine, and 2 treated with halofantrine suffered recrudescent infections after treatment. pLDH activity was detected in blood products obtained from patients with patent or recrudescent infections determined by microscopy and clinical symptoms. Levels of pLDH activities in whole blood and packed cells from the patients correlated with qualitative detection of parasites in blood smears and in patients with high gametocyte counts. Gametocyte counts in the patients after treatment ranged from 40 gametocytes/microliter of blood to 4923 gametocytes/microliter of blood. There is a consistent relationship between patent infection and pLDH activities that could easily be determined in whole blood and packed cells from the patients. Further development of the procedure will enhance its valuable application in clinical management of drug-resistant malaria in the endemic areas.
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... An ethnobotanical survey of herbal male contraceptives used in south-west Nigeria. Iyabo Mobolawa Adebisi, Shaibu Oricha Bello in Journal of Pharmacy and Pharmacology (2011). Save reference to library · Related research ...
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The clinical characteristics and the kinetics of the disposition of the hepatomegaly associated with acute, uncomplicated Plasmodium falciparum malaria were investigated in 162 children in an endemic area of Nigeria. Hepatomegaly was... more
The clinical characteristics and the kinetics of the disposition of the hepatomegaly associated with acute, uncomplicated Plasmodium falciparum malaria were investigated in 162 children in an endemic area of Nigeria. Hepatomegaly was significantly more common in the younger than in the older children. Complete resolution occurred in 48% following antimalarial chemotherapy. In the children in whom hepatomegaly did not resolve, a reduction in liver size of &lt; 17% by the time parasitaemia was cleared (usually on day 3) was associated with non-resolution of hepatomegaly by days 7 or 14 of follow-up. An increase in liver size to at least 125% of the baseline value by day 4 or 5 was associated with a lack of therapeutic response, providing the child involved was aged &lt; 5 years. In the children who had complete clearance of parasitaemia and resolution of hepatomegaly, there was no significant relationship between the parasitaemia-derived conventional indices of therapeutic response [i.e. time to clearance of 50% (PC50) or 90% (PC90) of the parasitaemia, and the parasite-clearance time (PCT)] and the corresponding parameters derived from measurement of liver size [i.e. time for resolution of 50% (HR50) or 90% (HR90) of the hepatomegaly and the hepatomegaly-resolution time (HRT)] in the same patients. However, as the HR50:PC50, HR90:PC90 and HRT:PCT ratios were similar (range = 1.6-2.1), the liver parameters may have therapeutic application. In the children with drug-sensitive P. falciparum infections and in whom hepatomegaly completely resolved, the area produced by plotting liver size against time (i.e. the area under the curve of hepatomegaly v. time, or AUChp) increased in proportion to the liver size below the costal margin (P = 0.02, from analysis of variance), but there was no significant difference in the half-lives of hepatomegaly (t1/2hp) or in the ratios of liver size to AUChp, indicating that the kinetics of the resolution of hepatomegaly were linear in the range examined. Comparison of the kinetic indices of hepatomegaly and parasitaemia showed that, although the half-lives of parasitaemia and hepatomegaly and the corresponding clearance values were similar, there was no correlation between these parameters among those in whom hepatomegaly completely resolved and parasitaemia completely cleared. These results indicate that routine clinical measurement of the liver size in children with hepatomegaly during acute, uncomplicated, P. falciparum malaria may have some use in evaluating and monitoring the therapeutic responses of infections. The resolution of hepatomegaly, a reflection of pathological changes, lags behind clearance of parasitaemia in children with P. falciparum malaria, and supports the use of the liver &#39;rate&#39; as a malariometric index for assessing the intensity of transmission in endemic areas.
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Research Interests: Medical Microbiology, Malaria, Medicine, Humans, Child, and 15 moreInternal Medicine, Female, Drug Resistance, Male, Infant, Endemic Diseases, Clinical Sciences, Analysis of Variance, Antimalarials, Age Factors, Combination drug therapy, Chloroquine, Amodiaquine, Child preschool, and Malaria Falciparum
ABSTRACT Chloroquine (CQ) resistance in Plasmodium falciparum has been associated with specific point mutations in the pfcrt and pfmdr-1 genes. In the present study, 30 children aged 1-12 years, who were all suffering from acute,... more
ABSTRACT Chloroquine (CQ) resistance in Plasmodium falciparum has been associated with specific point mutations in the pfcrt and pfmdr-1 genes. In the present study, 30 children aged 1-12 years, who were all suffering from acute, uncomplicated, P. falciparum malaria in Ibadan, Nigeria, were evaluated to assess the association between these mutations and clinical outcome following treatment with CQ. The parasites, in blood samples collected pre-treatment and, in those who failed treatment, on the day symptoms re-occurred post-treatment, were genotyped using the polymorphic MSP1, MSP2 and GLURP loci and PCR-RFLP. The results showed that, pre-treatment, all 30 patients had polyclonal infections, the mean numbers of P. falciparum clones detected per infection being 2.6 with MSP1, 4.2 with MSP2 and 2.8 with GLURP. The T76 allele of pfcrt and the Y86 allele of pfmdr-1 were found in 53% and 40%, respectively, of the pre-treatment samples from the 15 patients who failed CQ treatment, but the Y1246 mutation in pfmdr-1 was never detected. Although the parasites from the two patients with high-grade (RIII) resistance to CQ had both of these point mutations, the presence of the T76 allele of pfcrt or the Y86 allele of pfmdr-1 (considered individually) could not be used to predict treatment outcome. However, a high frequency of clonal multiplicity may confound attempts to associate the point mutations in pfcrt or pfmdr-1 with clinical response to CQ. It remains unclear whether the present results represent the characteristics of the predominant parasite populations in the study area. Further studies are needed before the strength of the association between the point mutations identified as markers of drug resistance and clinical outcome can be accurately evaluated, in this and other regions of intense transmission.
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Research Interests:
Research Interests: Focus Groups, Culture, Medication Adherence, Qualitative Research, Nigeria, and 15 moreMedicine, Thematic Analysis, Social Stigma, Humans, Female, Stereotyping, Male, Focus Group, Psychological Intervention, Middle Aged, Adult, Public health systems and services research, Tape Recording, Interviews as topic, and HIV infections
The gastrointestinal manifestations of acute symptomatic uncomplicated falciparum malaria were studied in 184 consecutive children aged from 6 months to 15 years. Vomiting was the most common and epigastralgia the least common presenting... more
The gastrointestinal manifestations of acute symptomatic uncomplicated falciparum malaria were studied in 184 consecutive children aged from 6 months to 15 years. Vomiting was the most common and epigastralgia the least common presenting symptom. Peripheral parasite density was higher in children who were vomiting than in those who were not. There was no relationship between the density of peripheral parasitaemia and the duration of gastrointestinal symptoms at presentation. All gastrointestinal symptoms cleared within 3 days after instituting antimalarial therapy.
Research Interests: Malaria, Adolescent, Medicine, Biological Sciences, Prospective studies, and 15 moreHumans, Child, Female, Animals, Male, Infant, Clearance, Plasmodium falciparum, Antimalarials, Abdominal Pain, Gastrointestinal Diseases, Acute Disease, Child preschool, Malaria Falciparum, and Medical and Health Sciences
Anti-inflammatory and analgesic activities of some newly synthesized pyridinedicarbonitrile and benzopyranopyridine derivativesIn continuation of our search for new substituted pyridine based anti-inflammatories, reaction of 1-(2-thienyl... more
Anti-inflammatory and analgesic activities of some newly synthesized pyridinedicarbonitrile and benzopyranopyridine derivativesIn continuation of our search for new substituted pyridine based anti-inflammatories, reaction of 1-(2-thienyl or furanyl)-3-(2-hydroxyphenyl)-2-propen-1-ones (1) with malononitrile in alcoholic KOH solution afforded a mixture of 4-alkoxy-2-(2-thienyl or furanyl)-5H-[1]benzopyrano[3,4-c]pyridine-5-ones (2) and 2-alkoxy-4-amino-6- (2-thienyl or furanyl)-3,5-pyridinedicarbonitriles (3). Some of the synthesized compounds were evaluated for their anti-inflammatory and analgesic activities compared to diclofenac potassium as positive control. Detailed synthesis, spectroscopic and toxicity data are reported.
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Research Interests: Family Medicine, Environmental Health, Adolescent, Humans, Female, and 15 moreAnimals, Adult, Control Strategy, Antimalarials, Antenatal Care, Indexation, Chi Square Test, Health Workers, Intermittent Preventive Treatment, Cross sectional Study, Cross Sectional Studies, Health Facility, Health Services Accessibility, Adverse effect, and Local Government Area
Background or Objectives: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is widespread in sub-Saharan Africa with similarity in geographical distribution of major pathogens of public health interest. The aim... more
Background or Objectives: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is widespread in sub-Saharan Africa with similarity in geographical distribution of major pathogens of public health interest. The aim of this study was to assess the effect of malaria and helminths on CD4 count, hematocrit values and viral load among HIV-infected pregnant women. Methods: One hundred and ninety-seven HIV-infected pregnant women aged 18-45 years were recruited from a registered HIV clinic and questionnaires were administered for socio-demographic details. Screening for malaria parasites in blood was through microscopy while helminths were identified in stool using Kato-Katz method. Hematocrit levels were determined through centrifugation of blood collected in capillary tubes. At the time of recruitment, most recent CD4 count and viral load was obtained from the patients’ case notes. Results: About three-quarters (73.6%) of the women had above primary school level of ...
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Morbidity and mortality due to malaria in sub-Sahara Africa remains unacceptably high, slowing socioeconomic development in endemic communities. Pain is one reason why malaria-patients seek medical attention. However, pain due to malaria... more
Morbidity and mortality due to malaria in sub-Sahara Africa remains unacceptably high, slowing socioeconomic development in endemic communities. Pain is one reason why malaria-patients seek medical attention. However, pain due to malaria is often ignored, poorly evaluated and virtually un-studied. This study explored this pain among outpatients in Ibadan, Nigeria. This facility-based, cross-sectional survey conducted in Ibadan examined seven-hundred out-patients, aged ≥6years, with acute-uncomplicated-malaria. They were evaluated for the presence, quality, intensity and effects of pain using validated instruments incorporating the category and Wong-Baker faces scales. Data were summarized, tested for association at α=0.05 and a logistic regression model of covariates fitted to predict the risk of pain. Respondents’ mean age was 33.0±16.1years, 12.7% children, 66.6% females and 72.3% had “malaria pain”. The head (66.0% vs.72.8%), general muscular sites (17.0% vs.39.5%), abdomen (37.7...
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Malaria and Intestinal helminth parasites co-exist in the tropics due to prevailing climatic conditions and poor sanitary practices. These parasites have adverse effects on cognitive development, educational performance and school... more
Malaria and Intestinal helminth parasites co-exist in the tropics due to prevailing climatic conditions and poor sanitary practices. These parasites have adverse effects on cognitive development, educational performance and school attendance of children. The epidemiology of these parasites and their co-infection among children have not been fully documented in Nigeria, community-based studies are limited. This study aims to highlight the burden of malaria parasites and intestinal helminths among children living in rural areas. A community-based cross-sectional study involving children aged 6 months - 14 years was carried out in six rural communities. Single stool and finger prick blood samples were collected. Wet mount and formol-ether techniques were employed to process stool samples for microscopy while Giemsa-stained thick blood smears were used to screen for Plasmodium. falciparum parasites. Overall prevalence of Plasmodium. falciparum asexual parasites, Intestinal helminth infe...
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Background. Malaria is prevalent in sub-Saharan Africa, where other concomitant parasitic infections, including intestinal helminths, are common. However, little is known about how concurrent infections affect the expression or... more
Background. Malaria is prevalent in sub-Saharan Africa, where other concomitant parasitic infections, including intestinal helminths, are common. However, little is known about how concurrent infections affect the expression or pathogenesis of each other. This study aimed to document the prevalence rates of malaria and intestinal helminths individually and as coinfection among asymptomatic children in a rural community in southwest Nigeria. Materials and Methods. Apparently healthy children aged 1-17 years, who were enrolled into a larger study that evaluated the efficacy and safety of two anti-helminthic drugs, were evaluated for intestinal helminths by stool examination using the saline wet mount and Kato-Katz methods. Capillary blood from finger prick samples was used for haematocrit determination and malaria screening by microscopy. Data analysis was conducted using SPSS and significance levels were set at p < 0.05. Results. Eighty-nine of 178 (50%) enrolees were male. One hu...
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1 Department of Sociology, University of Ibadan, Ibadan, Nigeria 2 Department of Epidemiology and Biostatistics, College of Medicine, University of Ibadan, Ibadan, Nigeria 3 Department of Health Promotion and Education, College of... more
1 Department of Sociology, University of Ibadan, Ibadan, Nigeria 2 Department of Epidemiology and Biostatistics, College of Medicine, University of Ibadan, Ibadan, Nigeria 3 Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria 4 Department of Pharmacology, College of Medicine, University of Ibadan, Ibadan, Nigeria 5 Disease Control Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom 6 Malaria Consortium, Development House, 56-64 Leonard Street, London EC24 4LT, United Kingdom 7 Support for National Malaria Programme, Abia House, Abuja, Nigeria
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Objectives: This study aimed to assess communities’ perception and adoption of the evidenced-based malaria diagnosis and case management intervention targeted at under-five children. The effectiveness of trained Volunteer Community Health... more
Objectives: This study aimed to assess communities’ perception and adoption of the evidenced-based malaria diagnosis and case management intervention targeted at under-five children. The effectiveness of trained Volunteer Community Health Workers (VCHWs) to diagnose malaria among under-five children using rapid diagnostic testing kit, provide treatment using Artemisinin Combination Therapy and rectal Artesunate were assessed.Design: A qualitative evaluation study was conducted in October 2015.Setting: Communities in the 6 rural wards in Ona-Ara Local Government Area, Oyo State Nigeria.Participants: Caregivers of under-five children, community–based frontline health workers, and community leaders selected using purposively sampling.Methods: Nine Focus Group Discussions and 15 Key Informant Interviews were conducted using a pre-tested guide. Data were subjected to thematic analysis.Results: It was disclosed that VCHWs promoted people’s access to prompt and appropriate malaria treatmen...