Genetic diversity in merozoite surface protein 1 of Plasmodium falciparum isolates from Igbogbo-bayeku, Lagos, Nigeria

Mutations in merozoite surface protein 1 (MSP1) serve as indicators of genetic diversity in Plasmodium falciparum population in a given area. Diversity in MSP1 gene of P. falciparum isolates in Igbogbo-Bayeku, a periurban settlement of Lagos, Nigeria was assessed. Malaria was diagnosed by microscopy and polymerase chain reaction (PCR). MSP1 gene polymorphisms were analyzed in P. falciparum-positive samples using allele-specific primers of the three families of MSP1 block 2. Of the 63 malaria cases, 34 (54%) were microscopic while 29 (46%) were sub-microscopic cases. The three MSP1 families were present in the P. falciparum isolates with RO33 being the most abundant (55; 87.3%). Thirteen distinct genotypes of MSP1 were observed. There were more polyclonal infections (40; 63.5%) than monoclonal infections (23; 36.5%). The multiplicity of infection (MOI) was 1.98 and the expected heterozygosity (He) was 0.64. Participants aged >8 years had significantly higher MOI (2.26±0.98) than those aged £ 8 years (1.78±0.83) (P=0.04). Polyclonal infections were similar in microscopic (23/39; 67.6%) and sub-microscopic infections (17/29; 58.6%) (P=0.46). However, polyinfections were more in microscopic (26/34; 76.5%) than in submicroscopic infections (15/29; 51.7%) (P=0.04). A high level of genetic diversity was observed in the P. falciparum isolates in this community-based study which is an indication of intense malaria transmission.&nbsp

Pattern of rural-urban acquisition of pfcrt T76 allele among Nigerian children with acute uncomplicated Plasmodium falciparum malaria

Malaria caused by Plasmodium falciparum remains a public health problem in Nigerian children with treatment complicated by expansion of chloroquine resistant strains known to harbour a common K76T point mutation in their pfcrt alleles. Here, we report the outcome of a 2 – year (March 2000 – February 2002) molecular surveillance for pfcrtT76 in children aged 6 months – 13 years with acute uncomplicated falciparum malaria in rural and urban Lagos, Nigeria. Rural-urban pfcrtT76 acquisition of 48.7 vs. 73.7% and 67.3 vs. 74.6% due to monoclonal and polyclonal P. falciparum parasitaemia, respectively, were found in the two study years, suggesting unstable but increasing prevalence of pfcrt T76 allele acquisition in the rural area. Further analyses showed that acquisition of pfcrtT76 allele was independent of sex but occurred more in ≤ 5 – year old children than older children in both populations. The impacts of K76T mutation in pfcrt gene and immunity on the clinical efficacy of chloroquine against acute uncomplicated malaria are discussed.African Journal of Biotechnology Vol. 4 (4), pp. 361-366, 200

Community pharmacists' contribution to public health: assessing the global evidence base

In the UK, community pharmacies are more accessible to the general population than general practices. Therefore, government white papers and briefing documents from pharmacy professional bodies have advocated the expansion of the role of community pharmacists, particularly in relation to the provision of services that contribute to disease prevention and health improvement. It is unknown whether the same evidence exists globally for the expansion of these roles. This article attempts to appraise and summarise the global evidence for the public health roles that community pharmacists play. Barriers, as well as strategies that can enhance these roles, are also discussed. Electronic databases were searched to retrieve relevant literature published since 1 January 2000. The selected literature included 2 meta-analyses, 7 literature reviews, 23 interventional studies and 41 descriptive studies. These were assessed according to health topics (i.e. smoking cessation, weight management, health promotion, disease screening and preventive activities, vaccination and immunisation, alcohol dependence advice and drug misuse, emergency hormonal contraception, and sexual health services). The effectiveness of community pharmacy-based public health interventions was shown in smoking cessation, health promotion, disease screening and preventive activities, provision of emergency hormonal contraceptive, and vaccination services. Although there was mixed evidence with respect to weight management and alcohol dependence advice interventions, the available data suggest feasibility and acceptability of these services due to the perceived ease of access and convenience

Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria

<p>Abstract</p> <p>Background</p> <p>The combination of artesunate and mefloquine has been reported to be effective against multi-drug resistant <it>Plasmodium falciparum </it>malaria, which has been reported in Nigeria. The objective of this multi-centre study was to evaluate the efficacy, safety and tolerability of the co-packaged formulation of artesunate and mefloquine in the treatment of uncomplicated malaria in two weight groups: those between 15 – 29 kg and ≥ 30 kg respectively.</p> <p>Methods</p> <p>The trial was conducted in rural communities in the north-east, north-central, south-west and south-eastern parts of Nigeria. The WHO protocol for testing antimalarial drugs was followed. Outpatients having amongst other criteria, parasite density of ≥1,000 μl were enrolled. The co-packaged drugs were administered for 3 days at a dosage of artesunate, 4 mg/kg body wt/day and mefloquine, 25 mg/kg/body wt total) on days 0, 1 and 2. Patients were followed up for 28 days with the assessment of the parasitological parameters on days 1, 2, 3, 7, and 28.</p> <p>Results</p> <p>Four hundred and forty-six (446) patients were enrolled and 431 completed the study. Cure rates in both treatment groups was >90% at day 28. The mean parasite clearance times in treatment groups I and II were 40.1 and 42.4 hours respectively. The combination of artesunate and mefloquine showed good gametocidal activity, (gametocyte clearance time of 42.0 & 45.6 hours in treatment groups I and II respectively). There were no serious adverse events. Other adverse events observed were headache, dizziness, vomiting and abdominal discomfort. There was no significant derangement in the haematological and biochemical parameters.</p> <p>Conclusion</p> <p>This co-packaged formulation of artesunate + mefloquine (Artequin™) is highly efficacious, safe and well-tolerated. It is recommended for the treatment of uncomplicated <it>P. falciparum </it>malaria in Nigeria.</p

Malaria Treatment in Enugu Urban Nigeria: Physicians\' Compliance with the National Treatment Guidelines

Incorrect use of antimalarial drugs undermines therapeutic effectiveness and promotes emergence and spread of drug-resistant malaria. Strategies for improving compliance require accurate information about current practices. This is a survey of the attitude and practices in the treatment of malaria among doctors practicing in Enugu urban, Nigeria. Standard questionnaire technique was used among 300 doctors practicing in Enugu urban. Chloronquine and sulfadoxine – pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria. More than 60% of the doctors prescribe intramuscular chloroquine in the dosage of 5ml (~200mg) daily for 3 days for adults and 5mg/kg/daily for 3 days for children. Recommended dosage of quinine was used by 41.8% of the doctors in treating children, and 50% of doctors in treating in treating children, and 50% of doctors in treating adults. Only 40% of the doctors utilized the National guidelines for treatment of malaria. Comparison between duration of practice, or area of intramuscular chloroquine and intravenous quinines showed no significant difference with P values > 0.05. It was concluded that incorrect use of parental antimalarial drugs occurs at all levels and specialties of medical doctors practicing in Enugu. NQJHM Vol. 14 (3&4) 2004: pp. 227-23