A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria

<p>Abstract</p> <p>Background</p> <p>In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ)) at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use.</p> <p>Methods</p> <p>A before and after qualitative study using key informant interviews (KII) and focus group discussions (FGDs) was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs) were trained in each village to dispense artemeter-lumenfantrine (AL) to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers.</p> <p>Results</p> <p>None of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised.</p> <p>Conclusion</p> <p>Our findings showed that the use of AL at home and community level is feasible with adequate training of community medicine distributors and caregivers. Community members perceived AL to be effective thus fostering acceptability. The negative attitudes of the health workers and issue of incentives to CMDs need to be addressed for successful scaling-up of ACT use at community level.</p

Characterisation of the opposing effects of G6PD deficiency on cerebral malaria and severe malarial anaemia.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is believed to confer protection against Plasmodium falciparum malaria, but the precise nature of the protective effecthas proved difficult to define as G6PD deficiency has multiple allelic variants with different effects in males and females, and it has heterogeneous effects on the clinical outcome of P. falciparum infection. Here we report an analysis of multiple allelic forms of G6PD deficiency in a large multi-centre case-control study of severe malaria, using the WHO classification of G6PD mutations to estimate each individual's level of enzyme activity from their genotype. Aggregated across all genotypes, we find that increasing levels of G6PD deficiency are associated with decreasing risk of cerebral malaria, but with increased risk of severe malarial anaemia. Models of balancing selection based on these findings indicate that an evolutionary trade-off between different clinical outcomes of P. falciparum infection could have been a major cause of the high levels of G6PD polymorphism seen in human populations

Quality Assessment of Fermented Gruel (ogi) Made from Sorghum (Sorghum bicolour) and Moringa Leaves (Moringa oleifera)

The effect of moringa leaf supplementation on the nutrient composition, quality attributes and consumer acceptability of sorghum-ogi was investigated the present study. Sorghum-ogi samples were produced from different ratios of sorghum grains and moringa leaf powder in the formulation of 100:0, 90:10, and 85:15, respectively. The effect of the moringa leaf powder substitution on the proximate composition, mineral content, swelling capacity, β-carotene content and on the sensory properties of sorghum-ogi was determined. The sorghum–ogi increased in the protein, ash and crude fibre with an increase in Moringa leaf substitution. An increase in the mineral content with increase in the level of substitution was observed as follows: calcium (75-390.10 mg/100 g); magnesium (21-88 mg/100 g); iron (12.40-14.13 mg/100 g); potassium (46.67-295.0 mg/100 g); zinc (0.33-0.77 mg/100 g); copper (0.53-0.67 mg/100 g). The swelling capacity decreased with increase in the substitution level while the β-carotene content of the sorghum-ogi samples ranged between 230-1241.67 µg/100 g. This study revealed that the fortification of ogi with moringa leaves at 15% improved the nutritional quality of sorghum-ogi and sorghum-ogi samples with 10% moringa leaf substitution is generally accepted by the consumers