Prevalence and Risk Factors of Malaria in HIV-Infected Pregnant Women on Anti-Retroviral Therapy in Enugu, South East Nigeria

Background and objective: Malaria and HIV co-infection pose significant health concerns in many regions of the world. Co-infection significantly increases the burden of these diseases in pregnancy, yet the interactions of these diseases in pregnant women are not well understood. The aim of the study was to determine the prevalence and examine the factors that could be associated with malaria in HIV positive infected pregnant women on antiretroviral therapy. Methodology: Blood samples were collected from 301 confirmed HIV positive pregnant women in various trimesters and examined for malaria parasite presence and density with other laboratory indices. Baseline socio-demographic information, antenatal information, CD4 levels, and viral load were collected from clinical records. Information on type of treatment, such as intermittent malaria preventive treatment (IPT) and ART therapy/ prophylaxis, was extracted from care cards. Information on the prior use of antimalarial drugs and cotrimoxazole intake was obtained from direct interviews. Results: The prevalence of malaria among HIV-positive pregnant women was 49.83% and the odds of having malaria doubledwith living in a rural community (AOR 2.04, CI [1.07-3.91] P 350 had reduced odds of malaria parasitaemia (AOR 0.50, CI [0.81-1.44] P=0.202) and (AOR 0.65, CI [0.24-1.73] P=0.391), respectively, compared with those with lower CD4 counts. Malaria parasites were unlikely in those with normal haemoglobin levels (AOR 0.08 CI [0.04-0.16] P<0.001). Pregnant women who were not on treatment before coming to the hospital ANC were about nine times more likely to have malaria parasites than those who had it recently (AOR 9.30, CI [4.44-19.50] P<0.001). Conclusion: The prevalence of malaria in HIV-positive pregnant women was influenced by the locality, level of haemoglobin and self-medication prior to coming to the hospital. Low haemoglobin, which serves as an index of malnutrition, was also a serious factor that should be evaluated to reduce the scourge and burden of malaria complications, and programs geared towards provision of mosquito and environmental barriers should be improved

Impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia in pregnant women of rural communities in Enugu, South East Nigeria

Introduction: Malaria and hookworm infections are common in sub-Saharan Africa and they increase the prevalence of anaemia in pregnancy with resultant poor pregnancy outcomes. This study was carried out to assess the impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia among pregnant women in two rural communities in Enugu, South East Nigeria. Methods: A cross sectional descriptive study was carried out in a total of 226 women attending antenatal clinics at two rural Primary Health Centres (PHC) from April 2011 to July 2011(each PHC with 113 subjects). Socio-demographic data were collected through a structured questionnaire. Blood and stool samples were evaluated for haemoglobin estimation and malaria parasites, and stool samples examined for parasitic infection in all the women. Data was analyzed using STATA 10 software statistical analysis package. Student t-test was used for comparing mean values and chi square test for comparing categorical variables and level of significance set at p&lt;0.05 and logistic regression was used to identify the risk factors associated with malaria in pregnancy. Results: The mean age of the women was 27years with range 18 - 38years and SD of 5years. Most of the women were housewives and over 50% in their second trimester. 53% of them had malaria parasites while 27% had hookworm infection. About 40% of the women were anaemic (haemoglobin &lt; 0.001). Similar association was found between hookworm infection and anaemia (p (p &lt;0.001). Though both malaria and hookworm infections greatly increase the odds for anaemia (AOR 18.06, CI 18.15 -39.99, P&lt;0.001) and (AOR 5.28, CI 2.26 -12.38, P&lt;0.001) respectively, the odds for having anaemia in pregnancy was higher for malaria than hookworm infections. Conclusion: Plasmodium falciparum and hookworm infections have significant impact on the high frequency of anaemia in pregnancy in our rural communities. There is need to strengthen the control program that has been in place with an integrated intervention to combat these parasitic infections in our rural communities, with mass distribution of antihelminthics as one of the included relevant methods, among others.Pan African Medical Journal 2013; 14:2

Use of Mobile Phone by Intercity Commercial Motorist in Three Towns in Benue State, Nigeria - A Threat to Road Crash

Inappropriate use of mobile phone by motorist has become an emerging issue of concern, most especially in low- and middle-income countries where majority of road accidents occur annually. A cross sectional descriptive study was conducted among 360 intercity commercial motorist in three towns in Benue State, Nigeria between April and May, 2013 using multi-staged sampling technique to assess the practice of mobile phones and the associated prevalence of auto clash. The data were analysed using SPSS (version 17) with statistical significant set at p-value of 0.05. Ninety -five (26.4%) receive calls only, 7921.9%) receive and made calls, 18(5.0%) made calls only, 14(3.9%) read or send sms text messages, while 57(15.8 %) engaged in all forms of use of mobile phone (i.e calls and sms text messages)

Effect of Health Education Intervention on Knowledge of HIV/AIDS and Risky Sexual Behaviours amongst Prison Inmates in Kaduna State, Nigeria

The prison population worldwide accommodates a higher proportion of individuals at high risk of HIV infection compared to the general population, and there is recognition of risky sexual activities among the inmates. But for complex political, legal, social, cultural and religious reasons, preventive measures like use of condom in prison are often not permitted and access to community based intervention in prison is limited. In order to make meaningful decisions about their reproductive health, inmates need reliable information. This study assessed the effect of health education on HIV/AIDS related knowledge and risky sexual behaviours amongst prison inmates in Kaduna State, Nigerian

An Evaluation of the Integrated Disease Surveillance and Response (IDSR) in Enugu State, Nigeria

Background: The Integrated Disease Surveillance and Response (IDSR), adopted in 1988 at the 48th World Health Organization Regional Committee for Africa meeting in Harare, Zimbabwe, is a regional strategy to strengthen the weak national surveillance systems in the region. In Nigeria, and prior 1988, there was no coordinated system of disease reporting and surveillance system in place until after a major yellow fever outbreak in 1986/87 that claimed many lives. The IDSR in Enugu state, as supported by the WHO, has 17 disease surveillance and notification officers across the 17 LGAs and 89 reporting sites covering the 3000 health facilities. Method: This study is a prospective cross-sectional study using WHO and CDC assessment protocols modified to reflect the local settings. The study samples were selected based on the IDSR performance indicators for AFP, measles core indicators, status of epidemic-prone diseases, and adequacy of feedback and feedforward of surveillance activities. Using desk review of the EPI/IDSR surveillance reports between 2012 and 2017, and also questionnaires between April and July 2017 to eligible participants, data were obtained, cleaned, and analysed using the SPSS version 24. Results: The Overall average score of IDSR performance indicator for Enugu state from the pooled data was 39% against the expected of &gt;80%. These findings are in disagreement with the globally recommended standard IDSR practice and response. Conclusion: The outcome of this study highlights that Enugu state surveillance and IDSR practice are short of the standard practice as prescribed by WHO and CDC assessment protocols. Main reasons for this include poor disease reporting, poor documentation of conducted activities, and lack of adequate feedback system. Similarly, there is non-involvement of community and private health facilities that made up more than 95% of surveillance networks in the state. However, global polio eradication initiative and change management approaches identified remain a huge opportunity for the improvement of the system. Keywords: Enugu State, IDSR, AFP, Measles, Outbreaks, Yellow Fever, Nigeria, WHO, CDC.

Plasmodium transmission blocking activities of Vernonia amygdalina extracts and isolated compounds

BACKGROUND: Medicinal plants are a validated source for discovery of new leads and standardized herbal medicines. The aim of this study was to assess the activity of Vernonia amygdalina leaf extracts and isolated compounds against gametocytes and sporogonic stages of Plasmodium berghei and to validate the findings on field isolates of Plasmodium falciparum. METHODS: Aqueous (Ver-H2O) and ethanolic (Ver-EtOH) leaf extracts were tested in vivo for activity against sexual and asexual blood stage P. berghei parasites. In vivo transmission blocking effects of Ver-EtOH and Ver-H2O were estimated by assessing P. berghei oocyst prevalence and density in Anopheles stephensi mosquitoes. Activity targeting early sporogonic stages (ESS), namely gametes, zygotes and ookinetes was assessed in vitro using P. berghei CTRPp.GFP strain. Bioassay guided fractionation was performed to characterize V. amygdalina fractions and molecules for anti-ESS activity. Fractions active against ESS of the murine parasite were tested for ex vivo transmission blocking activity on P. falciparum field isolates. Cytotoxic effects of extracts and isolated compounds vernolide and vernodalol were evaluated on the human cell lines HCT116 and EA.hy926. RESULTS: Ver-H2O reduced the P. berghei macrogametocyte density in mice by about 50% and Ver-EtOH reduced P. berghei oocyst prevalence and density by 27 and 90%, respectively, in An. stephensi mosquitoes. Ver-EtOH inhibited almost completely (>90%) ESS development in vitro at 50 μg/mL. At this concentration, four fractions obtained from the ethylacetate phase of the methanol extract displayed inhibitory activity >90% against ESS. Three tested fractions were also found active against field isolates of the human parasite P. falciparum, reducing oocyst prevalence in Anopheles coluzzii mosquitoes to one-half and oocyst density to one-fourth of controls. The molecules and fractions displayed considerable cytotoxicity on the two tested cell-lines. CONCLUSIONS: Vernonia amygdalina leaves contain molecules affecting multiple stages of Plasmodium, evidencing its potential for drug discovery. Chemical modification of the identified hit molecules, in particular vernodalol, could generate a library of druggable sesquiterpene lactones. The development of a multistage phytomedicine designed as preventive treatment to complement existing malaria control tools appears a challenging but feasible goal

Effectiveness of seasonal malaria chemoprevention (SMC) treatments when SMC is implemented at scale: Case-control studies in 5 countries.

BACKGROUND: Seasonal malaria chemoprevention (SMC) has shown high protective efficacy against clinical malaria and severe malaria in a series of clinical trials. We evaluated the effectiveness of SMC treatments against clinical malaria when delivered at scale through national malaria control programmes in 2015 and 2016. METHODS AND FINDINGS: Case-control studies were carried out in Mali and The Gambia in 2015, and in Burkina Faso, Chad, Mali, Nigeria, and The Gambia in 2016. Children aged 3-59 months presenting at selected health facilities with microscopically confirmed clinical malaria were recruited as cases. Two controls per case were recruited concurrently (on or shortly after the day the case was detected) from the neighbourhood in which the case lived. The primary exposure was the time since the most recent course of SMC treatment, determined from SMC recipient cards, caregiver recall, and administrative records. Conditional logistic regression was used to estimate the odds ratio (OR) associated with receipt of SMC within the previous 28 days, and SMC 29 to 42 days ago, compared with no SMC in the past 42 days. These ORs, which are equivalent to incidence rate ratios, were used to calculate the percentage reduction in clinical malaria incidence in the corresponding time periods. Results from individual countries were pooled in a random-effects meta-analysis. In total, 2,126 cases and 4,252 controls were included in the analysis. Across the 7 studies, the mean age ranged from 1.7 to 2.4 years and from 2.1 to 2.8 years among controls and cases, respectively; 42.2%-50.9% and 38.9%-46.9% of controls and cases, respectively, were male. In all 7 individual case-control studies, a high degree of personal protection from SMC against clinical malaria was observed, ranging from 73% in Mali in 2016 to 98% in Mali in 2015. The overall OR for SMC within 28 days was 0.12 (95% CI: 0.06, 0.21; p < 0.001), indicating a protective effectiveness of 88% (95% CI: 79%, 94%). Effectiveness against clinical malaria for SMC 29-42 days ago was 61% (95% CI: 47%, 72%). Similar results were obtained when the analysis was restricted to cases with parasite density in excess of 5,000 parasites per microlitre: Protective effectiveness 90% (95% CI: 79%, 96%; P<0.001), and 59% (95% CI: 34%, 74%; P<0.001) for SMC 0-28 days and 29-42 days ago, respectively. Potential limitations include the possibility of residual confounding due to an association between exposure to malaria and access to SMC, or differences in access to SMC between patients attending a clinic and community controls; however, neighbourhood matching of cases and controls, and covariate adjustment, attempted to control for these aspects, and the observed decline in protection over time, consistent with expected trends, argues against a major bias from these sources. CONCLUSIONS: SMC administered as part of routine national malaria control activities provided a very high level of personal protection against clinical malaria over 28 days post-treatment, similar to the efficacy observed in clinical trials. The case-control design used in this study can be used at intervals to ensure SMC treatments remain effective

Sector-specific development and policy vulnerability in the Philippines

Ministry of Education, Singapore under its Academic Research Funding Tier