Exposure to anti-malarial drugs and monitoring of adverse drug reactions using toll-free mobile phone calls in private retail sector in Sagamu, Nigeria: implications for pharmacovigilance

<p>Abstract</p> <p>Background</p> <p>Adverse drug reactions (ADRs) contribute to ill-health or life-threatening outcomes of therapy during management of infectious diseases. The exposure to anti-malarial and use of mobile phone technology to report ADRs following drug exposures were investigated in Sagamu - a peri-urban community in Southwest Nigeria.</p> <p>Methods</p> <p>Purchase of medicines was actively monitored for 28 days in three Community Pharmacies (CP) and four Patent and Proprietary Medicine Stores (PPMS) in the community. Information on experience of ADRs was obtained by telephone from 100 volunteers who purchased anti-malarials during the 28-day period.</p> <p>Results and Discussion</p> <p>A total of 12,093 purchases were recorded during the period. Antibiotics, analgesics, vitamins and anti-malarials were the most frequently purchased medicines. A total of 1,500 complete courses of anti-malarials were purchased (12.4% of total purchases); of this number, purchases of sulphadoxine-pyrimethamine (SP) and chloroquine (CQ) were highest (39.3 and 25.2% respectiuvely). Other anti-malarials purchased were artesunate monotherapy (AS) - 16.1%, artemether-lumefantrine (AL) 10.0%, amodiaquine (AQ) - 6.6%, quinine (QNN) - 1.9%, halofantrine (HF) - 0.2% and proguanil (PR) - 0.2%. CQ was the cheapest (USD 0.3) and halofantrine the most expensive (USD 7.7). AL was 15.6 times ($4.68) more expensive than CQ. The response to mobile phone monitoring of ADRs was 57% in the first 24 hours (day 1) after purchase and decreased to 33% by day 4. Participants in this monitoring exercise were mostly with low level of education (54%).</p> <p>Conclusion</p> <p>The findings from this study indicate that ineffective anti-malaria medicines including monotherapies remain widely available and are frequently purchased in the study area. Cost may be a factor in the continued use of ineffective monotherapies. Availability of a toll-free telephone line may facilitate pharmacovigilance and follow up of response to medicines in a resource-poor setting.</p

Luteal Phase Defect And Its Clinical Correlates In Infertile Females

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Generalized And Abdominal Obesity; The Association With Hypertension Among Men In Ikeja, Lagos State

Background: Obesity is an increasing problem in the developing world, with more than 115 million people suffering from obesity-related problems. Abdominal obesity and increased body mass index are known to be associated with hypertension5, an important public health problem worldwide and the most widely recognized modifiable risk factor for cardiovascular disease, cerebrovascular disease (stroke) and end-stage renal disease.Methods: A descriptive, cross-sectional communitybased study involving three hundred apparently healthy men aged 20 years and above to determine the prevalence of generalized and abdominal obesity and their association with hypertensionResults: The prevalence of abdominal and generalised obesity was 16.7% and 12.7% respectively. The prevalence of hypertension was 46.7%. Abdominal obesity (measured as waist circumference ≥ 120) had a stronger association with hypertension than generalized obesity(measured as BMI ≥30 kg/m2).Conclusion: The prevalence of generalized and abdominal obesity among urban men is high. Abdominal obesity is strongly associated with hypertension. The need for public health actions to reverse this trend cannot be over emphasized.Keywords: Abodominal obesity, Generalized Obesity, Hypertension, Men, Urba

Nutritional Issues of HIV/AIDS Orphans in Sagamu South Western, Nigeria

More than 12 million children under the age of 18 years have been orphaned worldwide, as a result of HIV/AIDS, with Nigeria having the largest number of HIV/AIDS orphans in Africa, as more people die from AIDS, the proportion and problems of orphans and vulnerable children will increase. Little is known about the health and nutrition of those HIV/AIDS orphans and inconsistent findings make it difficult to assess if orphans and other vulnerable children have specific nutritional needs. This study investigated nutritional status HIV/AIDS orphans in Sagamu. The study population consisted of fifty seronegative orphans of parents who died as a result of HIV infection and AIDS and fifty seronegative non-orphaned children whose parents were HIV negative who served as control. Nutritional status was assessed anthropometrically and biochemically. Height, weight, mid-upper arm circumference and head circumference were measured in orphans and control. Significant difference (p&lt; 0.05) was obtained in the percentage of children having stunted growth as determined by height-for-age in the orphans 30%, compared to 8% in the control. Also haemoglobin and plasma levels of total protein, albumin, calcium and phosphate were significantly reduced (p&lt; 0.05) in the orphans compared with the control Nutritional status seemed to be compromised in the HIV/AIDS orphaned. Micronutrient profile assessment in a large sample size is suggested

Cytokines, Type 2 DM and the Metabolic Syndrome

Background: Inflammatory markers have been widely implicated in Diabetes Mellitus (DM) and the metabolic syndrome (Mets). Data on the association of cytokines (pro inflammatory mediators) and components of the Mets are sparse in sub Saharan Africa.Objective: We sought to document the pattern of distribution of cytokines in Nigerian subjects with type 2 DM and compare cytokine levels between DM subjects with and without the Mets.Methods: 200 subjects with type 2 DM and 100 healthy sex and aged matched Controls were studied. Anthropometric indices, lipid parameters and cytokine levels, which included interleukin 10 (IL-10), tumour necrosis factor – alpha (TNF – α ), interferon gamma (IFN – α) and C reactive protein (CRP) were determined. Continuous variables were compared between subjects with type 2 DM and the controls and also between DM subjects with and without the Mets.Results: The mean levels of all studied cytokines were significantly higher in the subjects with type 2 DM than the Control subjects, save for IFN – α which was significantly lower in type 2 DM. The mean cytokine levels werecomparable in the DM subjects with and without the Mets and also  comparable in obese DM and non obese DM subjects. Of the Mets defining criteria, waist circumference (WC) and Triglyceride (TG) were found to be significantly associated with only two of the studied cytokines. The correlation coefficient and p values of these findings are as follows: WC vs TNF –α ( r = 0.16, p = 0.001) and TG vs CRP ( r = 0.15, p = 0.03). Multiple regression analyses showed that the cytokines were linearly associated with each other but not with other clinical and biochemical variables. Thecytokines were found to be interrelated. IL – 10 with a beta value of 0.14 predicted the presence of INF – α with a 95% confidence interval of 0.000 – 0.109 and a p value of 0.05. TNF- α with a beta value of 0.17 predicted the presence of IL – 10 with a 95% confidence interval of 0.004 – 0.034 anda p value of 0.01. IL – 10 with a beta value of 0.17 predicted the presence of TNF – α with a 95% confidence interval of 0.3 – 0.590 and a p value of 0.01.Conclusion: Cytokine levels are higher in DM than non DM subjects; however, the cytokine levels are not strongly associated with the Mets. Limited correlations were found between each of the cytokines and the parameters of the Mets. Further studies on this entity amongst Africansshould be carried out to ascertain if these results are peculiar to DM subjects in sub- Saharan Africa.Key words: Cytokines, Type 2 DM and the Metabolic Syndrome

Malaria and Typhoid as a Cause of Febrile Illness Amongst People Attending Redeemer’s Camp Centre in Mowe, Ogun State, Nigeria

MedMalaria parasites and salmonella species co-infection are mostly implicated amidst all other aeteological factors. Consequently, these life-threatening illnesses manifest slightly similar clinical symptoms, thus, the need to investigate febrile conditions among attendees of an  interdenominational religious retreat. Demographic data were obtained using structured questionnaire while blood was screened for malaria parasites and Salmonella typhiO and H antibodies. Out of the 445 patients that attended the clinic during their camping on account of fever, 219 (49.2%) were males and 226 (50.8%) were females. 169 (38%) was diagnosed of having malaria, 116 (26%) had typhoid and 57 (12%) had both malaria and typhoid. Malaria incidence was noted to be highest among children less than 10 years constituting about 12%, while typhoid was most seen in the age group of 41-50 years constituting 5.8%. Salmonella typhi and Plasmodium falciparum specie constituted significant etiological importance in malaria and typhoid patients. However, gender had no significant value effect on the result of malaria and widal test. Keywords: Plasmodium, Salmonella, co-infection, fever, blood

Postpartum Sexual Abstinence and Breastfeeding Pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groupsKeywords: Postpartum, Sexual, Abstinence, Breastfeeding, Sexually Transmitted InfectionsAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 96-10