An in-depth study of patent medicine sellers' perspectives on malaria in a rural Nigerian community

BACKGROUND: Malaria remains a major cause of mortality among under five children in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with antimalarial drugs bought from medicine sellers. These have led to increasing calls for interventions to improve treatment obtained in these outlets. However, information about the current practices of these medicine sellers is needed before such interventions. This study aims to determine the medicine sellers' perspectives on malaria and the determinants that underlie their dispensing patterns of antimalarial drugs. METHODS: The study was conducted in Ugwugo-Nike, a rural community in south-east Nigeria. It involved in-depth interviews with 13 patent medicine sellers. RESULTS: A majority of the medicine sellers were not trained health professionals and malaria is recognized as a major health problem by them. There is poor knowledge and poor dispensing behaviour in relation to childhood malaria episodes. Although referral of severe malaria is common, there are those who will not refer. Verbal advice is rarely given to the care-givers. CONCLUSION: More action research and interventions to improve prescription and referral practices and giving verbal advice to care-givers is recommended. Ways to integrate the drug sellers in the health system are also recommended

Asymptomatic bacteriuria in children with sickle cell anemia at The University of Nigeria teaching hospital, Enugu, South East, Nigeria

<p>Abstract</p> <p>Background</p> <p>Urinary tract infection (UTI) is a common cause of childhood morbidity and mortality in the tropics. Children with sickle cell anemia (SCA) may have compromised kidney function arising from repeated vaso-occlusive episodes and recurrent symptomatic or asymptomatic UTI.</p> <p>Objectives</p> <p>This study aims at determining the prevalence of asymptomatic bacteriuria and sensitivity pattern in children with homozygous sickle haemoglobin compared to children with normal haemoglobin.</p> <p>Methods</p> <p>One hundred children with SCA in stable state and 100 children with normal haemoglobin aged 2-12 years were screened for asymptomatic bacteriuria using midstream urine samples. The samples were incubated aerobically at 37°C for 24 hours within one hour of collection. Children whose urine samples yielded significant bacteriuria (≥10⁵cfu/ml) on two consecutive cultures were regarded as having asymptomatic bacteriuria.</p> <p>Results</p> <p>Asymptomatic bacteriuria was noted in 6% of children with SCA and occurred more in females than males (F: M = 5:1) when compared to 2% in children with normal haemoglobin. <it>Escherichia coli </it>was the commonest organism isolated (33.3%). All the organisms were resistant to co-trimoxazole and ampicillin while most were sensitive to gentamicin, ceftriaxone and the quinolones.</p> <p>Conclusion</p> <p>The risk of asymptomatic bacteriuria is three times more common in children with sickle cell anemia than in children with normal haemoglobin. It is therefore important to screen SCA patients, especially the females for UTI and should be treated according to the sensitivity result of the cultured organisms.</p

Acceptance of malaria vaccine by a rural community in Nigeria

Background: Introduction of malaria vaccine is imminent. This study evaluated the prevalence of malaria among a non-febrile population and their willingness to accept a malaria vaccine.Methods: This was a cross-sectional, community-based study done in a rural community in south east Nigeria. A total of 156 household heads were interviewed using a structured questionnaire. The questionnaire was pre-tested before commencement of the study to correct ambiguity.Results: Majority (78.2%) acknowledged that malaria is the commonest illness in the community, while 55.1% believed that presumptive treatment is the best malaria preventive measure. Most (98.7%) of the study participants immunized their children against childhood vaccine preventable diseases, while 91.6% would be willing to accept a malaria vaccine. The prevalence of malaria parasitaemia among non-febrile respondents was 35.4% and the use of mosquito nets was 17.9%.Conclusion: The high prevalence of malaria among non-febrile populations, the practice of presumptive treatment of unconfirmed fever as malaria preventive measure and the low use of bed nets, points that it is time to introduce malaria vaccine. The high willingness to receive the vaccine is positive to the introduction of the vaccine.Keywords; Acceptance; Malaria, Vaccine, Nigeria

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge.Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital.Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes.Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively.Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in childrenKeywords: Peritoneal dialysis; renal replacement therapy; acute kidney injury; children; dialysate; developing country

Digit-sucking habit of preschool children in Enugu , Eastern Nigeria

Although digit-sucking habit is common in preschool children, there is multiracial variation of prevalence rates. Hitherto unidentified variables are being reported as possible risk factors. To analyse this habit in preschool children in Enugu , Eastern Nigeria , a prospective cross-sectional study was conducted on one hundred (100) children. Their mothers were interviewed with a structured questionnaire. The habit was noted in 23% of the children, with a slight male preponderance. Using the correlation coefficient model, longer total duration of breast-feeding was not well correlated with increase in number of digit-sucking preschool children (correlation coefficient, r = 0.36, P < 0.05). The number of these children exposed to pacifier sucking was significantly greater than the number of their non-sucking counterparts with similar exposure (c2 = 38.56, P < 0.05). It is concluded that preschool children exposed to pacifier use and shorter duration of breast-feeding were more likely to exhibit the habit. (J Pediatr Neurol 2003; 1(2): 99-101)

Profile of chronic kidney disease modifiable risk factors in a rural community of south east Nigeria

Abstract Background Chronic kidney disease (CKD) is on the increase globally. Prevention of this condition is ideal, however early detection of the disease becomes desirable where the disease process has begun as there are known interventions which can slow the progress to end stage renal disease (ESRD). This study aimed at detecting the profile of some modifiable risk factors for CKD in a cohort of household heads in a rural community with limited resources for managing chronic kidney diseases. Methods The study was conducted in a rural community in southeast Nigeria. One hundred and forty five household heads from randomly selected households were interviewed. Their blood pressures were taken and their urine tested. The data was analyzed using SPSS version 21. Simple frequencies and means were calculated. Results A total of 145 house hold heads were enrolled. Their mean age was 45.08 (19.65) years. Forty-seven percent had no prior knowledge of their blood pressure and 31.5% were found to be hypertensive. Only one study participant (1%) had ever had a urinalysis test and proteinuria and glycosuria were found in 50.4 and 27.9% respectively. Most (75%) patronized patent medicine vendors for their primary healthcare while 31.8% had taken herbal mixtures in the past. Conclusion There are presently many modifiable risk factors for the development of chronic kidney disease in rural communities in south-east Nigeria. Urgent targeted intervention is required to forestall an epidemic of CKD in the near future

A systematic review of the safety and efficacy of artemether-lumefantrine against uncomplicated <it>Plasmodium falciparum</it> malaria during pregnancy

<p>Abstract</p> <p>Malaria during pregnancy, particularly <it>Plasmodium falciparum</it> malaria, has been linked to increased morbidity and mortality, which must be reduced by both preventive measures and effective case management. The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) to treat uncomplicated <it>falciparum</it> malaria during the second and third trimesters of pregnancy, and quinine plus clindamycin during the first trimester. However, the national policies of many African countries currently recommend quinine throughout pregnancy. Therefore, the aim of this article is to provide a summary of the available data on the safety and efficacy of artemether-lumefantrine (AL) in pregnancy. An English-language search identified 16 publications from 1989 to October 2011 with reports of artemether or AL exposure in pregnancy, including randomized clinical trials, observational studies and systematic reviews. Overall, there were 1,103 reports of AL use in pregnant women: 890 second/third trimester exposures; 212 first trimester exposures; and one case where the trimester of exposure was not reported. In the second and third trimesters, AL was not associated with increased adverse pregnancy outcomes as compared with quinine or sulphadoxine-pyrimethamine, showed improved tolerability relative to quinine, and its efficacy was non-inferior to quinine. There is evidence to suggest that the pharmacokinetics of anti-malarial drugs may change in pregnancy, although the impact on efficacy and safety needs to be studied further, especially since the majority of studies report high cure rates and adequate tolerability. As there are fewer reports of AL safety in the first trimester, additional data are required to assess the potential to use AL in the first trimester. Though the available safety and efficacy data support the use of AL in the second and third trimesters, there is still a need for further information. These findings reinforce the WHO recommendation to treat uncomplicated <it>falciparum</it> malaria with quinine plus clindamycin in early pregnancy and ACT in later pregnancy.</p

Bacteriology of asymptomatic bacteriuria in pre-school children in Enugu

Objective: This study was undertaken to ascertain the predominant bacterial isolates in the urine of pre-school children with asymptomatic bacteriuria and determine their sensitivity pattern. Methods: This was a cross-sectional study in which analysis of urine cultures obtained from 800 nursery school children aged 2-5 years in Enugu, South East Nigeria, between January and November 1989 was done. Results: Three hundred and ninety-one (48.8%) of the children were females while 409 were males, with a male female ratio of 1.05:1.The mean age was 3.79 ±1.3yrs and seventeen out of 800 (2.1%) cultures were positive, 2 (12%) from male children and 15 (88%) from female children. Nine out of the 17 (53%) positive cultures yielded Escherichia Coli. (E. Coli), 5 specimens (29%) yielded streptococcus faecalis (strept. Faecalis) while the remaining 3 specimens yielded Proteus species (6%), staphylococcus pyogenes (6%) and Micrococcus (6%) respectively. There was 100% resistance of the E. Coli, staphylococcus pyogenes (staph. Pyogenes) and proteus species to Ampicillin, while there was 100% sensitivity of all the organisms to nitrofurantoin. Seventy-eight percent of the E. Coli were sensitive to gentamycin while 100% sensitivity to this drug was obtained for staphylococcus, pyogenes, micrococcus and proteus spp. However only 40% of the Strept. Faecalis was sensitive to gentamycin. Most of the organisms (88%) were resistant to co-trimoxazole. Conclusion: It is concluded that nitrofurantoin or gentamycin should be used as first line drugs in urinary infections rather than co-trimoxazole which is the practice at present. Orient Journal of Medicine Vol. 17(3&4) 2005: 37-4