Prevalence of Intestinal Helminthes among Children in Selected Communities in Monrovia, Liberia

The present study was carried out among children below 15 years in 10 communities in Monrovia. Out of the 646 children recruited in the study, 216 (33.4%) were positive for at least one intestinal helminth parasite. Children between 11 – 15 years had the highest prevalence of intestinal helminthes. Ascaris lumbricoides was the most common intestinal helminth parasite encountered (79.6%), followed by Trichuris trichura (19.0%). Strongyloides stercoralis and Enterobius vermicularis were the least prevalent helminth parasites encountered among the study population (1% each). The population in these communities depended largely on poorly built latrines and buckets for faecal disposal although some (49%) used flush toilets despite their being in poor conditions. Only 23.45 of the 646 children surveyed used pipe borne water for drinking and other domestic purposes. The high prevalence rates of helminth infection obtained could be due to persistent infection and re-infection of the study population as a result of the constant seeding of the soil with parasite eggs and larvae in these communities. Keywords: Prevalence, Intestinal helminth, Children, Liberi

CHANGING TRENDS IN THE DIAGNOSIS OF MALARIA AND TYPHOID FEVER

Malaria In tropical Africa, fever is commonly associated with malaria that was known variously as Roman fever,   marsh fever(Rocco 2003),  and whose name was derived from the Italian ‘Mal=bad, Aria=air.’(Prakash et al. 2013).    Malaria is caused by five species of the plasmodium parasite: P. falciparum, P. vivax, P.ovale, P. malariae and P. knowlesi all of which are transmitted by the female anopheles mosquito, which is the vector of the parasite. Over 2.4 billion people are at risk of P. falciparum infection, which results in about 300 to  500 million clinical episodes and 1million deaths annually (Bousema & Drakeley 2011). While about 2.9 billion persons are at risk for P. vivax infection with up to 300 million clinical episodes per year(Bousema & Drakeley 2011). A vast proportion of malaria morbidity occurs in sub-Saharan Africa, (SSA). However, there is substantial evidence that the intensity of malaria transmission in Africa is declining (Snow et al. 2012, Graz et al. 2011), and rapid malaria parasitemia tests are well distributed in endemic countries and easy to use (Graz et al. 2011).    Certain recent developments, however, are worth considering when assessing malaria burden and control.First, the discovery of Plasmodium falciparum with deleted histidine-rich repeat region of the histidine-rich-protein 2 and the evidence that parasites not detected by HRP2 lateral flow immunoassay(LFI) cause latent infection(Koita et al. 2012), is of extreme importance in endemic countries such as Sierra Leone, where HRP2  LFIs are predominantly used. LFIs have made malaria testing ubiquitous in sub-Saharan Africa, including in very remote areas. However, false negatives resulting from deleted hrp2 in certain P.falciparum may result in lower prevalence reports. The alternative dipstick to HRP2 LFIs is the Plasmodium lactate dehydrogenase (pLDH)-based LFI. However, in Sierra Leone, the use of pLDH LFIs is less common, and a similar trend exists in the other parts of Sub-Saharan Africa. LFIs were intended to be used primarily in resource-limited locations where expert microscopists are unavailable. So the use of LFIs is not routinely duplicated with smear results in many developing countries. This could be a setback for resource-poor settings.The use of point of care, multiplex molecular detection methods have been highlighted as a means of salvaging diagnosis in resource-poor countries, but cost remains a major limitation. Notwithstanding, PCR is emerging as most sensitive malaria diagnostic apart from rapid antigen tests. Antigens and DNA may persist in blood after parasite clearance through treatment.  A plausible alternative has sought sexual stages of malaria parasites representing a small fraction of parasites during infection(Tao et al. 2014), but which can also be detected in body fluids such as saliva. Prior evidence indicates that saliva is an excellent non-invasive candidate for rapid malaria testing (Fung et al. 2012), but this aspect of malaria diagnostics is still under development including rapid tests based on nano trap technology.There has been a renewed global commitment for malaria elimination and both symptomatic and asymptomatic malaria infections are critical for the elimination of malaria. Novel diagnosis of subclinical malaria targeting sexual stages of the parasite are emerging, but the best candidate for such diagnostics are those that could be adaptable to the resource-poor settings in Africa. One such candidate is the nano trap, saliva-based, malaria rapid test that is under development by Johns Hopkins(http://www.jhsph.edu/news/news-releases/2015/johns-hopkins-bloomberg-school-of-public-health-researchers-receive-grant-to-evaluate-malaria-detection-test.html). Typhoid Fever In the case of typhoid fever, there seems to be an over-diagnosis.  The gold standard for the diagnosis of typhoid is by blood culture, which has a sensitivity of 40-60%(Parry et al. 1999), but low-cost tests, mainly the widal test, are more adaptable to resource-poverty and are commonly used in resource-poor settings such as Sierra Leone. Widal tests have been in use for over 110 years, but the results are very controversial(Olopoenia & King 2000, Nga et al. 2012),  and the test suffers from low specificity in endemic countries probably as a result of an increase in population antibody levels (Clegg et al. 1994).A positive Widal test does not always denote the presence of typhoid fever. Apart from increased population antibody levels, there exist up to 40 cross-reacting antigens between Salmonella enterica serotype Typhi and other Enterobacteriaceae(Parry et al. 1999). Cross-reacting antigens could also be from malaria, brucellosis, dengue fever, chronic liver disease or endocarditis(Colle et al. 1996).Blood culture which is the gold standard is time-consuming and may delay treatment apart from its inherently low sensitivity.  Several typhoid dipsticks have been reported, but side-by-side independent assessments in endemic countries do not always yield the expected outcome.Polymerase chain reaction is currently a better option for diagnosing typhoid fever with same day result, but cost remains a big issue in countries that could be most in need. While suitable alternatives based on economic conditions of countries are sought, the cut-off value for the widal test requires evaluation and standardization. Having a wrong diagnosis at the point of care could lead to wrong clinical outcomes.

Knowledge, Perception of Risk and Attitude of Sierra Leone Military Personnel towards Colleagues with HIV/AIDS

The aim of this survey was to gain an insight into the level of knowledge, perception of risk and attitude of Sierra Leone Military personnel towards colleagues with HIV/AIDS. Four hundred and fifty (450) randomly selected male and female military personnel including officers and other ranks from six battalions were surveyed with a standard questionnaire. Results of this survey demonstrated a relatively low level of knowledge of HIV and AIDS amongst the survey population as evidenced by the 40% and 52% of participants stating that HIV is transmitted by mosquito bites and from public toilets respectively. An equally low perception of risk of the infection was demonstrated from the responses of the participants about attitude towards HIV infected colleagues. Three-fourth of the participants indicated that nobody should be informed if a colleague is HIV positive, with almost all the participants expressing their willingness to take care of an HIV/AIDS person in their household. Varying responses obtained demonstrate the necessity for scaling-up HIV education within the Republic of Sierra Leone Armed Forces. More resources most therefore be made available to the HIV/AIDS office of the Republic of Sierra Leone Armed Forces so that HIV education activities can be extended to all the brigades and battalions. Keywords: Knowledge, Perception, Attitude, HIV/AIDS

Improved mapping strategy to better inform policy on the control of schistosomiasis and soil-transmitted helminthiasis in Sierra Leone

<p>Abstract</p> <p>Background</p> <p>Schistosomiasis and soil-transmitted helminthiasis (STH) are endemic in Sierra Leone confirmed by national mapping in 2008. To better inform planning of preventive chemotherapy strategy, another survey was conducted before mass drug administration (MDA) in seven districts according to the mapping results or local knowledge. Fifty-nine chiefdoms and one school in every chiefdom were selected. Thirty school children aged 9-14 years from each school (total: 1760) were examined by parasitological methods for infection with <it>Schistosoma mansoni </it>and STHs.</p> <p>Results</p> <p>The overall prevalence of <it>S. mansoni </it>was 40.2% (95% confidence interval (CI): 37.9-42.5%), particularly in Kailahun (63.3%), Kenema (46.7%), Koinadugu (41.9%) and Kono (71.7%). The results demonstrated the focal distribution of <it>S. mansoni </it>in Bo, Tonkolili and Bombali districts with prevalence ranging from 0.0-63.3%, 3.3-90.0% and 0.0-67.9% respectively. The arithmetic mean intensity of <it>S. mansoni </it>infection was 95.4 epg (95% CI: 61.4-129.5 epg), Heavy mean intensity of infection was found in Kailahun (120.2 epg), Kenema (104.5 epg), Koinadugu (112.3 epg) and Kono (250.3 epg). Heavy or moderate infection with <it>S. mansoni </it>occurred in 20.7% of children examined. Hookworm prevalence was moderate: 31.2% (95% CI: 29.1-33.4%), but high in Bo (50.0%) and Tonkolili (56.7%). Hookworm intensity of infection was light with a mean epg of 53.0 (95% CI: 38.4-67.7 epg). Prevalence and intensity of <it>Ascaris lumbricoides </it>(1.5%, 17.8 epg) and <it>Trichuris trichiura </it>(2.5%, 20.3 epg) was low.</p> <p>Conclusions</p> <p>The prediction by previous spatial analysis that <it>S. mansoni </it>was highly endemic across north-eastern Sierra Leone was confirmed with a significant proportion of children heavily or moderately infected. The distribution of <it>S. mansoni </it>in Bo, Tonkolili and Bombali districts ranged widely, highlighting the importance of considering the nature of focal transmission in national mapping exercises. These results were used to refine the MDA for schistosomiasis control to chiefdom implementation units rather than the entire district in these 3 districts. The survey demonstrated that sufficient number of survey sites for schistosomiasis mapping in each district should be used to provide a better national planning of MDA activities, and that it is affordable with the contributions from all parties involved and national resources mobilized.</p

Nutritional Status of Children in Displacement Camps in Sierra Leone

Civil wars have resulted in the displacement of millions of people worldwide and have forced many into temporary displacement camps. Sometimes, most are caught in prolonged and overcrowded refugee camps, which provide ideal grounds for the transmission of diseases, increased risk for acute respiratory infections, diarrhoeal diseases, and malnutrition. In this study, stunting, under nutrition, and wasting were measured among 454 children under the age of 10 years in four internally displaced persons (IDP) camps. Stunting was found to be the most common nutritional abnormality in all four IDP camps with the highest prevalence rate (29.3%) in the Trade Center Camp and lowest (14.2%) in the National Workshop Camp. This study indicates that forced internal displacement results in high prevalence of stunting, wasting and underweight among children.Key Words: Nutritional status, Children, Displacement, Sierra Leone

Prevalence and Intensity of Intestinal Helminth Parasites and Their Response to Treatment with Albendazole in a Rural Community in Sierra Leone

Helminth infections can be an important public health problem in most developing countries. Stool samples from five hundred and fourteen (514) participants in Gbondapi village were examined to determine the prevalence and intensity of intestinal helminths using the Kato-Katz method. The efficacy of a single dose of 200mg and 400mg albendazole in adults and subjects below and above 2 years respectively was also assessed. Seventy-nine (15.4%) of the 514 subjects were infected with at least one intestinal helminth. Data collected was analysed using Epi info statistical package. The most prevalent intestinal helminth was Hookworm (7.6%) followed by Ascaris lumbricoides (5.3%) and Strongyloides stercoralis (3.9%). The least prevalent helminth was Schistosoma mansoni (1.6%). The worm burden was generally light with mean egg counts ranging between 83 – 927eggs/gram of stool. Albendazole had an excellent safety record and found to be highly effective against Ascaris lumbricoides. In order to break the cycle of infection and re-infection in rural communities, programs embracing health education, mass treatment with albendazole, improved sanitation and the provision of protected water sources must be implemented

Treatment of Uncomplicated Falciparum Malaria with Artesunate-Amodiaquine Combination Therapy (ACT) in a Rural Fishing Community in Sierra Leone

Until recently, Chloroquine was the mainstay for malaria chemotherapy in Africa because it is cheap, safe and practicable for out-patient use. Resistance to this drug has however over the past decade, presented a major public health problem with therapeutic and prophylactic implications. As a response to the emergence of resistance to the commonly used antimalarial drugs, the World Health Organisation (WHO) now recommends the use of artemisinin-based combination therapies (ACTs). We assessed the therapeutic efficacy of oral Artesunate-Amodiaquine hydrochloride combination therapy in the treatment of uncomplicated falciparum malaria in a rural fishing community in Sierra Leone. One hundred and fourteen (114) participants aged 0 – 5 years attending the Outpatient Department of Gbondapi Health Centre were screened for recruitment into the study of which 70 fulfilled the inclusion criteria. Artesunate-Amodiaquine hydrochloride combined drug which passed the general counterfeit test of the Ministry of Health and Sanitation was used in the study. Adequate Clinical and parasitological Response (ACPR) was observed in 97% of the study population. Mean parasite clearance time in the participants with ACPR was found to be 24 hours (range 24 –72 hours). All 3% of the treatment failures were observed to be Early Treatment Failures (ETF). Results from the study indicate that Artesunate-Amodiaquine hydrochloride combination therapy is an effective antimalarial drug in a high transmission zone like Sierra Leone, and in the event that the drug is not effective, the results will be evident within one day of commencement of treatment

Presumptive self-diagnosis of malaria and other febrile illnesses in Sierra Leone

Introduction: The objective of this study was to evaluate the prevalence of self-diagnosis of malaria and other febrile illnesses in Bo, Sierra Leone. Methods: All households in two neighboring sections of Bo were invited to participate in a cross-sectional survey. Results: A total of 882 households (an 85% participation rate) that were home to 5410 individuals participated in the study. Of the 910 individuals reported to have had what the household considered to be malaria in the past month, only 41% were diagnosed by a healthcare professional or a laboratory test. Of the 1402 individuals reported to have had any type of febrile illness within the past six months, only 34% had sought a clinical or laboratory diagnosis. Self-diagnosis of influenza, yellow fever, typhoid, and pneumonia was also common. Conclusion: Self-diagnosis and presumptive treatment with antimalarial drugs and other antibiotic medications that are readily available without a prescription may compromise health outcomes for febrile adults and children.Key words: Malaria, fevers, self-care, health services accessibility, community pharmacy services, West Afric

Geographical Distribution of Intestinal Schistosomiasis and Soil-Transmitted Helminthiasis and Preventive Chemotherapy Strategies in Sierra Leone

The common intestinal roundworm, whipworm and hookworm (together known as soil-transmitted helminthes - STHs) together with schistosomes or bilharzia are responsible for extensive ill health, reduced life expectancy and death in sub-Saharan Africa. These diseases are transmitted in areas of poor water supply and sanitation. In order to implement an appropriate national control program, knowledge of the prevalence and geographical distribution of these diseases is required. A national survey was performed in Sierra Leone in 2008. Overall prevalence of intestinal schistosomiasis was 18.4% and that of STHs was 39.1%. Intestinal schistosomiasis was mainly prevalent in the northern and eastern regions while STH is widespread in the country. The results justify routine de-worming for pre-school children, school age children, women of childbearing age, and adults at high risk twice a year. The results also justify using anti-schistosomiasis drug (praziquantel) in school age children, all women of childbearing age, and adults at high risk annually or biennially depending upon the prevalence in the areas