Efficacy, safety and tolerability of artesunate-mefloquine in the treatment of uncomplicated Plasmodium falciparum malaria in four geographic zones of Nigeria

<p>Abstract</p> <p>Background</p> <p>The combination of artesunate and mefloquine has been reported to be effective against multi-drug resistant <it>Plasmodium falciparum </it>malaria, which has been reported in Nigeria. The objective of this multi-centre study was to evaluate the efficacy, safety and tolerability of the co-packaged formulation of artesunate and mefloquine in the treatment of uncomplicated malaria in two weight groups: those between 15 – 29 kg and ≥ 30 kg respectively.</p> <p>Methods</p> <p>The trial was conducted in rural communities in the north-east, north-central, south-west and south-eastern parts of Nigeria. The WHO protocol for testing antimalarial drugs was followed. Outpatients having amongst other criteria, parasite density of ≥1,000 μl were enrolled. The co-packaged drugs were administered for 3 days at a dosage of artesunate, 4 mg/kg body wt/day and mefloquine, 25 mg/kg/body wt total) on days 0, 1 and 2. Patients were followed up for 28 days with the assessment of the parasitological parameters on days 1, 2, 3, 7, and 28.</p> <p>Results</p> <p>Four hundred and forty-six (446) patients were enrolled and 431 completed the study. Cure rates in both treatment groups was >90% at day 28. The mean parasite clearance times in treatment groups I and II were 40.1 and 42.4 hours respectively. The combination of artesunate and mefloquine showed good gametocidal activity, (gametocyte clearance time of 42.0 & 45.6 hours in treatment groups I and II respectively). There were no serious adverse events. Other adverse events observed were headache, dizziness, vomiting and abdominal discomfort. There was no significant derangement in the haematological and biochemical parameters.</p> <p>Conclusion</p> <p>This co-packaged formulation of artesunate + mefloquine (Artequin™) is highly efficacious, safe and well-tolerated. It is recommended for the treatment of uncomplicated <it>P. falciparum </it>malaria in Nigeria.</p

Accelerometer-determined physical activity and its comparison with the International Physical Activity Questionnaire in a sample of Nigerian adults.

IntroductionAccurate assessment of physical activity to identify current levels and changes within the population is dependent on the precision of the measurement tools. The aim of this study was to compare components of physical activity measured with an adapted version of the International Physical Activity Questionnaire (Hausa IPAQ-SF) and the accelerometer in a sample of Nigeria adults.MethodsOne hundred and forty-four participants (Mean age = 32.6 ± 9.9 years, 40.3% women) in a cross-sectional study wore an accelerometer for seven consecutive days and completed the Hausa IPAQ-SF questionnaire on the eighth day. Total physical activity, time spent in moderate-to-vigorous activity (MVPA) and sedentary time assessed by Hausa IPAQ-SF and accelerometer were compared. The absolute and criterion- related validity of the Hausa IPAQ-SF was assessed by Bland-Altman analysis and Spearman Correlation Coefficients, respectively. Specificity and sensitivity were calculated to classify individuals according to the global standard guideline for sufficient physical activity.ResultsCompared with the accelerometer, higher time in MVPA and total physical activity were reported on the Hausa IPAQ-SF (pConclusionsThe Hausa IPAQ-SF overestimated components of physical activity among Nigerian adults, and demonstrated poor to moderate evidence of absolute and criterion validity. Further evaluation of IPAQ and other self-report physical activity instruments in other Africa populations could enhance accurate evaluation of physical activity data in the region countries

Number (%) of participants classified as being sufficiently active according to physical activity guidelines by self-report (Hausa IPAQ-SF) and by accelerometry (Actigraph).

<p>PA: Physical activity.</p

Bland-Altman plot for min.day⁻¹ reported for sitting time from the Actigraph and IPAQ.

<p>The mean error scores are illustrated by a solid horizontal line and the limits of agreement (±1.96 SD from the mean) are shown as dashed horizontal lines.</p

Bland-Altman plot for min.day⁻¹ reported in total physical activity (PA) from the Actigraph and IPAQ.

<p>The mean error scores are illustrated by a solid horizontal line and the limits of agreement (±1.96 SD from the mean) are shown as dashed horizontal lines.</p

Descriptive physical activity data from IPAQ and Actigraph, by sex, age, BMI and education; Mean (SD) and Interquartile Ranges.

*<p>- Significant difference between IPAQ-Actigraph tested for total PA, vigorous, moderate, Moderate-to-Vigorous PA, and sitting, respectively, using paired non parametric Wilcoxon test, <i>p</i><0.001;</p>†<p>- Cut-off values for sitting, moderate and vigorous were <100, 761–5724, and >5724 counts, respectively;</p>‡<p>_ Mean (±Standard deviation); <i>IQR</i>_ Interquartile range; BMI_ Body Mass Index; PA_ Physical.</p

Bland-Altman plot for min.day⁻¹ reported in Moderate-to-Vigorous (MVPA) physical activity from the Actigraph and IPAQ.

<p>The mean error scores are illustrated by a solid horizontal line and the limits of agreement (±1.96 SD from the mean) are shown as dashed horizontal lines.</p

Descriptive characteristics of the sample.

<p>*- Significant difference exists between men and women at p<0.05.</p><p>SD- Standard Deviation.</p><p>BMI- Body Mass Index.</p

Spearman Rank Correlation Coefficient (Rs) for Total Physical Activity and Time Spent in Physical Activity from IPAQ and Actigraph (n = 144).

†<p>_Cut-off values for sitting, moderate, and vigorous were <100, 1952–5734, and >5724, respectively.</p>‡<p>_IPAQ total PA (MET-min.d-1).</p>‡‡<p>_Actigraph Total Count (count.min-1).</p>*<p>_p<0.05;</p>**<p>_p<0.01.</p><p>MVPA: Moderate-to-vigorous physical activity.</p