Emmanuel Effa

Open-label trial of three dosage regimens of fixed-dose combination of artemisinin and naphthoquine for treating uncomplicated falciparum malaria in calabar, Nigeria

BackgroundThe use of anti-malarial drug combinations with artemisinin, or with one of its derivatives, is now widely recommended to overcome drug resistance in falciparum malaria. Fixed-dose combination of artemisinin and naphthoquine is a new generation artemisinin combination therapy (ACT) offered as a single dose therapy. The aim of the study was to assess the therapeutic efficacy, safety and tolerability of three dosage schedules of fixed-dose combination of artemisinin (125 mg) and naphthoquine (50 mg) for treating uncomplicated Plasmodium falciparum malaria among adolescents and adults in Calabar, South-east Nigeria.MethodA total of 121 patients aged ≥15 years with uncomplicated P. falciparum malaria were enrolled and randomly assigned to three dosage schedules: (A) 700 mg (four tablets) single dose; (B) 700 mg 12-hourly x two doses; and (C) 1,400 mg (eight tablets) single dose. Patients were observed for 28 days, with clinical, parasitological, and haematological assessments.ResultsA total of 108 patients completed the study. The overall 28-day cure rate was 88.9%. Day 28-cure rates of the three dosage schedules were 85.3%, 93.1% and 88.9% for Group A, B and C respectively. Adverse events were few and mild, the commonest being weakness and headache; there was no serious adverse event.ConclusionConcerns for emergence of parasite resistance due to the use of artemisinin-naphthoquine as single dose regimen is likely to compromise the usefulness of this potentially important combination treatment. A robust multi-centre trial is recommended to evaluate a three-day regimen with potentials to achieve high cure rates while minimizing the risk of emergence of resistant parasite strains.

Association between Urinary N-Acetyl-Beta-D-Glucosaminidase and Microalbuminuria in Diabetic Black Africans

Diabetes mellitus is the commonest cause of ESRD worldwide and third most common cause in Nigeria. Recent reports from Nigeria indicate the prevalence of diabetic nephropathy as an aetiology of ESRD is increasing necessitating early diagnosis of diabetic nephropathy. We measured the urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG), NAG/creatinine ratio, urinary protein-creatinine ratio and calculated eGFR in 30 recently diagnosed nonhypertensive diabetics and 67 controls. The age and sex distribution, systolic blood pressure, serum and urinary creatinine were similar for both groups. There was higher urinary excretion of NAG (304 versus 184 μmol/h/L, P < 0.001) and NAG/creatinine ratio (21.2 versus 15.7 μmol/h/L/mmolCr, P < 0.001) in the diabetics than controls. There was a strong correlation between NAG/creatinine ratio and albumin/creatinine ratio (r = 0.74, P < 0.001). A multivariate linear regression model showed a significant linear relationship between NAG/creatinine ratio and albumin/creatinine ratio after adjusting for the effect of blood pressure, age, sex, and serum creatinine. The strong association found between albumin/creatinine ratio and NAG/creatinine ratio perhaps indicates the need for further investigation of the clinical utility of NAG/creatinine ratio as a screening tool for early nephropathy in African diabetics.

Priority setting for systematic review of health care interventions in Nigeria

OBJECTIVES In an era of evidence based medicine and systematic review, this study seeks to identify priority systematic review topics that address common health problems in Nigeria. METHODS Firstly, a primary list of health problems was compiled from the National Health Management Information Systems and information from key informants (health professionals, researchers and NGOs) drawn from the six geo-political zones in Nigeria. Key steps included compilation and ranking of a comprehensive list of health problems into 4 categories: adult communicable, non-communicable, maternal and child health; searching the Cochrane Library and electronic databases for systematic reviews on identified priority problems, analysis of search outputs to identify gaps; listing and ranking of new priority systematic review topics using pre-determined criteria. RESULTS Eighteen questions made the final list of priorities systematic reviews and 9 of them were related to malaria. There were 7 additional issues that the panelists identified as crucial cross-cutting issues that need to be addressed in systematic reviews. CONCLUSION Identification and prioritization of systematic reviews relevant to health care in Nigeria will improve the opportunity to deliver evidence-based and equitable health care to the people. These topics are likely to be also important for health care decision in other resource-poor settings.

The Pattern of Respiratory Disease Morbidity and Mortality in a Tertiary Hospital in Southern-Eastern Nigeria

Background. Respiratory complaints are commonly encountered in medicine and respiratory diseases place a high burden on healthcare infrastructure. Healthcare planning should be based on adequate information: this study will help us to analyze the pattern of respiratory disease admissions in the medical wards in a developing country. Methods. The medical records of patients admitted into the medical wards over a 5-year period were retrieved and reviewed. Information obtained included demography, diagnosis, comorbid conditions, and risk factors for respiratory disease. Results. Three thousand four hundred and ninety patients were admitted into the medical wards with 325 (9.3%) of them diagnosed with a respiratory condition. There were 121 females and 204 males. The average age of the patients was 40.7 ± 14.7 years. Only 7% of the patients smoked cigarette. The commonest respiratory conditions were tuberculosis (66.8%) and pneumonia (24.9%). The commonest comorbidity was HIV infection (39.7%). Tuberculosis/HIV coinfection rate was 50.7%. HIV infection was the single most important predictor of an adverse outcome (OR 5.1, 95% CI 2.05–12.7, P < 0.001). Conclusion. Infective conditions make up a large percentage of respiratory diseases in low income countries with HIV infection constituting a significant risk factor for a poor disease outcome.

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review

Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence.

Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria

Objective This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist. Results A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%. Conclusion There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.

Management of severe malaria in children under 5 years of age in private and public health facilities in Cross River State, southeastern Nigeria: an audit of current practices

1Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria; 2Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria; 3Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria; 4Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria; 5Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria

Cochrane Africa: a network of evidence-informed health-care decision making across sub-saharan Africa

Cochrane Africa is a network of researchers and health stakeholders who aim to support the use of high quality Cochrane evidence to improve health outcomes in Africa. It comprises a coordinating centre in South Africa, a Francophone hub directed from Cameroon, a Southern and Eastern Africa Hub directed from South Africa and a West Africa Hub directed from Nigeria. The network supports the engagement with healthcare decision makers to guide priorities, production of high quality context-relevant Cochrane systematic reviews, capacity building to conduct and use reviews, dissemination of evidence, knowledge translation, partnerships for evidence-informed healthcare and the creation of opportunities to expand the network.

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

Introduction The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients. Methods We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman–Tukey transformation. Result Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2–7.7%) with MDRD, 4.8% (95%CI 2.9–7.1%) with CKD-EPI and 12.3% (95%CI 8.4–16.7%) with Cockcroft–Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2–11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9–20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0–3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status. Conclusion CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.