H. M. Gilles

Malaria anaemia and pregnancy.

Physicians at University College Hospital in Ibadan Nigeria selected 250 initially unmarried 17-25 year old women employed at the hospital as subjects of a prospective study of the relationship between malaria anemia and 1st pregnancy. 60 women later became pregnant. Physicians gave full physical examination to each of the 250 women which included urine analysis determination of liver and spleen size and a variety of hematologic tests such as packed cell volume (PCV) and blood film for malaria parasites. The frequency of malaria parasitemia and the density of infection were higher in pregnant women (4-12 times more frequent and 1775 parasites/cubic mm respectively) than the same women prior to pregnancy or in the nonpregnant women. Plasmodium falciparum caused infection in almost all cases with P. malariae being responsible for only 4 cases. The incidence of splenomegaly was much higher in the group of pregnant women (42%) than found in the same women before pregnancy. 38 women did not take antimalaria chemoprophylaxis until that point in pregnancy when treatment was necessary and 24 (63%) of them developed hemolytic anemia (PCV <28%). On the other hand none of the 19 women who received antimalarial drugs developed hemolytic anemia but 1 did develop megaloblastic anemia in the 18th week. The hemolytic anemia occurred between weeks 16-24. In some cases PCV fell before the appearance of detectable parasite densities and hemolysis continued for 2 weeks after chloroquine therapy effectively eliminated parasites. In a country where malaria is endemic administering antimalarial drugs prophylactically throughout pregnancy is the most important antenatal treatment.

The chemotherapy of onchocerciasis. XII. The prediction of microfilarial loads in patients with onchocerciasis after treatment with diethylcarbamazine in northern Ghana.

This paper presents some statistical problems of analysing changes in patterns of microfilarial loads in onchocerciasis patients after chemotherapeutic treatment. Analyses are made of a pooled set of data from ten separate studies of diethylcarbamazine (DEC) conducted at the Onchocerciasis Chemotherapeutic Research Centre, Tamale, between 1978 and 1983. Regression models of microfilarial load at different intervals post-treatment are fitted with initial microfilarial load, total dose of DEC, duration of treatment and age of the patient as the independent variables. Appropriate transformations of the variables are chosen by examination of plots of residuals for violations of the assumptions underlying the regression models. A dose response curve for DEC is produced.

The chemotherapy of onchocerciasis VIII Levamisole and its combination with the benzimidazoles.

In two separate studies the antifilarial activity of levamisole, mebendazole and their combination, and of flubendazole combined with levamisole, were investigated in a total of 96 patients. Ten patients received levamisole 2·;5 mg kg−1 on two occasions during the first week and then weekly for three weeks. Twelve patients received mebendazole 30 mg kg−1 daily in divided doses for three weeks. Thirteen patients received a combination of levamisole and mebendazole. In 12 patients mebendazole was given after two ‘priming’ doses of levamisole. A control group of 11 patients received vitamin preparations. In the second study 20 patients received flubendazole 30 mg kg−1 daily in divided doses for three weeks combined with levamisole 2·5 mg kg−1 given on two occasions in the first week and then weekly. A control group of 18 patients received vitamin preparations. The microfilaricidal effect of the drug regimes was determined by weekly skin snips during and one week after completion of therapy.Levamisole was ine...

The chemotherapy of onchocerciasis. VII. The effect of prednisone on the Mazzotti reaction.

Forty-four patients with onchocerciasis who were treated with diethylcarbamazine (DEC) were entered into a double-blind study using prednisone or placebo to try to alleviate the reactions to treatment. Prednisone was given in an initial dose of 20 mg t.i.d. starting the day before DEC and was decreased stepwise over the next week. The reactions to treatment were quantitated using a recently described scoring system.The mean (±S.D.) microfilarial count in the placebo group prior to treatment was 279 ± 177·6 and in the prednisone group was 283±222±6. Prednisone produced a significant reduction in the severity of the reaction to treatment with DEC, the peak mean score being 88 in the placebo group and 25 in the prednisone group. Prednisone almost completely abolished the cardiovascular and glandular components of the reaction but pruritus was not prevented and the skin rash still occurred although it appeared later than in the control group.Prednisone also significantly reduced the effectiveness of DEC. In t...

The chemotherapy of onchocerciasis IX. The effect of prednisone plus cyproheptadine on the Mazzotti reaction.

Forty male patients with onchocerciasis who were treated with diethylcarbamazine (DEC) were entered into a double-blind study using prednisone plus cyproheptadine or matching placebo to try to alleviate the reactions to treatment. Patients received either both active drugs or both placebo preparations. Prednisone was given in a dose of 20 mg t.i.d. for three days starting one day before DEC (200 mg day−1 for ten days). Cyproheptadine was given in a dose of 4 mg t.i.d. for two days. The reactions to treatment were quantitated using a recently described scoring system.The mean (±S.D.) microfilarial count in the placebo group prior to therapy was 421·2±43·4 and in the active treatment group was 417·8±52·6. Prednisone and cyproheptadine had no significant effect on the overall severity of the Mazzotti reaction over the eight days of the study. However, the reaction scores on Day 1 and Day 2 were significantly less in the active treatment group than in the placebo group (P<0·001). Thereafter the reaction score...

Malumfashi Endemic Diseases Research Project, X. Schistosoma haematobium and bacteriuria in the Malumfashi area.

No association was found between bacteriuria and Schistosoma haematobium infection in the Malumfashi area, and no male had a confirmed significant bacteriuria. The overall bacteriuria prevalence rate in a separate group of schoolgirls was 0.96%, while in females over the age of 20 it was 1.37%; there was an estimated prevalence of 3.2% in women over the age of 30. These figures for females agree with those from populations which have no experience of bilharzia. No urinary S. typhi carriers were found. The lack of association between urinary bacterial infection and schistosomiasis probably reflects the low intensity of S. haematobium infection in the Malumfashi area of northern Nigeria.

Malumfashi Endemic Diseases Research Project XX. Demographic findings: mortality.

Population studies were undertaken as part of the Endemic Diseases Research Project at Malumfashi, northern Nigeria, 1974–1978. This paper is concerned with estimates of mortality. Analyses of prospective registration data indicate under-reporting of deaths and so reliance is placed on estimates derived from the application of indirect techniques to retrospective enumeration data. Twenty-seven per cent of all reported deaths were amongst infants and 64% of deaths occurred during the wet season. Estimates of infant and child mortality are spliced together with estimates of adult mortality to produce a current model life table for Malumfashi. The table suggests an infant mortality rate of 170%‰ and a total mortality in the first five years of life of about 320 per thousand live births. There is some indication that infant mortality has fallen from well over 200%‰ in recent years. This may have resulted in part from the establishment of mother and child health clinics in the area. All data point to a higher ...

Malumfashi Endemic Diseases Research Project. XVII. A knowledge-attitude-practice survey on perception of disease and fertility.

In 1977 a knowledge-attitude-practice survey was conducted on a random sample of 255 mothers of children participating in the malaria study of the Endemic Diseases Research Project at Malumfashi northern Nigeria. The 1st part of the questionnaire was concerned with causation treatment and prevention of childhood diseases common in the area. The 2nd part related food to sickness and health as perceived by the people and focused particularly on food supplementation and weaning practices. Finally information on birth spacing and limitation of family size was sought. The replies on causation of disease had the common theme that God was ultimately responsible for illness. The picture regarding the cause of diarrhea was confused and the answers to the question on the cause of measles suggests that the question was not asked properly. No replies even approached a Western explanation for marasmus and over 3/4 denied knowledge or culpability. In regard to treatment of fever and marasmus Western style therapy was chosen in preference to traditional treatment. The reverse was the case for the treatment of diarrhea and measles. The typical diet is described before focusing on the foods taken or avoided in different disease or health states. Foods such as meat eggs and fish were not considered to be important but reliance largely on guineacorn meant that most nutritional needs were met. Many of the food preferences in different disease or health states were sensible. 91% of mothers completed weaning around 24 months and no earlier than 18 months. Nearly all mothers indicated that the best time to leave between births was 2-3 years. These same data from fertility histories however indicated that a considerable number of conceptions occurred before lactation had finished. 98% of the mothers claimed to finish breastfeeding before resuming sexual relations. Most respondents seemed to have been disinclined to admit knowlege of any contraceptive method even traditional techniques which are well known. Mechanical and chemical contraceptives had not been heard of but a few women admitted to knowledge of hormonal preparations.

Malumfashi Endemic Diseases Research Project. II. Malariometry in Malumfashi, Northern Nigeria.

Prior to longitudinal studies into the effects of malaria upon the immune response, nutritional status and haematological indices in young children in northern Nigeria, the degree of malarial endemicity in the area has been established. Field work was carried out in the wet seasons of 1976 and 1977 and the dry season of 1977 (April). Seasonal variation in transmission has been demonstrated. Age-specific parasite prevalence rates and splenic indices confirm previous studies that this northern part of the Guinea savannah belt of West Central Africa is an holoendemic area.

Studies in Ancylostoma caninum infection in dogs. II. Anatomical changes in the gastrointestinal tract.

(1972). Studies in Ancylostoma caninum infection in dogs. Annals of Tropical Medicine & Parasitology: Vol. 66, No. 1, pp. 107-128.