Ins Dozie

The varied beneficial effects of ivermectin (Mectizan) treatment, as observed within onchocerciasis foci in south–eastern Nigeria

Abstract In the treatment of humans, ivermectin (Mectizan®), a semi-synthetic macrocyclic lactone, is now primarily used as a rapid microfilaricide. The drug has several other benefits, however, and these have recently been investigated in five states in south–eastern Nigeria, where there have been mass treatments with ivermectin, for the control of Onchocerca volvulus, for more than 10 years. Between the January and December of 2005, 3125 adult onchocerciasis patients (each aged ≥20 years and known to have at least one clinical sign of onchocerciasis) were enlisted, clinically examined and interviewed. Relevant data were collected in the interviews, using a structured, pre-tested questionnaire, and in personal and focus-group discussions. Overall, 612 (19.6%) of the subjects reported that they had had nodules that had disappeared following repeated doses of ivermectin, although only 83.8% of the 612 attributed their nodule clearance to ivermectin (the other 16.2% being unsure of the cause). A larger percentage of the subjects (24.6%) reported that they had expelled intestinal helminths following the last round of ivermectin treatment (i.e. been dewormed). Other side-benefits reported in the study were improved vision (11.7% of subjects), reversal of secondary amenorrhea (4.5%), increased appetite (22.3%), reduction in arthritic or other musculo–skeletal pain (7.9%), reductions in the severity of body itching (18.5%) and skin rash (17.3%), darkening of leopard skin (6.6%), improved libido in men (6.6%), and clearance of head lice (4.5%). If, via health education, the local communities could be made more aware of the side-benefits of ivermectin treatment, the sustainability of the on-going programme of community-directed treatment with ivermectin (CDTI) in south–eastern Nigeria would probably be improved.

Endemicity of schistosomiasis in some parts of Anambra State, Nigeria

Investigation on the prevalence of infections with schistosoma was carried out amongst inhabitants of two local government areas (LGAs), Nigeria between October 2007 and September 2008. A total of 2064 randomly selected subjects had their urine and stool samples examined for eggs of Schistosoma and 323 (15.7%) were excreting eggs of S. haematobium in their urine with geometric mean egg count (GMEC) of 10.1 eggs/10 ml of urine. No eggs of S. mansoni were found. Prevalence of infection varied between 12.8 and 19.8% between the LGAs, but the differences were not statistically significant (P>0.05). Prevalence also varied significantly between the age groups (P<0.05) with peak occurring among persons aged 11 to 20 years and decreased thereafter. There was a close association between haematuria and the presence of eggs of S. haematobium in the urine (P<0.05). People that tested positive for schistosomiasis were 26.4 times at greater risk (P<0.001) of haematuria as compared to those who tested negative. The result indicated 83.1% sensitivity and a specificity of 91.4%. Farmers (OR=2.31; P<0.05) were significantly at greater risk of schistosomiasis infection as compared to the artisans. The importance of these findings and their implications for control of the disease in Anambra State are discussed. Key words: Schistosomiasis, endemicity, Anambra State.

Control of endemic dracunculiasis in Ebonyi state, south-eastern Nigeria.

A field study was carried out in Ozibo and the Ebonyi local government area of Ebonyi state, south-eastern Nigeria to determine the effectiveness of several intervention strategies in the control of endemic dracunculiasis in that area. During the initial study prior to the application of such measures, 14,421 subjects were examined. A total of 8,688 (60.2%) persons had either Dracunculus ulcers or emergent worms. Sex-related prevalence rates were 56.1% and 63.9% for males and females respectively. Age specific prevalence rates increased with age in males, whereas highest infection rates were found in females younger than 20 years. Twenty-eight months after the introduction of intervention strategies the prevalence rate fell by 85.1% to 9% (males: by 88.2% to 6.6%, females: by 83.0% to 10.8%). Reduction rates of more than 90% were observed in males aged 10 to 19 and in females aged 0 to 9 years. Intervention measures included systematic pond treatment, distribution or replacement of filters, intensive health education, provision of hand-dug wells, regular bore-hole installation/rehabilitation as well as active case detection, containment, management, and prompt reporting. Active involvement of the endemic communities, governments and the Global 2000 staff regarding the control efforts is a necessity towards the final eradication of the disease in the near future. The relationship between some of these intervention strategies and community development are highlighted.

Prevalent home management techniques and outcome among mothers of febrile children in Eastern Nigeria

The magnitude of the consequences and the extent of problem associated with febrile illnesses in children have been shown to be associated to mothers’ behaviour in treatment, decision making and prevention of childhood illnesses which are in turn influenced by social, cultural and intra-household relations. This study employed a cross-sectional survey design to assess the method employed by caregivers in the management of febrile conditions of their children in parts of Eastern Nigeria. About 100 women were sampled using multistage sampling techniques. Common actions taken by mothers and caregivers in the management of febrile include administration of home drug (32%), tepid sponging (4%), striping the baby naked (16%) and took baby/child to hospital (48%). Result from the study showed significant relationship between age of mother (p<0.05), educational attainment of mother (p<0.05), number of children (p<0.05) as well as occupation of mothers (p<0.05) and management action taken. Caregivers need to be properly aware of ill health conditions of their children and be properly equipped with prowess to manage them. There is also need for the governments through the primary health care system to improve their interaction with the grass root women and educate them more on integrated management of childhood illness.

Clinical and parasitological aspects of onchocercal skin diseases in Nigeria.

An assessment of onchocercal skin disease (OSD) conducted in 38 rural communities in the Imo River Basin, Nigeria, between March 1999 and September 2000, showed that depigmentation (DPM) was the most prevalent lesion in persons with skin microfilariae (mf) (26.3%), followed by chronic papular onchodermatitis (CPOD) (18.1%) and acute papular onchodermatitis (APOD) (15.5%). There was no significant difference (P>0.05) in sex-related prevalence of OSD. While CPOD, lichenified onchodermatitis (LOD) and DPM were more prevalent in subjects over 30 years old, APOD was associated more with those aged less than 30 years. OSD occurred with concomitant itching in nearly 50% of subjects. The geometric mean intensity of infection was 13 mf/mg per skin snip.

Onchocerciasis in Imo state, Nigeria (2): the prevalence, intensity and distribution in the upper Imo river basin.

Human infection with Onchocerca volvulus was investigated in 13 rural communities in the Upper Imo River basin, Imo State, Nigeria between March 1997 and December 2000 using the skin snip method. Of the 3,311 persons examined, 889 (26.8%) had microfilariae. There were significant differences between communities in microfilariae prevalence and intensity of infection (P < 0.05). Sex infection was similar in males (26.8%) and females (26.9%); whereas farmers (46.6%) and fishermen (28.4%) were more affected than people in other occupations. The proportion of infected persons increased with age coinciding with the period when most clinical signs manifest. A significant proportion of the 889 persons with positive microfilariae skin biopsy had musculoskeletal pain (57.1%). Thirty-four (47.2%) of the 72 epileptics identified had positive skin biopsy in addition to other manifestations. The present findings show that onchocerciasis is a public health problem in the area. The use of ivermectin has reduced the incidence of the disease when compared with data from the pre-ivermectin era. This shows that Community Directed Treatment with Ivermectin (CDTI) campaign is successful and should be sustained until onchocerciasis is eliminated as a public health problem in the area.