Paul Okonkwo

Economic burden of malaria illness on households versus that of all other illness episodes: a study in five malaria holo-endemic Nigerian communities.

We compared the financial and economic costs of malaria attack to that of a combination of other illness episodes on households in five malaria holo-endemic rural communities. The data was collected from household heads or their representatives using pre-tested interviewer-administered questionnaire. Information was collected on the amount of money household spent to treat both malaria and other illnesses respectively, together with the time lost due to both the groups of illnesses within 1 month prior to the interview. The findings showed that the cost of treating malaria illness accounted for 49.87% of curative health care costs incurred by the households. Average malaria expenditure was

Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria

1.84 per household per month, while it was

Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children

2.60 per month for the combination of other illness episodes. The average person-days lost due to malaria and the combination of other illnesses were almost equal. If the financial costs of treating malaria and other illnesses are combined, this cost will deplete 7.03% of the monthly average household income, with treatment of malaria illness alone depleting 2.91%. Thus, malaria is a big contributor to the economic burden of disease, in malaria holo-endemic communities. Community-effective malaria control programs are needed to reduce this burden on the households.

Hypothetical and actual willingness to pay for insecticide‐treated nets in five Nigerian communities

BackgroundThere is little existing knowledge about actual quality of drugs provided by different providers in Nigeria and in many sub-Saharan African countries. Such information is important for improving malaria treatment that will help in the development and implementation of actions designed to improve the quality of treatment. The objective of the study was to determine the quality of drugs used for the treatment of malaria in a broad spectrum of public and private healthcare providers.MethodsThe study was undertaken in six towns (three urban and three rural) in Anambra state, south-east Nigeria. Anti-malarials (225 samples), which included artesunate, dihydroartemisinin, sulphadoxine-pyrimethamine (SP), quinine, and chloroquine, were either purchased or collected from randomly selected providers. The quality of these drugs was assessed by laboratory analysis of the dissolution profile using published pharmacopoeial monograms and measuring the amount of active ingredient using high performance liquid chromatography (HPLC).FindingsIt was found that 60 (37%) of the anti-malarials tested did not meet the United States Pharmacopoeia (USP) specifications for the amount of active ingredients, with the suspect drugs either lacking the active ingredients or containing suboptimal quantities of the active ingredients. Quinine (46%) and SP formulations (39%) were among drugs that did not satisfy the tolerance limits published in USP monograms. A total of 78% of the suspect drugs were from private facilities, mostly low-level providers, such as patent medicine dealers (vendors).ConclusionThis study found that there was a high prevalence of poor quality drugs. The findings provide areas for public intervention to improve the quality of malaria treatment services. There should be enforced checks and regulation of drug supply management as well as stiffer penalties for people stocking substandard and counterfeit drugs.

Aflatoxin load of common food in savanna and forest regions of Nigeria

Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.

Willingness to pay for community-based ivermectin distribution: A study of three onchocerciasis-endemic communities in Nigeria

OBJECTIVES To determine the hypothetical and actual willingness of households to pay (WTP) for insecticide‐treated nets (ITNs), and compare these in areas with and without previous exposure to free ITNs.

Adverse events following mass ivermectin therapy for onchocerciasis

Aflatoxin, one of the most widespread of the known carcinogens, is present at a high level in most common foods stored poorly for long periods in Nigeria. It may work synergistically with other carcinogens to produce the high incidence of primary liver cancer seen in young men under the age of 40. In the northern savanna areas cereals, especially sorghum and millets, as well as groundnut products are the high risk foods. In the southern forest areas, dried fish, groundnuts and oil palm products often carry unwholesome quantities of aflatoxin. Public health measures aimed at reducing the aflatoxin load in high risk foods identified should now be actively considered.

Willingness to pay for the retreatment of mosquito nets with insecticide in four communities of south‐eastern Nigeria

Objective To determine the willingness to pay (WTP) for local ivermectin distribution in a community financing framework.

A health club for a community school in south-eastern Nigeria: influence on adult perception of onchocerciasis and compliance with community-based ivermectin therapy.

The Achi community of south-east Nigeria was given mass ivermectin therapy to control endemic onchocerciasis. 7556 subjects (75.6% of those eligible) were dosed. 992 patients (13.1%) complained of adverse effects, mostly within one week of dosing. Adverse events were mainly of the Mazzotti type. Exacerbation of pruritus (71.2%), oedema (47.4%), headache (46.4%), and worsening of rash (24.4%) were the most common. In 962 subjects (97%), adverse events were mild and did not prevent work. Two patients suffered severe sustained postural hypotension. The incidence of adverse events was greater in villages with a high load of microfilarial infection.

Comparison of three strategies for mass distribution of ivermectin in Achi, Nigeria

Summary objectives  To determine the willingness to pay (WTP) for the retreatment of insecticide‐treated nets (ITN) in four malaria holoendemic communities of Nigeria.