Effect of health education on long lasting insecticidal nets utilization among mothers of under five children in Yamaltu Deba Lga, Gombe State, Nigeria

Background: Malaria remains a major global public health challenge. It is the leading cause of death among children below the age of five years and constitutes 10% of the continent's disease burden. The objective of this study was to determine effect of health education on utilization of long lasting insecticidal nets (LLINs) among mothers of under five children in Yamaltu Deba LGA of Gombe state: Objective: This study was aimed at determining the effect of health education on LLINs utilization among mothers of under five children in Yamaltu Deba LGA of Gombe State. Method: The study was a community-based quasi-experimental intervention where 240 mothers of under five children were selected from two communities using a multi stage sampling technique. Health education was given in the study community and withheld in the control community. Data was collected from both communities before and after the intervention using an interviewer administered structured questionnaire. Data was analyzed using EPI-INFO 3.7.1 and Micro soft Excel software. Result obtained was presented using proportion, Chi-square test was used to assess the relationship between categorical variables and decision taken at p<0.05. Results: The mean ages of respondents in study and control communities were 28.9±6.2 and 27.9±6.7 years respectively. At pre-intervention, LLIN ownership was found to be 86.6% and 76.3% while its utilization was 45.4% and 38.1% in both communities. After health education intervention, (LLINs) improved significantly in study community from 42.9% to 89.9% compared with control community which increased from 33.9% to 60.9% and the difference was statistically significant(P=0.0001). Conclusion: This study concludes that health education significantly improved utilization. We recommended continuous health education on LLINs utilization in communities especially among mothers of under five children

Adherence to antimalarial drug policy among doctors in Delta State, Nigeria: implications for malaria control

Background: Malaria is a public health problem compounded with a widespread emergence of drug-resistant Plasmodium falciparum which necessitated the formulation of a new antimalarial drug policy (AMP).Objective: This study was designed to assess adherence to the policy among physicians in health facilities in Delta state, Nigeria. Design: Cross-sectional, analytic study. Data were collected with a semi-structured questionnaire.Setting: Two secondary and one tertiary health facilities in Delta State, Nigeria Participants: Physicians selected with a simple random technique from the facilities Main outcome measures: Prescribing pattern of antimalarial drugs and adherence to WHO treatment guideline among doctors. Results: Majority (90.8%) of respondents believed the antimalarial policy (AMP) should be strictly adhered to, although three-fifth (61.0%) of them rated its performance as poor. The level of adherence to the national antimalarial drug policy was high (78.5%) as most doctors prescribed Arthemeter-Lumefantrine, AL for uncomplicated malaria however barely two-fifth (35.4%) adhered to prescribing injectable Artesunate for complicated malaria. AL, (71.9%) was the most prescribed antimalarial drug for uncomplicated malaria The most prescribed antimalarial drugs for complicated malaria was artesunate (40.0%) followed by quinine (27.6%) and artemether (26.7%); although, chloroquine was also prescribed.Conclusion: The level of adherence to AMP among doctors was sub-optimal. Continuous education of doctors on the new AMP is needed to achieve malarial control

Factors affecting treatment practices of patent medicine vendors for malaria in under-five children: implications for malaria control in Nigeria

Background: Patent medicine vendors (PMVs) are the most common source of antimalarial drugs and treatment for majority of Nigerians. The quality of their practice could have implications for malaria control. This study sought to explore the factors influencing the malaria treatment practices of PMVs for under-five children in Akwa Ibom State. Methods: A cross-sectional survey using an interviewer-administered questionnaire was conducted among 176 PMVs selected by simple random sampling from two local government areas (LGAs). In addition, four focus group discussions (FGD) were conducted to generate qualitative data. Quantitative data was analysed using SPSS version 20 while content analysis was done on the qualitative data. Results: Artemisinin Combination Therapy (ACT) was the most frequently recommended antimalarial treatment by PMVs (75.6%) for children as against chloroquine (17%) and Sulphadoxine/Pyrimethamine (2.8%). However, only 39.2% of PMVs recommended the appropriate antimalarial treatment (ACTs at the right dose for age), while 71% recommended referral for severe malaria. Factors found to be associated with appropriate management of malaria from quantitative analysis included Educational qualification, attending malaria training and their knowledge of malaria. The FGDs showed that severity of child's illness, parents/caregivers drug request and perceived ability of the parents/caregiver to afford the drugs influenced PMVs malaria treatment practices. Conclusion: Knowledge of malaria, severity of child's illness and parents' drug request influenced the treatment practices of PMVs. Training PMVs on appropriate malaria management and community health education/sensitization to leverage on the influence of client-demand on ACT use is recommended to improve PMVs treatment practice

Assessment of adverse drug reactions in the home management of malaria cases of children under 5 years using artemisinin-based combination therapy in Mfou health district, Center region of Cameroon

health concerns in Cameroon. Its treatment is frequently initiated at home, most often with street drugs. The home management of malaria cases entails the prescription of Artemisinin-based combination (ACTs) as first-line therapy for treatment of uncomplicated malaria after having confirmed the malaria case using rapid diagnostic tests. But induced adverse reactions of this therapy are not well known in Cameroon. Thus, a prospective, observational, cohort study of adverse events associated with ACTs was conducted from January 2013 to November 2013 in the health district of Mfou. Children under 5 years receiving ACTs for malaria treatment at home were enrolled. Suspected ADRs and other clinical events were recorded. Data were managed and analysed using Epi Info version 3.5.3 and Statistical Package for Social Sciences, statistical software version 20. Of the 479 children investigated, 56.8% (n=272/479) were males, the age group 25-59 months (49.5%; n=237/479) was most represented, 27.1% (n=130/479) had experienced one form of ADRs, male children (56.2%; n=73/130) and the age group 25-59 months (50.8%; n=66/130) were most affected. No significant association was found between age, sex and incidence of adverse ACTs reactions. The main experienced ACTs reactions were tiredness (43.1%; n=56/130) followed by lack of appetite (24.6%; n=32/130). The incidence ACTs ARDs was found to be relatively low and tolerable. Home management of malaria cases using ACTs should be encouraged and community members should be trained to improve the recognizing and reporting of adverse effects

Post-malaria myasthenia gravis

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction of medial gaze following an attack of febrile illness. The child was admitted into a rural hospital where she was misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospital when her condition was not improving and where she developed the eye signs. She was diagnosed as a case of severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examination revealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors. Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorum communis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvement after pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrence of her symptoms

Efficacité et tolérance de Malacur® (dihydroartémisinine-pipéraquine) dans le traitement du paludisme simple à Plasmodium falciparum chez les sujets âgés de plus de 14 ans au Cameroun

Introduction: Les combinaisons thérapeutiques à base d'artémisinine sont depuis quelques années le traitement antipaludique de première intention dans une grande partie des pays endémiques. Des souches résistantes à différentes combinaisons ont été décelées en Asie du sud-est, ce qui oblige à une surveillance continuelle dans le monde entier. Matériels et méthode : Pour cela, à Yaoundé (Cameroun), a été réalisée une étude prospective,ouverte, non-randomisée pour évaluer l'efficacité clinique et parasitologique de l'association dihydroar- témisinine-pipéraquine (DHA-PQ) dans le traitement du paludisme simple à P. falciparum, chez les sujets âgés de plus de 14 ans. Résultats : Les résultats ont montré que 100% des 47 patients inclus dans cette analyse ont été libres de parasitémie dès le premier jour après la fin du traitement et les résultats se sont maintenus jusqu'à la fin du suivi, le 28ème jour. De la même manière 78,7% des patients ont été apyrétiques le jour après la première prise et 100% après les 3 jours de traitement. Aucun patient n'a montré d'évènement indésirable grave ni n'a abandonné le traitement pour cette raison. Conclusion : Les résultats confirment l'efficacité de l'association DHA-PQ comme traitement de première intention dans le traitement du paludisme non-compliqué à Plasmodium falciparum

Management of malaria in pregnancy by Traditional Birth Attendants in Ogun State, Nigeria

Background: Malaria in pregnancy is a major public health issue in sub-Saharan Africa. Most deliveries in this region are attended by the Traditional Birth Attendants (TBAs).Objective: To assess the knowledge and practice of prevention and treatment of malaria in pregnancy amongst TBAs in Ogun State, south-west Nigeria.Methods: This descriptive, cross-sectional study used systematic random sampling to select 200 registered TBAs within the state. Pre-tested, semi-structured interviewer-based questionnaires were used to obtain relevant data.Results: The mean age of respondents was 37.7 ± 2.2 years. Most of the respondents had secondary school education (82.0%) and were females (89.0%). The majority (68.0%) had good knowledge of malaria during pregnancy; 83.0% used blood test for the diagnosis of malaria while 62.2% of these used Malaria Rapid Diagnostic Test kits. A third of the respondents (33.0%) used Artemisinin-Combination Therapy for treatment while 13.0% used Chloroquine. The majority (85.5%) of the respondents did not practice directly observed therapy in intermittent preventive treatment for malaria using Sulphadoxine-Pyrimethamine (SP). The age of the respondents was significantly associated with their level of knowledge (p = 0.019).Conclusion: The TBAs had high level of knowledge and good practice of the management of malaria in pregnancy. However, some still treated malaria with Chloroquine and were not conversant with the use of SP for the prevention of malaria. It is recommended that capacity building sessions for the TBAs be instituted to improve the quality of care they provide

Methods Employed in the Prevention and Treatment of Malaria among Pregnant Women in a Riverine Community in Bayelsa State; Nigeria

Background: Malaria remains a major public health problem in Nigeria and is the most common cause of hospital attendance in all age groups of which children and pregnant women are the major risk groups; therefore this study was designed to explore various methods of prevention and treatment of malaria among pregnant women in riverine community in Bayelsa State.Method: A descriptive survey with a sample size of 120 respondents. Data were collected using questionnaire and SPSS version 20 was used for data analysis.Results: The finding of the study revealed that majority of the respondents were within 16-25; with a minimum age of 16; maximum age of 45 and a mean of 30. More than half of the respondents agreed that malaria can be transmitted to the fetus and can lead to intrauterine fetal death. Majority uses insecticide treated nets (ITNs); snapper; insecticide spray; window and door net in preventing malaria; while a good number of the respondent claimed to use drug when they have malaria; most of which were prescribed.Conclusion: Majority of the respondents employed good practices in the prevention and treatment of malaria. However; some of the respondents still use crude methods that are detrimental to health. Therefore; it was recommended that community awareness and enlightenment programmes should be put in place in order to eradicate the crude methods that are harmful; as well as promote the good methods used in the prevention and treatment of malaria

Traitement preventif intermittent du nourrisson par la Sulfadoxine-Pyrimethamine en Republique Democratique du Congo : etude de faisabilite au niveau des sites sentinelles de Kinshasa et du Bas-Congo.(Protocole de recherche)

Introduction : La paludisme est responsable d'une importante morbidite en milieu tropical principalement chez le jeune enfant. Le TPI administre au nourrisson dans le cadre du programme elargi de vaccination reduit l'incidence du paludisme maladie et le taux de mortalite infantile. Cependant; le succes du traitement preventif intermittent du nourrisson (TPI) a la Sulfadoxine-pyrimethamine (SP); outre l'efficacite de la molecule utilisee; repose aussi sur la perception de la chimio prevention par la communaute. L'objectif principal de l'etude est d'evaluer la faisabilite du TPI du nourrisson a la SP en RDC. Methodologie: Notre etude sera transversale analytique avec un volet quantitatif et un volet qualitatif. L'etude sera menee du 01 Novembre au 31 Decembre 2014 dans les sites sentinelles de Kingasani et Kimpese respectivement dans les provinces de Kinshasa et du Bas-Congo incluant respectivement 311 et 309 nourrissons de 2 a 11 mois. Resultats : Les donnees principales a recueillir sont; pour la partie quantitative; la prevalence de la fievre et la prevalence parasitaire; et la couverture vaccinale ainsi que leur determinants y compris la prevalence des les mutations C59 R pfdhfr et 540 E pfdhps. Pour la partie qualitative; on explorera l'adhesion ou non au TPI ainsi que les raisons d'une non adhesion eventuelle. Discussion: A travers cette etude; nous esperons obtenir les donnees sur les conditions d'application du TPIn a la SP dans le contexte de la RDC afin de mettre a jour la politique de lutte pour elargir le pannel d'outils capables de reduire la morbidite et la mortalite palustre en RDC

Malaria in Developing Countries

Malaria still poses a real threat to travellers; particularly in areas with high transmission rates such as sub-Saharan Africa; Papua New Guinea; and the South Pacific islands. Malaria causes an estimated 660;000 deaths each year from 219 million cases of illness. It is a preventable and curable disease. Malaria symptoms appear after a period of seven days or longer; and without treatment; the disease can lead to death. Mosquito bite prevention is the main way to reduce malaria transmission. Chemoprophylaxis recommendations depend on travelers' age; destination; type of travelling; or length of stay. Pregnant women; children; and immunosuppressed travelers are the most susceptible. There are currently no licensed vaccines against malaria. Results about a research vaccine candidate known as RTS;S/AS01 are expected in 2015

Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory

Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053; P = 0.035). Intermittent preventive treatment was used by 15.9 of the respondents. Insecticide-treated net ownership was 42.6; however; its use declined from 28.5 before pregnancy to 24.6 during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy; but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions

Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a new Nigerian teaching hospital, Ado-Ekiti

Background: Malaria is a public health problem globally especially in the Sub-Saharan Africa and among the under five children and pregnant women and is associated with a lot of maternal and foetal complications. Objective: The study was on the effect of intermittent preventive treatment of malaria in pregnancy on the prevalence of malaria in pregnancy and the outcome of pregnancy. Materials and Methods: In a descriptive cross-sectional study, a semi-structured questionnaire was administered to women admitted in Ekiti State University Teaching Hospital labour ward, Ado-Ekiti. About 4,200 women participated in the study and the inclusion criteria were women who were booked in the hospital, attended at least four antenatal clinic visits, and consented to the study while the exclusion criteria were those who didn't book in the hospital and failed to give their consent. Results: The study revealed that about 75% of the pregnant women studied had access to intermittent preventive treatment of malaria. Among the women attending the antenatal clinic that received sulphadoxine-pyrimethamine (SP), about 78% of them took two doses of SP. The prevalence of clinical malaria was statistically higher in women who did not receive intermittent preventive treatment with SP during pregnancy (44.7% vs. 31.3%, P = 0.0001) and among women who had one dose of the drug instead of two doses (40.0% vs. 28.7%, P = 0.0001). There was no statistical significant difference in the mean age in years (31.53 ± 5.238 vs. 31.07 ± 4.751, P = 0.09 and the gestational age at delivery (38.76 ± 1.784 vs. 38.85 ± 1.459, P = 0.122) between the women who did not receive SP and those who had it. There was a statistical significant difference in the outcome of pregnancy among women who had Intermittent Preventive Treatment in pregnancy (IPTp) and those who did not viz.-a-viz. in the duration of labor (8.6 ± 1.491 vs. 8.7 ± 1.634, P = 0.011) and the birth weight of the babies (3.138 ± 0.402 vs. 3.263 ± 0.398, P = 0.0001)

Les tests de diagnostic rapide du paludisme en pratique quotidienne

Le paludisme reste un probleme de sante publique mondial; plus particulierement en Afrique. En 2010; le nombre des cas de paludisme a ete estime a 216 millions; dont 81en Afrique. Le nombre de deces lie paludisme s'est eleve a 655 000; dont 91en Afrique. Une confirmation parasitologique rapide par un examen parasitologique; en moins de 2 heures apres l'arrivee en consultation; est recommandee avant tout traitement antipaludique dans tous les cas suspects de paludisme. Alors qu'en 2009; seulement 20des cas de paludisme declare etaient confirmes par un examen parasitologique; dans les 21 pays sur 42 de la region Organisation Mondiale de la Sante (OMS) Afrique. Le test de diagnostic rapide (RDT) est un test immunochromato-graphique detectant la presence d'un antigene specifique de Plasmodium sp dans le sang en 10 a 15 mn. Il est un outil tres interessant et facile a utiliser pour ameliorer la prise en charge des cas de fievre et du paludisme et constitue un nouvel elan dans la marche vers l'elimination du paludisme. Il existe sur le marche plusieurs types de RDT en fonction du nombre d'antigenes specifiques de Plasmodium sp qu'ils detectent. Ils ont subi de tests d'evaluation de la performance sous l'egide de l'OMS. Depuis quelques annees; les RDT ont pris une place tres importante dans le diagnostic de paludisme. De plus; leurs sensibilites ont depasse largement celles exigees par l'OMS. Le respect de conditions de conservation et d'utilisation est indispensable pour leur fiabilite. L'accessibilite par les formations sanitaires publiques et prives reste a regler pour pouvoir tirer tous les benefices de RDT

Access to Subsidized Artemether-Lumefantrine from the Private Sector among Febrile Children in Rural Setting in Kilosa; Tanzania

Abstract:The World Health Organization aims at universal access to effective antimalarial treatment by the year 2015. Consequently; an enormous financial resource has been invested on Artemisinin Combination Therapy (ACT))) subsidy. In Tanzania; strategies to increase access of artemether-lumufantrine (ALu) rural areas; where the burden is highest; includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria access ALu from the private sector in rural areas. A total of 1;235 under fives randomly selected from 12 rural villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured questionnaire; caretakers were interviewed about the child's history of fever in the past 7 days; type of treatment given and the source. Baseline data were obtained on demographic characteristics; caretakers' knowledge about malaria and social economic indicators of the household. Of the 1;235 children followed-up; 740 care-seeking visits were recorded; of which; 264 (35.7) were made at government health facilities and nearly a quarter (24.1; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22 of the caretakers sought care from FBO and ADDOs. While 686 (86.6) of the episodes were treated with antimalarials; only 319 (43) received ALu; the recommended antimalarial. Majority (83) of the visits made at government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0) and ADDOs (25.0). In conclusion; this study has shown that less than a quarter of fever episodes suspected to be malaria in rural areas were made at FBO facilities and ADDOs; of which; less than half were treated with ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas; where the malaria burden is highest. This cast some doubts if the target of universal access to effective antimalarial; by 2015; will be reached. There is need to consider enlisting the services of community health workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers' / dispensers' preference for non-recommended antimalarials in the private sector and caretakers' preference for ordinary