Epidemiology, therapeutic agents and cost of management of paediatric malaria in a Nigerian tertiary hospital.

BACKGROUND AND OBJECTIVES: Malaria is the most widespread parasitic disease in sub-Saharan Africa with associated high morbidity and mortality especially among the highly predisposed population of pregnant women and children of age five years and below. Living in malaria endemic regions of the world has become associated with health and economic hazards placing financial and productive burden on affected households. METHODS: A prospective study of children treated for malaria and other associated illnesses at a Nigeria tertiary health institution between May and October 2003 was undertaken. The various malaria-associated diseases treated were determined from their provisional diagnosis, hospital records and causative agents confirmed from their diagnostic laboratory results. Cost of treatment was determined from the patients' guardian and confirmed from relevant hospital departments. Common drugs for malaria treatment, their costs, relative effectiveness and frequency of use were determined through a completed questionnaire by health officers and patients' guidance. RESULTS: Of 5356 paediatric patients suspected of having malaria, 5100 (95.2%) were confirmed positive for malaria parasites microscopically. Of these, 4119 (80.8%) were aged 0 - 6 years, with children aged 1 to 3 years being mostly affected. Eight hundred and twenty (16.1%) of them were in-patients spending an average of six days on hospital bed. Over 22 million naira (dollar 0.22 m) was spent on the treatment of malaria with drugs accounting for the major cost (66.81%). About 33.7% of the patients had malaria complicated with other diseases. INTERPRETATION AND CONCLUSION: The effectiveness of common therapeutic agents used for malaria treatment, their costs and associated side effects is discussed. Recommendations are made for appropriate care and government subsidy for paediatric malaria management in sub-Saharan Africa.

Life-table analysis of Anopheles malaria vectors: generational mortality as tool in mosquito vector abundance and control studies.

BACKGROUND & OBJECTIVES: Vector control will for sometime remain a primary weapon in the war against vector borne diseases. Malaria is of paramount importance in this with its associated high morbidity and mortality especially in sub-Saharan Africa. This study on generational mortality associated factors in Anopheles mosquitoes life-table analysis was designed to investigate the fecundity, levels of mortality and mortality associated factors at the aquatic stages of anopheline malaria vectors. METHODS: Mortality associated factors were investigated at the eggs, I and II instar larval, III and IV instar larval and pupal stages of two anopheline species--Anopheles pseudopunctipennis (Theobald) and An. gambiae life-cycles in screen cages. Adult male and female mosquitoes were membrane filter-fed and algae in culture medium formed the bulk of food substances for the larval stage. Environmental temperature of culture media, pH and some associated physio-chemical factors were also determined. RESULTS: Results showed significant mortality rates at various aquatic stages. Infertility, cannibalism and environmental factors were the major factors responsible for mortality at the egg, larval and pupal stages respectively. INTERPRETATION & CONCLUSION: The aquatic stages of Anopheles mosquito mortality factor K and the mortality factors at the various stages investigated k1, k2, k3 and k4 are discussed. Our recommendations include further studies on the possible genetic modification of predacious An. pseudopunctipennis larvae and/or its modification for the production of sterile/infertile eggs as possible alternatives in the reduction and control of anopheline malaria burden.

Seroprevalence of human immunodeficiency virus and some AIDS associated opportunistic infections in parts of Northern Nigeria

A total of 620 consenting patients were tested for HIV by rapid Elisa method in three government hospital in Wukari Local government area Taraba State, Nigeria between April 2001 and March 2002. Seropositive subjects were followed up on their subsequent visits to the hospital and using their hospital records to obtain information on their HIV status, other associated and opportunistic infections. A total of 124 [20%] subjects subdivided into males 58 [9.4%] and females 66 [10.6%] of those tested were positive for HIV. While 10 [1.6%] males and 14 [2.3%] females had developed AIDS. Six different infections were identified among the infected subjects including 39 cases of diarrhoea. 31 cases of pulmonary tuberculosis [PTB] 21, cases of oral candidiasis and 19 cases of skin/ soft tissue infections. There were 3 cases of urethral track infection and 24 cases of bronchopneumonia. The productive age group 15-50 years remains mainly the most affected group with the HIV scourge. The negative impact of polygamy, extramarital affairs and lack of women sex right. Empowerment and low level human development on the spread of HIV/AIDS is discussed