Adverse reactions from community directed treatment with ivermectin (CDTI ) for onchocerciasis and loiasis in Ondo State, Nigeria

Onchocerciasis is an endemic disease in Ondo state, Nigeria. Community directed distribution of ivermectin is currently on-going in some local government areas of the state. Randomly selected persons (2 331 males and 2 469 females) were interviewed using a modified rapid assessment procedure for Loa loa (RAPLOA) to assess community directed treatment with ivermectin. The retrospective study evaluated the coverage, impacts and adverse reactions to the drug treatment. A questionnaire was administered by house-to-house visit in six local government areas, implementing community directed treatment with ivermectin (CDTI) in this bioclimatic zone. A total of 2,398 respondents were reported to have participated in the treatment. The overall ivermectin coverage of 49.96% was recorded (range 0 - 52% in different communities). Adverse reactions from ivermectin administration were experienced in 38% of individuals. Diverse adverse reactions experienced included predominantly itching (18.50%); oedema, especially of the face and the limbs (8.2%); rashes (3.4%) and body weakness (2.4%). Expulsion of intestinal worms occurred in 0.96% of the respondents. The occurrence of adverse reactions in relation to age categories was statistically significant. Neither fatal nor severe adverse reactions were reported by respondents. Significantly, despite experienced adverse reactions, continued participation, acceptability and compliance to ivermectin treatment was expressed by the various communities. This attitude is in consonance with the African Programme for Onchocerciasis Control (APOC) objectives. Rev. Biol. Trop. 56 (4): 1635-1643. Epub 2008 December 12.

La oncocercosis es endémica en el estado Ondo, Nigeria. Se seleccionaron 4 800 personas al azar para evaluar con encuesta retrospectiva la cobertura, efectos y reacciones al tratamiento farmacológico con ivermectina administrado por la misma comunidad. La cobertura global de ivermectina fue 50 % con reacciones adversas en 38 % de los individuos. Estas fueron comezón picazón (18%), edema, especialmente de la cara y las extremidades (8%), erupciones cutáneas (3%) y debilidad (2%); dependieron de la edad y no hubo reacciones más graves. La expulsión de las lombrices intestinales se produjo en 96% de los encuestados. A pesar de las reacciones adversas, hubo continuidad, aceptación y cumplimiento del tratamiento con ivermectina, en consonancia con los objetivos del Programa Africano para el Control de Oncocercosis (APOC).

Prevalences of loiasis in Ondo state, Nigeria, as evaluated by the rapid assessment procedure for loiasis (RAPLOA).

The rapid assessment procedure for loiasis (RAPLOA) was used to assess the prevalences of loiasis among 4800 subjects in 60 villages in Ondo state, south-western Nigeria. Coverages for community-directed treatment with ivermectin (CDTI) were assessed in the same communities, which were located in the Owo, Akure North, Ifedore, Akure South, Ondo East and Ondo West local government areas (LGA). In addition, fingerprick blood samples were collected from 80 individuals in each of six villages (i.e. one village in each LGA investigated) and checked for Loa loa microfilaraemia. Microfilaraemias were only detected in three of the villages where blood samples were collected and then only at low prevalences (1.25%-5.0%) and intensities (267-1600 microfilariae/ml). No serious adverse events were or ever had been related to the CDTI but mild or moderate adverse reactions were quite common, especially in Akure North (55.0%) and Owo (40.2%). A female subject was more likely to report an history of eye worm than a male subject (20.3%-35.7% v. 20.8%-26.5%, according to LGA). Although the subjects aged 41-50 years formed the age-group most likely to report an history of eye worm (32.7%), the highest CDTI coverage was recorded in the subjects aged 61-70 years (54.7%). The results indicated that CDTI had helped to reduce the prevalence and intensity of Loa microfilaraemia and that ivermectin can continue to be used for mass administrations in Ondo state with little risk of serious adverse events.

Adverse reactions from community directed treatment with ivermectin (CDTI) for onchocerciasis and loiasis in Ondo State, Nigeria.

Onchocerciasis is an endemic disease in Ondo state, Nigeria. Community directed distribution of ivermectin is currently on-going in some local government areas of the state. Randomly selected persons (2331 males and 2469 females) were interviewed using a modified rapid assessment procedure for Loa loa (RAPLOA) to assess community directed treatment with ivermectin. The retrospective study evaluated the coverage, impacts and adverse reactions to the drug treatment. A questionnaire was administered by house-to-house visit in six local government areas, implementing community directed treatment with ivermectin (CDTI) in this bioclimatic zone. A total of 2,398 respondents were reported to have participated in the treatment. The overall ivermectin coverage of 49.96% was recorded (range 0-52% in different communities). Adverse reactions from ivermectin administration were experienced in 38% of individuals. Diverse adverse reactions experienced included predominantly itching (18.50%); oedema, especially of the face and the limbs (8.2%); rashes (3.4%) and body weakness (2.4%). Expulsion of intestinal worms occurred in 0.96% of the respondents. The occurrence of adverse reactions in relation to age categories was statistically significant. Neither fatal nor severe adverse reactions were reported by respondents. Significantly, despite experienced adverse reactions, continued participation, acceptability and compliance to ivermectin treatment was expressed by the various communities. This attitude is in consonance with the African Programme for Onchocerciasis Control (APOC) objectives. Rev. Biol.

Market survey of loiasis: prevalence and adverse reactions to ivermectin using a rapid procedure for loiasis.

OBJECTIVES: 1. To assess the levels of endemicity of loiasis in a total of 30 selected villages covering an area of 5.2 sq km in Owo, Akure North, Akure South, Ondo East, Ondo West and Ifedore local governments in Ondo State, Nigeria, using Rapid Assessment for loiasis technique. 2. To obtain information on adverse reactions which occurred during previous administrations of the drug ivermectin used for the treatment of loiasis and onchocerciasis in the study area. METHODS: Consent was obtained from the chairman of each local government village head and individuals were co-opted into the study. A total of 480 individuals were interviewed, 80 from each of the six local governments, during the regular scheduled community market days. Survey for Loa loa was carried out according to specifications in "Guidelines for rapid Assessment of Loa loa (TDR, 2002). RESULTS: Among the 480 respondents, 80 (16.7%) reported having had a history of loiasis while 11 (2.3%) had recent occurrence of the disease. The local name given to the disease in all the villages studied is "aran oju". Respondents in Ondo East local government had an eyeworm history of 23 (28.8%) and occurrence of loiasis was 02 (2.5%), these were the highest figures recorded. Using the SPSS version 10 package for data analysis, demographic factors of age and gender were not significant determinants of prevalence (> 0.05). Ondo East and Ifedore local governments had significant levels of loiasis prevalence (p < 0.05). Adverse reactions from the retrospective ivermectin administration was 04 (0.83%). This was statistically insignificant (p > 0.05). CONCLUSION: Market surveys in rural communities were considered to be cost effective and rapid in the determination of prevalence of any disease. Since less than 40% of the respondents in the study area reported having had a history of eyeworm, the entire area was classified as "low risk" as regards the administration of ivermectin.

Comparison of Quantitative Buffy Coat technique (QBC) with Giemsa-stained Thick Film (GTF) for diagnosis of malaria.

The renewed interest in the use of fluorescent microscopy for malaria diagnosis prompted the comparison of Quantitative Buffy Coat technique (QBC) with the old standard Giemsa-stained Thick blood Film (GTF) in Ikeja General Hospital, now Lagos State University Teaching Hospital, in Lagos. Blood samples were collected from 353 patients, each examined with the QBC and GTF techniques. Of these, 68 were positive with GTF, 70 with QBC giving a positive rate of 19.3% and 19.8% respectively. The malaria positive rate was calculated as 19.3% using GTF as the standard. In general, females recorded higher percentages (58.6% and 54.4%) than males (41.4% and 45.6%) among those positive with QBC and GTF respectively. The overall sensitivity rate for QBC was 55.9% and the specificity was 88.8%. The positive and negative predictive values of QBC compared to GTF were 54.3%, 89.4% respectively while the concordance of the two techniques was 82.4%. These values were lower than those reported for QBC in previous studies. The sensitivity of QBC reduced further (33.3%) with samples having low parasite density (<1000 parasites/ul). QBC test was not able to accurately differentiate between different Plasmodium species but with the GTF, 86.7% of the infected individuals had Plasmodium falciparum, 7.5% had P. malariae and only 5.9% had mixed infections. In spite of the speed and simplicity of QBC technique, it cannot be considered an acceptable alternative to GTF under routine clinical laboratory situation. However, its speed and ease of use make it an important new tool for the diagnosis of malaria.

Helminth parasites of the African lizard Agama agama (Squamata: Agamidae), in Lagos, Nigeria

Agama agama, the agamid rainbow lizard, has been reported to serve as transport and reservoir host to several protozoan and helminth parasites. We randomly sampled 310 specimens between May and July, 2005, at Oyingbo, Lagos, Nigeria (6°34’60’’ N-3°19’59’’ E and 6°34’60’’ N-3°19’59’’ E).They harboured four species of nematodes: Strongyluris brevicaudata, Parapharyngodon awokoyai, Capillaria sp. and Oxyuris sp.; one of Cestoda, Oochoristica agamae; one of Trematoda, Mesocoelium monas; and one of Pentastomida, Raillietiella sp. Strongyluris brevicaudata had the highest prevalence of infection (82.3 %), followed by P. awokoyai (74.5 %), Raillietiella (10.3 %), Capillaria sp. (8.4 %) and O. agamae (7.4 %). M. monas and Oxyuris sp. had low prevalences: 1.61 % each. Raillietiella sp. and Capillaria sp. can cause localized inflammation and intestinal infections in humans. The prevalence of infection was higher in larger adult lizards. Prevalence in males was 97.6 % (94.1 % in females). in four of the helminth species, intensity of infection was higher in male lizards. Parasite intensity was highest in the rectum, followed by the intestine (p<0.05). infection intensity was, to a large extent, dependent on the type of parasite, and age of lizard. During May, P. awokoyai had its highest mean intensities and prevalence. The prevalence and mean intensity of helminthes varied with the month of collection (both p<0.05). For the three months studied, prevalence and mean intensity of S. brevicaudata were highest in June (July for the other species). Rev. Biol. Trop. 55 (2): 417-425. Epub 2007 June, 29.

La lagartija Agama agama actúa como medio de transporte y hospedero para varios protozoos y helmintos parásitos. Capturamos 310 lagartijas, muestreadas aleatoriamente, entre mayo y julio 2005, en Oyingbo, Lagos, Nigeria (6°34’60’’ N-3°19’59’’ E y 6°34’60’’ N-3°19’59’’ E). Hallamos cuatro especies de nematodos: Strongyluris brevicaudata, Parapharyngodon awokoyai, Capillaria y Oxyuris; un céstodo intestinal, Oochoristica agamae; un trematodo, Mesocoelium monodi; y un pentastómido, Raillietiella. S. brevicaudata tuvo la mayor prevalencia de infección (82.26 %), seguida por P. awokoyai (74.52 %), Raillietiella (10.32 %), Capillaria (8.38 %) y O. agamae (7.41 %). M. monodi y Oxyuris tuvieron baja prevalencia con 1.61 % cada uno. Raillietiella y Capillaria causan inflamación localizada e infección intestinal en humanos. La prevalencia de infección estuvo positivamente relacionada con el tamaño de las lagartijas adultas. Los machos tuvieron mayor prevalencia, con 97.58 % (hembras 94.09 %). La infección intestinal en los machos fue mayor para cuatro de las especies de helmintos. La intensidad parasitaria fue mayor en el recto, seguida por el intestino (p<0.05). La intensidad de la infección fue dependiente del tipo de parásito y la edad de la lagartija. En mayo, P. awokoyai tuvo el mayor promedio de intensidad y prevalencia. La prevalencia y la intensidad promedio de S. brevicaudata fue mayor en junio (julio en las demás especies). La prevalencia y la intensidad variaron con el mes (ambos p<0.05).

Helminth parasites of the African lizard Agama agama (Squamata: Agamidae), in Lagos, Nigeria.

Agama agama, the agamid rainbow lizard, has been reported to serve as transport and reservoir host to several protozoan and helminth parasites. We randomly sampled 310 specimens between May and July, 2005, at Oyingbo, Lagos, Nigeria (6 degrees 34'60" N-3 degrees 19'59" E and 6 degrees 34'60" N-3 degrees 19'59" E).They harboured four species of nematodes: Strongyluris brevicaudata, Parapharyngodon awokoyai, Capillaria sp. and Oxyuris sp.; one of Cestoda, Oochoristica agamae; one of Trematoda, Mesocoelium monas; and one of Pentastomida, Raillietiella sp. Strongyluris brevicaudata had the highest prevalence of infection (82.3%), followed by P. awokoyai (74.5%), Raillietiella (10.3%), Capillaria sp. (8.4%) and O. agamae (7.4%). M. monas and Oxyuris sp. had low prevalences: 1.61% each. Raillietiella sp. and Capillaria sp. can cause localized inflammation and intestinal infections in humans. The prevalence of infection was higher in larger adult lizards. Prevalence in males was 97.6% (94.1% in females). In four of the helminth species, intensity of infection was higher in male lizards. Parasite intensity was highest in the rectum, followed by the intestine (p<0.05). Infection intensity was, to a large extent, dependent on the type of parasite, and age of lizard. During May, P. awokoyai had its highest mean intensities and prevalence. The prevalence and mean intensity of helminthes varied with the month of collection (both p<0.05). For the three months studied, prevalence and mean intensity of S. brevicaudata were highest in June (July for the other species).

Epidemiology of Trichomonas vaginalis among women in Lagos metropolis, Nigeria.

A total of 544 women outpatients comprising 320 and 224 from Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos and Military Hospital, Yaba, Lagos, respectively, were examined for Trichomonas vaginalis infection. Both wet mount microscopy and Giemsa staining technique were used. A prevalence of 3.3% was recorded from the 544 women using both methods, 5.4% in the Military Hospital and 1.9% from LUTH. The difference in prevalence was statistically significant using Chi-square test analysis (p<0.05). Age group 21-30 years had the highest prevalence of 1.8%; A higher prevalence of 2.9% was recorded among married women compared to 0.4% prevalence in unmarried women. About one-fifth of the infected individuals were asymptomatic. Symptomatic patients had characteristic symptoms such as greenish yellow vaginal discharge (33.3%), itching/pruritus (22.2%) and malodorous discharge (11.1%) Water system toilet users had the highest prevalence of T. vaginalis infection compared to others using different types of toilet facilities. About 1% of T. vaginalis infection were mixed with Candida albicans. Single infections of Candida albicans was recorded in 33.6% of the total population examined. Sexual promiscuity, age and socio-economic status were important contributory factors in the pattern of infection amongst studied population.

Epidemiological studies of intestinal helminthes and malaria among children in Lagos, Nigeria.

Of the 1177 randomly surveyed children, 46.8% had parasitic infections, four types of helminthes, Ascaris lumbricoides (29.7%), Trichuris trichiura (18.4%), hookworm (0.7%), Strongyloides stercoralis (0.3%); and the malarial stages, trophozoites (34.3%) and gametocytes (2.0%). Highest prevalence of 58.25% was observed in the 0-2 years. Both Ascaris and Plasmodium had peak intensities in children aged 2-4 years; another peak for Ascaris in 8-10 years old. There was positive correlation between the age groups and the prevalence of A. lumbricoides and T. trichiura (both p<0.05), difference in other parasites were not significant. Males had higher prevalence of 52.8% than females 45.8%. Difference in prevalence between sexes was only significant in ascariasis (p<0.05). Pit latrine users were the most infected (51.43%) while the water closet users were the least (33.28%). Children who drank well water regularly had the highest infection rate (43.5%). Intensity of malaria was highest in children whose families used nets only, lowest in those who combined insecticides, coils and nets. Sixty seven percent of infected cases were single infections while 29% were mixed infections.

The achievements and challenges of the African Programme for Onchocerciasis Control (APOC).

The main strategy of APOC, of community-directed treatment with ivermectin (CDTI), has enabled the programme to reach, empower and bring relief to remote and under-served, onchocerciasis-endemic communities. With CDTI, geographical and therapeutic coverages have increased substantially, in most areas, to the levels required to eliminate onchocerciasis as a public-health problem. Over 20 million people received treatment in 2000. APOC has also made effective use of the combination of the rapid epidemiological mapping of onchocerciasis (REMO) and geographical information systems (GIS), to provide information on the geographical distribution and prevalence of the disease. This has led to improvements in the identification of CDTI-priority areas, and in the estimates of the numbers of people to be treated. A unique public-private-sector partnership has been at the heart of APOC's relative success. Through efficient capacity-building, the programme's operations have positively influenced and strengthened the health services of participating countries. These laudable achievements notwithstanding, APOC faces many challenges during the second phase of its operations, when the full impact of the programme is expected to be felt. Notable among these challenges are the sustainability of CDTI, the strategy's effective integration into the healthcare system, and the full exploitation of its potential as an entry point for other health programmes. The channels created for CDTI, could, for example, help efforts to eliminate lymphatic filariasis (which will feature on the agenda of many participating countries during APOC's Phase 2). However, these other programmes need to be executed without compromising the onchocerciasis-control programme itself. Success in meeting these challenges will depend on the continued, wholehearted commitment of all the partners involved, particularly that of the governments of the participating countries.

Alternate nitrogen amendments for organic fertilizers.

The use of compost or manure in agriculture as an organic source of nutrients is common in many tropical, developing countries like Nigeria. One of the drawbacks of such materials is their low nitrogen (N) content (=1% N). Farmers commonly use chemical N fertilizers such as urea, calcium ammonium nitrate (CAN), and NPK formulations to obtain better crop growth and yield. These chemical supplements may have a negative impact on the environment through nitrate leaching into water, leading to eutrophication of surface waters that can affect public health. Gliricidia sepium, a fast-growing, tropical, perennial hedge plant was tested as a source of N in organo-mineral fertilizer formulations. Average nutrient content of Gliricidia is 3.8% N, 0.32% P, 1.8% K, 0.8% Ca, and 0.2% Mg. Using a sand culture and Amaranthus caudatus as a test crop, it was shown that amending commercial composts with 30% Gliricidia prunings would benefit many small-scale farmers and control environmental pollution.

Immunological identification of Schistosoma mansoni peptidases.

Precipitin arcs formed after immunoelectrophoresis of Schistosoma mansoni egg, worm and cercarial antigens with polyspecific rabbit antisera have been 'stained' at neutral pH with chromogenic enzyme substrates specific for proteases and peptidases. A total of 7 antigenically distinct enzymes with peptidolytic properties were identified. An enzyme which hydrolyzed phenylalanine naphthyl ester bonds was found in adult worm extracts, but appeared to be host-derived in so far as it was also immunoprecipitable from the same extracts by rabbit anti-normal mouse plasma. Three more phenylalanine naphthyl esterases were found, all stage-specific; one was in cercarial homogenates and two were in egg homogenates. A leucine naphthylamidase was also found in egg extracts, and it was antigenically distinct from, and did not react on dipeptide substrates that were hydrolyzed by two other leucine aminopeptidases present in extracts of all three stages of S. mansoni. The method provides a simple means of distinguishing constituents of complex mixtures of antigens by a combination of their immunological and biochemical properties.