Sociocultural aspects of mass delivery of praziquantel in schistosomiasis control: the Abeokuta experience.

BACKGROUND: Schistosomiasis is a public health problem in Nigeria. Although there is an ongoing national program for its control, disease control programs in other countries have shown the need to understand the sociocultural aspects of disease transmission, prevention, and treatment in endemic communities before control efforts are undertaken. OBJECTIVE: To describe sociocultural factors that influence the distribution process of praziquantel for the mass treatment of schistosomiasis infection. METHODS: Data for the study were collected through focus group discussions held separately with adult males and females, male and female adolescents (13-19 years), and male and female children (5-12 years). In-depth interviews were similarly held with the drug distributors of praziquantel for mass treatment and with community/opinion leaders of six hyperendemic communities in Ogun State, Southwest Nigeria on mass treatment using praziquantel. These focus group discussions and in-depth interviews were held both before and following the drug distribution. The data were analyzed using the textual analysis program, Textbase Beta. RESULTS: Following a 3-week period of mass treatment in six communities, we observed an increased awareness of rivers/streams as a source of schistosomiasis. In addition, the communities reported overwhelming support for the mass treatment after receiving treatment. The reasons for this acceptance appear to include the perceived efficacy of praziquantel against the disease and its availability free of charge. The drug's distributors adhered to the originally specified systems-based protocol for mass treatment in only two of the six communities. The systems-based protocol adhered to strict distribution through primary health centers and schools. The four other communities used a community-based approach for mass treatment with praziquantel and attained greater coverage of treatment as a result. CONCLUSION: Obtaining community support and involvement before the implementation of mass treatment of schistosomiasis with praziquantel contributes to an effective treatment strategy for this disease. A detailed assessment of a community's health needs, before the initiation of the control efforts against endemic infections, should be undertaken.

Height as a substitute for weight for estimating praziquantel dosage.

The study evaluated height and weight measurements of 750 school children from five rural communities in western Nigeria. The measurements were taken by 12 trained community members designated as distributors in determining treatment dose with praziquantel for these children. A very strong correlation value, r=0.97, was obtained for the weight of treated children measured by the distributors and the research team. The distributors obtained a correlation coefficient value of r=0.87 on weight and height measurements, showing that height can be used by community distributors in lieu of weight for correct dose determination.

Willingness to pay for praziquantel treatment in a hyperendemic community of Ogun State, Nigeria.

BACKGROUND: Schistosomiasis is highly endemic in Nigeria. However, very little is known about the usage and social marketing of praziquantel in the control of schistosomiasis in endemic communities and on the persons willingness to pay for the drug to support its extensive use and thus aid control efforts in Nigeria. OBJECTIVE: The study examined the willingness of people in a hyperendemic community, to pay for treatment with praziquantel before and after provision of the drug, with a view to assess the feasibility of achieving widespread coverage. METHODS: Data were collected through focus group discussions among household heads and other adult family members and through the use of a questionnaire to survey household heads in Imala-Odo, a community hyperendemic for schistosomiasis, in southwest Nigeria. The main outcome measure was the respondents' willingness to pay for schistosomiasis treatment. RESULTS: The results showed that in contrast to the 92.3% of respondents who expressed willingness to buy the drug in the preintervention study, only 46.5% actually purchased the drug during intervention for the treatment of their infected household members. The respondents' level of education, occupation, and income influenced their willingness to pay (P<.05). Statistical tests showed that those willing to pay for treatment had a higher income score than those unwilling to do so. Most respondents preferred their community head and reliable persons chosen by the community as convenient outlets for drug distribution. The number of household members respondents were willing to treat increased from 4 to 6 at N320.00 (US $2.52) in the preintervention and postintervention phases, respectively. Gender factor was found to influence the respondents' perceived average treatment cost; the females wanted N300.00 (US $2.36) against N100.00 (US $0.79) among the males. CONCLUSION: Efforts need to be made and sustained to ensure that all families can afford to praziquantel drug to achieve the ultimate goal of controlling the infection in endemic communities of Nigeria.

Effectiveness of different approaches to mass delivery of praziquantel among school-aged children in rural communities in Nigeria.

Schistosomiasis is hyperendemic in Nigeria. The national policy on schistosomiasis control has adopted praziquantel as the main drug of use in the control strategy aimed at reducing morbidity. However, the best delivery channel for praziquantel in schistosomiasis control in Nigeria is yet to be determined. This study assessed different channels for praziquantel delivery in a mass treatment effort. Three groups, each of two communities, were assigned to one of the following three channels: health facility (HF), school, and community for mass delivery of praziquantel to school-aged children. Distributors were trained on all aspects of praziquantel distribution and sufficient praziquantel tablets were provided for the drug distribution within 3 weeks following which an evaluation of the drug distribution by the different treatment channels was conducted. Overall, the community channel of delivery achieved the best coverage of 72.2% (range: 69-73%) compared to 44.3% (range: 39.5-62%) and 28.5% (range: 26.3-74.5%) for the HF and school channels, respectively. Community channel of praziquantel delivery as shown in this study ensures good coverage of both in and out-of-school children.

Endemicity of onchocerciasis in some local government areas of Niger state.

The established method of justifying the need for ivermectin delivery to a community is the use of Rapid Assessment Method (RAM). This method involves the clinical examination of 50 adult males, who have been resident in the community for at least five years, for onchocercal nodules and leopard skin. The values obtained for these indices will guide the classification of such a community as being hypoendemic, mesoendemic or hyperendemic. Those that fall within mesoendemic and hyperendemic category onchocerciasis qualify for ivermectin delivery. This study was carried out to determine the endemicity level of onchocerciasis in 74 communities of 8 Local Government Areas (LGAs) of Niger state to justify their inclusion or otherwise in the ongoing state wide mass treatment for onchocerciasis using ivermectin. The communities were selected using the Geographical Information System (GIS) data and following the World Health Organization (WHO) guideline for RAM. A total of 3000 subjects were examined comprising of 2395 (79.8%) males and 605 (20.2%) females. None of the LGAs, based on overall prevalence for nodules qualify for mass treatment with ivermectin. However the study identified communities within some of these LGAs that were mesoendemic for onchocerciasis and thus qualified for mass treatment with ivermectin.

Dupuytren's contracture in black Zimbabweans.

Four cases of Dupuytren's contracture treated at Mpilo Central Hospital over the last 13 years are presented. Three of these patients were men aged 45, 59 and 74 years. Only one woman aged 55 years was treated during this period. All the four patients were indigenous Black Zimbabweans. There was some history of trauma to the affected upper limb in all three of the male patients and all of them agreed to being moderate smokers but only two gave a history of drinking alcohol. One of the men had been treated for pulmonary tuberculosis. The female patient has been on treatment for epilepsy for more than 10 years. There was no family history of Dupuytren's contracture in any of these patients. Although Dupuytren's contracture is generally considered to be a European disease this report and a few isolated case reports confirm that this condition occurs in indigenous Black Africans.

Photocalorimetry of light-cured dental composites.

The reactivity of six light-curable dental composite materials has been examined by a novel technique, photocalorimetry, which permits in situ analysis of photoreactions in opaque cross-linking systems. According to photocalorimetry, the rates of reaction of dental composites decrease in the following order: Uvio Fil, Scintilux 2, Visio Dispers, Visio Fil, Silux, and Prisma Fil. By comparing the heats of reaction of the composites and of the resins, one may assume that at least two types of reactive resins are used in these dental composites: one with a heat of reaction of about 35 cal/g, and others with considerably less reactivity, ranging from 14 cal/g to 25 cal/g. Photocalorimetry allows for a rapid assessment of the rate of polymerization (photospeed) of light-curing dental composites and is ideally suited for the study of kinetics and for optimization of formulations.

[Description of the process of in vitro liberation of matrix tablets]. / Zur Beschreibung des in-vitro-Liberationsvorganges aus Matrixtabletten.

After a short description of the drug liberation process from a porous matrix the influence of the matrix forming substance on the drug liberation is characterized. The compression process is the decisive step in forming the hydrophobic, nondissolved matrix. The temporal lapse of the in vitro liberation process of the model drug quinidine is demonstrated by means of electronmicroscopical photographies.

[The in vitro liberation behavior of quinidine from drug forms with prolonged release by various liberation methods]. / Untersuchungen zum in-vitro-Freisetzungsverhalten von Chinidin aus Arzneiformen mit verlängerter Wirksamkeit anhand verschiedener Liberationsmodelle.

The liberation behaviour of the following preparations were tested using two models: Chinidin-Duriles (Astra, Sweden), Chinidin-longo (VEB Isis-Chemie Zwickau, GDR), Chinidin-retard-Isis (VEB Isis-Chemie Zwickau, GDR). The received data were estimated by multivariate statistical methods. It was found, that the three tested preparations are different in their liberation behaviour. Moreover it was shown, that there are differences between the two apparatus. Nevertheless both methods are able to characterize the liberation behaviour of the three preparations.