Malaria Infection among Blood Donors in Onitsha Urban; Southeast Nigeria

Blood safety is a major issue of global concern in transfusion medicine especially in developing countries; where national blood transfusion policies and services as well as financial resources are lacking or inadequate. Transfusion-transmitted malaria is a potential health hazard but is often neglected in many malarious areas. Malaria infection among blood donors in Onitsha urban; Southeast Nigeria was studied between August and October 2008. Venous blood of donors was screened for malaria parasites using Giemsa-stained thick and thin blood films. The ABO and Rhesus phenotypes were classified using a haemaglutination standard test and demographic data of donors documented. Of the 410 blood donors analysed; 304 (74.1) were infected. Plasmodium falciparium was identified in all positive cases and mixed infection with P. malariae was seen in 5(1.6) cases. Infection significantly varied with age and not with sex and occupation (p0.05). People with blood group O+ showed significantly higher rate of infection (p0.05). Since there is scarcity of voluntary donors in Nigeria; donor deferral done in non-malarial endemic regions cannot be practiced in Nigeria. The high prevalence of asymptomatic malaria in this area; suggests the need for careful screening of blood samples for malaria parasites. Positive samples should be indicated on the blood packs and transfusion of malaria positive blood requires the administration of curative dose of antimalarials to the patient. Commercial donors should be freely given mosquito treated bed nets and be encouraged to sleep under them

Parasites associated with sachet drinking water (Pure Water) in Awka; South-Eastern; Nigeria

A study to ascertain the parasites associated with sachet drinking water, (popularly called "Pure Water" in Nigeria), in Awka, capital of Anambra State, southeast Nigeria was conducted. This was in order to determine the safety and suitability of such water for human consumption. Sachet water is a major source of drinking water for low and middle class Nigerians. The increase in demand of this water has led to the proliferation of industries in this sector, because of the economic benefits derivable from the sale. Samples of differently packaged sachet drinking water were purchased from producers, distributors, marketers and hawkers. Samples were observed macroscopically and pH tested. Using a sterile syringe, 10mls of water was taken from each sample and centrifuged at 2,500rpm per minute. Sediments observed were placed on a glass slide and observed microscopically using x10 and x40 objective lens for a possible parasite ova or cyst. The surface of each sachet of the packaged drinking water was also washed thoroughly and the resulting water was centrifuged and observed microscopically. All the tested water samples met the W.H.O. recommended standard, of being colorless, tasteless, odourless with average pH of 6.93. No parasites were found in the water in the sachets but some parasites were found on the surfaces of the sachets. The surface of the sachets of the packaged water purchased from hawkers had the highest number of parasites {15 (41.7%)}. Identified parasites include cysts of Ascaris lumbricoides (5.6%), Entamoeba histolytica (4.6%), hookworm (2.8), Trichuris trichuria (2.8%) and Giardia lamblia cysts (1.9%). Hawkers possibly play a very significant role (χ2 = 20.21, df =2, p<0.05) in the transmission of parasitic infection from the outside of the sachets through improper handling. It is advocated among others that cleaning and washing of sachets of packaged drinking water before use will aid in breaking the transmission circle

Gender and the stigma of onchocercal skin disease in Africa.

This paper reports results from a multicenter study of gender differences in the stigma associated with onchocercal skin disease (OSD) in five African sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies used a common protocol to compare affected and unaffected respondents, that is, men and women with onchodermatitis in highly endemic areas and respondents from communities with low endemicity or no onchocerciasis. The methods were both quantitative and qualitative, allowing for the comparison of stigma scores and people's verbal descriptions of their experiences and attitudes. Questions to the unaffected were asked after providing them with photographs and short descriptions (vignettes) depicting typical cases. We found that stigma was expressed more openly by the unaffected, who perceived OSD as something foreign or removed from themselves, whereas the affected tended to deny that they experienced stigma as a result of the condition. Gender differences in stigma scores were not significantly different for men and women, but qualitative data revealed that stigma was experienced differently by men and women, and that men and women were affected by it in distinctive ways. Men were more concerned about the impact of the disease on sexual performance and economic prospects, whereas women expressed more concern about physical appearance and life chances, especially marriage. Similar trends were found in the different sites in the responses of affected and unaffected respondents, and differences between them, despite geographical and cultural variations.

A multi-centre study of the effect of Mectizan treatment on onchocercal skin disease: clinical findings.

A multi-centre, double-blind, placebo-controlled trial of the effect of Mectizan (ivermectin, MSD) treatment on the skin disease and severe itching associated with onchocerciasis was carried out in the forest zones of Nigeria, Ghana and Uganda. Overall, 4072 subjects, none of whom had received Mectizan previously, were enrolled and allocated into four groups, to receive Mectizan every 3, 6 or 12 months or placebo every 3 months. Subjects with skin lesions were stratified within each treatment group to ensure equal representation. Each subject was given a clinical examination and interviewed on enrolment and then 3-monthly for 15 months. The presence and severity of itching were determined by open-ended questions followed by probing questions. Skin lesions were classified and their severity graded using a standard system. Analysis of the results was restricted to the data from the 1530 subjects who received all their scheduled treatments and attended all the follow-up visits. From 6 months onwards, all subjects who had received Mectizan reported less severe itching, had lower prevalences of reactive skin lesions and had less severe skin lesions than those in the placebo group (P < 0.05 for each). The greatest reductions, in both itching and skin disease, were seen in subjects treated with Mectizan every 6 months. Mectizan treatment is therefore beneficial for the control of troublesome itching and for reducing the prevalence and severity of skin disease causes by Onchocerca. it is recommended that mass distribution of Mectizan to communities in the study areas be carried out at 6-monthly intervals for maximum efficacy.

The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial.

OBJECTIVE: To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching. METHOD: A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. RESULTS: While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. CONCLUSION: This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.