Treatment of uncomplicated malaria in Africa: evaluation of randomized clinical trials.

BACKGROUND: Malaria is a major devastating infectious diseases in tropical countries. The resistance of P. falciparum to the traditional antimalarial drugs is believed to be contributing to increased malaria mortality. OBJECTIVE: The purpose of this study is to evaluate randomized clinical trials of uncomplicated P. faciparum malaria with the hope of providing recent scientific evidence on the current antimalarial drugs that would be effective, safe, affordable and available in Africa. METHODS: We reviewed articles based only on data collected between 2005 and 2009 and randomized clinical trials of uncomplicated P. faciparum malaria in Africa published between January 2006 and August 2009. Relevant articles were sourced using data available from PubMed Central, NCBI, NEJM, BMJ, Google, and Biomed Central. Data were analysed to determine the best outcomes of treatment. RESULTS: Sixty-two articles were identified as relevant. Twenty of these, involving 2967 patients, met our inclusion criteria. Three (3), 4, 3, 1, 3, 2 and 4 of the articles were based on chloroquine, sulphadoxine/pyrimethamine, amodiaquine, quinine, artemether-lumefantrine, artesunate plus sulphadoxine/pyrimethamine, and artesunate plus amodiaquine, respectively. The respective mean cure rates for these drugs were 66.7 +/- 28.4%, 72.0 +/- 35.6%, 83.0 +/- 24.3%, 64.0%, 95.4 +/- 0.56%, 97.4%, and 88.2 +/- 13.0%. While artemisinin combination therapy (ACT) remained highly effective across countries, there was no evidence of the effectiveness of chloroquine in most parts of the continent. No serious side effects was reported by ACT. CONCLUSION: ACT remains the best antimalarial for the treatment of uncomplicated P. falciparum malaria in Africa. Clinical trials on current state of the effectiveness of chloroquine in the various countries of the continent is recommended to be able to understand whether chloroquine needs to be returned for the effective treatment of uncomplicated malaria in the region.

Irrational prescribing of calcium channel blockers for the elderly in health facilities: a qualitative study in four hospitals in Benin City; Nigeria

Calcium channel blockers (CCBs) can further depress a failing heart and are not recommended for elderly patients with systolic heart failure (HF).This study conducted in four hospitals in Benin City was undertaken to evaluate rational prescribing of CCBs in hypertensive elderly outpatients.Self-administered questionnaire was administered to 161 medical doctors to detect the proportion of physicians who prescribe CCBs to elderly outpatients with systolic HF with or without evaluating the heart status and/or counseling them on the possibility of recognizing the dangerous effect on heart while taking the CCBs. The association between inappropriate prescription of CCBs and sociodemographic variables was determined using logistic regression analysis.Majority (98.7) of the 150 respondents reported ever treating hypertension in 48.5 +/- 42.3 (range: 2-250) elderly outpatients per month with most evaluating the patients' heart status. CCBs (nifedipine and amlodipine) were often prescribed for systolic HF for the elderly by 34.3of participants but only 4.7of them properly counseled the patients. Area of specialization (odds ratio = 1.076); hospital where the doctors worked (OD = 1.080) and status of the doctors were good predictors of CCBs prescription in systolic HF.It is concluded that irrational prescribing of CCBs for elderly outpatients is common in the four hospitals studied. This calls for appropriate educational intervention that will improve the knowledge of physicians in Benin City in rational prescribing of drugs for the elderly

Success of the Control of Tuberculosis in Nigeria: a Review

Tuberculosis (TB) has emerged as the single leading cause of death from any single infectious agent and has continued to be a major public health problem all over the world. Of the over 14 million cases worldwide reported by World Health Organisation (WHO) in 2008; Nigeria ranked fifth in terms of incidence. Depending on the prevailing social factors such as socio-economic status of the people; malnutrition; crowded living conditions; incidence of HIV/AIDS; level of development of health infrastructures; quality of available control programmes; degree of drug resistance to anti-tuberculous agents; etc; prevalence; patterns of presentation; and outcomes of treatment from TB can vary from one country to another and from one region of a country to the other. Attempts to deal with the problems of the disease led to the development of Directly Observed Treatment Short Course (DOTS) by WHO in 1995; and more recently the Stop TB strategy in 2006. In Nigeria; the DOTS programme has been implemented in all States and local government areas in the country and 3;000 DOTS centres have been operating across the country since 2006. This article reviewed the available information on the success of the control of TB in Nigeria has observed a significant improvement in TB detection and treatment. However; neither the set target for the detection rate nor the cure rate have been achieved nationally as several challenges have militated against the effective implementation of the DOTS programme

HIV/AIDS : Related Knowledge and Sexual Behaviour among Secondary School Students in Benin City

Purpose: The high prevalence of HIV/AIDS amongst African youths has been a major problem in recent times; particularly in Nigeria where over 5of the population is at risk of the disease. We undertook to assess HIV/AIDS related knowledge and sexual behaviour among secondary school students in Benin City. Methods: In a cross-sectional study using a 59-item self-administered questionnaire; a survey was carried out among 1917 students (48.7male and 51.3female; age: 11-24 years) systematically selected from 13 secondary schools in Benin City to assess HIV/AIDS related knowledge and sexual behaviour. Results: Awareness of HIV/AIDS was high. Misconceptions about the cause and spread was very high (91.4and 93.1of respondents; respectively). The knowledge on prevention was poor as only 40.4of the respondents knew how to avoid contacting HIV/AIDS. While 9.1of the students indicated ever having sex (with 67.4of them using condom before sex); only 2.4engaged in commercial sex. Some of the males (4.2) are homosexuals. As many as 5.8of the youths (and 12.4of those who had done HIV test in the preceding 12 months) were HIV positive. Conclusion: Despite the various educational efforts to address the problems of HIV/AIDS; the knowledge of secondary school students in Benin City is still poor and the adolescents still engage in risky behavours. This calls for educational intervention that will impact in-depth knowledge about HIV/AIDS among the youths who are at the center of HIV/AIDS pandemic

Pharmacy Students Perception of the Application of Learning Management System in Patient-oriented Pharmacy Education: University of Benin Experience

Objective: To evaluate pharmacy students' perception of the application of learning management system (LMS) in their education in a Doctor of Pharmacy program in Benin City.Method: In a special ICT class; 165 pharmacy students were introduced to LMS using an open source program; Docebo after which a questionnaire with core questions in five domains; namely; sociodemographic data; access to computer and internet; problems in applying ICT facilities; perception of e-learning and LMS was administered. Students' responses to the questionnaire were analysed. Results: Although most students (84) had access to internet; only 16.1owned computers and majority (82.1) use cybercafes for internet access. Frequent electric power failure; inadequate computer facilities; skilled personnel; and slow internet speed were identified by 64.8-82.5of the students as problems in using computer facilities in the University. While willingness to pay was not considered a problem; 80.4of the students were only willing to pay not more than US$ 7.96 per semester for internet access. Over 92of them felt that LMS will make teaching and learning more exciting and effective when combined with the traditional teaching approach. Conclusion: The use of LMS will improve the teaching and learning of pharmacy students

Pharmacy Students Perception of the Application of Learning Management System in Patient-oriented Pharmacy Education: University of Benin Experience

Objective: To evaluate pharmacy students' perception of the application of learning management system (LMS) in their education in a Doctor of Pharmacy program in Benin City. Method: In a special ICT class; 165 pharmacy students were introduced to LMS using an open source program; DoceboO after which a questionnaire with core questions in five domains; namely; sociodemographic data; access to computer and internet; problems in applying ICT facilities; perception of e-learning and LMS was administered. Students' responses to the questionnaire were analysed. Results: Although most students (84) had access to internet; only 16.1owned computers and majority (82.1) use cybercafes for internet access. Frequent electric power failure; inadequate computer facilities; skilled personnel; and slow internet speed were identified by 64.8-82.5of the students as problems in using computer facilities in the University. While willingness to pay was not considered a problem; 80.4of the students were only willing to pay not more than US$ 7.96 per semester for internet access. Over 92of them felt that LMS will make teaching and learning more exciting and effective when combined with the traditional teaching approach. Conclusion: The use of LMS will improve the teaching and learning of pharmacy students

Facial Plexiform Neurofibromatosis in a 16 Year-Old Female from Eastern Nigeria: a Rare Presentation

Plexiform neurofibromatosis or von Pleckinghausen's disease is an uncommon variety of neurofibromatosis type I; usually associated with trigeminal nerve. We report a rare case of the disease on the face of a 16 year-old female patient. The patient presented with overhanging mass of skin folds on the face; completely covering one eye and partially covering the second eye; as well as occasional pain and itching. Physical examination revealed the presence of cafe au lait macules; freckling in the axillary; optic glioma and iris hamartomas. Family history was not contributory. An interventional reconstructive surgical procedure with excision of surplus skin folds on the face and lip margin was performed on the patient. Doloneurobionr (paracetamol and vitamins B1; B6 and B12 combination) as well as Vecutenr (neomycin sulphate; clortrimazole and dexamethosone combination) cream were used to successfully manage the occasional pain and itching. There was evidence of re-growth of the tumours over a one year follow-up period

Patients' Perception of the Benefits of Pharmaceutical Care Services in the Management of Hypertension in a Tertiary Health Care Facility in Benin City

"Purpose: Measuring the perceptions of patients is essential in evaluating the success of therapy and needs of patients. The objective of this study was to investigate patients' perceptions of the benefits of regular participation in pharmaceutical care services in the management of hypertension. Method : In a cross sectional study; 285 systematically selected hypertensive patients attending consultant outpatient clinic in University of Benin Teaching Hospital; Benin City (UBTH) were interviewed on the benefits of pharma- ceutical care services they received from pharmacists; susceptibility to health-related problems and threat reduction associated with regularly meeting with the pharmacists; using a validated structured interview format with reliability coefficient in the range of 0.79 to 0.87. Results: The patients rated medications supply and medication cost infor- mation provision as beneficial but rated patient education/counseling as fairly beneficial. However; patient monitoring; provision of nonmedication information and other specific information such as side effects; exercises; weight and blood pressure control were rated as ""not beneficial"". The services provided by the pharmacists in preventing /reducing health-related problems were poorly rated. While the perceived benefits and thread reduction were not associated with age; sex and education of the patients or the type of medication taken; patients perceived a significantly lower chance of developing health-related problem when they met with the pharmacists as compared to when they did not (P0.001). Conclusion: Although the hypertensive patients studied perceived that pharmacists contribute to the reduction in hypertension-related problems; they do not currently benefit much from the level of services offered by the pharmacists. Therefore; pharmacists working in UBTH needs to develop and fully implement comprehensive pharmaceutical care and the Health Ministries should work in collaboration with the relevant professional bodies to ensure that there is effective pharmaceutical care services in all health care facilities."

The Quality of Groundwater in Benin City : a Baseline Study on Inorganic Chemicals and Microbial Contaminants of Health Importance in Boreholes and Open Wells

PURPOSE : Inorganic chemicals and microorganisms are common in human environments and at high levels poisoning from the chronic effects have occasionally occurred. The purpose of this study was therefore to investigate whether the levels of inorganic chemicals and microbial contaminants in boreholes and open wells in selected Districts in Benin City are sufficient to affect the health of the inhabitants of the areas under investigation. METHOD: Six (6) boreholes and three (3) open wells were randomly selected from two Districts (Okhoro and Teboga) in Benin City. Water samples were collected from the boreholes and open wells using standard techniques. Lead (Pb); chromium (Cr); zinc (Zn); and cadmium (Cd) concentrations as well as aerobic bacteria; presumptive faecal coliform; E. coli; faecal Streptococci and fungi in the water samples were determined using standard procedures. World Health Organisation acceptable limits for drinking water were used in the evaluation. RESULT: All the boreholes and open wells were contaminated with abnormal levels of Pb. High levels of Cr and Cd were found in the borehole and open wells at Okhoro. Abnormal levels of Zn concentrations were detected in almost all the boreholes and open wells. All the boreholes at Teboga were contaminated with unacceptable levels of aerobic bacteria and fungi. Presumptive faecal colifom; E.coli and faecal Streptococci were seen in all the boreholes. CONCLUSION: Some boreholes and open wells in Okhoro and Teboga Districts in Benin City are contaminated with abnormal levels of metals and microorganisms capable of causing health hazards to the consumers of boreholes and open wells

Prescribing Practices in two Health Care Facilities in Warri; Southern Nigeria : a Comparative Study

PURPOSE: Inappropriate prescribing has been identified in many health facilities in developing countries. The purpose of this study was to evaluate the prescribing practices in two health care facilities in Warri located in south-south geopolitical region of Nigeria and identify factors influencing the practices. METHOD: WHO Prescribing Indicators were applied to evaluate 2000 prescription records; retrospectively; from a private and a public hospital in Warri. Factors influencing the prescribing practices in the facilities were identified through informal interviews of 10 prescribers in the facilities. Using a self-administered questionnaire administered to 40 prescribers in the facilities; we also evaluated the order of importance of the factors affecting drug prescribing. RESULTS: Average number of drugs per encounter in the health facilities is 3.4 (3.9 in the public hospital and 2.8 in the private hospital). Generic prescribing was generally low (54 percent in the public hospital and 16 percent in the private hospital) while the percentage of encounters with antibiotics prescribed was high (75 percent in the public hospital and 55 percent in the private hospital). Antimalarials; antihypertensives; antidiarrhoeals and analgesics accounted for 47.4 percent; 7.5 percent; 1.0 percent and 18.2 percent; respectively. The overuse of drugs and generic prescribing were significantly lower in the private hospital than in the public hospital. Major factors influencing prescribing practices included drug availability; clinician's level of training; cost of drugs; feedback from patients and socio-economic status of patients. CONCLUSION: Polypharmacy; overuse of antibiotics and low rate generic prescribing still occur in the health facilities studied. Drug availability; clinician's level of training; cost of drugs; feedback from patients and socio-economic status of patients are major factors influencing prescribing in the facilities

The effect of protein binding and lipophilicity of penicillins on their in-vitro flux across gastric mucosa.

Delivery of amoxycillin across the human gastric mucosa to Helicobacter pylori is poor compared with that of metronidazole and clarithromycin, limiting the clinical effectiveness of this penicillin. To investigate the physicochemical properties of penicillins that influence their flux across gastric mucosa, the fluxes of metronidazole and eight penicillins were measured in vitro across rat gastric mucosa. The lipophilicity of these drugs was also measured using potentiometric titration. The mean fluxes of monobasic penicillins (range 0.66-0.89 nmol/cm2/h) were significantly lower than those of the aminopenicillins (range 1.94-2.80 nmol/cm2/h) (P < 0.005). Penicillin flux was not significantly correlated with lipophilicity as measured, but was significantly correlated with published protein binding data (rs = 0.9048, P < 0.002). Metronidazole flux was significantly higher than that of any penicillin at 22.6 (+/-0.9) nmol/cm2/h (P < 0.001). Therefore, the in-vitro gastric delivery of penicillins can be predicted from protein binding which may in turn predict activity against H. pylori in vivo.

Reversed-phase high-performance liquid chromatographic assay methods for the analysis of a range of penicillins in in vitro permeation studies.

Simple, rapid and selective HPLC methods have been developed for the analysis of amoxycillin, ampicillin, epicillin, mecillinam and propicillin. A Hypersil ODS 5 microm (150x4.6 mm I.D.) column was used with mobile phases containing aqueous phosphate buffers, pH 3-4.6 and either methanol or acetonitrile as the organic modifier. Samples were detected by their optimal UV absorption (210-230 nm). The lower limits of quantitation of the compounds (100 microl injection volume) were 0.1 microg/ml. The assays were linear in the range of 0.1-100 microg/ml with r2 values greater than 0.99. The methods have been applied successfully for the measurement of the flux of the compounds across Caco-2 cells monolayers.

The stability of amoxycillin, clarithromycin and metronidazole in gastric juice: relevance to the treatment of Helicobacter pylori infection.

Although omeprazole is an important component in anti-Helicobacter pylori therapeutic regimes using clarithromycin, amoxycillin and metronidazole, the mechanism by which it enhances antimicrobial action is unknown. One potential explanation for this effect is increased antibiotic chemical stability resulting from gastric pH changes induced by co-administration of omeprazole. The chemical stability of clarithromycin, amoxycillin and metronidazole was investigated in aqueous solutions and in human gastric juice collected before and after a 7-day course of omeprazole. Amoxycillin, clarithromycin and metronidazole were prepared in buffered aqueous solutions of pH 1.0 to 8.0 and in gastric juice of pH 2.0 and 7.0. The gastric juice samples were obtained from fasted H. pylori-negative volunteers before and after they had received a 7-day course of omeprazole. All the samples were incubated at 37 degrees C and analysed at intervals by HPLC. Amoxycillin, clarithromycin and metronidazole were stable in aqueous solutions of pH 4.0-7.0, pH 5.0-8.0 and pH 2.0-7.0, respectively. At pH 2.0, the degradation half-lives were 19.0 +/- 0.2 h, 1.3 +/- 0.05 h and 2200 +/- 1100 h, respectively. In gastric juice samples of pH 2.0, the degradation half-lives were 15.2 +/- 0.3 h, 1.0 +/- 0.04 h and > or = 800 h, respectively. The half-lives of the drugs in the gastric juice samples of pH 7.0 were all > 68 h. The co-administration of omeprazole with amoxycillin or clarithromycin is likely to increase the chemical stability of amoxycillin and clarithromycin in gastric juice. Clarithromycin degrades rapidly at normal gastric pH (1.0-2.0) but amoxycillin and metronidazole are sufficiently stable at this pH to maintain an antibacterial concentration in the stomach.

Ion-pair high-performance liquid chromatographic assay method for the assessment of clarithromycin stability in aqueous solution and in gastric juice.

A simple and selective ion-pair HPLC method has been developed for the analysis of clarithromycin in aqueous solutions and in gastric juice. A Hypersil ODS 5-microns (150 x 4.6 mm I.D.) column was used with a mobile phase consisting of acetonitrile-aqueous 0.05 M phosphate buffer (pH 4.6) containing 5 mM l-octanesulphonic acid (50:50, v/v). The column temperature was 50 degrees C and detection was by UV absorption (210 nm). The limits of detection of 50-microliters samples were 0.4 microgram/ml (aqueous) and 0.78 microgram/ml (0.5 ml gastric juice) or better. The assay was linear in the range of 1.56 to 100 micrograms/ml with r2 values greater than 0.99. The recovery from the gastric juice samples was 98.5 +/- 2.9%. The method was applied successfully to determine the stability of clarithromycin in 0.01 M HCl and gastric juice.