The sensitivity of Plasmodium falciparum to chloroquine and amodiaquine in Ibadan, Nigeria

An extended in vivo test of the sensitivity of Plasmodium falciparum to antimalarial drugs in Nigerian children showed no evidence of resistance to chloroquine and amodiaquine. However, the results of a small number of in vitro tests suggest a decreased sensitivity of the parasite to chloroquine when compared with the results of earlier studies in the same locality.     

Chloroquine sensitivity of Plasmodium falciparum in Ibadan,Nigeria: II. Correlation of in vitrowith in vivo sensitivity

Plasmodium falciparum malaria was treated in 82 children with 25 mg/kg chloroquine orally over three days. They were observed for 28 days during which blood films were examined periodically for malaria parasites. Asexual forms of P. falciparum, present in the blood films of all the patients before commencing treatment, disappeared rapidly and by the third day no parasites were seen in blood films from any of them. Among the patients observed for more than three days, blood films remained negative throughout the observation period. In vitro tests of sensitivity of blood samples from 10 patients showed chloroquine concentrations of 0·5 to 0·8 nmol/ml to inhibit completely maturation from ring forms to schizonts.This suggests that P. falciparum in the Ibadan area is probably still fully sensitive to chloroquine.     

Chloroquine sensitivity of Plasmodium falciparum in Ibadan,Nigeria

Thirty-five children with Plasmodium falciparum malaria were treated with 25 mg/kg chloroquine over three days and observed for seven days during which blood films were examined daily for malaria parasites.Asexual forms of P. falciparum which were present in the blood films of all the patients before commencing treatment disappeared rapidly from the blood so that by the third day no parasites were seen in the blood film. The blood films remained negative for the rest of the seven-day observation period.Plasma chloroquine determination in eight of the patients showed high blood levels during the first three days.The results do not confirm the suspicion of chloroquine-resistant P. falciparum in the area studied although RI level of resistance by WHO criteria was not excluded.     

Distribution of rubella antibodies in Nigeria

A total of 1,847 serum samples obtained from human subjects in various areas of Nigeria (North, East and West) were tested for the presence of rubella haemagglutination inhibition antibodies. The results showed that an average of 68% of the Nigerian population studied possessed rubella antibody.     

Exposure of Dentists to Mycobacterium tuberculosis, Ibadan, Nigeria

To determine the prevalence of Mycobacterium tuberculosis infection among dental patients and to assess dentists’ risk for exposure, we conducted a study among dental patients at a large tertiary hospital in Nigeria, a country where tuberculosis is endemic. Ten (13%) of 78 sputum samples obtained were positive for M. tuberculosis.     

Serum concentrations of chloroquine in a patient with a late recrudescence of Kenyan Plasmodium falciparum malaria

A Swedish tourist who had visited Kenya fell ill with Plasmodium falciparum malaria 11 days after returning home, in spite of taking pyrimethamine (50 mg weekly) as malaria prophylaxis. Chloroquine treatment (25 mg base/kg body-weight) giving serum concentrations of 0·30 μmol/l cleared the patent parasitaemia and the patient recovered. Recrudescence occurred, however, within 42 days. A second chloroquine course (30 mg base/kg) gave serum levels up to 1·28 μmol/1. The patient improved rapidly and remained healthy during 28 days without renewed parasitaemia. Further follow-up for 10 months was uneventful. We consider it urgent to assess chloroquine concentrations in serum in patients being treated for falciparum malaria in order to obtain data on fully effective levels. Ineffective serum levels should be ruled out in cases not responding to chloroquine, especially when chloroquine-resistance is suspected.     

Characteristics of family planning acceptors at aprimary health care project in Lagos, Nigeria

Analysis of data collected from the family planning section of a Primary Health Care Project in Lagos, shows that the majority of the 275 acceptors in 1979 were aged 25-39 years. 96% of the clients were married. 1 explanation is that unmarried women may be wary of coming forth for family planning, as this might indicate that they have an active sexual life in a culture which is probably still conservative. Clients with 2ndary and post 2ndary education are over represented. This underscores the importance of education in stimulating demand for family planning in the population. A comparison of the data with those from the Lagos University Hospital in 1972 shows that women with 2 or fewer children continue to be under presented in relation to their proportion in the population. The number of children and the age of the acceptors suggests that people in this environment tend to adopt modern family planning after completion of their family, rather than to space children. Catholics seem to be over represented in the data. Lower socioeconomic groups patronize the clinic more than the higher socioeconomic groups or professionals. The majority of the clients were referred by nurse-midwives and friends. The most common method of family planning was the IUD, followed by the pill. It was felt that part of the reason for the much lower clinic continuation rate for the pill was due to the fact that patients may continue on the pill without the knowledge of the clinic. It was also found that even though the project was catering to a geographically demarcated target population, most clients came from outside of the area, and some from very far away. This suggests that other strategies for delivery of family planning services may be called for.     

Traditional medicine and lead-containing preparations in Nigeria

Traditional medicine, its preparations and practices, plays a major role in the health care of the community of Nigeria. In many cases the native doctor (“Babalawo”) and the local herbalist (“Eleweomo”) are the only practitioners available for the treatment of illness. Even in the towns where allopathic medicine is available the limited facilities it offers make many patients rely on traditional methods. Little is known of the pharmacological action of these traditional remedies which the native doctor prescribes. Our own studies have concentrated on the metal content of such materials. Here we report on the material known as “tiro” which is used for the treatment of eye infections and disease as well as an “eye cleaner” and cosmetic. On analysis we found that all samples of tiro measured contained lead ranging from 12·8 to 81·1% (w/w), with a mean concentration over all samples determined of 50·1% (w/w). In addition, it was also found that tiro is used by some members of the Nigerian community in Britain and is brought in in decorative containers as a gift. The extent of use in this country still remains to be determined, however. The use of lead-containing preparations^* in traditional practices presents a significant health hazard to a substantial section of the world's population. We suggest urgent steps are required to encourage governments to establish education programmes to eliminate this avoidable source of morbidity among their populations.     

Sociodemographic Factors Related to Quality of Life Among Premenopausal Women in Ibadan,Nigeria

Quality of life (QoL) of premenopausal women (PW) was assessed using primary data collected between September and December 2011. A 26-item questionnaire (WHO-QoL BREF) was administered to 285 apparently healthy women selected from two local government areas in Ibadan. The scores were categorized into poor (≤79.53) and good (>79.53) QoL. Multiple logistic regressions were used to study factors associated with QoL. The mean score for the overall QoL (OQoL) was 65.18 ± 11.35 (range = 81.25). The Cronbach’s alpha for all domains as well as the OQoL were within an acceptable range. The proportion of women with good OQoL was significantly higher in the urban areas (18.2 percent) than in the rural areas (9.2 percent) (p < .05). The proportion of respondents with good OQoL was significantly higher for women aged <20 years (37.5 percent) than older women (p < .01). Teenage participants were almost ten times as likely to have a good social relationship than participants above 35 years of age (odds ratio: 9.52; 95% confidence interval: 1.83–49.40). The authors’ results suggest that the WHO-QoL BREF is a reliable instrument for measuring QoL among PW in Nigeria. Younger PW and women in the urban areas were more likely to have good QoL.     

Tuberculin sensitivity in kala-azar

In 66 patients with active kala-azar, tuberculin skin tests were negative. During follow-up after apparently successful cure, some patients developed positive tuberculin skin tests. This suggests that active kala-azar is associated with a generalized, non-specific depression of cell-mediated immune responses, which reverts to normal after treatment.     

Hepatitis-B virus infection in children and adults in Northern Nigeria: a preliminary survey

Hepatitis-B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) have been detected by radio-immunoassay in children and adults and in adult expatriates in Zaria, Northern Nigeria. The exposure rate to hepatitis-B virus (frequency of HBsAg and anti-Hbs) was found to vary from 59% in children under five years to 72·5% in adults over 30 years of age, while the frequency of HBsAg alone was 40% and 10% respectively. The anti-HBs prevalence rates rose progressively with age and reached a peak at 62·5% in adults. Five of 32 adult expatriates (15·6%) were positive for anti-HBs. The factors contributing to the high exposure rate in the indigenous population in this region require further study to enable judicious use to be made of preventive measures.     

Clinical significance of serum transcobalamins in protein-energy malnutrition

The serum concentrations of Unsaturated Vitamin B(12) binding (UBBC) capacity and the three individual transcobalamins were measured in 34 malnourished children aged 9 months-5 y. Levels of serum vitamin B12, aspartate aminotransferase, alanine aminotransferase, albumin and total proteins were also estimated. The serum UBBC, Transcobalamin I (TC I), Transcobalamin III (TC III), vitamin B12 and the enzyme activities were significantly higher in the kwashiorkor children when compared with both the marasmic and control children. There was also a marked reduction of serum Transcobalamin II (TC II), albumin and total proteins in the kwashiorkor children. In contrast with kwashiorkor, there was a slight increase of serum TC II in the marasmic children. Their serum UBBC, TC I, TC III and B12 were also raised but not as high as in kwashiorkor. These results are discussed in the light of the hepatic dysfunction in kwashiorkor affecting the production of TC II in the liver, while the elevated serum B12 in Protein-energy malnutrition (PEM) may be due to both hepatic damage and intensified release of TC I as a result of infection.     

Absence of malaria mortality in villagers with chloroquine-resistant Plasmodium falciparum treated with chloroquine

We carried out a series of malaria studies in Robek , Flores, Indonesia, a coastal village of 900 farmers and fishermen where malaria is hyperendemic by parasite rate and holoendemic by spleen rate. The studies showed that: (i) 28 of 31 isolates (90%) of Plasmodium falciparum were resistant to chloroquine in vitro, (ii) 3 of 12 isolates (25%) were resistant at the R-11 level in vivo, (iii) 376 P. falciparum infections occurred in 301 individuals during one year, (iv) no villagers who were treated with chloroquine for P. falciparum infections during the year died, and (v) increasing the dosage of chloroquine base from 15 to 25 to 37.5 mg/kg led to improved clearing of parasitaemia. We conclude that chloroquine can still be used as the primary antimalarial in Robek , but the dosage may have to be increased to clear parasitaemia.     

Evaluation of milk and nutrient intakes of school children in Nigeria

The study was conducted to evaluate the contribution made by school milk to the nutrient intake of 246 primary school children in urban and rural areas of Anambra State, Nigeria. The information collected included a brief medical examination, socio-economic data, food consumption pattern and a weighed food intake. Urban and rural children who drank school milk had a mean daily intake of 426 ml compared with only 185 ml per day for children who did not receive school milk. Children who drank school milk daily, when compared with those who did not, had higher statistically significant mean daily intake for several nutrients including calcium and riboflavin (p less than 0.001) in both sexes and groups; protein and fat for rural children (p less than 0.01) and vitamin A for urban and rural boys (p less than 0.001). Symptoms suggestive of lactose intolerance were low in the population investigated. The relative beneficial effects of milk supplementation were more marked in rural than in urban children.     

Evaluation of the sensitivity in vivo and in vitro of Plasmodium falciparum malaria to quinine in an area of full sensitivity to chloroquine

The sensitivity of Plasmodium falciparum to quinine in Nigeria was examined in vivo and in vitro prior to the re-introduction of the drug into malaria therapy in that country in the face of spreading chloroquine resistance in Africa. The parasites showed full sensitivity in vivo to quinine, with a mean parasite clearance time of 2.4 d and a mean fever clearance time of 1.4 d. Using the in vitro microculture technique, the Nigerian isolates were found to have a minimum inhibitory concentration (IC) of 1.28 mumol quinine/litre blood-medium mixture. The IC50 and IC99 were 0.25 mumol/litre and 0.8 mumol/litre respectively. The study afforded an opportunity to compare the sensitivity of P. falciparum to quinine and chloroquine in a population in which chloroquine resistance was not a problem and the results showed slower parasitological and clinical response to quinine than to chloroquine.     

In vivo and in vitro assessment of the sensitivity of Plasmodium falciparum to chloroquine in four districts of Tanga region, Tanzania

The sensitivity of Plasmodium falciparum to chloroquine was tested in Muheza, Pangani, Tanga and Korogwe districts in north-eastern Tanzania by applying both in vivo and in vitro tests in schoolchildren. A total dose of 25 mg chloroquine base/kg body-weight given over a period of three days (10 mg/kg on days 0 and one; and 5 mg/kg on day 2) failed to clear asexual parasites from the peripheral blood by day 7 in 12.5% of the children tested at Muheza, 5.9% at Pangani, 31.8% at Tanga, and 39.5% at Korogwe. In vitro micro tests were successfully carried out on 44 isolates at Muheza, 29 isolates at Pangani, 45 isolates at Tanga and 44 isolates at Korogwe. Schizont maturation at chloroquine concentrations of 1.14 mu mol/litre of blood and above, an indication of drug resistance, was observed in 20.5% of the isolates at Muheza, 41.4% at Pangani, 51.1% at Tanga and 45.5% at Korogwe. In vivo and in vitro results of the tests for resistance have been compared.     

Susceptibility of Plasmodium falciparum in The Gambia to pyrimethamine, Maloprim and chloroquine

A five-year malaria chemoprophylaxis study has begun with Maloprim in children aged three months to five years and pregnant women in a population of 13,000 in the area of Farafenni, The Gambia. Sensitivity of Plasmodium falciparum to pyrimethamine, Maloprim and chloroquine was assessed in vivo and in vitro in rural Gambian villages before drug intervention. 569 children aged one to seven years inclusive were sampled at the end of the wet season of 1982; 46% had positive blood films. All afebrile children were treated with a single dose of one of the antimalarials under study. Febrile children were treated with chloroquine. 109 infected children were retested 7 to 10 days after treatment and none showed asexual parasitaemia. 83 micro in vitro tests were successfully performed from fingerprick blood samples and the results confirmed the in vivo study. Pyrimethamine in combination with dapsone, in the proportion present in Maloprim, i.e., 1:8, showed a synergistic effect, the mean effective dose of pyrimethamine being reduced 13 times at the 50% inhibitory level.