Malaria In Nigeria Research Articles

Efficacy of Plasmodium falciparum histidine-rich protein 2 ( Pfhrp 2) rapid diagnostic test (RDT) and microscopy in the detection of falciparum malaria among symptomatic patients in Akure, Nigeria.

Accurate diagnosis and prompt treatment are highly essential in the management of malaria, which is one of the deadliest infectious diseases worldwide, particularly in tropical and sub-tropical regions including Nigeria. This study was designed to evaluate the efficacy of malaria histidine-rich protein 2-based rapid diagnostic test (RDT) and microscopy in the diagnosis of falciparum malaria in Nigeria. This was a cross-sectional and hospital-based study. The standard method of microscopy was used as the gold standard. Giemsa stained thick and thin smears were prepared to count and detect malaria parasite species. Also, a malaria histidine-rich protein 2-based RDT was used to detect malaria parasites and diagnostic efficacy were determined through the measure of sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy and Youden Index (J). The result showed that out of the total 303 individuals examined, a total malaria prevalence of 67.0% and 68.0% were recorded for micr oscopy and RDT, respectively. Additionally, the sensitivity (95% C.I), specificity (95% C.I), PPV (95% C.I), and NPV (95% C.I) of RDT compared to microscopy were 97.54 (94.36-98.94), 92.00 (85.00-95.89), 96.12 (92.53-98.02), and 94.85 (88.50- 97.78), respectively. The diagnostic accuracy (95% C.I) and Youden Index (J) were 95.71 (92.77- 97.70) and 0.89, respectively. Conclusively, our study revealed that RDT continues to remain efficacious. Thus, while malaria diagnosis by microscopy which is the gold standard remains the major method of malaria detection, it should be complemented by rapid diagnostic test (RDT), particularly in high malaria endemic regions where mean parasite density of patients are usually high.

Adulticidal Activity of Essential Oils of Laggera pterodonta and Laggera aurita against Anopheles gambiae. (Diptera: Culicidae); the major Vector of Malaria in Nigeria

Effects of essential oils from two Laggera species (Laggera pterodonta and L. aurita) found in Nigeria were evaluated on adult Anopheles gambiae. The essential oils were obtained by hydro-distillation and showed significant bioactivity at high doses. L. pterodonta essential oil was found to be more toxic against adults of An. gambiae (LC50 of 943 mg/L) than L. aurita essential oil (LC50 of 1313 mg/L). The major constituents of the essential oil of L. pterodonta by GC/MS were ɤ-Terpinene (12.72%), Benzene,2-tert-butyl-1,4-dimethoxy (12.66%), (+)-4-Carene (10.40%), 4-Carvomenthenol (9.22%), gamma-Eudesmol (8.67%) and Caryophyllene (5.83%) while that of L. aurita include Benzene, 2-tert-butyl-1,4-dimethoxy (25.24%), Caryophyllene (12.25%), ɤ-Terpinene (8.92%), α -Bourbonene (6.30%), tau-Muurolol (5.91%), (+)-4-Carene 4,7,7-Trimethylbicy (5.58%) and α-Cadinol (5.29%). The result obtained suggests L. pterodonta and L. aurita can also serve as natural mosquitocides.

Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis

BackgroundUnder-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines.MethodsUsing a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions.ResultsFully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs.ConclusionSubsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking.

Nonlinear Dynamical Systems for Malaria Transmission and Control: Ross-Macdonald Model

Malaria was declared an emergency in Nigeria and strategies for the control of Malaria in Nigeria were adopted to reduce its prevalence to a level at which the disease will no longer constitute public health problems. In this work, we presented a deterministic (Ross–Macdonald model susceptible, expose/ infected, infectious and recovered) model incorporating the method of control adopted by national Malaria and leprosy control program. We established the disease free and the endemic equilibrium states and carried out the stability analysis of the disease. Free and the equilibrium state. We also carried out numerical simulation of the model to have an insight into the dynamics of the model. We found out that the disease free equilibrium state is stable. The feedback dynamics from mosquito to human and back to mosquito involve considerable time due to the incubation periods of the parasites. In this paper, taking explicit account of the incubation periods of parasites within the human and the mosquito, we first propose a Ross–Macdonald model. The Jacobiant results showed that it would be very difficult to completely eradicate Malaria from Nigeria using the method adopted by national Malaria and leprosy control program.

The influence of training outcome and competency on effective utilization of malaria microscopy result amongst health professionals in South Eastern Nigeria

Malaria diagnosis in Nigeria mostly relied on clinical manifestations until 2011, when the government issued a policy requiring parasitological confirmation of all suspected malaria cases prior to treatment. Poor usage of malaria test results in health care delivery is one of the possible causes of over-diagnosis and over-treatment of malaria in Nigeria. This study demonstrated the influence of in-service training on malaria microscopy amongst medical laboratory scientists on the utilization of malaria microscopy results in a selected Government Health Facility in Nigeria. In 2014, a baseline study was conducted, and a follow-up study was conducted in which end users of laboratory results in selected secondary health facilities were given a pre-tested questionnaire on perception and utilization of malaria microscopy results by health care providers in malaria case management. Medical laboratory scientists working in these selected facilities were then given basic malaria microscopy training in accordance with the World Health Organization's (WHO) basic microscopy training manual. The training was followed by a supporting supervision visit to the Medical Laboratories, where other factors that can skew microscopy results, such as the need for special equipment, were addressed during the basic and refresher training. We conducted paired t-test to determine statistically significant differences between pre-test and post-test results at 0.05 significance level and ANOVA to determine if there were differences in knowledge level before and after the training and between the basic and refresher training. The study demonstrates a significant improvement in both the basic and refresher training mean parasite detection pre-and post-tests scores from 56.3% (95% CI 53.6-58.8%) to 77.7% (95% CI 74.4-80.2%) and 76.7 (95% CI 74.2-79.2%) to 91.2% (95% CI 88.3-94.1%)(P< 0.001). When comparing the rate of utilization of malaria results from trained Medical Laboratory Scientists to the baseline and follow-up studies, as well as the assessment of facilities' malaria test requests and utilization pattern during the study period, there was a substantial difference (p< 0.001). The increase in utilization of malaria microscopy result for effective case management of malaria in the study area was influenced by training outcome and competency of Medical Laboratory Scientists. Key words: Malaria results, microscopy T raining, medical Laboratory scientists, health care providers.

Survey of ethnobotanical cocktails commonly used in the treatment of malaria in southwestern Nigeria

BackgroundCombination of different antimalarials has become the popular method of care for malaria morbidity in conventional and traditional treatment approaches due to the need to increase the efficacy and reduce the selection of drug resistance. A worrisome concern is the critical gaps with regards to the information available on antimalarial herbal cocktails. This study presents cocktail herbal remedies in ethnomedicinal approaches to malaria treatment in Oyo and Ogun states, South West Nigeria. Ethnobotanical information on indigenous antimalarials used in combination remedies was collected from herbal practitioners using a semi-structured questionnaire.ResultsFindings showed majority of respondents treat malaria with combination herbal remedies. They sighted their beliefs and customs, the efficacy, affordability and availability of these herbs as reasons for their adoption of herbal medicines as their preferred mode of treating malaria. Enquiry revealed 26 sets of cocktail antimalarials from a variety of plant species. The plants and ingredients are extracted and used as decoction, infusion or steam baths. Oral route was the most popular mode of administration. Respondents reported they drink one to two medium-sized cups of the recipe on an average of two times daily within a duration of about 10 days.ConclusionsHerbal antimalarial remedies continue to be the popular treatments option in our localities. This study provides knowledge of the diverse ways respondents combine medicinal herbs and other local ingredients for malaria treatment. Pharmacological screening is urgently needed to validate their safety and efficacy in order to protect the health of our locals heavily relying on them to combat high burdens of malaria.

In vitro antiplasmodial activity, cytotoxicity, and gas chromatography – flame ionization detector metabolites fingerprint of extracts and fractions from Tetrorchidium didymostemon

BackgroundTetrorchidium didymostemon is used as an antimalarial remedy in southern Nigeria. Objective(s)This study was aimed at providing scientific validation for the use of T. didymostemon in the treatment of malaria in Nigeria. Materials and methodsPlasmodium falciparum 3D7 (Pf3D7) strain was cultured and maintained in fresh O+ human erythrocytes. Standard methods were used to evaluate in vitro antiplasmodial activity, cytotoxic effect on Vero cell line, phytochemical screening, and antioxidant capacity. Gas Chromatography – Flame Ionization Detector (GC-FID) metabolite fingerprinting of the most potent fraction was carried out. ResultsThe methanol leaf extract had higher antiplasmodial activity (IC50Pf3D7 = 25 ± 0.21 μg/mL) in comparison with the stem bark extract (SBE) (IC50Pf3D7 = 50 ± 0.94 μg/mL). The n-hexane fraction of the leaf extract had the best antiplasmodial activity (IC50Pf3D7 = 3.92 ± 0.46 μg/mL) and selectivity index. This was followed by the dichloromethane (IC50Pf3D7 = 12.5 ± 1.32 μg/mL), ethyl acetate (IC50Pf3D7 = 35.0 ± 4.80 μg/mL), and hydromethanol fraction which was inactive (IC50Pf3D7 > 100 μg/mL). All extracts and fractions were not toxic on Vero cell line (CC50 > 1000 μg/mL). The n-hexane and dichloromethane fractions had the highest amount of phytochemicals. GC-FID analysis revealed high amounts of kaempferol, α-pinene, camphor, humulene, azulene, and β-caryophyllene in the n-hexane fraction. ConclusionThe results of our study validate the traditional use of T. didymostemon in the treatment of malaria in southern Nigeria. They also suggest that the phytoconstituent(s) responsible for the antiplasmodial activity of this plant may be more extractable in non-polar solvents.

Evidence supporting the use of Combretum nigricans as an antimalarial agent in ethnomedicine

Background: Combretum nigricans (Combretaceae) is a small, smooth bark tree used in traditional medicine for the treatment of prurigo, dysentery, fever and other symptoms of acute malaria in North-Central Nigeria. Materials and Methods: The antimalarial activity of C nigricans hydro-methanol crude leaf extract was evaluated against Plasmodium berghei in mice. The Peters’ 4-day suppressive test against early malaria infection and Rane’s curative test against established malaria were employed in assessing the antimalarial activity of the crude extract. In each test model, five groups containing five mice each were used. Group 1 mice were administered with 10 ml distilled water/kg b.w. p.o., groups 2 - 4 were administered with 200, 400, and 800 mg extract/kg b.w. p.o. respectively, while group 5 mice were administered with artesunate 10 mg/kg b.w. p.o. Result: All doses of C. nigricans extract employed for the study (200 – 800 mg/kg b.w. p.o.) gave significant (P&lt;0.05) chemosuppressive effect against P. berghei, this effect was observed to be dose-related; while the 400 mg/kg extract dose gave the highest curative effect. Compared to control, the extract also prolonged the mean survival time at all doses, and as well prevented the characteristic decrease in body temperature elicited by P. berghei in mice. The LD50 of the extract was &gt;5000 mg/kg b.w. p.o. in mice. Conclusion: The result from the study indicates that C. nigicans crude leaf extract is safe orally and possesses significant antimalarial activity.

Galvanizing Communities towards Zero Malaria in Nigeria: An Account of 2019 World Malaria Day in Bayelsa State

Nigeria had a vision of zero death from malaria by 2020 and was making efforts to achieve the goal. Reducing malaria mortality or eliminating malaria requires community ownership and active participation. This paper describes activities carried out in Bayelsa State to commemorate the 2019 World Malaria Day – an important global event towards eliminating malaria. Several organizations in the state collaborated to organize the event and used various media to spread the key messages of the day. Inadequate resources however limited full commemoration. A better- funded event in the future has potential for a larger impact.

Evaluation of the Pediatric Antimalarial Prescriptions in a Teaching Hospital in Southeastern Nigeria

Background: Malaria in Nigeria with the highest morbidity and mortality in children between 6 months and 5 years continues to be a disease burden. In line with the World Health Organization recommendation of diagnosis in all ages before treatment, Nigeria provided guidelines on parasite-based diagnosis. Therefore, in order to achieve its preelimination and the reduction of mortality caused by it to zero by 2020, it is necessary to assess the compliance of the prescribers to the guidelines. Objectives: The objectives of this study were to determine the cases who were diagnosed based on positive malaria parasite test and the level of compliance of the prescribers to the National Malaria Treatment Guidelines. Methods: A total of 3034 prescriptions of antimalarial drugs were collected between 2003 and 2011 in the Outpatient Department of the Pediatric Clinic. Data were analyzed using Microsoft Excel and SPSS V.20.0 and grouped into two: prepolicy (2003–2005) and postpolicy (2006–2011) periods. Descriptive and inferential statistics were used at P &lt; 0.05 level of significance. Results: The study revealed that diagnosis based on positive malaria parasite test was 4.8% of 2765 patients. There was a noticeable increase in the prescription of artemisinin combination therapy in the postpolicy period (32.6%), but the compliance to the Antimalarial Treatment Guideline was low (23.8%). Conclusion: There was a high incidence of empirical diagnoses of malaria and treatment. Many of the artemisinin-based combination therapies prescribed were not recommended.

Physicochemical and phytochemical screening of six plants commonly used in the treatment of malaria in Nigeria.

Medicinal plants contain active compounds usually present as complex mixtures though at low concentrations, which accounts for the medicinal properties. Therefore it is important to identify and characterize these compounds. This study aims to quantify and characterize the physicochemical and phytochemical compositions of six plants commonly used in the treatment of malaria using High-Performance Liquid Chromatography (HPLC). These plants which are used individually or in combinations: Enantia chlorantha, Cymbopogon citratus, Curcuma longa, Carica papaya, Alstonia boonei and Mangifera indica, were extracted with hot water and the extracts characterized with HPLC using standard procedures. The results showed that M. indica stem bark had the highest yield with 81.48% and C. papaya had the lowest yield with 53.80%. Physicochemical properties of the extracts of E. chlorantha, C. citratus, C. longa, C. papaya, A. boonei and M. indica respectively are as follows: Melting point 90, 80, 95, 92, 96 and 96; pH 7.43, 8.02, 6.24, 6.81, 6.41, 6.85; moisture content 18.27, 22.77, 9.96, 9.62, 3.85 and 10.00; Total ash 1.45, 3.51, 0.34, 0.57, 9.10,10.21; refractive index 1.34, 1.34, 1.34, 1.34, 1.34, 1.34 and 1.34. Alkaloids, phenols, flavonoids, terpenoids, tannins, coumarin were some of the antimalarial active phytochemicals identified. Alkaloid (Atropine) was highest in C. longa (4382.2mg/g). M. indica (32982.8mg/g) had the highest Rutin Hydrate content. While Quercetin was not detected in C. papaya, it was considerably present in A. boonei (491.1mg/g). All the analyzed six plants contain low phenol (gallic acid). The characterized physicochemical and phytochemical compositions of the examined plants suggests why the plants are effective in the treatment of malaria. The information reported herein describes the physicochemical and phytochemical contents of six commonly used antimalarial plants in Nigeria. It is expected that the information will be useful in understanding the pharmaceutical effects of how the plants work in the body and in the development of efficacious and safe antimalarial drugs.

Geo-additive modelling of children under-five sleeping under Insecticide treated nets in Nigeria

Number of children under-five at risk of malaria in Nigeria is overwhelming and despite several reported effectiveness of Insecticide Treated Nets (ITNs) in malaria prevention, many factors deterring utilization have been reported. To examine spatial variation in South-West region of Nigeria, this study examines level of utilization among under-five children in the region. Data from the 2018 Nigeria Demographic Health Survey is used to examine relationships between different covariates and spatial variation using a semi-parametric model. Gaussian, Poisson and Zero Inflated Poisson distributions were assumed for the response variable and comparisons were made. The Deviance Information Criteria (DIC) is used as selection criteria. With lowest DIC among the competing distributions, Gaussian has the best fit for the model. Spatial variation is observed in the utilization across states. Ondo state has highest net usage among children follow by Ogun state. Both Lagos and Ekiti states have the least. Higher utilizations are observed among rural residents and households without some basic amenities and mass media. Utilization is found to be higher among respondents in the poor category of wealth index. Educational status of mothers is found to affect ITNs utilization. Non-linear effect of age of the children on the number of children sleeping under net has a bathtub shape, indicating decrease in number of children sleeping under net as age increases till around two years and then starts increasing. For effective utilization of ITNs, more efforts are to be put into campaigns on the importance of utilization rather than only ownership.

In Vivo Efficacy and Metabolism of the Antimalarial Cycleanine and Improved In Vitro Antiplasmodial Activity of Semisynthetic Analogues.

Bisbenzylisoquinoline (BBIQ) alkaloids are a diverse group of natural products that demonstrate a range of biological activities. In this study, the in vitro antiplasmodial activity of three BBIQ alkaloids (cycleanine [compound 1], isochondodendrine [compound 2], and 2'-norcocsuline [compound 3]) isolated from the Triclisia subcordata Oliv. medicinal plant traditionally used for the treatment of malaria in Nigeria are studied alongside two semisynthetic analogues (compounds 4 and 5) of cycleanine. The antiproliferative effects against a chloroquine-resistant Plasmodium falciparum strain were determined using a SYBR green 1 fluorescence assay. The in vivo antimalarial activity of cycleanine is then investigated in suppressive, prophylactic, and curative murine malaria models after infection with a chloroquine-sensitive Plasmodium berghei strain. BBIQ alkaloids (compounds 1 to 5) exerted in vitro antiplasmodial activities with 50% inhibitory concentration (IC50) at low micromolar concentrations and the two semisynthetic cycleanine analogues showed an improved potency and selectivity compared to those of cycleanine. At oral doses of 25 and 50 mg/kg body weight of infected mice, cycleanine suppressed the levels of parasitemia and increased mean survival times significantly compared to those of the control groups. The metabolites and metabolic pathways of cycleanine were also studied using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry. Twelve novel metabolites were detected in rats after intragastric administration of cycleanine. The metabolic pathways of cycleanine were demonstrated to involve hydroxylation, dehydrogenation, and demethylation. Overall, these in vitro and in vivo results provide a basis for the future evaluation of cycleanine and its analogues as leads for further development.

Antiplasmodial, antinociceptive and antipyretic potential of the stem bark extract of Burkea africana and identification of its antiplasmodial-active fraction

Background and aimBurkea africana stem bark is used as a remedy for malaria in north-central and southern Nigeria. Based on its traditional use, this study was conducted to investigate the antiplasmodial, antinociceptive and antipyretic potential of an extract of B. africana stem bark. Experimental procedureA 70% v/v ethanol extract of stem bark of B. africana was prepared by cold maceration. Fractions (dichloromethane, ethyl acetate, and residual) were also prepared. The extract was screened for hemolytic, cytotoxic and antiplasmodial activity effects. The effect of the extract and fractions against chloroquine-sensitive (3D7) and multi-drug resistant (W2mef) P. falciparum was assessed. Acute toxicity test, acetic acid-induced abdominal writhing in mice, and lipopolysaccharide-induced fever in rats were also employed to screen the extract. Chromatographic fingerprints of the extract and active fraction were obtained. ResultsB. africana extract showed no cytotoxic or significant hemolytic effects and did not cause acute toxicity or mortality. The ethanol extract exhibited moderate antiplasmodial activity while the dichloromethane fraction showed high activity against P. falciparum 3D7 (IC50 = 6.44 μg/ml) and W2mef (IC50 = 6.30 μg/ml) respectively. The extract elicited significant (p < 0.05) attenuation of acetic acid-induced writhing and significantly (p < 0.05) ameliorated lipopolysaccharide-induced pyrexia at 300 mg/kg. The HPLC profile of the dichloromethane fraction showed peaks with retention times that corresponded with those of rutin and caffeic acid. ConclusionBurkea africana extract has antiplasmodial, antinociceptive and antipyretic potential and its antiplasmodial constituents are concentrated in its dichloromethane fraction.

Brief Communication COVID-19 in the midst of Malaria, Cold, and Flu in Nigeria

There is a relationship existing in the nature of management of COVID-19, malaria, cold, and flu ranging from the use of anti-malaria to immune boosters such as vitamin C, herbal/home remedies, large intake of fluids and rest while recommending conventional drugs. This study was done to establish the relationships in terms of clinical symptoms, diagnosis and management. In Nigeria, NAFDAC acknowledged the positive effects of vitamin C enriched plants and vegetables on COVID-19 as discovered by r

Spatial distribution and sociodemographic risk factors of malaria in Nigerian children less than 5 years old.

Malaria remains a leading cause of morbidity and mortality among children in Nigeria less than 5 years old (under-5). This study utilized nationally representative secondary data extracted from the 2015 Nigeria Malaria Indicator Survey (NMIS) to investigate the spatial variability in malaria distribution in those under- 5 and to explore the influence of socioeconomic and demographic factors on malaria prevalence in this population group. To account for spatial correlation, a Spatially Generalized Linear Mixed Model (SGMM) was employed and predictive risk maps was developed using Kriging. Highly significant spatial variability in under-5 malaria distribution was observed (P<0.0001) with a higher likelihood of malaria prevalence in this group in the Northwest and North-east of the country. The number of malaria infections increased with age, children aged between 49-59 months were found to be at a higher risk (Odds Ratio=4.680, 95% CI=3.674 to 5.961 at P<0.0001). After accounting for spatial correlation, we observed a strong significant association between the non-availability or non-use of mosquito bed-nets, low household socioeconomic status, low level of mother's educational attainment, family size, anaemia prevalence, rural type of residence and under-5 malaria prevalence. Faced with a high rate of under-5 mortality due to malaria in Nigeria, targeted interventions (which requires the identification of the child's location) may reduce malaria prevalence, and we conclude that socioeconomic impediments need to be confronted to reduce the burden of childhood malaria infection.

Cost-Effectiveness of PBO versus Conventional Long-Lasting Insecticidal Bed Nets in Preventing Symptomatic Malaria in Nigeria: Results of a Pragmatic Randomized Trial.

ABSTRACTInsecticide treated nets (ITNs) have been the major tool in halving malaria’s burden since 2000, but pyrethroid insecticide resistance threatens their ongoing effectiveness. In 2017, the WHO concluded that long-lasting ITNs (LLINs) with a synergist, piperonyl butoxide (PBO), provided additional public health benefit over conventional (pyrethroid-only) LLINs alone in areas of moderate insecticide resistance and endorsed them as a new class of vector control products. We performed an economic appraisal of PBO nets compared with conventional LLINs in 2019 US$ from prevention and health systems perspectives (including treatment cost offsets). We used data from a pragmatic randomized 2012–2014 trial in Nigeria with epidemiological outcomes in an area with confirmed pyrethroid resistance. Each village had 50 months of epidemiologic data, analyzed by village by month, using negative binomial regression. Compared with LLINs, although adding $0.90 per net delivered, PBO nets reduced symptomatic malaria cases by 33.4% (95% CI 10.2–50.6%). From a prevention perspective, the incremental cost-effectiveness ratio was $11 (95% CI $8–$37) per disability-adjusted life year averted. From the health systems perspective, PBO nets were significantly cost-saving relative to conventional LLINs. The benefit–cost analysis found that the added economic benefits of PBO nets over LLINs were $201 (95% CI $61–$304) for every $1 in incremental costs. Growing pyrethroid resistance is likely to strengthen the economic value of PBO nets over LLINs. Beyond their contribution to reducing malaria, PBO nets deliver outstanding economic returns for a small additional cost above conventional LLINs in locations with insecticide resistance.

The Prevalence of Malaria amongst Adults in Remote Primary Health Care Facility in South-South Nigeria

Malaria is a serious public health burden with high morbidity and mortality in Nigeria accounting for 60% outpatient visits, 30% childhood mortality, 25% infant mortality and 11% maternal mortality, respectively, in the country. Malaria is endemic in Nigeria with consequent high economic burden. Malaria is one of the leading causes of death in Nigeria. The prevalence of malaria is high in Nigeria resulting from several climatic, bioenvironmental and socio-demographic factors. Malaria prevalence is higher amongst dwellers with high poverty and illiteracy levels. The prevalence of malaria was evaluated retrospectively in this study using clinical records over 12 months in a remote primary healthcare facility in South-South Nigeria. The findings show varied malaria prevalence rates amongst the months, with 3 months below 50% and the remaining 9 months above 50%. The overall period prevalence was 56% (541/966). The high prevalence rate reported in this study reflects the endemicity of malaria in Nigeria and is consistent with other reports that malaria prevalence is higher in the south-south Nigeria than observed with other regions of the country. The study prevalence 56% is twice higher than the average national period prevalence of 23%.

ANTIPLASMODIAL POTENTIAL OF Garcinia kola (HECKEL) STEMBARK EXTRACT IN ALBINO MICE

Garcinia kola stem bark forms part of recipes used traditionally for the treatment of malaria. In view of the prevalence of malaria in Nigeria, this study investigated the phytochemical, mineral and proximate components, as well as antiplasmodial activity and toxicological effect of Garcinia kola stem bark extract against Plasmodium berghei infected mice. The plant sample was screened for phytochemical, mineral and proximate components using standard laboratory techniques. Thirty five mice were divided into seven groups of five mice each. Malaria was induced in all the groups intraperitoneally with 0.2 mL of infected blood containing about 107 of P. berghei parasitized red blood cells, except group 6 (extract only) and group 7 (normal control). Group 1 received 100 mg/kg bodyweight of the extract orally. Group 2 received 200 mg/kg of the extract. Group 3 received 300 mg/kg of the extract. Group 4 received 5 mg/kg of chloroquine. Group 5 (induced but untreated control). The haematology, liver function enzymes and histopathology of the liver were carried out using standard protocols. The plant was rich in alkaloids, iron and fibre. The extract treated groups (1-3) showed significant decrease (p≤0.05) in parasitemia level after seven days of treatment. There was no significant difference in AST, ALT, ALP, bilirubin and GGT activities in all the extract treated groups compared to the control. No pathological changes were evident in histopathology of all the groups treated with various concentration of the extract. The result obtained from this study confirmed the antiplasmodial activity of methanol extract of G. kola stem bark. The highest inhibition of P. berghie parasite was observed at dose 300 mg/kg comparable to chloroquine, with no hepatoxicity which confirmed the safety of G. kola. The phytochemicals and nutritional components could be responsible for the observed antiplasmodial activity of the plant.&#x0D; &#x0D;

Malaria and meningitis under climate change: initial assessment of climate information service in Nigeria

AbstractIt is often difficult to define the relationship and the influence of climate on the occurrence and distribution of disease. To examine this issue, the effects of climate indices on the distributions of malaria and meningitis in Nigeria were assessed over space and time. The main purpose of the study was to evaluate the relationships between climatic variables and the prevalence of malaria and meningitis, and develop an early warning system for predicting the prevalence of malaria and meningitis as the climate varies. An early warning system was developed to predetermine the months in a year that people are vulnerable to malaria and meningitis. The results revealed a significant positive relationship between rainfall and malaria, especially during the wet season with correlation coefficient R2 ≥ 60.0 in almost all the ecological zones. In the Sahel, Sudan and Guinea, there appears to be a strong relationship between temperature and meningitis with R2 &gt; 60.0. In all, the results further reveal that temperatures and aerosols have a strong relationship with meningitis. The assessment of these initial data seems to support the finding that the occurrence of meningitis is higher in the northern region, especially the Sahel and Sudan. In contrast, malaria occurrence is higher in the southern part of the study area. We suggest that a thorough investigation of climate parameters is critical for the reallocation of clinical resources and infrastructures in economically underprivileged regions.