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The impact of a school health club on adult perception of onchocerciasis and compliance with ivermectin was evaluated in an onchocerciasis-endemic community in southeastern Nigeria. Venous blood was collected from each of 26, 32 and 124 randomly selected subjects during ivermectin distribution programmes in 1995 1996 and 1997 respectively. Ivermectin concentrations were measured in the samples. Data was also collected from 334 and 319 randomly selected household heads or their representatives (aged 24 to 65 years) before and after health talks by schoolchildren, using interviewer-administered questionnaires. There was an increasing number of subjects who participated in control programmes (116 in 1995, 437 in 1996 and 2055 in 1997). Compliance with ivermectin treatment was low (53.9%) in 1995 but increased dramatically (90.1%) in 1997. A significant proportion (chi2 = 108.7, df = 1, P < 0.0001) of respondents knew about onchocerciasis after health education, predominantly from health workers (64.5%) before the tests and children (92.3%) after. Knowledge and beliefs about causative agents (chi2 = 266.4, df = 5, P < 0.0001), diagnostic method (chi2 = 207.4, df = 3, P < 0.0001), prevention (chi2 = 67.0, df = 4, P < 0.0001) of onchocerciasis and the effectiveness of ivermectin (chi2 = 40.4, df = 1, P < 0.0001) also differed significantly between the periods before and after tests. The school health club increased adult knowledge about onchocerciasis and its treatment. Schoolchildren could therefore supplement the information, education and communication (IEC) aspect of health care delivery in a community through such health clubs. [ABSTRACT FROM AUTHOR]

We assessed the influence of health education on the knowledge about onchocerciasis in school children in Okpatu, Nigeria. The children, aged between 11 and 17 y, received health education in both English and Igbo (local language) for three months on the transmission, clinical manifestations, treatment and prevention of onchocerciasis. Illustrated pictorial materials were used to support and enhance their understanding of the subject matter. Their level of knowledge was evaluated nine months later using a pre-tested personal interview administered questionnaire. A significantly higher proportion of these children knew about onchocerciasis (χ2=260.4, df=1, P<0.0001), and its causative agent (χ2=175.0, df=4, P<0.0001), clinical manifestations (χ2=254.0, df=5, P<0.0001), diagnosis (χ2=123.9, df=2, P<0.0001), treatment (χ2=197.8, df=3, P<0.0001) and prevention (χ2=220.8, df=3, P<0.0001) in the post- than in the pre-educational intervention. It is therefore concluded that school-based health education showed an increase in knowledge about onchocerciasis and school children could provide a useful ‘multiplier’ resource for health education in the community. [ABSTRACT FROM AUTHOR]

Objective: To determine the willingness to pay (WTP) for local ivermectin distribution in a community financing framework.Method: Contingent valuation in three communities in Nigeria, using randomly selected household heads. WTP was elicited using a bidding game, and for collecting information on the households' socio-economic status, level of knowledge, priority ranking and perception of risk of contracting the disease, structured questionnaires were used. Ordinary least squares (OLS) multiple regression analysis was used to analyse factors associated with WTP.Results: Between 92.1% and 93.3 % of respondents were willing to pay amounts ranging from 5 Naira (US$ 0.06) to 100 Naira (US$ 1.25) (median: 20 Naira, US$ 0.25) in the three communities, more than three times the modelled unit direct cost of distributing ivermectin by the communities themselves. Occupation of the respondent, marital status, average monthly expenditure on health care, manifestations of onchocerciasis, the type of savings scheme embarked on by the respondent, age-group, level of education and type of property were statistically significant (P < 0.05) variables affecting WTP.Conclusion: This study shows that there is WTP for local ivermectin distribution in the three study communities, and that it should be assessed before instituting community-directed treatment with ivermectin. [ABSTRACT FROM AUTHOR]

The willingness to pay (WTP) for the maintenance of equity in a local ivermectin distribution scheme in the context of a community financing framework was determined in Toro, Northern Nigeria, using 214 randomly selected heads of households, or their representatives. Though WTP of the respondents for their own households was elicited, the focus of this paper is on WTP to maintain equity in a community financing scheme. Contingent valuation was used for the exercise, and WTP was elicited using an open-ended question. 97.2% of the respondents were in favour of allowing those that lack the ability to pay, to benefit from the scheme and the maximum WTP amounts they were willing to contribute annually so that those who lack the ability to pay could benefit from the scheme ranged from 5 Naira ($0.06) to 100 Naira ($1.25). The mean WTP to maintain equity was 29.00 Naira ($0.36) while the median was 20.00 Naira ($0.25). This study shows that a community financing scheme for local ivermectin distribution will not be inequitable, since enough funds will be realised from well-to-do community members to cover the costs for those who are unable to pay. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine households' levels of prioritization and perception of malaria, ordinary mosquito nets and insecticide-treated nets (ITNs). A cross-sectional survey was conducted in five malaria holo-endemic communities in Enugu State, South-eastern Nigeria. The household heads or the representatives from randomly selected households were interviewed, using a pre-tested interviewer-administered questionnaire. The majority of the respondents had a good knowledge about malaria and the use of ordinary mosquito nets to prevent malaria. However, few knew about the existence of ITNs. Most respondents also stated that malaria was a priority problem and perceived some risk of contracting it. Despite the high level of knowledge about the use of mosquito nets, only 14.0%, 15.7%, 9.6% and 8.0% of the respondents from four of the communities had ever purchased any type of mosquito nets, except in Orba where the proportion was 50.3%. However, more than 80% in all the communities expressed a desire to buy insecticide-treated mosquito nets for the prevention of mosquito bites. There was considerable knowledge about malaria and the use of mosquito nets to prevent it. There were also high levels of prioritization of the disease, mosquito nets and ITNs which signalled the possibility of establishing sustainable community-based ITN programmes, especially as households wanted to buy the ITNs. Public Health (2000) 114, 407–410 [ABSTRACT FROM AUTHOR]

A total of 270 febrile patients (130 males and 140 females) aged between 15 and 59 were screened using thick and thin blood film stains for malaria, bacteriologic culture and Widal test for enteric fevers. Sixty (22%) were positive for malaria while 38 (14%) were positive for enteric fevers out of which 16 (26.6%) concomitantly had malaria parasite. Cases without malaria parasite (MP) or enteric fever organism were 172 (63.7%) and classified as pyrexia of unknown origin (PUO). Forty-four were strictly malaria cases out of which 36 (82%) were due to Plasmodium falciparum, and all had antibody Widal titres > or = 160 to 0 antigen while 4 (9%) were due to Plasmodium malariae, 3 (6.8%) were due to P. ovale and 1 (2.3%) was due to P. vivax. Twenty (52.6%) of the 38 patients with enteric fever had typhoid, all had Widal titres > or = 160 to 0 antigen. In all, antibody reaction Widal titres to H antigen were < 20. There was no statistical significant difference [chi2 = 327.2, P > 0.05] between Widal titres of malaria and typhoid cases. Hence using Widal test alone, one cannot differentiate typhoid fever from malaria. In another 250 healthy adults, of equal sex distribution, used as controls 12 (4.8%) had malaria parasite and 4 (1.6%) had enteric fever organisms. While only 4 (1.6%) gave Widal titre of 80 to 0 antigen the rest had antibody titres of < 20 to O antigen. Malaria could interfere with serological diagnosis of typhoid and hence lead to over diagnosis of typhoid in Nigeria.

A new method of assessment based on mid-upper arm circumference (MUAC) is described for dosage adjustment for community-based ivermectin distribution. We studied 878 subjects eligible for ivermectin dosing in Awhum, Nigeria. In a previous preliminary study of 40 persons, MUAC (in cm) correlated with weight (kg) in the first 20 male (r = 0.97, r2 = 0.95, P < 0.0001) and the first 20 female subjects (r = 0.94, r2 = 0.88, P < 0.0001). We therefore studied the use of height, physical appearance, and MUAC for calculating the dose of ivermectin. The MUAC-based schedule underdosed only 4.1% of the population. The methods based on height underdosed 3.3% and 21.1%, and assignment based on physical appearance underdosed 10.2% of the population studied. This MUAC-based method (13-15 cm, 0.5 tablet; 16-20 cm, 1.0 tablet; 21-27 cm, 1.5 tablets; > or = 28 cm, 2.0 tablets) is more convenient and corresponds closely to dosing by weight. An adaptation of this method with reference to other prevalent tropical diseases and their respective drugs is therefore advocated.

Non-compliance to correct dosing is thought to be one of the main causes of treatment failure of chloroquine in the home management of childhood malaria. There are few studies of compliance to drugs used for tropical diseases. In order to study compliance in the rural setting, chloroquine syrup was packaged with a novel pictorial insert for compliance to correct dosing. Compliance was assessed in a field trial in September 1996-December 1997, involving 632 children with uncomplicated malaria in Udi local government area in Nigeria. Written informed consent was obtained from mothers/guardians before children were enrolled in the study. There were 3 arms to the trial: control villages (group I) received chloroquine syrup without further intervention, group II received a pictorial insert with chloroquine syrup, and group III received chloroquine syrup, the pictorial insert and verbal instructions. Each group was made up of 3 health centres. Compliance was assessed by volumetric measurement of the chloroquine syrup left in 30-mL bottles and by questionnaires administered to mothers/helpers of the children. Control villages recorded full compliance for 36.5 +/- 4.4% of the children, group II for 51.9 +/- 7.9% and group III for 73.3 +/- 4.2%. There was a significant correlation (P < 0.0001) between full compliance, improvement and time for improvement of the condition. This study is deemed important because it focuses on children, who bear the greatest burden of malaria. It is unique for introducing a pictorial insert that illiterate villagers, who may not understand the use of age or weight in drug dispensing, may utilize as a substitute.

The effect of increasing concentrations of ivermectin on adenosine triphosphatase (ATPase) activity was investigated in adult worms of Onchocerca volvulus. Mean Mg- and Na,K-ATPase activities decreased significantly (F ratio = 29.82, P < 0.01 and F ratio = 28.54, P < 0.01, respectively) with increasing concentrations of ivermectin (0-100 ng/ml) in the female worms. When male and female worms were mixed with equal amounts of proteins from each, only the Na,K-ATPase activity was significantly decreased (F ratio = 56.61, P < 0.01) over a similar range of ivermectin concentrations. Since ivermectin exhibits concentration-dependent effects on both ATPases in female adult worms, this might provide an insight into other effects of the drug. However, the adjustment of the dose of ivermectin to obtain a nodular concentration of at least 40 ng/ml is therefore recommended in the complete chemotherapy of onchocerciasis.

In a forest-saving mosaic zone of south-eastern Nigeria endemic for onchocerciasis, we identified eye disorders in 65.5% of a randomly selected population sample. Onchocerciasis-related eye disease was present in 13.7% of the study sample and constituted 21% of the total number of eye disorders. A total of 78 (33.2%) of 235 subjects with visual impairment had onchocerciasis-related eye lesions, and of 35 who were blind in both eyes, onchocerciasis-induced eye disease was the cause in 28 (80%). The prevalence of bilateral blindness from all causes in the study area was 4.1%, while that from onchocerciasis-related causes was 3.3%. The commonest onchocerciasis-induced lesions that were responsible for visual impairment and blindness were choroidoretinitis and optic nerve disease. Sclerosing keratitis, an important causative lesion in onchocerciasis-endemic savanna regions, was encountered only one. Eye disease is therefore an important feature of onchocerciasis in the forest-savanna mosaic areas of Nigeria and should be borne in mind when planning and executing control programmes.

The Nigerian Ministry of Health has estimated that there are 40 million people in Nigeria at risk of onchocerciasis, and has asked for supplies of free ivermectin (Mectizan) to be donated by Merck, Sharpe and Dohme. In anticipation, three methods of distribution--door-to-door, clinic-based and centralized--were compared for cost-effectiveness. Costs were based on market values, and included salaries of and per diem payments to staff, cost of transportation, and subsistence during field activities. Effectiveness was measured by the total number of subjects successfully dosed. The local cost of dosing was N3.7 per person for the centralized system, N5.8 for the clinic-based system, and N9.2 for the door-to-door system (N10 = U.S. $1).

We measured ivermectin in plasma, urine, and saliva of nine patients with onchocerciasis. The aim was to establish pharmacokinetic parameters and to assess the most facile medium for use in monitoring compliance. Binding of ivermectin to plasma proteins in vitro was also investigated. The mean (+/- SEM) plasma values for the nine subjects were as follows: weight, 66.3 +/- 2.8 kg; dose, 11.11 +/- 0.4 mg; half-life, 56.50 +/- 7.01 hours; clearance, 142.5 +/- 22.6 L/kg; volume of distribution, 9.91 +/- 2.67 L/kg; area under the plasma concentration-time curve, 1545.3 +/- 190.5 ng/ml.hr; time to reach maximum concentration, 4.7 +/- 0.5 hours; and maximum concentration, 38.2 +/- 5.8 ng/ml. Ivermectin was not detected in the urine of any of the nine subjects. Low levels were found in saliva. Blood specimens remain the only reliable biologic fluid for assessment of compliance after ivermectin oral administration. Ivermectin binds specifically to human serum albumin.

Ivermectin levels were measured in breastmilk and plasma of 4 healthy mothers after an oral 150 micrograms/kg dose. Mean +/- S.D. plasma and milk values were 37.9 +/- 0.54 and 14.13 +/- 0.43 (ng/ml) respectively. Steady-state ivermectin levels in milk were low. Our results suggest that exclusion of lactating mothers from mass chemotherapy with ivermectin may be unnecessary.

Aflatoxin B1 levels were determined in Nigerian rural and urban market foods from 1977 to 1978. In general, levels were found to be highest during the peak rainy season, and the data suggest that livestock and humans are at highest risk from aflatoxicosis during this time. The incubation period for humans and nonhumans varies, and the risk to man from seasonal exposure to aflatoxin is assessed and reviewed. Primary hepatocellular carcinoma patients showed first symptoms of tumors during the dry season.

Chloroquine (CQ) and metronidazole (MZ) were measured in human urine and plasma by HPLC with UV detection. This method was used to analyse plasma levels in 4 African volunteers after an oral dose of 1000 mg CQ and 750 mg MZ, in a European on weekly prophylaxis of 500 mg CQ, and on 50 hospital urine samples. In the Africans peak plasma levels were over 1 microgram/ml and peak time was 1 1/2-2 hr. In the European plasma levels ranged from 0.58 to 0.36 microgram/ml. Over 80% of the urine samples contained CQ, MZ or both. The assay system was found flexible and economical for the therapeutic monitoring of these two important tropical drugs.

Serum gamma glutamyl transferase (GGT), bilirubin, alkaline phosphatase and aspartate transaminase levels were measured in 41 Nigerians (24 males and 17 females) aged 15-59 years (mean 41.7 years) with uncomplicated diabetes mellitus and without any previous history or physical findings of liver diseases; and in 41 healthy controls matched with the diabetics for age and sex. Twenty-six diabetics (63.4%) had raised GGT compared to three controls (7.3%). Fifteen diabetics (36.6%) had elevated alkaline phosphatase compared to one control (2.4%). Only three diabetics (7.3%) had elevated transaminase levels. The bilirubin was normal in both the diabetics and controls. The high incidence of raised GGT in the diabetics without physical findings of liver diseases suggest that many Nigerian diabetics may have latent or subclinical liver disorders. Such disorders may play an important role in the aetiology of diabetes in Nigeria or modify the natural history of coexisting diabetes. A common aetiological factor may also be responsible for the coexistence of the liver disorders and diabetes in these patients.