Open Access Original Research Article

Cost Effectiveness of Intermittent Preventive Treatment of Malaria in Infants in Ghana

Anselm Komla Abotsi, Ebenezer Inkoom, Eric Ribaira, Rozenn Le Mentec, Pierre Levy, Herve Lafarge, Alexandra de Sousa

International Journal of TROPICAL DISEASE & Health, Page 1-15
DOI: 10.9734/IJTDH/2012/1017

Aim: In order to integrate malaria Intermittent Preventive Treatment in infants (IPTi) into the Ghana national immunization programme, there was the need to evaluate the feasibility of IPTi by assessing the intervention operational issues including its implementation costs, and its cost effectiveness.
Study Design: Cross-sectional study.
Place and Duration of Study: Upper East Region, Ghana, between July 2007 and July 2009
Methods: We calculated the costs of administrating IPTi during vaccination sessions; the costs of programme implementation during the first year of implementation (start-up costs) and in routine years (recurrent costs). For the purposes of cost-effectiveness analysis, all economic costs (including financial and opportunity costs) and the net cost were estimated. To estimate the cost effectiveness ratios of IPTi, the aggregate cost of providing the intervention for a reference target population of 1,000 infants was divided by its health outcome. Sensitivity analyses were carried out to understand the results robustness.
Results: IPTi gross costs in start up and in routine years were estimated at 70.66 cents and 29.72 cents per dose, or $2.0 and $0.87 per infant, respectively. The gross cost per DALY saved was estimated at $3.49 and the net cost of IPTi for 1,000 infants was $-3,416.38 in the routine years rending IPTi a highly cost saving intervention. Sensitivity analyses showed that the cost per DALY saved never went up more than $4.50 maintaining the intervention still highly cost effective.
Conclusion: IPTi in Ghana is a highly and robust cost effective intervention. The intervention is cost-saving and should be scaled up nationally to save children’s health and economic capital.

Open Access Original Research Article

Still Births in a Tertiary Hospital, Niger Delta Area of Nigeria; Less Than a Decade to the Millennium Developmental Goals

H. A. A. Ugboma, C. N. Onyearugha

International Journal of TROPICAL DISEASE & Health, Page 16-23
DOI: 10.9734/IJTDH/2012/707

Aims: To determine the prevalence and associated factors of stillbirths in the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, south-south Nigeria.
Study Design: Retrospective study.
Place and Duration of Study: Data were obtained from the delivery registers in the theatre, labour and isolation wards and the records department of the UPTH between 1st January 2005 and 31st December 2010.
Methodology: We included 580 stillbirths (316 males and 264 females) whose data were analyzed using Epi-Info software version 6.04 and SPSS version 11.
Results: The prevalence of stillbirths was 45 per 1000 births. Fresh stillbirths (SB) (50.9%) were not significantly more than macerated SB (49.1%) p=0.792. Preterms (47.8%) were insignificantly more than term SB (41.5%) p=0.765. Unbooked mothers (86.7%), age 25-34 years (70%) and lower parities 1, 2 and 0 (43.4% and 29% respectively) were significantly associated with stillbirth delivery p<0.05. Places of antenatal supervision of the unbooked mothers were primary health centre (27%), traditional birth attendants’ (25%), churches, (22.3%), private maternities, (21.1%). Predominant pregnancy and labour complications associated with SB were prolonged labour (23.1%) abruptio placentae (14.1%), retained second twin (21.8%). Significantly more SB were delivered vaginally (66.9%) than abdominally (33.1%) p=0.026.
Conclusion: Lack of booking, inadequate pregnancy and labour supervision, avoidable delays are major contributors to high prevalence of stillbirths in Nigeria.

Open Access Original Research Article

Assessment of Adult Peripheral Lymphadenopathy in Red Sea State, Sudan

Ali K. Ageep

International Journal of TROPICAL DISEASE & Health, Page 24-32
DOI: 10.9734/IJTDH/2012/1008

Background: Although peripheral lymphadenopathy is a common presentation in Red Sea State, Sudan, no previous work was made to assess its causes. So, this study is done to identify the underlying causes of peripheral lymph nodes enlargement in the adult patients.
Place and Duration of Study: Red Sea Medical Center laboratory, Port Sudan, Sudan between November 2006 and June 2010.
Methods: Three hundred twenty seven patients presented with lymphadenopathy were examined by FNAC and histopathological techniques. The sites and the causes of the enlarged lymph nodes were identified. Clinical data were collected in predesigned questionnaires.
Results: Generalized lymphadenopathy was found in 25 patients (7.7%). The vast majority of the patients (69.4%) had cervical lymph node enlargement. The commonest cause of lymphadenopathy was tuberculosis (39.5%), followed by metastatic diseases (24.7%). Non Hodgkin’s and Hodgkin’s lymphoma represent 16.6% of the patients. Metastatic tumors commonly present after the age of 50 years (92.6%). Females are more affected by TB than males (60.1%). In this study, 180 of the cases were females and 147 cases were males. 
Conclusions: FNAC and in some cases lymph node biopsy should be done to any adult patient with chronic peripheral lymphadenopathy in the studied area. This will assist in the early diagnosis and proper management of the patients.

Open Access Original Research Article

Anticonvulsant and Depressant Activity of Methanol Leaf Extract of Croton zambesicus

O. T. Kolawole, M. O. Akiibinu, A. A. Ayankunle

International Journal of TROPICAL DISEASE & Health, Page 33-41
DOI: 10.9734/IJTDH/2012/1043

Aims: To study anticonvulsant and central nervous system depressant activity of methanol leaf extract of Croton zambesicus (MECZ) in Swiss albino mice and investigate the role of serotonin in these activities. 
Methodology: Anticonvulsant activity of graded doses (200, 300 and 400 mg/kg p.o) of MECZ was assessed through seizures induced by picrotoxin and pentylenetetrazole (PTZ). Effects of the extract on pentobarbitone-induced sleep and amphetamine-induced stereotype behavior were also evaluated. Possible involvement of serotonergic pathways was studied using cyproheptadine (4mg/kg i.p), a non-selective serotonin antagonist (5-HT1/5HT2). 
Results: In both picrotoxin and PTZ-induced seizures, the extract significantly delayed onset of seizure (p<0.05) in a dose-dependent manner and provided significant protection against death. There was a dose-dependent increase of pentobarbitone sleeping time and a significant reduction (p<0.05) in the sleep latency. The extract also produced a significant reduction in amphetamine-induced stereotype behavior. Pretreatment with cyproheptadine abolished the anticonvulsant effect of the extract. The inhibitory effect of the extract on amphetamine-induced hyperactivity and its potentiation of pentobarbitone-induced sleep were also reversed by cyproheptadine. 
Conclusion: The results of this study showed that methanol extract of Croton zambesicus leaf possesses anticonvulsant activity and other CNS depressant activities and these activities are possibly mediated through interaction between serotonergic and GABAergic transmissions.

Open Access Original Research Article

Gestational Diabetes: Risk Factors, Perinatal Complications and Screening Importance in Niger Delta Region of Nigeria: A Public Health Dilemma

H. A. A. Ugboma, H. Aburoma, P. Ukaigwe

International Journal of TROPICAL DISEASE & Health, Page 42-54
DOI: 10.9734/IJTDH/2012/648

Aim: The study identified the incidence of undiagnosed gestational diabetes and its consequences on maternal/neonatal mortality and highlighted screening importance in an African urban setting in the Niger Delta region in Nigeria.
Study Design: Randomised study. 
Place and Duration of Study: Pregnant women attending antenatal clinics in one tertiary, six primary, six secondary, hospitals, and six maternity homes in the Niger delta area of Nigeria between May 2006 to May 2009.
Method: A total of 1920 pregnant women were recruited into the study. While 956 received the oral glucose test and formed the study group, 964 declined from continuing in the study, and formed the control group.
Results: Women with gestational diabetes were at increased risk for premature rupture of membranes, preterm birth; breech presentation and high birth weight adjusting for maternal age.
Conclusion: The presence of gestational diabetes in pregnancy is predictive of poor pregnancy outcome as it remains undetected in conception resulting in unto wards maternal/neonatal complications.

Open Access Case Study

Anaemia in Critically Ill Children- A Case Study from Nigeria

I. O. George, B. E. Otaigbe

International Journal of TROPICAL DISEASE & Health, Page 55-61
DOI: 10.9734/IJTDH/2012/851

Background and Aim: Anaemia is a common cause of morbidity and mortality in the tropics. World Health Organization estimated that anaemia affects one-quarter of the world's population and is concentrated within preschool age children and in resource-poor countries like ours. The aim of this study was to evaluate the prevalence and severity of anaemia in critically ill children presenting at the Children Emergency Ward of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria.
Materials and Methods: This was a retrospective study of anaemic children (1 month to 16 years) admitted into the Children Emergency Ward of the UPTH from January to December 2010. Medical case notes of the patients were reviewed. Information obtained included age, gender, presenting complaints, diagnosis, packed cell volume (PCV), blood transfusion and outcome. The PCV was determined by microhaemtocrit method. Data generated were analysed using SPSS for widow, version 12.0 (SPSS Inc, Chicago Illinois, USA). Descriptive statistics in the form of the frequency and percentage were used.
Results: There were a total of 1581 children admitted into the Children Emergency Ward of the UPTH during the period of study. Four hundred and twenty three were confirmed to have anaemia of varying degree giving a prevalence of 26.8%. Most 295(69.7%) of the mothers were poorly educated and live in the urban slums. There were more males 418(67.1%) than females 205(32.9%). Fever, vomiting and weakness were the main presenting features. Ninety two patients (6.3%) had mild anaemia, 102 patients (6.5%) had moderate anaemia and 229 patients (14.5%) had severe anaemia. Two hundred and twelve of the critically ill children (50.1%) were transfused on account of severe anaemia. Malaria and septiicaemia were the commonest associated morbid conditions. Twenty five deaths were recorded. Severe anaemia accounted for 13(52.0%) of the total deaths. 
Conclusion: Anaemia is prevalent among Nigerian children in critical condition. Severe anemia is common and associated with increased risk of clinically relevant outcomes such as hospitalization and mortality.