Open Access Case Report

Currently Observed Trend in the Resistance of Malaria to Artemisinin Based Combination Therapy in Nigeria – A Report of 5 Cases

Gonen S. Wundermann, Agbonmeire Awele Osiki

International Journal of TROPICAL DISEASE & Health, Page 1-5
DOI: 10.9734/IJTDH/2017/30914

Malaria is a life threatening disease caused by parasites transmitted through the bite of an infected female mosquito. About 3.2 million (about half of the world’s population) are at risk of malaria; it affects all age group from young to old. Between 2002 – 2015, Sub-Saharan Africa was home to 88% of malaria cases and 90% of malaria deaths most of which were under-five years old.  Plasmodium falciparum – transmitted by female Anopleles mosquito (one of the five parasites that cause malaria in humans) is the most prevalent malaria parasite in the African continent and is responsible for most malaria-related deaths globally [1].

Artemisinin-based combination therapy (ACT) resistance is rare in Sub-Saharan Africa. The World Health Organization (WHO) identifies monitoring and surveillance using day – 3 parasitaemia post treatment as the standard test for identifying suspected artemisinin resistance [2]. Early treatment failure due to possible ACT resistant Plasmodium falciparum has been identified in 5 cases across different age group, race, sex and gender. All cases managed showed significant clinical and parasitological responses to further treatment with combined Artesunate (intravenous) and Arthemeter (intramuscular), Arthemeter only (IM) or Artesunate tablets.

This study seeks to emphasize the need for a re-evaluation of the malaria treatment protocol and to throw more light on the increasing resistance of Plasmodium falciparum to the commonly used Artemisinin – based combination therapy agents in Nigeria.

Open Access Short Research Article

Molecular Identification of Plasmodium Species in Malaria in Zimbabwe by Mitochondrial DNA Sequencing

Willard Mbiri, Nyasha Chin’ombe

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2017/31517

Aim: To identify the Plasmodium species circulating in Zimbabwe.

Study Design: Cross-sectional study.

Place of Study: The study was conducted at three malaria referral hospitals in Harare, Zimbabwe from January to May 2016.

Methodology: Blood samples from patients with malaria were collected at three referral hospitals and DNA extracted. Plasmodium mitochondrial genomic DNA was amplified by polymerase chain reaction (PCR) and amplicons were sequenced. The sequences were analyzed using bioinformatics tools and Plasmodium species identified.

Results: A total of 160 blood samples were collected throughout Zimbabwe through three referral hospitals, of which 130 were malaria-positive and 30 were malaria-negative by microscopy. DNA was extracted from 100 samples (80 malaria-positive and 20 malaria-negative) and amplification of Plasmodium mitochondrial DNA was performed. Out of the 100 samples, 78 (78%) showed amplification of the expected PCR band of 220 bp. Of the 80 malaria-positive samples, 77 showed mitochondrial genome amplification and of the 20 malaria-negative samples, 1 showed amplification of the expected band. Out of 78 samples that were successfully amplified, 60 were sequenced. Analysis of the sequences showed that all (100%) the selected samples belonged to Plasmodium falciparum species.

Conclusion: From the analyzed malaria-positive blood samples, P. falciparum was shown to be the only species of Plasmodium present. Further studies with larger sample size may need to be done in order to ascertain whether P. falciparum is the only species causing malaria in Zimbabwe.

Open Access Original Research Article

Prevalence of Malaria Infection and Reliability of ACCUCARE One Step Malaria Test® for Diagnosing Malaria in People Living with Human Immunodeficiency Virus Infection in Cameroon

Lugarde Mawabo Kamgain, Jean-Paul Assam-Assam, Loick Pradel Kojom Foko, Henri Lucien Kamga Fouamno

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2017/30277

Aims: This study aimed at determining the malaria prevalence and appraising the diagnostic performances of a rapid diagnostic test (RDT), namely ACCUCARE one step Malaria Test®, for malaria in people living with human immunodeficiency virus infection (PLWHIV).

Study design:  This study was a cross-sectional study.

Place and Duration of Study: The study was carried out at the District hospital of Deido in Douala, Cameroon between August 2015 and March 2016.

Methodology: A total of 723 patients were included in the study. Malaria parasites were detected using Giemsa-stained blood films and RDT. The reliability of the RDT was evaluated by calculating the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and Kappa index (κ). Results were analyzed and compared using light Giemsa-stained blood films as gold standard. HIV infection was confirmed using methods based on immunochromatography and ELISA. CD4 lymphocytes count was determined by flow cytometry to depict the immune status.

Results: Overall, Plasmodia were found in 121 (16.7%; 95%CI: 14.2%-19.6%) and 91 (12.6%; 95%CI: 10.3%-15.3%) using light microscopy and RDT respectively. The sensitivity, specificity, PPV and NPV of the RDT were 75.2% (95%CI: 66.8%-82.1%), 100% (95%CI: 99.4%-100%), 100% (95% CI: 95.9% -100%) and 95.3% (95% CI: 93.3% - 96.7%) respectively. The agreement between both methods was excellent (κ = 0.835; P < .0001).

Conclusion: The study showed a good performance of the RDT in terms of specificity, PPV, NPV, accuracy and agreement. This test might represent a good alternative to the standard method for diagnosis of malaria in PLVIH.

Open Access Original Research Article

Caesarean Delivery at a Teaching Hospital, South-South Nigeria: A Five-Year Review

C. O. John, J. O. Alegbeleye

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2017/31142

Objectives: To determine the rate, indications, outcome and complications of caesarean sections in a tertiary health facility.

Materials and Methods: A retrospective study of all caesarean sections carried out at the obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH) Nigeria, between January 1, 2011 and December 31, 2015 was conducted. Data was obtained from the theatre records and case notes of patients, and were analysed using the statistical package SPSS 20. 

Results: Over the 5-year period under review, there were 12,421 deliveries. The overall caesarean section rate was 30.3%. There were 2,780 (73.8%) emergency caesarean sections and 987 (26.2%) elective caesarean sections. Feto-pelvic disproportion was the commonest indication for caesarean section 1049 (27.8%), followed by repeat caesarean section (16.7%). Anaemia was the commonest postoperative complication, occurring in 488 (19%) women, followed by pyrexia in 241 (9.6%) and wound infection 104 (3.7%). There were 4 cases of maternal deaths recorded in the study period giving a case fatality rate of 0.1%. Three of these four maternal deaths followed emergency caesarean section. Majority of the babies 2,799 (74.3%) were delivered by emergency procedure.                                                                      

More than half of the babies 1,584 (41.4%) had birth asphyxia and there were 231 (6%) perinatal deaths. All the cases of perinatal deaths were following emergency procedure.

Conclusion: The CS rate in this study is high. Feto-pelvic disproportion was the most common indication. The perinatal outcome following emergency caesarean section is poor. Risk appraisal and efforts geared towards reducing caesarean section rate especially in our environment where subsequent deliveries might not be attended to by skilled health personnel must be done.

Open Access Original Research Article

Otologic Disorders in Children: Our Experience in a Private Hospital Setting in Port Harcourt, Nigeria

Lucky Obukowho Onotai, Okechi Chibuzo Mbalaso

International Journal of TROPICAL DISEASE & Health, Page 1-5
DOI: 10.9734/IJTDH/2017/30959

Background: Otologic disorders have been found to be important health problems among children Worldwide. This study was done to establish the pattern of otologic disorders in children as seen in a private hospital setting in Port Harcourt Nigeria and to suggest measures to curb the menace posed by these diseases.

Patients and Methods: A prospective study of all children seen with otologic disorders in Kinx Medical Consultant clinic located in Port Harcourt, Rivers State, Nigeria over a 2 years period from January 2013 to December 2014. The following patients’ data were documented in a proforma and analyzed for age, gender, investigation results, diagnosis and treatment modalities. The data were entered into SPSS version 16 computer software and analyzed descriptively.

Results: A total of 85 patients presented with otologic disorders out of a total number of 650 cases seen in the clinic during the period of study, giving a prevalence of 13.08%. There were 35 males and 50 females giving M: F ratio of 1: 1.4. The age range was 6 months to 17 years with mean of (2.4 ± 1.6) years. The age range 2-4 years accounted for majority of the cases 35 (41.18%). Chronic Suppurative Otitis Media was the commonest condition seen 30 (35.29%), followed by hearing loss 15 (17.65%) and otomycosis 15 (17.65%). The commonest mode of treatment was conservative medical treatment 50 (58.8%). The patients with hearing loss were further sent for more audiological assessment in centres that have the appropriate facilities to carry out complete audiological assessment.

Conclusion: Chronic suppurative otitis media was the commonest otologic disorder found among children in our series. Meanwhile, conservative medical treatment was the commonest mode of treatment. It is important to put some effort into the training of otologists, provide all the relevant surgical equipments as well as carry out otologic health education by embarking on public enlightenment campaigns targeting parents and guardians.