Open Access Case Study

Traditional Medicines for HIV/AIDS and Opportunistic Infections in North-West Cameroon: Case of Skin Infections

Emmanuel Noumi, Patricia Nung Manga

International Journal of TROPICAL DISEASE & Health, Page 44-64

Background: The aim of this study was to evaluate the treatment of HIV/AIDS with locally available medicinal plants and its opportunistic infections, mainly skin diseases, in the population of Mezam Division, North-West Cameroon.
Methods: Information was gathered from 3 target groups: patients registered in the regional hospital of Bamenda; patients encountered during fieldwork; and traditional healers.
Results: The prevalence of HIV/AIDS is real in the Mezam Division and girls and women are relatively more infected. Out of thirty-five former and new patients interviewed, 8.5% used only anti-retroviral drugs (ARV) and 20% used both conventional and traditional medicines. Forty-one plant species belonging to 39 genera and 23 families were collected. They form 29 therapeutic preparations used to treat the pandemic. Ten patients were ‘’treated’’, i.e., they were symptom-free in this awareness-based medicine. Traditional healers used preparations made of Aloe barteri, Artemisia annua, Citrus aurantiifolia, Moringa oleifera and Vernonia guinneensis. Opportunistic skin infections such as herpes zoster, kaposi’s sarcoma and ringworm were easily treated by Aloe barteri, Leea guineensis, Pteleopsis hylodendron and Zehneria scabra. Chemistry and pharmacology confirm the virtues of these plants, as they produce flavonoids, antioxidants and antifungals. 
Conclusion: The traditional healers of the Mezam Division overcome non-complicated HIV/AIDS-related disorders. The chemical composition of plant species used in the combined therapy principle shows some efficiency of the therapeutic preparations used.

Open Access Case Study

Towards Sustainable Distribution of Health Centers Using GIS: A Case Study from Nigeria

Michael Oloyede Alabi

International Journal of TROPICAL DISEASE & Health, Page 130-136

Aim: This research is aimed to assess the spatial distribution of health centres in Lokoja, Nigeria.
Study design: Case study.
Place and Duration of Study: Lokoja is located in Kogi State of Nigeria and lies within latitude 7º45’N and 7º51N and longitude 6º41’E and 6º45’E of Greenwich meridian, between June 2010 and may 2011.
Methodology: This study was conducted within 5 neighborhoods in the study area. The Global Positioning System (GPS) was used to pinpoint the location of existing health centres. The inferential statistical tool applied in analyzing the data in this research is the “Nearest Neighbour Analysis” (NNA); this was used in establishing the distribution pattern of public and private health centres in the study area. Nearest Neighbour Analysis is the method of exploring pattern in the locational data by comparing mean distance (Do) of the phenomena in question to the same expected mean distance (De) usually under a random distribution. 
Results: An output of 0.99228 was found, an indication of weak randomness, because it exceeds the Z-score table value of -0.723417 which is indicative of insignificant accessibility. This scenario is a microcosm of state of health facility distribution in typical Nigerian cities where health facility distributions do not adhere to any particular pattern or criteria
Conclusion: In the area where population is not evenly distributed, the mean centre of population distribution is calculated as the “demand”, which forms the origin of location. The facility location point is considered as destination points or “supply”. The travel time can then be estimated as the shortest time through the road networks between the pair of population and the healthcare facility locations. The best route can then be created using network data set and network analysis in arc/info.

Open Access Original Research Article

Delayed Viral Response and its Predictors in Non Responder Chronic Hepatitis C Patients to Conventional Interferon and Ribavirin Therapy

Muhammad Irfan, Aftab Mohsin, Muhammmad Ghias

International Journal of TROPICAL DISEASE & Health, Page 37-43

Objective: To determine delayed viral response and its influencing factors in non responders patients of chronic hepatitis C who were not taking any antiviral treatment 6 months after completion of their conventional interferon therapy.
Study Design: Retrospective; Cohort Study 
Place and Duration of Study: Department of Medicine, Gastroenterology and Hepatology, SIMS / Services Hospital, Lahore, from January, 2007 to December, 2010.
Methodology: The medical record of non-responder patients of chronic hepatitis C to conventional interferon and ribavirin were retrospectively analyzed as well as their viral status was checked by Real Time Amplification method during 6 months to 2 years post-treatment. Non-compliant and incomplete follow-up cases were excluded. Factors influencing the post-treatment viral response were analyzed by bivariate analysis.
Results: A total of 1175 patients received interferon therapy along with ribavirin; 700 were called, but only 314 came for follow up. Among 70 patients who were non responders to conventional interferon, 5 (7.14%) patients developed delayed response and 65 (92.86%) remained still non responders. Post-treatment delayed self clearance of virus was seen more in male gender, having age >40 years, body weight <70 Kg and normal ALT at the end of treatment. However, there was a statistically significant association between the body weight (OR=0.839, CI: 0.719-0.979, p=0.014) and delayed response of chronic hepatitis c virus. Result depicts that chance of delayed response among over weight non-responder patients decreases to 16.1%.
Conclusion: Post treatment follow up for viral status in non responders patients of chronic hepatitis C can be beneficial in the form of delayed response and body weight <70 Kg is its best predictor.

Open Access Original Research Article

Evaluation of Biochemical Aspects of Formulated Drugs against Typhoid

S. S. Haque

International Journal of TROPICAL DISEASE & Health, Page 65-72

Typhoid fever one of the major health problems in many developing countries. Salmonella is a gram-negative, rod-shaped facultative anaerobic bacterium. Salmonella has developed resistance to many antibiotics used now a day that has complicated its management, that thus it has necessitated the search of formulated drugs for its treatments. Nitric oxide (NO) is an important signaling molecule that regulates a diverse range of patho-physiological processes in many tissues. Earlier studies have suggested that exogenous administration of Larginine results in increased NO production, indicating that endogenous substrate is insufficient for maximal NO production. Taking these facts in to consideration, it was thought pertinent to see the effect of oral administration of NO precursor, i.e., L-Arginine. Bacterial Clearance Study shows the bacterial burdens in the liver of S. typhimurium infected mice were consistently greater as compared to formulated drugs (L-Arginine+Ciprofloxacin) treated mice and ALT and AST decreases by 38.84% and 53.61% in 1/2 L-Arg+1/2 Cip group as compared to bacterial treated groups.

Open Access Original Research Article

Evaluation of Glucose- 6- Phosphate Dehydrogenase Deficiency in Icteric Newborns in Nigeria

I. O. George, N. A. Akani

International Journal of TROPICAL DISEASE & Health, Page 73-78

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most important causes of neonatal jaundice in Far Eastern, Mediterranean and African countries including Nigeria. Although neonatal jaundice is common in our area of practice (Rivers state), no documentation has been made of the prevalence of G6PD deficiency and its contribution to neonatal jaundice in Port Harcourt, Nigeria. 
Aims: The aim of this study was to determine the prevalence G6PD deficiency among neonates at University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria.
Study design: Descriptive cross-sectional study.
Place and Duration of Study: Special Care Baby Unit of UPTH, Port Harcourt, Nigeria between January 2006 to December 2006.
Materials and Methods: We included 400 neonates with jaundice. Jaundice was assessed clinically and confirmed by laboratory estimation of serum bilirubin. G6PD enzyme activity was assayed quantitatively using the method of Kombery. 
Results: A total of 400 neonates comprising 288 (78.0%) males and 112 (28.0%) females were recruited into the study. The male/female ratio was 2.6:1. Of these, two hundred and eight (52.0%) were born in UPTH, the study site while 192 (48.0%) were born in other hospitals but referred and admitted into SCBU of UPTH. A total of 210 neonates were G6PD deficient giving a prevalence of 52.5%. Among the G6PD deficient neonates, 145 (69.0%) were males while 65(31.0%) were females. The mean level of G6PD activity for the deficient neonates was 17.3 ± 10.9 %. Levels of enzyme activity were significantly lower in affected males than in the affected females (P<0.05).
Conclusion: There is a high prevalence of G6PD deficiency among neonates seen at the UPTH, in Port Harcourt, Nigeria. This calls for routine screening of every new born for the enzyme deficiency.

Open Access Original Research Article

Healthcare Workers′ Perceptions of Hospitals′ Institutional Structure

Abiodun Olukoga, Morenike Folayan, Tinu Olukoga, Geoff Harris, Eyitope Ogunbodede

International Journal of TROPICAL DISEASE & Health, Page 79-88

Objective: To analyse the perception of healthcare professionals and managers of the institutional structure of four hospitals in Nigeria to successfully implement the health sector reform (HSR) programme in the country. 
Study design: A cross-sectional survey of 507 healthcare professionals and managers in four hospitals located in four cities in southwest Nigeria conducted between December 2007 and March 2008. 
Methods: A self-administered questionnaire was used as the instrument for the assessment of staff perception of institutional structure of the hospitals to successfully implement the HSR programme. The questionnaire had questions ranked on a 5-point Likert scale that explored the respondents’ perceptions of institutional structure and closed-ended questions of socio-demographic nature.
Results: The overall perception of institutional structure was 52.5%. The perception of the four dimensions of institutional structure was design 60.7%, human resources 54.7%, financial resources 50.9% and infrastructure 39.4%. Out of the seventeen items on institutional structure, the qualification and competence of staff had the highest perception (78.3%) and adequacy of staff the lowest perception (28.9%). 
Conclusion: The rather low perception of infrastructure may be a direct reflection of the poor state of the infrastructure available in major hospitals in Nigeria to support the health sector reform programme in the country. The major infrastructural issues were inadequacy and poor maintenance of facilities and equipment, the lack of adequate staff, poor compensation and lack of resources to meet major recurrent and capital expenditures in the hospitals.

Open Access Original Research Article

Acute Effects of Formalin-Treated Cadaver on Nigerian Medical Students

Bernard EwonuBari Emue, Abdulkabir Ayansiji Ayanniyi, Maxwell Madueke Nwegbu, Titus Sunday Ibekwe

International Journal of TROPICAL DISEASE & Health, Page 89-96

Aims: To determine acute effects of Formalin-Fixed Cadaver (FFC) among Nigerian medical students (MS)
Study design: A cohort study.
Place and Duration of Study: College of Health and Medical Sciences, Universities of Abuja and Maiduguri, Nigeria respectively, between January, 2010 and February, 2011.
Methodology: We conducted a survey of 226 MS for acute effects of FFC on general conditions (feelings), eyes, nasal and skin symptoms on their first and subsequent exposures during gross anatomy dissections. The duration for relieve of bodily symptoms and protective devices used to reduce the effect of formalin on bodily organs were documented.
Results: The most common feelings and symptoms among study cohort on first exposure to FFC include general discomfort 183 (81%), eye irritation/itching 108 (48%) and nasal irritation/itching 113 (50%). By the fifth hour after the first exposure most of the studied MS were relieved of eyes 177 (78%) and nasal 186 (82%) symptoms. On subsequent exposures, most 199 (88%) had no nasal symptoms and many 106 (47%) also had no eye symptoms. However, many still experienced at least mild eye 120 (53%) and nasal 27 (12%) symptoms. Many used bodily protective measures including laboratory coats 86 (38%), hand gloves 78 (35%) and eyes goggles 62 (27%) to reduce/prevent the toxic effects of formalin. Most 197 (87.2%) rated high the benefit of protective measures.
Conclusion: These findings confirmed the irritating actions of FFC on MS. Thus, the concentration of FFC for dissection should be controlled and the exposure time should be limited. User friendly alternative preservative to formalin can be sought. Education of MS on formalin related health hazards ahead of their first exposure and the use of protective measures among them should be highlighted.

Open Access Original Research Article

Some Protective Effects of Aqueous Leaf Extract of Azadirachta indica on Paracetamol-induced Hepatotoxicity in Adult Wistar Rats

Ajibade Adeshina John, Fakunle Ponle Bamidele, Oloyede Adegoke OluwaSeun

International Journal of TROPICAL DISEASE & Health, Page 97-106

Background: Azadirachta indica is a plant used widely in the Indian system of medicine for its diverse medicinal properties. Its extracts have a vast pharmacological activity and are used as raw materials for pesticide, medicine and other commodities. Each part of this plant have its own therapeutic importance and uses which include: antifertility antipyretic, anti-inflamatory, antimalaria, anti-rheumatic and others. The present study investigated some effects of aqueous extract of Azadirachta indica on paracetamol-induced hepatotoxicity in adult wistar rats.
Place and Duration of Study: Department of Anatomy, Faculty of Basic Medical Sciences, LAUTECH, Nigeria between November 2009 and July 2010. 
Methodology: A total of twenty-four (24) rats of wistar strain of both sexes weighing 150g-232g were divided into four (4) groups of six (6) rats each. Groups A served as normal control given only distilled water for seven days orally. Group B received only paracetamol at a dose of 3g/kg body weight orally, on the fifth day of seven days administration, group C received a pretreatment of Azadirachta indica aqueous extract at a dose (400mg/kg b.w orally) for seven days while paracetamol (3g/kg .orally) was given on the fifth day of the administration and group D only received the aqueous extract of Azadirachta indica (400mg/kg/ b.w.) orally for seven days.
At the end of the experimental period, all animals were sacrificed using cervical dislocation method, blood was obtained for assay for the following of hepatic marker enzymes Alanine amino transaminase (ALT), Aspartate amino transaminase (AST) and Alkaline phosphatase (ALP) respectively. Liver tissue was removed, fixed in 10% formol saline and processed for histopathological studies using Heamatoxylin and Eosin (H and E) staining technique. 
Results: The results obtained from body weight parameter showed that paracetamol treated group (group B) showed a significant reduction in weight compared to groups A, C and D. Histopathological observations revealed well preserved histoarchitecture, without portal inflammation, cytoplasmic inclusion, binucleation or necrosis in group A, C and D. However, group B showed portal inflammation, moderate to mild cytoplasmic inclusion, sinusoid congestion and marked tissue necrosis in most of the group compared with group C in which the leaf extract of Azadirachta indica inhibited paracetamol induced hepatic damage. Biochemical analysis of hepatic enzymes also showed an increased in serum marker enzymes of hepatic damage (AST, ALT and ALP) after paracetamol administration in group B. Azadirachta indica pretreatment stabilized the serum levels of these enzymes in group C and D, respectively.
Conclusion: The study concluded that aqueous leaf extract of Azadirachta indica offers protection to the hepatocytes against paracetamol induced hepatotoxicity in wistar rats.

Open Access Original Research Article

Effect of Leaf Aqueous Extracts of Vernonia amygdalina Del on Contraction of Mammary Gland and Uterus of Guinea Pig Dams

Ifeoma I. IJEH, Kalu K. IGWE, Chukwunonso E.C.C. EJIKE

International Journal of TROPICAL DISEASE & Health, Page 107-116

Aims: To determine the effects of aqueous extracts of Vernonia amygdalina on litter-weight gain, milk production and uterine contraction amplitude and mammary gland smooth muscle contraction amplitudes in the guinea pig model.
Methodology: The animals were placed in four groups of three animals each with group1 as control, and groups II-IV receiving 5 mg/kg, 10 mg/kg and 100 mg/kg V. amygdalina respectively. Using a chymograph, uterine and mammary gland contraction amplitudes were determined at 5, 10 and 100mg/ml of the extract with ergometrine as the control drug.
Results: After 5 weeks, the litter-weight of the control group (1.88 ± 0.68 g) was significantly (P<0.05) less than that in groups III (4.20 ±0.20 g) and IV (13.69 ± 1.53 g) but not different from group III (3.11 ± 0.10 g). All the dams had their highest mean milk production index (g) at week 2. From week 4, all the treatment groups produced more milk than the control group. At concentrations of 5 mg/ml and 10 mg/ml, uterine contraction amplitudes (mm) were 1.22 ± 0.03 and 3.60 ± 0.03, respectively. The contraction amplitude at 100 mg/ml matched that of ergometrine (9.58 ± 0.39 mm). The mammary gland contraction amplitudes (mm) recorded for 5 mg/ml, 10 mg/ml and 100 mg/ml V. amygdalina were 1.2 ± 0.14, 2.70 ± 0.36 and 6.15 ± 0.13 respectively. These values were significantly (P< 0.05) lower than those observed for the equivalent concentrations of ergometrine.
Conclusion: The results appear to support the claims of traditional birth attendants who use the plant to induce uterine motility and milk let-down after parturition.

Open Access Original Research Article

Preferences and Selection of Health Plans by Members of an Employer Based Medical Scheme

Michael Mncedisi Willie

International Journal of TROPICAL DISEASE & Health, Page 117-129

Aims: The aim of the current study was to explore employee preferences for health plans offered by members of an employer based medical scheme.
Study design: The study was a cross section survey on a restricted scheme or an employer based medical scheme. Multinomial logistic regression model were employed on the outcome variable, which was the attributes of choosing a health plan. 
Results: The study revealed that affordability access to benefits, and health care needs as most prevalent attributes for choosing health plans and the response rates were 28.1 %, 22.0% and 21.2%, respectively. Multinomial logistic regression model results revealed demographic characteristics such as gender (p=0.005), age (p<0.0001), income (p=0.0129), ethnicity (p=0.0062), and health plan characteristic (p<0.001) as significant effects of choosing a health plan. 
Conclusion: Comprehensive and affordable health care remains a problem for many, even in insured groups of individuals on employer sponsored health plans. Access to benefits, healthcare needs and convenient access a service provider remain second key attributes to choosing health plans. 
Originality/value: The study is original research work on medical schemes members and provides insightful and meaningful results on preference by purchasers of private health insurance plans.

Open Access Original Research Article

Regenerative Effects of Coconut Water and Coconut Milk on the Pancreatic β–Cells and Cyto Architecture in Alloxan Induced Diabetic Wistar Albino Rats

Eze K. Nwangwa, Chukwuemeka P. Aloamaka

International Journal of TROPICAL DISEASE & Health, Page 137-146

The effects of Coconut water and Coconut milk on the total body weight, blood glucose level and the cyto- architecture of the pancreatic tissue were studied. A total of 30 albino wistar rats were randomly divided into five experimental groups (n=6). Group 1 –normal control was fed on normal rat chow, Group 2,3,4,5 were made diabetic by single intraperitoneal dose of 100mg/kg b.wt. of alloxan monohydrate. Group 2- diabetic, non treated, were fed on normal rat chow, Group 3, and 4 were fed on coconut water ad libitum for 14 and 28 days respectively, and Group 5 were fed on coconut milk ad libitum for 28 days. The result shows a statistically significant decrease in total body weight in Group 2, 3 and 4 and a non statistically significant increase in body weight in groups 1 and 5. Also there was a statistically significant decrease in blood glucose level in the group fed with coconut water. The pancreatic histology also shows a regenerative effect with administration of both coconut water and especially coconut milk on the degenerative changes caused by diabetes. This study has shown that coconut water has a hypoglycaemic effects and coconut milk has a regenerative effect on the pancreatic cells of alloxan induced diabetic rats. The findings in this research may be of benefit in the management of diabetic patients.