Showing papers by "University of Nigeria, Nsukka published in 2009"

Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria.

Abstract: The anti-retroviral (ARV) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate. The government aims to scale up ARV treatment in the country. However, non-adherence to ARV medication can lead to viral resistance, treatment failure, toxicities and waste of financial resources. This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria. The study was cross-sectional and descriptive. Information was collected from 174 patients selected by simple random sampling from the register of all patients who had been on anti-retroviral therapy (ART) for at least 12 months at the beginning of the study period. Patients were identified during their clinic visits. Information on their socio-demographic profile, ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent, using pre-tested interviewer-administered questionnaires. All patients clearly understood the need to take ARV drugs throughout their lives, and what the costs entailed. They understood the need for periodic testing, the probability that complications would develop, cost of transportation to treatment site and the daily treatment regimen. Seventy-five per cent of respondents were not adhering fully to their drug regimen; the mean number of days that respondents had been off drugs was 3.57 days the preceding month. Reasons for non-adherence included: physical discomfort (side effects); non-availability of drugs at treatment site; forgetting to carry drugs during the day; fear of social rejection; treatment being a reminder of HIV status; and selling of own drugs to those unable to enrol in the projects. Being female, under 35 years, single, and having higher educational status were significantly associated with non-adherence. It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa.

Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria.

Abstract: There is little existing knowledge about actual quality of drugs provided by different providers in Nigeria and in many sub-Saharan African countries. Such information is important for improving malaria treatment that will help in the development and implementation of actions designed to improve the quality of treatment. The objective of the study was to determine the quality of drugs used for the treatment of malaria in a broad spectrum of public and private healthcare providers. The study was undertaken in six towns (three urban and three rural) in Anambra state, south-east Nigeria. Anti-malarials (225 samples), which included artesunate, dihydroartemisinin, sulphadoxine-pyrimethamine (SP), quinine, and chloroquine, were either purchased or collected from randomly selected providers. The quality of these drugs was assessed by laboratory analysis of the dissolution profile using published pharmacopoeial monograms and measuring the amount of active ingredient using high performance liquid chromatography (HPLC). It was found that 60 (37%) of the anti-malarials tested did not meet the United States Pharmacopoeia (USP) specifications for the amount of active ingredients, with the suspect drugs either lacking the active ingredients or containing suboptimal quantities of the active ingredients. Quinine (46%) and SP formulations (39%) were among drugs that did not satisfy the tolerance limits published in USP monograms. A total of 78% of the suspect drugs were from private facilities, mostly low-level providers, such as patent medicine dealers (vendors). This study found that there was a high prevalence of poor quality drugs. The findings provide areas for public intervention to improve the quality of malaria treatment services. There should be enforced checks and regulation of drug supply management as well as stiffer penalties for people stocking substandard and counterfeit drugs.

Justification for the use of Ocimum gratissimum L in herbal medicine and its interaction with disc antibiotics.

Abstract: The ethanolic extract of the leaves of Ocimium gratisimum L. (Lamiaceae), used in traditional medicine for the treatment of several ailments such as urinary tract, wound, skin and gastrointestinal infections, was evaluated for its antibacterial properties against four clinical bacteria isolates namely: Escherichia coli, Proteus mirabilis, Staphylococcus aureus and Pseudomonas aeruginosa and the antifungal properties using a clinical isolate of Candida albicans. A typed bacterium of Escherichia coli ATCC 11775 and another typed fungal strain of Candida albicans (ATCC 90028) were also included. The study also intended to verify if the concomitant administration of conventional antibiotics with Ocimium gratisimum which is normally taken as food (spice) will negatively affect its activity. The agar diffusion method was used to test the in vitro activity of the plant extract. The interaction of the plant extract with some disc antibiotics namely: ciprofloxacin, septrin, streptomycin, ampicillin, nystatin and ketoconazole was tested using the agar overlay inoculum susceptibility disc method. Phytochemical analysis of the extract was performed following established methods. The extract showed good but varying in vitro activities against all the isolates tested. While ampicillin showed synergistic interaction with the plant extract against clinical isolates of E. coli and P. mirabilis, septrin was synergistic against the clinical isolate of E. coli only. Similarly, the activity of the extract against C. albicans isolate was synergistic with ketoconazole and nystatin. The study has validated the folkloric use of O. gratissimum in traditional medicinal practice and goes further to show that the use of this plant material as food spice may not really threaten the efficacy of some conventional antibiotics that may have been taken concomitantly with it as is the popular belief in the practice of herbal medicine in local/rural communities of many countries in the world.

Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT

Abstract: The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment) and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs) have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria) by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT) and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy), RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER) of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated at that level. There was also a lesser cost of RDT ($0.34 million) compared to presumptive treatment ($0.37 million) and microscopy ($0.39 million), with effectiveness values of 99,862, 99,735 and 99,851 for RDT, presumptive treatment and microscopy, respectively. Cost-effectiveness was affected by malaria prevalence level, ACT adherence level, cost of ACT, proportion of non-malaria febrile illness cases that were bacterial, and microscopy and RDT sensitivity. RDT is cost-effective when compared to other diagnostic strategies for malaria treatment at malaria prevalence of 43.1% and, therefore, a very good strategy for diagnosis of malaria in Nigeria. There is opportunity for cost savings if rapid diagnostic tests are introduced in health facilities in Nigeria for case management of malaria.

Are malaria treatment expenditures catastrophic to different socio-economic and geographic groups and how do they cope with payment? A study in southeast Nigeria.

Abstract: OBJECTIVES To determine the inequities in the household income depletion resulting from malaria treatment expenditures, the sacrifice of basic household needs (catastrophe) and the differences in payment strategies among different socio-economic and geographic groups in southeast Nigeria. METHODS Data were gathered through pre-tested, structured questionnaires from a random sample of 2 250 householders in rural and urban parts of southeast Nigeria. The level of catastrophic malaria treatment expenditure was computed as the percentage of average monthly malaria treatment expenditure divided by the average monthly non-food household expenditure, using a threshold of 5%. Socio-economic inequity was established using a socio-economic status (SES) index, while a rural-urban comparison examined geographic disparities. RESULTS The average cost to treat a case of malaria was 796.5 Naira ($6.64) for adults and 789.0 Naira ($6.58) for children. The monthly malaria treatment expenditure as a proportion of monthly household non-food expenditure was 7.8%, 8.5%, 5.5% and 3.9% for the most poor, very poor, poor and least poor SES groups respectively. Malaria treatment accounted for 7.1% and 5.0% of non-food expenditures for rural and urban dwellers, respectively. More than 95% of the people financed their treatment through out-of-pocket payment (OOP), with no SES and rural-urban variance, as opposed to insurance payment mechanisms and fee exemptions. CONCLUSION There were socio-economic and geographic inequities in the financial burden resulting from malaria treatment. The treatment expenditure depleted more of the aggregate income of the two worse-off SES (Q1 and Q2) and of the rural dwellers. Government and donor agencies should institute the abolition of user fees for malaria, the transition from OOP to pre-payment mechanisms and the improvement of physical access to appropriate malaria treatment services, as well as subsidies and deferrals in order to engender financial risk protection from malaria treatment.

Knowledge about childhood autism and opinion among healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders in Nigeria.

Abstract: In designing programs to raise the community level of awareness about childhood autism in sub-Saharan Africa, it is logical to use the primary healthcare workers as contact point for education of the general public. Tertiary healthcare workers could play the role of trainers on childhood autism at primary healthcare level. Assessing their baseline knowledge about childhood autism to detect areas of knowledge gap is an essential ingredient in starting off such programs that would be aimed at early diagnosis and interventions. Knowledge of the healthcare workers on availability of facilities and law that would promote the required interventions is also important. This study assessed the baseline knowledge about childhood autism and opinion among Nigerian healthcare workers on availability of facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders. A total of one hundred and thirty four (134) consented healthcare workers working in tertiary healthcare facilities located in south east and south-south regions of Nigeria were interviewed with Socio-demographic, Knowledge about Childhood Autism among Health Workers (KCAHW) and Opinion on availability of Facilities and Law caring for the needs and rights of children with Childhood Autism and other developmental disorders (OFLCA) questionnaires. The total mean score of participated healthcare workers on KCAHW questionnaire was 12.35 ± 4.40 out of a total score of 19 possible. Knowledge gap was found to be higher in domain 3 (symptoms of obsessive and repetitive pattern of behavior), followed by domains 1 (symptoms of impairments in social interaction), 4 (type of disorder autism is and associated co-morbidity) and 2 (symptoms of communication impairments) of KCAHW respectively among the healthcare workers. Knowledge about childhood autism (KCA) as measured by scores on KCAHW questionnaire was significantly associated with age group distribution of the healthcare workers, with those age group of fourth decades and above more likely to have higher mean score (p = 0.004) and previous experience of managing children with autism spectrum disorders (ASD) (p = 0.000). KCA showed near significant association with area of specialty, with those healthcare workers in psychiatry compared to pediatrics having higher mean score (p = 0.071) and also with years of working experience of the healthcare workers (p = 0.056). More than half of the healthcare workers subscribed to the opinion that facilities and law caring for the needs and rights of children with childhood autism and other developmental disorders are lacking in Nigeria. The correlates of KCA may help in selection of those tertiary healthcare workers that would best fit the role of trainers. It is important to update the knowledge gaps of those healthcare workers who scored low in different domains of KCAHW questionnaire. It is imperative for policy makers in Nigeria to advocate and implement multidisciplinary healthcare service system that would ensure early diagnosis and interventions. Nationally representative baseline epidemiological data that would guide policy and planning are also desirable.

Sustained release and permeation of timolol from surface-modified solid lipid nanoparticles through bioengineered human cornea.

Abstract: Purpose: The aim of the study was to formulate and evaluate surface-modified solid lipid nanoparticles sustained delivery system of timolol hydrogen maleate, a prototype ocular drug using a human cornea construct. Materials and Methods: Surface-modified solid lipid nanoparticles containing timolol with and without phospholipid were formulated by melt emulsification with high-pressure homogenization and characterized by particle size, wide-angle X-ray diffraction, encapsulation efficiency, and in vitro drug release. Drug transport studies through cornea bioengineered from human donor cornea cells were carried out using a modified Franz diffusion cell and drug concentration analyzed by high-performance liquid chromatography. Results: Results show that surface-modified solid lipid nanoparticles possessed very small particles (42.9 ± 0.3 nm, 47.2 ± 0.3 nm, 42.7 ± 0.7 nm, and 37.7 ± 0.3 nm, respectively for SM-SLN 1, SM-SLN 2, SM-SLN 3, and SM-SLN 4) with low polydispersity indices, increased encapsulation eff...

Sustainable biodiversity conservation in the Niger Delta: a practical approach to conservation site selection

Abstract: The rich biodiversity repository of the Niger Delta region of Nigeria is under severe threat from diverse sources such as deforestation, inadequate farming practices, invasive alien species, urbanization and oil and gas exploration and development activities. This biodiversity “hot spot” is the second most sensitive environment in Africa. The over 70 Protected Areas (PAs) here have lost substantial portions of their area which translates to loss of biodiversity. The need to select representative sites within each of the ecological zones of the region for effective and sustainable biodiversity conservation is, therefore, essential. Vital site criteria that have ecological, socio-economic and cultural dimensions were selected and assessed through a combination of relevant scientific information, indigenous traditional knowledge and participatory rural appraisal (PRA) to yield Key Biodiversity Areas (KBAs).They are significantly different from the site selection criteria and principles used in the UK and to a large extent adopt the critical factors that underscore biodiversity conservation in a largely primary production based economy such as in much of the developing world. The three sites selected for biodiversity conservation through this process yielded not only community buy-in but also participatory action and ownership, which are critical for the sustainability of the biodiversity conservation efforts. Shell Nigeria and World Wide Fund (WWF) representatives are already concluding plans to commence effective conservation projects in the selected sites. This approach is hereby advocated for consideration and adoption for the preservation of the remaining stock of the unique biodiversity in developing countries.

Colloidal stability in some tropical soils of southeastern Nigeria as affected by iron and aluminium oxides

Abstract: The stability of microaggregates in soils as opposed to its dispersion is a very important soil phenomenon that checks degradation arising from unguided tillage and soil erosion. Ten soils from southeastern Nigeria were sampled from their typical A and B horizons for the study. The aim was to identify the extent of colloidal stability of the soils and the forms of Fe and Al oxides in the soils contributing to their stability. The soils are mostly Ultisols and Inceptisols formed on sandstones and shale parent materials. The soils are low in soil basic cations including the soil organic carbon (SOC). The major clay mineral is kaolinite while the soil is acid in reaction. The various forms of soil Fe and Al oxides are high with the total forms of Fe and Al being most dominant and > dithionite extracted Fe and Al > oxalate extracted Fe and Al > pyrophosphate extracted Fe and Al. The water-dispersible clay and silt (WDC) and (WDSi) which are index of dispersion in most soils are low to medium thus reflecting in the low to medium dispersion ratio (DR). The clay flocculation index (CFI) and aggregated silt + clay (ASC) were moderate to high implying the high potential stability of the soils. Soil organic carbon did not seem to be contributing much to the stability of the microaggregates while oxalate and pyrophosphate extractable Fe (Feox, Fep) and to some extent total Al (Alt) were among the different forms of oxides that act as aggregating agents. We propose here that rather than SOC acting as a disaggregating agent in the soils, it might have acted in association with these oxides in a linkage or bridge such as C–P–OM–C to ensure stability of the soils.

Therapeutic Effect of an Interval Exercise Training Program in the Management of Erectile Dysfunction in Hypertensive Patients

Abstract: The purpose of the present study was to determine the effect of an interval exercise training program on C-reactive protein and erectile dysfunction (ED) management in older male hypertensive patients. Twenty-two male hypertensive patients with ED (n=22; 62.10+/-5.23 years) were involved in interval exercise training (60%-79% heart rate max reserve) for 8 weeks for a duration of between 45 to 60 min/d, while an age-matched control hypertensive (n=21; 64.00+/-4.77 years) group remained sedentary during this period. The study revealed a significant effect of an exercise training program on erectile function of hypertensive patients with ED (P<.05). It was concluded that an exercise program is a possible effective noninvasive and nonpharmacologic management of ED in male hypertensive patients.

Effects of Rice Husk Ash on Some Geotechnical Properties of Lateritic Soil

Abstract: The study is an investigation into the effect of rice husk ash (RHA) on some geotechnical properties of a lateritic soil classified as A-2-6 (0) or SW for sub-grade purposes The investigation includes evaluation of properties such as compaction, consistency limits and strength of the soil with RHA content of 5%, 75%, 10% and 125% by weight of the dry soil The results obtained show that the increase in RHA content increased the optimum moisture content but decreased the maximum dry density It was also observed that increase in RHA content, reduced plasticity and increased volume stability as well as the strength of the soil 10% RHA content was also observed to be the optimum content

Hepatitis B Virus infection in Nigeria – a review

Abstract: Background:Hepatitis B virus infection is a pandemic and chronic infection may lead to chronic liver diseases which are often lethal. This review was done to assess the status of hepatitis B virus infection in Nigeria. Materials and Method:Source of information was mainly from published works in Nigeria and elsewhere. The information was extracted over period of 5 months from May to December 2007. Result: Since over 30years when pioneer works were done in Nigeria to the recent tunes the prevalence of hepatitis B virus infection has remained very high. In Nigeria, the transmission of hepatitis B virus occurs mainly during childhood and all the risk factors (like blood transfusion, sexual promiscuity, lower socioecomic status etc) implicated elsewhere in the spread of the virus in the general population also play role in Nigeria. Conclusion: Reduction in the of hepatitis B virus infection could be achieved by public enlightenment campaign, mass immunization of the children and adults at risk while antiviral drugs and immunostimulatory therapy should be provided for those already infected.

Chlorproguanil - Dapsone - Artesunate versus artemether - Lumefantrine: A randomized, double-blind phase III trial in African children and adolescents with uncomplicated Plasmodium falciparum malaria

Abstract: Chlorproguanil−dapsone−artesunate (CDA) was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether−lumefantrine (AL) efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD) -deficient patients.

Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria

Abstract: Malaria during pregnancy is a major cause of fetal and maternal morbidity and mortality. In malaria-endemic areas, the condition may remain asymptomatic but is still associated with complications. The objective of this study was to determine the prevalence of asymptomatic malaria parasitaemia and its relationship with various sociodemographic characteristics. The study was performed at three hospitals in Enugu, the centre of southeast Nigeria, during the rainy season between March 2006 and October 2007. Pregnant women attending the antenatal clinic at the index pregnancy were randomly selected and counseled, and peripheral blood samples were collected for malaria parasite and packed cell volume estimation. Age, parity, gestational age at booking, degree of anaemia and parasite density were recorded. Of 125 pregnant women tested, 73 had microscopic Plasmodium parasitaemia, giving a prevalence of 58.4%. Asymptomatic malaria parasitaemia was more common in primigravidae, in the second trimester and in the younger age group. Anaemia in pregnancy was prevalent (55.2%) and there was no significant difference in the density of parasitaemia in those with mild, moderate and severe anaemia. The prevalence of Plasmodium parasitaemia in pregnant Nigerian women is still very high nearly a decade after Roll Back Malaria. It is therefore pertinent to reappraise Roll Back Malaria strategies or to design a more effective programme for the prevention and treatment of malaria in pregnancy.

Challenges in critical care services in Sub-Saharan Africa: perspectives from Nigeria.

Abstract: Critical care services in Nigeria and other West African countries had been hampered by economic reversals resulting in low wages, manpower flight overseas, government apathy towards funding of hospitals, and endemic corruption. Since then things have somewhat improved with the government's willingness to invest more in healthcare, and clampdown on resource diversion in some countries like Nigeria. Due to the health needs of these countries, including funding and preventive medicine, it may take a long time to reach reasonably high standards. Things are better than they were several years ago and that gives cause for optimism, especially with the debt cancellation by Western nations for most countries in the region. Since most of the earlier studies have been done by visiting doctors, mainly outside the West African subregion, this paper seeks to present a view of the challenges faced by providers of critical care services in the region, so that people do not have to rely on anecdotal evidence for future references.

Formulation and in vitro evaluation of a PEGylated microscopic lipospheres delivery system for ceftriaxone sodium.

Abstract: The aim of this study was to formulate and evaluate in vitro, ceftriaxone sodium lipospheres dispersions for oral administration. Ceftriaxone sodium lipospheres were prepared by melt-emulsification using 30%w/w Phospholipon® 90H in Softisan® 154 as the lipid matrix containing increasing quantities of PEG 4000 (10, 20, 30, and 40%w/w). Characterization based on particle size, particle morphology, encapsulation efficiency, loading capacity and pH were carried out on the lipospheres. Microbiological studies of the ceftriaxone sodium-loaded lipospheres were performed using Escherichia coli as the model organism. In vitro permeation of ceftriaxone sodium from the lipospheres through artificial membrane (0.22 μm pore size) was carried out using Franz cell and simulated intestinal fluid (SIF) without pancreatin as acceptor medium. Photomicrographs revealed spherical particles within a micrometer range with minimal growth after 1 month (Maximum size = 64.76 ± 3.81 μm). Microbiological studies indicated that lipos...

Development Planning in Nigeria: Reflections on the National Economic Empowerment and Development Strategy (NEEDS) 2003-2007

Abstract: Nigeria returned to democratic rule in 1999 with the enthusiasm to chat new political and socio- economic dispensation. The introduction of National Economic Empowerment and Development Strategy (NEEDS) as a medium term planning strategy was a blueprint for new order. It contains all the envisaged policies and programmes of the federal government for the period 2003-2007 and far beyond, and serves as the fountain of the much-touted Obasanjo's reforms. NEEDS is not only a macro-economic plan document, but also a comprehensive vision, goals and principles of a new Nigeria that would be made possible through four key policies of wealth creation, employment generation, poverty eradication and value reorientation. This paper is a reflection on NEEDS. Using historical and content analysis methods, the paper explores common indices of development planning in the country. It reveals that NEEDS is not different from previous development plans in Nigeria, despite the claims to the contrary. While claiming to be a home-grown plan, it is very much in line with the wishes of the international agents of developed capitalist economies; there is lack of commitment of the leadership in pursing plan objectives; corruption is still rife and priority in selecting plan projects is still poor. The paper recommends among others, the need for committed leadership, continuity with NEEDS II document, drawing adequate scale of preference in choosing policies and programmes, and determined efforts to break from the crutches of neo imperialist and neo colonial tendencies of the developed countries.

Carica papaya (Paw-Paw) Unripe Fruit May Be Beneficial in Ulcer

Abstract: The anti-ulcer potentials of aqueous (AE) and methanol (ME) extracts of whole unripe Carica papaya fruit were evaluated using ethanol- and indomethacin-induced gastric ulcer models in rats. The effect of the extracts on small intestinal propulsion was also investigated. The extracts significantly reduced the ulcer index in both experimental models (P < .05) compared to the control group. ME showed a better protection against indomethacin-induced ulcers, whereas AE was more effective against ethanol-induced gastric ulcers. The extracts also significantly (P < .05) inhibited intestinal motility, with ME showing greater activity. Oral administration of AE and ME up to 5,000 mg/kg did not produce lethality or signs of acute toxicity in mice after 24 hours. The extracts of unripe C. papaya contain terpenoids, alkaloids, flavonoids, carbohydrates, glycosides, saponins, and steroids. The cytoprotective and antimotility properties of the extracts may account for the anti-ulcer property of the unripe fruit.

Diagnosing skin diseases using an artificial neural network

Abstract: Development of medical expert systems that use artificial neural networks as their knowledge bases appears to be a promising method for predicting diagnosis and possible treatment routine. This paper deals with the construction and training of an artificial neural network for Skin Disease Diagnosis (SDD) based on patients' symptoms and causative organisms. The artificial neural network constructed using a feed-forward architectural design is shown to be capable of successfully diagnosing selected skin diseases in the tropical areas such as Nigeria with 90 percent accuracy. The work may in the future serve as a knowledge base for an expert system specializing in medical diagnosis, testing evaluation, treatment evaluation, and treatment effectiveness. The work serves as the first component of a much larger system that will assist physicians facilitate the reasonable ordering of tests and treatments and minimize unnecessary laboratory routines while reducing operational costs.

Etiological explanation, treatability and preventability of childhood autism: a survey of Nigerian healthcare workers' opinion

Abstract: Background Because of their peculiar sociocultural background, healthcare workers in sub-Saharan African subcultures may have various conceptions on different aspects of autism spectrum disorders (ASD), such as etiology, treatment and issues of prognosis. These various conceptions, if different from current knowledge in literature about ASD, may negatively influence help-seeking behavior of parents of children with ASD who seek advice and information from the healthcare workers. This study assessed the opinions of healthcare workers in Nigeria on aspects of etiology, treatability and preventability of childhood autism, and relates their opinions to the sociodemographic variables.

Improved awareness of Pap smear may not affect its use in Nigeria: a case study of female medical practitioners in Enugu, southeastern Nigeria

Abstract: Improved awareness of Pap test by Nigerian women may not necessarily increase its use. This hypothesis was tested using female medical practitioners in Enugu state, Nigeria. They were expected to be advocates of disease screening and therefore should lead by example. All respondents were aware of the Pap smear but only 18% had used it. The mean frequency of Pap smear was 1.8+/-1.2 (range 1-5). Repeat Pap tests were observed only among respondents that had screened as routine. The majority (32%) of those who never screened for cervical cancer had no reason. There may be more to the use of Pap smear among women in Nigeria than its awareness.

Mycotic flora of the intestine and other internal organs of certain reptiles and amphibians with special reference to characterization of Basidiobolus isolates.

Abstract: Summary: The occurrence of pathogenic fungi was investigated in intestines, lungs, livers and spleens of 200 lizards (Agama agama), 50 wall geckos (Hemiolactylus sp.), 20 toads (Bufo bufo) and 10 turtles (Chelonia mydas). The most important pathogenic fungus isolated was Basidiobolus haptosporus. It was recovered from intestinal contents of 125 (62.5%) lizards, 5 (10%) geckos, and a toad. Other important fungi isolated included 2 isolates of Allescheria boydii from lungs, 10 of Aspergillus fumigatus from lungs and intestines, and 5 of Geotrichum candidum from intestines of lizards. The yeast-like fungi were represented by 6 isolates of Candida parapsilosis from intestines of a turtle and 2 toads, lungs of 2 lizards and from the lungs and liver of a toad, 3 of Candida sp. and 2 of Trichosporon sp. from intestines of lizards, and 1 of Pichia burtoni from the lungs of a lizard. The liver of the toad yielding C. parapsilosis showed abscess like pustules on its surface; direct microscopic examination of a pustule in 10% KOH showed budding yeast cells but histology did not reveal any invasion of the tissue by the fungus. None of the other animals yielding fungal cultures revealed any gross or microscopic evidence of fungal infection of the organs. The significance of the findings has been discussed. Zusammenfassung: Bei 200 Eidechsen (Agama agama), 50 Mauergeckos (Hemiolactylus sp.), 20 Kroten (Bufo bufo) und 10 Schildkroten (Chelonia mydas) wurde das Vorkommen von Pilzen im Darm, in der Lunge, in der Leber und in der Milz untersucht. Als wichtigster pathogener Pilz wurde Basidiobolus haptosporus gefunden. Er wurde aus dem Darminhalt von 125 (62,5%) Eidechsen, 5 (10%) Geckos und bei einer Krote gefunden. Andere wichtige Pilze, die gefunden wurden, waren 2 Isolate von Allescheria boydii aus der Lunge, 10 Stamme von Aspergillus fumigatus aus Lunge und Darm sowie 5 Stamme von Geotrichum candidum aus dem Darm von Eidechsen. Als hefeartige Pilze wurden 6 Isolate von Candida parapsilosis aus dem Darm einer Schildkrote und von 2 Kroten, aus der Lunge von 2 Eidechsen und aus der Lunge und Leber von einer Krote gefunden. Ferner wurde 3 × Candida spezies und 2 × Trichosporon spezies aus dem Darm von Eidechsen sowie 1 × Pichia burtoni aus der Lunge einer Eidechse isoliert. Die Leber einer Krote aus der Candida parapsilosis isoliert worden war, zeigte abszessartige Pusteln an der Oberflache. Die direkte mikroskopische Untersuchung der Pusteln mit 10% KOH lies Sproszellen erkennen. In der Histologie fand sich jedoch keinerlei invasives Wachstum des Pilzes im Gewebe. Bei keinem der anderen Tiere, von denen Pilze isoliert worden waren, zeigten sich makroskopische oder mikroskopische Anzeichen einer mykotischen Infektion der Organe. Die Bedeutung der Befunde wird diskutiert.

Informed consent practices in Nigeria.

Abstract: Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely Western model. Empirical studies show that 70-95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences. Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians' behaviors.

Establishment of reference values of CD4 and CD8 lymphocyte subsets in healthy Nigerian adults.

Abstract: A total of 2,570 apparently healthy human immunodeficiency virus-negative adults from the six geopolitical zones in the country were enrolled in our study in 2006. The samples were assayed using the Cyflow technique. Data were analyzed using the Statistical Package for Social Scientists (SPSS). The majority (64%) of the participants had CD4 counts within the range of 501 to 1,000 cells/μl. The reference range for CD4 was 365 to 1,571 cells/μl, while the reference range for CD8 was 145 to 884 cells/μl.

Outcome of allo-SCT for chronic myelomonocytic leukemia

Abstract: Chronic myelomonocytic leukemia (CMML) is a rare heterogeneous malignancy with an annual incidence of 13:100 000 occurring predominantly465 years of age. The phenotype varies from myelodysplastic to myeloproliferative features, and the clinical course is heterogeneous. Treatment strategies are expanding because of new compounds, for example, lenalidomide or intensive chemotherapy for advanced stages, and increasing numbers of patients receive allogeneic haematopoietic SCT from related/unrelated donors facilitated by reduced intensity conditioning (RIC). The design of guidelines based on the individual risk profiles is difficult in CMML, as its rare heterogenous presentation hampers the evaluation of larger samples. To contribute to insights in the outcome of SCT in this rare disorder, we retrospectively analyzed 12 consecutive CMML patients receiving 13 allogeneic SCT at the University of Hamburg, Germany, from January 2003 to June 2007. All 12 patients gave informed consent. Some patients were included in a previous study. One patient (no. 1) received two allo-SCTs from two different unrelated donors. Eleven patients had unrelated donors (six HLA matched, five mismatched in the HLA-DQB1-alleles), and two received SCT from HLA-identical siblings. All 13 transplants were performed with PBSCs (mean dose 7.65 10 CD34þ /kg; range 3.9–11.34). The CMV status was the same in 12 donor/recipient pairs (Table 1). Eight patients had CMML-1 and four CMML-2; patient no. 1 with two SCTs showed CMML-2 also at relapse. Only two transplantations were performed in CR after previous chemotherapy. Four transplants were performed in therapy-refractory patients. Allo-SCT was upfront strategy in seven cases. The median interval from diagnosis to transplantation was 7 months (range 1–36). Cytogenetics were available in 11 cases and revealed seven normal karyotypes; the remaining four patients showed complex aberrations, þ 5 and 9, þ 21 and del(17q), and one t(3;3)(q21;q26). Myeloablative conditioning was performed in seven and reduced conditioning in six cases. Myeloablative conditioning regimens consisted of i.v. BU (cumulative doses 10.4– 14mg/kg) combined in all cases with CY (120/mg/kg) and in six cases with etoposide (30mg/kg). Antithymocyte globulin was used in five patients (ATG Fresenius; 30–90mg/kg, or ATG Merieux, 8mg/kg). Reduced conditioning was performed according to the FLAMSA protocol (cumulative doses fludarabine 120– 180mg/m, amsacrine 400mg/m, cytarabine 8000mg/m) in five patients in combination with i.v. BU (6.4mg/kg) or CY (120mg/kg) and TBI (4Gy). The sixth patient received treosulfan (30mg/m). All patients received antithymocyte globulin with cumulative dosages of 6–8mg/kg. Immunosuppression was performed by CsA from day 1 over 6 months (serum level 140–220 ng/ml), combined with MTX (10mg/mg; days þ 1, þ 3, þ 6) in myeloablative conditioning, or with mycophenolate mofetil in reduced conditioning. G-CSF was maintained from day þ 5 until granulocytes exceeded 1.0 10/l. The median age at diagnosis of CMML was 56 years (range 37–66 years). Four patients (all after myeloablative conditioning) developed hepatic veno-occlusive disease of the liver. Acute GVHD (I–IV) was seen in 10 of the 13 cases (77%). Severe GVHD (II–IV) occurred in six cases (46%), in four cases after reduced, in two after myeloablative conditioning. Chronic GVHD was seen in 5 of 10 patients (50%) who survived 4day 100 (limited in three patients; extensive in two patients)—in three cases after RIC, in two after myeloablative conditioning. Nine of twelve patients are alive after a median follow-up of 26 months (range 5–40 months) following SCT. The probability of overall survival was 75% (95% confidence interval (CI): 50–100%) (Figure 1a). Three patients (nos. 2, 4, 9) died because of TRM from severe GVHD or sepsis on days þ 37, þ 47 and þ 82 after myeloablative conditioning. Both patients with grade IV acute GVHD (nos. 4, 9) were transplanted from HLA DQB-mismatched unrelated donors and had received antithymocyte globuline (no. 4: ATG Fresenius; 60mg/kg; patient no. 9: ATG Merieux/ thymoglobuline; 8mg/kg). One patient (no. 1) had two alloSCTs (myeloablative/RIC) from two different donors and is still alive. Two patients (nos. 1, 5) (both with CMML-1) relapsed 5 and 38 months after SCT, but are still alive after myeloablative conditioning and RIC. In more detail, the first patient who relapsed (no. 1) 38 months after the first SCT received a second allograft from a different matched unrelated donor after RIC, and at the time of this report—2 months from allo-SCT, he was still in remission. Before relapse, he had maintained complete donor chimerism. The other patient showing relapse (no.5) 5 months from SCT had a decrease of chimerism to 38%, so donor lymphocytes were planned at the time of this report. Thus, there was a relapse rate of 17%. The probability of diseasefree survival was 50% (95% CI: 15–85%), and the probability of 2-year disease-free survival was 67% (40– 94%; Figure 1b). Four of seven patients who are alive in stable remission at the time of this report have a good quality of life, whereas three of these patients are disabled by severe sicca syndrome of the eyes. Six patients with myeloablative Bone Marrow Transplantation (2009) 43, 659–661 & 2009 Macmillan Publishers Limited All rights reserved 0268-3369/09 $32.00