Exploring Consumer Perceptions and Economic Burden of Onchocerciasis on Households in Enugu State,South-East Nigeria

Introduction

Onchocerciasis or river blindness constitutes a major burden to households especially in resource-poor settings, causing a significant reduction in household productivity. There has been renewed interest from policy makers to reduce the burden of Neglected Tropical Diseases (NTDs) such as onchocerciasis on individuals and households. This paper provides new information on the patient’s perceptions of onchocerciasis and its economic burden on households in South-eastern Nigeria. The information will be useful to health providers and policy makers for evidence-informed resource allocation decisions.

Methods

Information was generated from a cross-sectional household survey conducted in Achi community, Oji River Local Government Area (LGA) of Enugu State, Southeast Nigeria. A pre-tested interviewer-administered questionnaire was used to collect data. A total of 747 households were visited randomly and data were collected using pre-tested interviewer administered questionnaire from 370 respondents. The respondents’ knowledge of the cause of symptoms of the disease, costs incurred for seeking treatment and productivity losses were elicited. Data were analyzed using tabulations and inferential statistics. A socio-economic status (SES) index was used to disaggregate some key variables by SES quintiles for equity analysis.

Results

Many people had more than one type of manifestation of onchocerciasis. However, more than half of the respondents (57%) had no knowledge of the cause of their symptoms. Male respondents had significantly more knowledge of the cause of symptoms than females (P = 0.04) but knowledge did not differ across SES (P = 0.82). The average monthly treatment cost per respondent was US$ 14.0. Drug cost (US$10) made up about 72% of total treatment cost. The per capita productivity loss among patients was US$16 and it was higher in the poorest (Q1) (US$20) and the third SES quintiles (Q3) (US$21). The average monthly productivity loss among caregivers was US$3.5.

Conclusion

Onchocerciasis still constitutes considerable economic burden on patients due to the high cost of treatment and productivity loss. Prioritizing domestic resource allocation for the treatment of onchocerciasis is important for significant and sustained reduction in the burden of the disease. In addition, focused health promotion interventions such as health education campaigns should be scaled up in onchocerciasis-endemic communities.     

Black flies and Onchocerciasis: Knowledge,attitude and practices among inhabitants of Alabameta,Osun State,Southwestern, Nigeria

Background and objectivesThis study reports knowledge of residents of Alabameta community, Osun State, Nigeria on the bioecology and socio-economic burden of black flies and onchocerciasis.MethodsUsing structured questionnaires and Focus Group Discussion (FGD), a total of 150 community respondents participated in the study.ResultsThe knowledge of the residents on the existence of black flies in the community was significant (p<0.05) as all the 150 respondents confirmed the presence of black flies with the local name ‘Amukuru’ i.e causing itching. However, their lack of knowledge of the flies breeding site (104) (69%), prevention (134) (89%), cause (132) (88%), and treatment (133) (89%) of onchocerciasis was profound. Majority 147(98%) of the respondents reported that flies bite more in the wet season as against dry season 3(2%) and have a higher affinity (124) (82%) for biting the leg than any other part of the body. A larger percentage (89%) of the respondents are unaware of any medication for the treatment of onchocerciasis while 11% are aware. There had been no sensitization on onchocerciasis according to 89% of the respondents.ConclusionDue to lack of resident’s knowledge on black flies bioecology which may continuously expose them to the bite of the flies and ultimately infection, it is paramount that the Osun State government and the NTD implementing partner map out new public health education strategies during routine Mass Administration of Medicines with Ivermectin with a view to preventing onchocerciasis infection as well as man-vector contact.     

Complex ecological dynamics and eradicability of the vector borne macroparasitic disease, lymphatic filariasis

Background

The current global efforts to control the morbidity and mortality caused by infectious diseases affecting developing countries—such as HIV/AIDS, polio, tuberculosis, malaria and the Neglected Tropical Diseases (NTDs)—have led to an increasing focus on the biological controllability or eradicability of disease transmission by management action. Here, we use an age-structured dynamical model of lymphatic filariasis transmission to show how a quantitative understanding of the dynamic processes underlying infection persistence and extinction is key to evaluating the eradicability of this macroparasitic disease.

Methodology/Principal Findings

We investigated the persistence and extinction dynamics of lymphatic filariasis by undertaking a numerical equilibrium analysis of a deterministic model of parasite transmission, based on varying values of the initial L3 larval density in the system. The results highlighted the likely occurrence of complex dynamics in parasite transmission with three major outcomes for the eradicability of filariasis. First, both vector biting and worm breakpoint thresholds are shown to be complex dynamic entities with values dependent on the nature and magnitude of vector-and host specific density-dependent processes and the degree of host infection aggregation prevailing in endemic communities. Second, these thresholds as well as the potential size of the attractor domains and hence system resilience are strongly dependent on peculiarities of infection dynamics in different vector species. Finally, the existence of multiple stable states indicates the presence of hysteresis nonlinearity in the filariasis system dynamics in which infection thresholds for infection invasion are lower but occur at higher biting rates than do the corresponding thresholds for parasite elimination.

Conclusions/Significance

The variable dynamic nature of thresholds and parasite system resilience reflecting both initial conditions and vector species-infection specificities, and the existence of hysteresis loop phenomenon, suggests that eradication of filariasis may require taking a more flexible and locally relevant approach to designing elimination programmes compared to the current command and control approach advocated by the global programme.     

The evolutionary dynamics of local infection and global reproduction in host–parasite interactions

A fundamental question in both evolutionary biology and parasitology is why do different levels of virulence evolve in different parasites. Here we use explicitly spatial lattice models to show how the spatial relationships of infection and host reproduction determine the degree of virulence that will occur. When the reproduction of the host acts over larger spatial scales than the infection process higher virulence is predicted. In contrast to both the mean-field and the case where infection acts over larger spatial scales than reproduction, the transmission and virulence predicted are always finite as "self-shading" of infected individuals always occurs. This process may help to explain the evolution of the high virulence of larval diseases of insects where reproduction clearly acts over greater distances than infection.     

The chikungunya disease: modeling, vector and transmission global dynamics

Models for the transmission of the chikungunya virus to human population are discussed. The chikungunya virus is an alpha arbovirus, first identified in 1953. It is transmitted by Aedes mosquitoes and is responsible for a little documented uncommon acute tropical disease. Models describing the mosquito population dynamics and the virus transmission to the human population are discussed. Global analysis of equilibria are given, which use on the one hand Lyapunov functions and on the other hand results of the theory of competitive systems and stability of periodic orbits.     

Traditional healers in Nigeria: perception of cause, treatment and referral practices for severe malaria

Malaria remains one of the main causes of mortality among young children in sub-Saharan Africa. In Nigeria traditional healers play an important role in health care delivery and the majority of the population depend on them for most of their ailments. The aim of this study was to investigate the perceptions of traditional healers regarding causes, symptoms, treatment of uncomplicated malaria and referral practices for severe malaria with a view to developing appropriate intervention strategies aimed at improving referral practices for severe malaria. A qualitative study was carried out in Ugwogo-Nike, a rural community in south-east Nigeria, which included in-depth interviews with 23 traditional healers. The traditional healers believed that the treatment of severe malaria, especially convulsions, with herbal remedies was very effective. Some traditional healers were familiar with the signs and symptoms of malaria, but malaria was perceived as an environmentally related disease caused by heat from the scorching sun. The majority of traditional healers believed that convulsions are inherited from parents, while a minority attributed them to evil spirits. Most (16/23) will not refer cases to a health facility because they believe in the efficacy of their herbal remedies. The few that did refer did so after several stages of traditional treatment, which resulted in long delays of about two weeks before appropriate treatment was received. The fact that traditional healers are important providers of treatment for severe malaria, especially convulsions, underlines the need to enlist their support in efforts to improve referral practices for severe malaria.     

角果藜的生长动态及其生殖配置

通过对角果藜(Ceratocarpus arenarius L.)的地上与地下部分生长动态以及生物量配置进行研究,结合其生活周期内土壤含水量变化规律,分析了角果藜的生态适应对策。结果表明:①角果藜植株高度生长速率随时间变化呈"增加—减缓—增加"的模式,而根的生长速率呈"逐渐减缓"的模式。角果藜株高、垂直根的生长速率变化同土壤水分的变化密切相关。②地上部分生物量在5月果实初形成时期和8月至9月的果实成熟期形成两个高峰值。地下部分生物量在3月至5月增长缓慢,随后以最大增长速率迅速达到地下生物量的最大值。角果藜地上、地下生物量的积累动态体现了其与季节变化相吻合的生长发育特点。③具有地上地下结果性的角果藜的生殖配置高达40%以上,高于一次结实的草本植物的生殖投入。这些特性是角果藜适应荒漠生境生长策略选择的综合表现。     

Population dynamics ofTelenomus fariai [Hym.: Scelionidae], a parasite of chagas' disease vectors VIII. Morphological and ecological comparison between two allopatric populations under laboratory conditions

Telenomus fariai Lima ranges from Argentina and Chile to Mexico; some ecological parameters and morphological characters were compared between tropical (Costa Rica) and temperate (Argentina) populations, as reared on tropical and temperate hosts. The results of the 4 combinations between the 2 parasite populations and the 2 host species (Triatoma phyllosoma pallidipennis Stal) andTriatoma infestans Klug) [Hym.: Reduviidae] showed that only the parasite's geographical origin was statistically significant when evaluated through adult female life expectancy at time of emergence from the host, development time, total progeny per host per female 0–24 h old, and generation time. No difference was found between parasite populations with respect to total progeny per female and net reproductive rate. The morphometry proved statistically significant for all body measurements except the antennae.     

Distribution of ABO and rhesus blood groups in Abraka, Delta State, Nigeria.

Blood group systems are determined early in intrauterine life, specific to the individual and therefore significant in management and identification. Seven hundred and ninety five volunteer students of the Abraka campus of Delta State University were analyzed in this 4-year retrospective study. Amongst ABO system, blood group O was most common followed by A, B and AB respectively. Rhesus positive was more common than Rhesus negative in the rhesus system. Gender had no significant effect on both blood group systems studied. In the combined ABO and Rhesus blood groups, O positive was most common followed by A positive, B positive, AB positive O negative and A negative respectively. This study documents ABO and Rhesus blood group distribution patterns amongst south southern Nigerians. Findings will be useful in maintaining a register of possible donors, for effective management of medical emergencies.     

The effectiveness of combined control measures on the prevalence of guinea worm disease in Anambra State, Nigeria.

The prevalence of guinea worm Dracunculus medinensis was determined in communities in Anambra State, Eastern Nigeria during the 1984-1985 guinea worm season. Thereafter combined intervention measures which included health education and community participation in pond treatment were introduced in one of the two communities. There was a decrease in disease prevalence from 88.7% to 33% in Group A (372 households) and from 88% to 53% in Group B (368 households), two years after control measures were introduced in Igbeagu community. However, in 345 households in Mpu community without control measures, any decrease was not significant (from 88.7% to 86.5%). Health Education combined with pond disinfection proved to be a much better intervention measure, contributing to the change in attitude and therefore decrease in disease prevalence, than pond disinfection alone.     

Filariasis in Gongola State Nigeria. I: Clinical and parasitological studies in Mutum-Biyu district.

A total of 2552 persons living in 9 villages along the Benue river valley, Mutum-Biyu district of Gongola State, Nigeria were examined between October and December 1989 for filariasis. It is the first time a filariasis survey will be carried out in this State. 276 (10.8%) had Wuchereria bancrofti, 50 (2.0%) had Loa loa, 281 (11.0%) were positive for Mansonella perstans while 12 (0.5%) were positive for Onchocerca volvulus. Villages located near the Benue river had higher prevalence rates than those further away. Dermatitis and hydrocoele were common and clinical manifestations were associated with parasite types. Clinical symptoms without microfilaremia and microfilaremia without clinical symptoms were also observed. The study will fill the gap in our knowledge of filariasis in this part of Nigeria.     

Seasonal effects and fine‐scale population dynamics of Aedes taeniorhynchus,a major disease vector in the Galapagos Islands

Characterization of the fine‐scale population dynamics of the mosquito Aedes taeniorhynchus is needed to improve our understanding of its role as a disease vector in the Galapagos Islands. We used microsatellite data to assess the genetic structure of coastal and highland mosquito populations and patterns of gene flow between the two habitats through time on Santa Cruz Island. In addition, we assessed possible associations of mosquito abundance and genetic diversity with environmental variables. The coastal and highland mosquito populations were highly differentiated from each other all year round, with some gene flow detected only during periods of increased precipitation. The results support the hypothesis that selection arising from ecological differences between habitats is driving adaptation and divergence in A. taeniorhynchus, and maintaining long‐term genetic differentiation of the populations against gene flow. The highland and lowland populations may constitute an example of incipient speciation in progress. Highland populations were characterized by lower observed heterozygosity and allelic richness, suggesting a founder effect and/or lower breeding site availability in the highlands. A lack of reduction in genetic diversity over time in highland populations suggests that they survive dry periods as dormant eggs. Association between mosquito abundance and precipitation was strong in the highlands, whereas tide height was the main factor affecting mosquito abundance on the coast. Our findings suggests differences in the infection dynamics of mosquito‐borne parasites in the highlands compared to the coast, and a higher risk of mosquito‐driven disease spread across these habitats during periods of increased precipitation.     

Human arthropod-borne virus infections in Nigeria. Serological and virological investigations and Shaki, Oyo State

During the early dry season of 1972, an arbovirus surveillance was carried out is Shaki. On hundred and twenty human blood samples and 304 sera were processed for virus isolation and serology respectively. A high prevalence of antibodies to 8 arbovirus antigens was found in the community. Percentage of positive sera was as follows: Chikungunya (24%) Sindbis (19%), Yellow fever (55%), Dengue (54%), West Nile (58%) and Wesselsbron (67%). Human infections by Ilesha virus (35%) and Ingwavuma (15%) were also demonstrated. No virus was isolated from the blood samples processed.     

Transmission of malaria in the Tesseney area of Eritrea: parasite prevalence in children, and vector density, host preferences, and sporozoite rate.

Malaria transmission was studied from July to September, 2002 in three villages of the Tesseney sub-zone, in the western lowlands of Eritrea. The three methods used for mosquito collection were light traps, pyrethrum spray catches, and pit shelter collections. All anopheline mosquitoes that were collected belonged to the Anopheles gambiae complex and they were identified by PCR as the sibling species Anopheles arabiensis (Patton). Apart from An. arabiensis, the only other mosquitoes caught were culicines. The vector population increased greatly for about a month after the start of the rains. The anthropophilic indices obtained from the blood-fed An. arabiensis resting indoors and outdoors were only 20% and 25%, respectively, with most of the other meals on goats. ELISA for P. falciparum circumsporozoite protein revealed only one positive out of 1,026 tested. The malaria prevalence among children <10 years was only 3.3% (all P.falciparum) from 300 slides examined. These low rates seem to reflect recent success in malaria control in Eritrea.     

Schistosomiasis in Cross River State, Nigeria: 1. Prevalence and intensity of infection in Adim, Akamkpa Local Government Area

Mid-stream urine was randomly collected from 248 subjects in Adim. Blood and protein concentrations were determined semi-quantitatively using Combi-7 reagent strips. The urine samples were then processed and any ova of Schistosoma haematobium present were counted per 10 ml urine. Fresh stool samples were also randomly collected, processed and examined for S. masoni and other helminthic ova. The prevalence of S. haematobium in the area was 43.5% and this was found to be age-related but not sex-related. Mean egg count was 137.2 per 10 ml urine. Intense haematuria of 250 ery/microliters and proteinuria of 500 mg/dl accompanied the high egg counts. The stool examination showed no cases of Manson's schistosomiasis but polyparasitism with other intestinal helminths was common particularly among children under 10 years old. This is the first report of urinary schistosomiasis in this area and the high prevalence rate is consistent with the rice farming occupation of the natives of the area. The sensitive nature and the case of application of the reagent strips in determining heavy infections by measuring haematuria and proteinuria is once again confirmed.     

Fungi associated with stored unprocessed cowpea and groundnut varieties available in Borno State, Nigeria.

Five stored unprocessed cowpea (Vigna spp) and four groundnut (Arachis hypogeae) varieties available in Borno State were examined for the mould flora. The degree of infestation of the grains ranged from 31% to 100% and 68% to 86% for surface sterilized cowpea and groundnut respectively. The mould flora commonly encountered were species of the genera Aspergillus. Penicillium species, Scopulariopsis species and Trichoderma species were also found. The flora of the cowpea was dominated by Aspergillus niger while Aspergillus flavus was the dominant mould on groundnut.     

Seasonal changes in chemistry,algal populations,chlorophyll a and photosynthetic activity in the R. Delimi,Jos Plateau,Nigeria

Seasonal studies were undertaken (August 1983–July 1984) toevaluate the algal distribution and ecology of the RiverDelimi, Jos Plateau, Nigeria at three stations: upstream, withlittle allochthonous input; midstream, receiving heavy domesticaffluents; downstream. A wide amplitude of variability wasdiscernible in physicochemical factors, and photosyntheticactivity and abundance of suspended algae in relation to thedegree of pollution along the first 7-km stretch of the river.Conductivity (µS cm^-1) showed a 9-fold increase fromupstream (x = 35) to downstream. The standing crop(Chl a) fluctuated markedly, with 6-times higher valuesfor a polluted midstream site (x = 18.2 mg m^-3). Production rate measurements (mg C m^-3 d^-1) showed significant variability with relatively lowvalues (x = 610) recorded for the upstream andhighest (x = 1050) at the midstream site. Apositive correlation was obtained between production rates andChl a for the polluted midstream zone.