84 research outputs found
The Content of African Diets is Adequate to Achieve Optimal Efficacy with Fixed-Dose Artemether-Lumefantrine: A Review of the Evidence.
Get PDFA fixed-dose combination of artemether-lumefantrine (AL, Coartem(R)) has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat.As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat) results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat). African diets are typically based on a carbohydrate staple (starchy root vegetables, fruit [plantain] or cereals) supplemented by soups, relishes and sauces derived from vegetables, pulses, nuts or fish. The most important sources of dietary fat in African countries are oil crops (e.g. peanuts, soya beans) and cooking oils as red palm, peanut, coconut and sesame oils. Total fat intake in the majority of subSaharan countries is estimated to be in the range 30-60 g/person/day across the whole population (average 43 g/person/day). Breast-feeding of infants up to two years of age is standard, with one study estimating a fat intake of 15-30 g fat/day from breast milk up to the age of 18 months. Weaning foods typically contain low levels of fat, and the transition from breast milk to complete weaning is associated with a marked reduction in dietary fat. Nevertheless, fat intake >10 g/day has been reported in young children post-weaning. A randomized trial in Uganda reported no difference in the efficacy of AL between patients receiving supervised meals with a fixed fat content (~23 g fat) or taking AL unsupervised, suggesting that fat intake at home was sufficient for optimal efficacy. Moreover, randomized trials in African children aged 5-59 months have shown similar high cure rates to those observed in older populations, indicating that food consumption is adequate post-weaning. In conclusion, it appears that only a very small amount of dietary fat is necessary to ensure optimal efficacy with AL and that the fat content of standard meals or breast milk in sub-Saharan Africa is adequate
Model for predicting wax deposition in stock tank
No full textNo Abstract. Journal of Applied Science, Engineering and Technology Vol. 4(2) 2004: 23-2
Anthrax in captive carnivores in Ibadan, Nigeria
No full textBetween 20 and 22 June 1974, three captive carnivores (two genets, Genetta sp. and one caracal, Felis caracal) died suddenly in the University of Ibadan Zoological Garden without previous signs of illness. Bacillus anthracis was isolated from their blood and tissues. The organism was highly pathogenic to laboratory animals. The disease was believed to have been contracted from meat fed the animals.LR: 20031114; PUBM: Print; JID: 0244160; ppublishSource type: Electronic(1
Potential antimalarial activity of Methyl Jasmonate and its effect on lipid profiles in Plasmodium Berghei infected mice
Get PDFBackground: The antimalarial activity and lipid profiles of Methyl
Jasmonate (MJ) were investigated against established malaria infection
in vivo using BALB/c mice. Methods: Arteether (AE) and chloroquine (CQ)
were used as reference drugs while ethanol was used as the vehicle for
drug delivery for MJ. Results: Mice treated with 10 and 25 mg/kg MJ
showed a remarkable reduction in percentage parasitemia by 68.3% and
78.2% on day 10(post treatment) respectively while 45.4% and 87.2%
reduction in percentage parasitemia were observed in the group treated
with 50 mg/kg on day 3 and 10 ( post treatment ) respectively. The
highest mean survival time was observed in CQ followed by AE and MJ in
dose-dependent manner. A progressive decrease in packed cell volume
(PCV) was observed in infected untreated mice which led to the death of
all the mice by day 9 (post treatment). Infected mice treated with MJ
showed reduced level of HDL and LDL compared with infected untreated
group. As the dose of MJ increased in infected mice cholesterol levels
increased while there was reduction in triglyceride. Conclusion:
Overall there was marked decrease in parasitemia in Plasmodium berghei
infected mice treated with graded doses of MJ but appears to have
reduced antimalarial activity compared with CQ and AE
Efficacy Of <i>Jatropha gossypifolia</i> And <i>Manihot esculenta</i> Seed Extract For The Control Of <i>Sclerotium rolfsii</i> And <i>Fusarium oxysporum</i> In South-Western Nigeria
No full textThe efficacy of physic nut (Jatropha gossypifolia linn) and cassava (Manihot esculenta crantz) seed extracts in controlling Sclerotium rolfsii sacc and Fusarium oxysporum schlect was evaluated in a laboratory study. The oil extracts were applied at four concentrations 0,10,100,1000 ppm to cultures of S. rolfsii and F. oxysporium isolates from tomato and cowpea respectively. There were significant differences (
Comparative performances of composite flours from blends of yam (Dioscorea rotundata), cassava (Manihot esculenta Crantz) and wheat flours in cake preparation
No full textInvestigation was carried out on comparative performance of composite flours of wheat-cassava and wheat-yam blends in preparation of cake. Low cyanide cassava and white yam were prepared into flours. Each of the flour was added to wheat flour at different ratios 10:90, 20:80 and 30:70(w/w) respectively. Physico-chemical properties of the composite flours including moisture content, particle size distribution, gluten content and extensibility were determined. Cake samples were prepared from the composite flours and 100% wheat flour using standard recipe. The codedsamples of cake were evaluated for organoleptic qualities of colour, taste, mouth feel, texture and overall acceptability. These properties are considered to be very important in the attempt to replace wheat flour in preparation of cake. The performance of the composite flours weresignificantly affected (p<0.05) by level of substitution of wheat flour and type of substituted flour. Substitution of wheat flour reduced gluten content and extensibility of the composite flours. Wheat-cassava flours comparatively performed better than wheat-yam flours in all quality attributes evaluated. Cassava substitution at 10% produced cake that compared favourably with the control sample from 100% wheat flour. Other blends produced cakes that were scored low in all quality attributes but within the acceptable limits.Key words: Wheat flour, Cassava flour, Yam flour, Cak
An Innovative Model to Estimate Fracture Extensions.
No full textHydraulic fracturing is a Well intervention program, designed to create fracture(s) within a reservoir system and hopefully, extend the volumes of these fractures, to facilitate improved recovery of in-situ fluid(s). This paper presents mathematical equations in dimensionless forms, to rapidly estimate the fracture extension and efficiency during a hydraulic fracturing operation. The fracture extension profiles over time are captured in generated plots. The results are consistent with theory established in this work, and provide an innovative method of rapidly estimating the extensions of fracture lengths
Tolerability of Ramipril in High Doses and Its Comparative Effects (In Combination with Hydrochlorothiazade) with Felodipine Extended Release on Mild to Moderate Hypertension in Nigerian Africans
No full textAngiotensin converting enzyme Inhibitors are often used in sub-optimal doses among Nigerian hypertensive patients and others at high risk of cardiovascular events because of concerns of tolerability or high cost of sustaining therapy. In an open randomized comparative trial, blood pressure lowering effects and safety of high doses of ramipril titrated over a 3 to 12 week period was compared with that of felodipine extended release (ER). Sixty patients with mild to moderate primary hypertension were randomized to receive ramipril (RP) or felodipine ER (FER) in a four phase stepped care trial of 3 weeks interval each. RP or FER was started at a dose of 5mg daily and then increased in subsequent phases according to responses. Hydrochlorothiazide (HCT) was added as required. Hematological and biochemical parameters and adverse effects were monitored.Monotherapy of FER was significantly more effective than RP in lowering blood pressure (88% FER vs. 7% RP, r= 0.020). 92% of patients treated with RP required addition of HCT (25-50mg) to achieve satisfactory blood pressure control. FER produced significantly higher mean reduction in blood pressure at the ends of weeks 3 and 6 of treatment but comparable mean changes at the end of study period. Both drugs were safe and well tolerated. Ramipril is safe at high doses of 10mg daily in black Nigerian patients with mild to moderate hypertension when titrated over an appropriate period of time and it produces comparative blood pressure lowering effects as 10mg felodipine when used in combination with 25-50mg hydrochlorothiazide.Key words: Ramipril, high doses, felodipine ER, hypertension, blacks
Understanding motivations and patterns of care-seeking and adherence to medical treatments for paediatric pneumonia in Nigeria
No full textBackground: Nigeria has the highest number of childhood pneumonia deaths worldwide, and it is not on track to meet the sustainable development goal 3.2. Despite the availability of proven interventions to prevent pneumonia deaths, uptake and quality implementation have been lacking and inequitably distributed. It is therefore important to understand the motivations around care seeking and treatment adherence behaviours for paediatric pneumonia in Nigeria.Methods: Five sub-studies (I-V) were conducted at different times across Lagos and Jigawa states in Nigeria, which have different sociocultural and health- related characteristics. Sub-study I was a household survey conducted in Jigawa (December 2019-March 2020) to assess pneumonia knowledge and care seeking behaviour for under five children with pneumonia symptoms. Sub-study II was a qualitative study conducted in both states among caregivers and community members to understand pneumonia perception and care seeking experiences during the quest for therapy for children with pneumonia symptoms. In sub-studies III and IV, we conducted interviews with healthcare providers and caregivers. We had group discussions with community members to understand and explore motivations and barriers shaping antibiotic adherence (sub-study III) and medical oxygen acceptance (sub-study IV). In sub-study III, we assessed antibiotic adherence levels from a repeat household survey. Between December 2020 and March 2021, we conducted in-depth interviews with caregivers and healthcare providers in Lagos to understand care seeking practices during the COVID-19 pandemic (sub-study V).Results: In sub-study I, 1,661 eligible women with 2,828 children under five were recruited. Caregiver's knowledge of pneumonia was low, as just 4.9% of the women could name both cough and fast/difficulty in breathing as pneumonia symptoms; 1% correctly reported all four transmission risks for pneumonia (breathing dust, poor hygiene, being near someone sick, being near someone coughing); 36.4% and 4.2% answered antibiotics and oxygen therapy as a treatment for pneumonia respectively. Of the 2828 children sampled, 536 (19.0) had symptoms of acute respiratory illness (ARI) in the prior two weeks, and 341/536 (63.6%) were considered sick and less than half were taken to a healthcare provider for care (161/341, 47.2%). In total, 240 children (8.5%) presented to a healthcare provider in the preceding 2 weeks; of these, 72% had pneumonia-specific symptoms. Primary health centres (PHCs) and private patent medicine vendors (PPMVs) were the most common sources of care outside the home. Maternal knowledge was not associated with care seeking, but care seeking was higher among children with fever compared to those without fever(aOR:2:45 [95% CI: 1.38-4.34]) whose mothers first married when they were older - aged 20-35 years compared to those whose mother married at younger age (AOR: 5.15 [95% CI: 1.38-19.26]), and children from the wealthiest homes compared to those from household with less income (AOR: 2:13 [95% CI: 1.03- 4.38]).In sub-study II, we found evidence of a gendered role in care seeking behaviours, with female caregivers saddled with the responsibility of child's care and illness recognition while the husband provides financial resources. However, participants did not mention preferential care seeking behaviours for male and female children. Some participants perceived traditional medicine to be better than modern medicine. Care experience included self-medication with cough medicine or attendance at PPMV for a cocktail of medicine or presentation at primary health facilities or hospitals if previous care was unsuccessful.In sub-study III, 645/9994 children aged 2-59 months had ARI symptoms in the prior two weeks, 71.5% (461/645) were taken for care, and 41.2% (190/461) were prescribed antibiotics. Of these, 42 (21.9%) and 18 (9.4%) were prescribed dispersible amoxicillin (amoxicillin DT) and amoxicillin tablets respectively-the recommended treatment for pneumonia. The median duration of antibiotic use was five days (range:1-14 days). Overall, 98/190 (51.6%) had good antibiotic adherence. Reasons for non-adherence were caregiver's carelessness and nonchalant attitude towards antibiotic use, child struggling with caregivers, and the lack of adequate information from providers.From interview data in sub-study IV, we found that oxygen therapy was a source of financial and emotional distress to caregivers. Acceptance of medical oxygen treatment was a sense-making process characterised by a perceived sense of urgency, trust in healthcare, and a feeling of hopelessness especially in Jigawa state. Knowledge of medical oxygen was limited, causing rumours and misconceptions to shape caregivers' perceptions of medical oxygen treatment. While these were modifiable, cost was a major barrier to oxygen acceptance in Lagos.In sub-study V, we found the COVID-19 pandemic affected care-seeking behaviour for children, as health facilities were considered high risk, and there was fear of a COVID-19 diagnosis. Aside from hospital avoidance, care was delayed or sought from alternative sources. Lack of transportation and diminished household income contributed indirectly to low care-seeking from hospitals.Conclusion: Individual, family, and community factors strongly influenced care- seeking and adherence to therapy for children with pneumonia in Nigeria, revealing opportunities to improve care and outcomes for this priority population. Pneumonia knowledge was low among caregivers and was not associated with care seeking behaviour. Children with pneumonia were taken for care from multiple sources, notably PHCs and PPMVs. Motivation to seek care is influenced by social and systemic barriers, notably household dynamics, illness perception, financial considerations and perceived health system responsiveness. Oxygen hesitancy exists and can be modified but the underlying causes vary with context. Caregivers require more support to improve adherence to antibiotics.List of scientific papersI. Bakare AA, King C, Salako J, Bakare D, Uchendu OC, Burgess RA, Shittu F, Juliano A, Isah A, Ahmed T, Ahmar S, Valentine P, Olowookere TF, McCollum ED, Colbourn T, Falade AG, Graham HR. Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study. Front Public Health. 2023;11:1198225. https://doi.org/10.3389/fpubh.2023.1198225II. Bakare AA, Graham H, Agwai IC, Shittu F, King C, Colbourn T, Iuliano A, Aranda Z, McCollum ED, Isah A, Bahiru S, Valentine P, Falade AG, Burgess RA, Consortium IP. Community and caregivers' perceptions of pneumonia and care-seeking experiences in Nigeria: A qualitative study. Pediatr Pulmonol. 2020;55 Suppl 1:S104-S12. https://doi.org/10.1002/ppul.24620III. Bakare AA, Stagg HR, Salako J, Bakare D, Colbourn T, Graham HR, Falade AG, King C. Understanding adherence to antibiotic prescription among caregivers of children with pneumonia symptoms in Jigawa state: a mixed-method study. [manuscript]IV. Bakare AA, Salako J, King C, Olojede OE, Bakare D, Olasupo O, Burgess R, Mccollum ED, Colbourn T, Falade AG, Molsted-Alvesson H, Graham HR. 'Let him die in peace': understanding caregiver's refusal of medical oxygen treatment for children in Nigeria. BMJ Global Health. 2024;9(5):e014902. https://doi.org/10.1136/bmjgh-2023-014902V. Bakare AA, Olojede OE, King C, Graham H, Uchendu O, Colbourn T, Falade AG, Alvesson HM. Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study. BMJ open. 2023;13(3):e069294. https://doi.org/10.1136/bmjopen-2022-069294</p
Adherence to and acceptability of artemether-lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania.
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Controlled clinical trials have shown that a six-dose regimen of artemether-lumefantrine (AL) therapy for uncomplicated Plasmodium falciparum malaria results in cure rates >95% with good tolerability. A prospective study was carried out to document the adherence to and acceptability of AL administration. This was undertaken in the context of the ALIVE study, a prospective, community-based, observational study in a rural, malaria-endemic area of Tanzania. Following microscopic confirmation of P. falciparum infection, the first AL dose was taken under supervision, with the subsequent five doses taken unsupervised at home. Patients were randomized to receive a home-based assessment close to the scheduled time for one of the unsupervised doses, but were blinded to which follow-up visit they had been allocated. A structured questionnaire was administered by trained staff and AL consumption was confirmed by inspection of blister packs. A total of 552 patients were recruited of whom 352 (63.8%) were <13 years old. The randomization process allocated 112, 109, 110, 100 and 111 patients to a follow-up visit after doses 2, 3, 4, 5 and 6, respectively. For dose 2, 92.0% of patients (103/112) correctly took AL at 8 +/- 1 hours after dose 1. The remaining doses were taken within four hours of the correct time in 87-95% of cases. Nine patients (1.7%) missed one dose. Blister packs were available for inspection in 548 of cases (99.3%) and confirmed patient-reported data that the previous dose had been administered. Nearly all patients took AL with water (549/552 [99.5%]). Two patients (0.4%) took the drug with food. The dosing pictogram and clustering of tablets within the blister packs was considered helpful by 91.8% and 100.0% of patients, respectively. Overall, 87.1% of patients (481/552) found AL easier to take/administer than sulphadoxine-pyrimethamine (SP) and 87.7% (484/552) believed that AL was more effective than SP. Factors contributing to adherence were likely to be helpful packaging, pictorial dosing instructions and patients' conviction that AL is effective. Adherence to the dosing regimen and timing of AL administration was very good.\u
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