Artemisinin drug resistance and monitoring: a narrative review

*1Iwuafor, A. A., 1Ogban, G. I., 1Emanghe, U. E., 2Erengwa, P. C., 2Offiong, A. B.,      2Nsor, G. E., and 2Owai, P. A.

1Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, University of Calabar, Nigeria

2Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria

*Correspondence to: tonyiwuafor@unical.edu.ng; +2348033441539; ORCID ID: 0000-0001-6796-3870

 

Abstract:

Artemisinin drug resistance is one of the major reasons for malaria treatment failures in the sub-Saharan African countries where artemisinin-based combination therapy (ACT) is the first-line treatment for uncomplicated malaria. The occurrence of single nucleotide polymorphisms (SNPs) is found to correlate with antimalarial drug resistance. With artemisinin, the SNPs occurs at the Kelch 13-propeller gene locus on chromosome 13. The artemisinin drug resistance surveillance strategy involves continuous monitoring of Kelch 13-propeller biomarker to detect emergence of mutations which could herald drug resistance in the region. In this narrative review paper, we examined existing literature to bridge the knowledge gap and accentuate the importance of routine surveillance for artemisinin resistance in sub-Saharan Africa. We conducted our search on PubMed database and Google Scholar to identify peer-reviewed articles, reports, and abstracts on artemisinin drug resistance using the following keywords; ‘artemisinin drug resistance’, ‘antimalarial drug resistance’, ‘artemisinin-based combination therapy’, ‘Kelch 13-propeller’, ‘K13propeller gene’, and ‘K13 molecular marker’. The review provided pertinent information on artemisinin derivatives, artemisinin-based combination therapy, molecular action of artemisinin, definition of artemisinin resistance, genetic basis of artemisinin drug resistance and discovery of Kelch 13, and the importance of artemisinin resistance surveillance. Molecular surveillance can provide healthcare policy makers a forecast of impending threats to malaria treatment. This is more so when drugs are in combination therapy, for instance, molecular surveillance can give a hint that one drug is failing despite the fact that in combination, it is still apparently clinically effective. Continue reading “Artemisinin drug resistance and monitoring: a narrative review”

Malaria treatment failure after Artemisinin-based combination therapy: A case series of children managed at a private tertiary hospital in southwest Nigeria

1,2*Fatunla, O. A. T., 3,4Irek, E. O., 1,2Oyebanji, A. H., 2Adisa, S. O., [1]Jesulana, T. E., and 2Ajibola, T. O.

1Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria

2Department of Paediatrics, Afe Babalola Multi-System Hospital, Ado-Ekiti, Nigeria                                              

3Department of Medical Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria

4Department of Medical Microbiology and Parasitology, Afe Babalola Multi-System Hospital, Ado-Ekiti, Nigeria

5Department of Internal Medicine, Afe Babalola Multi-System Hospital, Ado-Ekiti, Nigeria                                

*Correspondence to: odunayofatunla@abuad.edu.ng; +2348034397539; ORCiD: //orcid.org/0000000228391491

Contributed equally to the study

Abstract:

Malaria treatment failure is the inability to clear parasitaemia after antimalarial drug administration. There are reports of treatment failure with artemisinin-based combination therapy (ACT) in Nigeria but few reported among children. We report three paediatric cases of treatment failure with ACT admitted at a private tertiary hospital in Nigeria in early 2022. All three were ‘under-fives’ admitted for open-heart surgery, major flame burns, and cerebral malaria respectively. They had symptomatic Plasmodium falciparum infection but one had mixed P. falciparum and Plasmodium vivax infections. Cases 1 and 2 were initially given oral artemether-lumefantrine while case 3 received intravenous artesunate. Despite appropriate antimalarial drug compliance, all the 3 still had fever with heavy parasitaemia. They subsequently received intravenous quinine, with improvement within the first 24 hours of therapy, and no longer had fever at the fourth week of follow-up. Although ACT resistance was not established, poor drug quality may have contributed to treatment failure. There is a need for pharmacovigilance of anti-malarial in Nigeria. Continue reading “Malaria treatment failure after Artemisinin-based combination therapy: A case series of children managed at a private tertiary hospital in southwest Nigeria”

Baseline health facility assessment of quality assurance for malaria diagnosis in existing government hospital laboratories in Sokoto State, Nigeria

*1Ogboi, J. S., 2Ume, I., 2Mohammed, Z., 2Usman, A., 2Bashaar, A., 3Okoro, C., and 2Lawal, L.

1Department of Medical Laboratory Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria

2IHP, Abuja, Nigeria

3Department of Microbiology, Federal Medical Centre, Owerri, Nigeria

*Correspondence to: ogboijb@yahoo.com

Abstract:
Background: Quality laboratory services are needed to direct reasonable malaria case management through malaria
microscopy and rapid diagnostic test. This study assessed the existing diagnostic capacities including laboratory
structures and systems, human resource, skills and competences, using the standardized WHO/NMEP EQA
assessment tool.

Methodology: Data were collected by an assessment team using a standardized assessment instrument/checklist
drawn from WHO/NMEP assessment tool and analyzed with Open Data Kit (ODK) and Open-source suite of tools on
Android mobile devices from September 3-11, 2020. The use of ODK allowed data to be collated offline where internet
services were poor or unavailable and uploaded thereafter. Continue reading “Baseline health facility assessment of quality assurance for malaria diagnosis in existing government hospital laboratories in Sokoto State, Nigeria”

Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility

*1Obu, D. C., 1Asiegbu, U. V., 1Okereke, B. E., 1Ukoh, U. C., 2Ujunwa, F. A., 1Afefi, C. O., 1Enya, V. E., 1Item, S., and 3Efunshile, A. M.

1Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria

2Department of Paediatrics, University of Nigeria, Enugu State, Nigeria

3Department of Clinical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria

*Correspondence to: obudora@yahoo.com; +2348037511272

Abstract:
Background: Malaria, a life-threatening parasitic disease transmitted to humans by the female Anopheles mosquito is one of the infectious causes of fever in children. In Nigeria, malaria remains one of the most important health problems, accounting for 25% of infants and 30% of under-five mortalities. The objective of this study was to determine the prevalence of malaria among febrile children presenting at the children’s emergency room (CHER) of a tertiary health facility in Abakaliki using a malaria rapid diagnostic test (mRDT). Continue reading “Malaria rapid diagnostic test positivity rate among febrile patients seen at the Paediatric emergency unit of a tertiary care facility”

Differences in haematological parameters and haemoglobin phenotypes in symptomatic and asymptomatic subjects with Plasmodium falciparum infection in parts of Kaduna metropolis, Nigeria

*

1Dikwa, K. B.,

2Maikaje, D. B., 1Yahaya, U. A., and

3Suleiman, A. B.

1Department of Biological Sciences, Nigerian Defence Academy, Kaduna, Nigeria

2Department of Microbiology, Kaduna State University, Kaduna, Nigeria

3Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria
*Correspondence to: kbdikwa@nda.edu.ng

Abstract

Background: Plasmodium falciparum is the leading cause of malaria morbidity and mortality in Nigeria with varied symptoms and haematological consequences. The objective of this study is to assess the differences in haematological parameters and haemoglobin phenotypes in symptomatic P. falciparum infected and apparently healthy asymptomatic individuals in parts of Kaduna metropolis.

Methodology: A total of 1000 subjects; 500 symptomatic and 500 apparently healthy subjects asymptomatic for malaria, were recruited from selected hospitals and National Blood Bank in Kaduna metropolis. Blood samples were collected for thick and thin film microscopy to determine malaria parasitaemia and parasite species identification respectively. Haematological parameters were determined using automated blood analyser (KX-21N, Sysmex, Japan) and haemoglobin phenotypes by alkaline cellulose acetate electrophoresis. Continue reading “Differences in haematological parameters and haemoglobin phenotypes in symptomatic and asymptomatic subjects with Plasmodium falciparum infection in parts of Kaduna metropolis, Nigeria”

In vivo anti-malarial activity of propranolol against experimental Plasmodium berghei ANKA infection in mice

*1Adeyemi, O. I., 1Ige, O. O., 1Akanmu, M. A., and 2Ukponmwan, O. E.

1Department of Pharmacology, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria

2Department of Medical Pharmacology and Therapeutics, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

*Correspondence to: wadeyemi01@yahoo.com & isaacon@oauife.edu.ng

Abstract:

Background: Malaria is a mosquito-borne infectious disease caused by Plasmodium spp, which is widespread in tropical and subtropical regions of the world. The objective of this study is to evaluate in vivo antimalarial activity of propranolol against experimental Plasmodium berghei ANKA (PbA) infection in a mouse model.

Methods: A total of 36 mice weighing between 15 to 18g were randomly divided into six groups of six mice each. Mice in the first group (SAL) were non-infected with P. berghei but received normal saline (control), second group (PbA) were mice infected without treatment (control), third group (PRL) were non-infected mice treated with propranolol at the dose of 7.5 mg/kg/bid, fourth group (PbA+PRL) were mice infected and treated with same dose of propranolol, fifth group (QUN) were non-infected mice treated with quinine at a dose of 20 mg/kg stat, then 10 mg/kg bid, and sixth group (PbA+QUN) were infected mice treated with quinine. Parasitaemia, physiological conditions (cognitive function, temperature) and lethality of infected mice were monitored over 7-day period to assess the antimalarial activity of propranolol and quinine. The Y-maze paradigm was used to assess cognitive impairment induced by PbA infection. The effects of propranolol on malaria indices and cognitive impairment were compared with that of quinine and the control using T-test statistical method.

Results: Mortality of mice at day 7 in the infected group without treatment (PbA) was 100% (6/6) while mortality was 50% (3/6) in infected group treated with propranolol (PbA+PRL) and 33.3% (2/6) in infected group treated with quinine (PbA+QUN) (OR=2.000, p=1.000). No mortality was recorded in any of the three groups of uninfected mice. Propranolol reduced parasitaemia to a trough level of 1.40±0.07 three days after treatment, comparable to trough level of 1.39±0.0633 by quinine but did not reverse PbA-induced hypothermia, which quinine did.

Conclusion: Propranolol demonstrated in vivo antimalarial activity against experimental PbA infection in mice comparable to that of quinine.

Keywords: malaria, propranolol, quinine, Plasmodium, cerebral malaria
Continue reading “In vivo anti-malarial activity of propranolol against experimental Plasmodium berghei ANKA infection in mice”

The risk of transfusion transmitted malaria and the need for malaria screening of blood donors in Abuja, Nigeria

1* Ezeonu, C. M., 1 Adabara, N. U., 1 Garba, S. A., 1 Kuta, F. A., 2 Ewa, E. E.,

2 Oloruntoba, P. O., and 3 Atureta, Z.

1 Department of Microbiology, School of Life Sciences, Federal University of Technology, Minna, Nigeria

2 Maitama District Hospital, Federal Capital Territory, Abuja 3 Federal Medical Centre, Jabi, Federal Capital Territory, Abuja

*Correspondence to: scholajane@yahoo.com

Abstract

Background: Blood transfusion saves life but it is also a major risk factor in the transmission of certain infections such as malaria, which remains a public health problem in tropical and sub-Saharan Africa. Methodology: This study investigated the prevalence of malaria among 550 blood donors aged 18 to 60 years from blood bank units of some selected hospitals in Federal Capital Territory (FCT), Abuja, using gold standard microscopy for malaria parasite detection. Results: Two hundred and fifty two (45.8%) donors were positive for malaria parasites. Replacement donors had higher prevalence rate of malaria compared to voluntary donors. The distribution of infection on the basis of age revealed the highest prevalence rate of malaria among the 20- 29yrs age group. The rate of infection among the males and the females was not significantly different (p>0.05). No association was observed between the blood group types and the rate of malaria infection (p > 0.05). Conclusion: A high prevalence of malaria parasitaemia was observed among blood donors in FCT, Abuja, Nigeria in this study. The introduction of malaria screening as part of routine screening for blood donation and the provision of modern blood screening equipment within healthcare facilities are highly advocated.

Keywords: Blood, Malaria, Microscopy, ABO Blood group

Received March 18, 2018; Revised March 18, 2019; Accepted March 30, 2019

Copyright 2019 AJCEM Open Access. This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License (//creativecommmons.org/licenses/by/4.0), which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

 

Risque de paludisme transmis par transfusion et nécessité d’un dépistage du paludisme chez les donneurs de sang à Abuja, Nigéria

1* Ezeonu, C. M., 1 Adabara, N. U., 1 Garba, S. A., 1 Kuta, F. A., 2 Ewa, E. E.,

2 Oloruntoba, P. O., and 3 Atureta, Z

1 Département de microbiologie, École des sciences de la vie, Université fédérale de technologie de Minna, Nigéria

2 Hôpital de district Maitama, Territoire de la capitale fédérale, Abuja

3 Centre médical fédéral, Jabi, Territoire de la capitale fédérale, Abuja

*Correspondance à: scholajane@yahoo.com

Abstrait 

Contexte: La transfusion sanguine sauve des vies, mais elle constitue également un facteur de risque majeur dans la transmission de certaines infections, telles que le paludisme, qui reste un problème de santé publique en Afrique tropicale et en Afrique subsaharienne. Méthodologie: Cette étude a examiné la prévalence du paludisme chez 550 donneurs de sang âgés de 18 à 60 ans appartenant aux banques de sang de certains hôpitaux sélectionnés du Territoire de la capitale fédérale (FCT), à Abuja, en utilisant la microscopie de référence pour la détection des parasites du paludisme. Résultats: Deux cent cinquante deux (45,8%) donneurs étaient positifs pour les parasites du paludisme. Le taux de prévalence du paludisme était plus élevé chez les donneurs de remplacement que chez les donneurs volontaires. La répartition de l’infection sur la base de l’âge a révélé le taux de prévalence du paludisme le plus élevé parmi le groupe d’âge des 20-29 ans. Le taux d’infection chez les hommes et les femmes n’était pas significativement différent (p> 0,05). Aucune association n’a été observée entre les types de groupes sanguins et le taux d’infection palustre (p> 0,05). Conclusion: Une prévalence élevée de parasitémie paludéenne a été observée chez les donneurs de sang à FCT, à Abuja, au Nigeria, dans cette étude. L’introduction du dépistage du paludisme dans le cadre du dépistage systématique des dons de sang et la fourniture d’équipements modernes de dépistage du sang dans les

Mots-clés: Sang, Paludisme, Microscopie, Groupe sanguin ABO

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The risk of transfusion transmitted malaria and the need for malaria screening of blood donors in Abuja, Nigeria

Prevalence of hepatitis B virus infections among blood donors in Federal Capital Territory, Abuja, Nigeria

Ezeonu, C. M., Garba, S. A., Adabara, N. U., and Kuta, F. A.

Department of Microbiology, School of Life Sciences, Federal University of Technology, Minna, Nigeria
Correspondence to: scholajane@yahoo.com

Abstract

Background: Transfusion of hepatitis B virus (HBV) infected blood represents a major but avoidable means of HBV transmission, which unfortunately still account for millions of global HBV infections annually. Method: This study determined the prevalence of HBV infection among 550 blood donors aged 18 to 60 years from selected hospitals and blood transfusion centres within the Federal Capital Territory, Nigeria, using hepatitis B surface antigen (HBsAg) rapid diagnostic test (RDT) kit and Enzyme linked Immuno-sorbent Assay (ELISA). Representative positive and negative samples for RDT and ELISA were tested by both conventional and real-time polymerase chain reaction (PCR) assay Results: Forty nine (8.9%) and 14 (2.8%) out of the 550 blood donors tested positive for HBsAg with the RDT and ELISA respectively. Replacement donors had higher prevalence rate of the HBV infection than voluntary donors. The highest prevalence of HBV infection was recorded among the 30–39 year age group. The difference in the rate of infection between the males and the females was not statistically significant (p>0.05). A perfect agreement between RDT and PCR and fair agreement between ELISA and PCR were observed. Conclusion: This study report a high prevalence of hepatitis B virus infections among blood donors in Abuja, Nigeria which underscores the need for proper screening of blood for transfusion to completely eliminate the incidence of transfusion transmitted HBV infections.

Key words: Blood, Malaria, Hepatitis, Rapid, Immuno-sorbent, Polymerase

Received March 18, 2018; Revised March 18, 2019; Accepted March 20, 2019

Copyright 2019 AJCEM Open Access.

This article is licensed and distributed under the terms of the Creative Commons Attrition 4.0 International License (//creativecommmons.org/licenses/by/4.0), which permits unrestricted use, distribution and reproduction in any medium, provided credit is given to the original author(s) and the source.

 

Prévalence de l’infection par le virus de l’hépatite B chez les donneurs de sang dans le Territoire de la capitale fédérale, Abuja, Nigéria

Ezeonu, C. M., Garba, S. A., Adabara, N. U., and Kuta, F. A.

Département de microbiologie, École des sciences de la vie, Université fédérale de technologie de Minna, Nigéria

Correspondance à: scholajane@yahoo.com

Abstrait Contexte

La transfusion de sang infecté par le virus de l’hépatite B (VHB) représente un moyen important mais évitable de transmission du VHB, qui représente malheureusement toujours des millions d’infections mondiales au VHB chaque année. Méthode: Cette étude a déterminé la prévalence de l’infection à VHB chez 550 donneurs de sang âgés de 18 à 60 ans de certains hôpitaux et centres de transfusion sanguine situés dans le Territoire de la capitale fédérale, au Nigéria, à l’aide du kit de test de diagnostic rapide (TDR) de l’antigène de l’hépatite B (HBsAg) et Essai immuno-sorbant lié à une enzyme (ELISA). Des échantillons positifs et négatifs représentatifs pour les TDR et ELISA ont été testés à la fois par le test de réaction en chaîne par polymérase (PCR) classique et en temps réel Résultats: Quarante-neuf (8,9%) et 14 (2,8%) des 550 donneurs de sang ont été testés positifs pour HBsAg avec le TDR et le test ELISA, respectivement. Le taux de prévalence de l’infection à VHB était plus élevé chez les donneurs de remplacement que chez les donneurs volontaires. La prévalence la plus élevée d’infection par le VHB a été enregistrée dans le groupe d’âge des 30 à 39 ans. La différence de taux d’infection entre les hommes et les femmes n’était pas statistiquement significative (p> 0,05). Un accord parfait entre TDR et PCR et un accord juste entre ELISA et PCR ont Conclusion: Cette étude fait état d’une prévalence élevée d’infections par le virus de l’hépatite B chez les donneurs de sang à Abuja, au Nigéria, ce qui souligne la nécessité d’un dépistage approprié du sang par transfusion afin d’éliminer

Mots-clés: sang, paludisme, hépatite, rapide, immuno-sorbant, polymérase

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Prevalence of hepatitis B virus infections among blood donors in Federal Capital Territory, Abuja, Nigeria

 

Malaria prevention in the Buea health district in Cameroon: factors influencing Mosquito bed net use in households

FHL Kamga, P Nde-Fon, C. Morfaw, NDS Nsagha

 

Abstract

Background: Insecticide treated bed nets (ITNs), though proven to be effective in preventing malaria will have little impact unless people sleep under them. Several studies have shown that owned ITNs are usually not used and that ITN use is influenced by several factors that vary between communities.
Objective: To investigate the factors influencing the use of mosquito bed nets in households in the Buea Health District (BHD) in Cameroon.
Material and Methods: A cross-sectional study with two-stage cluster sampling included 420 households from 35 sites. Questionnaires adapted from the Malaria Indicator Survey were used. CSPro 4.1 and Epi info 3.5.3 were used to create database and analyze respectively.
Results: ITN ownership in the BHD was high (92.6%; 95% CI: 89.6%-94.9%) but ITN use was less than average (41.2%; 95% CI: 39.2%-43.3%). ITN use was least likely in the age group 5-15 years (P<0.01), in educated individuals (P<0.01) and in households with less than one ITN for two persons (P<0.01). White ITNs were less likely to be used (P<0.01). Conclusion: There is a gap between ITN ownership and use in the malaria holoendemic BHD and ITN use is associated with age of individual, level of education, colour of ITNs and household net density. Use of the highly owned ITNs could be increased by targeting the least protected 5-15 years age group and schooling individuals; by promoting school-based education on ITN use.

Keywords: Insecticide-treated nets, malaria, Buea Health District

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Malaria prevention in the Buea health district in Cameroon factors influencing Mosquito bed net use in households

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Prevalence of malaria infection among patients attending Murtala Muhammed specialist hospital Kano, Nigeria

O.V. Oladele, S.C. Onuoha, H.S. Hamafyelto, O. Omisope, A. Fauziyya, M. Akindigh, T. Abdullahi, M.L. Ilu, E. Ikeh

 

Abstract

Malaria is one of the most common diseased conditions in Nigeria and  across most developing countries triggered by one of four species of Plasmodium. The objective of this study was to screen and detect for the presence of Plasmodium species via microscopic analysis on Malaria patients attending a healthcare facility Northern Nigeria and present the epidemiological data of malaria.Finger prick blood samples, Thick and Thin Giemsa-stained blood smears, were collected from 350 malaria-suspected individuals representing all age groups. The Giemsa-stained blood smears were examined microscopically. Demographic information on rural and urban dwellings, use of  insecticides and mosquito nets were collected using structured questionnaires. Malaria cases were detected in in 227 (64.9%) of the participants with a higher infection rate amongst the males (147) than the females (80). The  predominant specie found was Plasmodium  falciparum. All age groups in this study were vulnerable in the order of 61-above>31-40>51-60>41-50>1-10>21-30> 11-20 years of age.A large number of participants dwelling in urban area (219) were tested positive for malaria in contrast to eight(8) from the rural area. Not using insecticides and mosquito treated nets were significantly associated with the prevalence of malaria as 59.4% of participants who were tested positive for  Plasmodium falciparum infection utilized insecticides, while 66.9% of those who did not were also tested positive. Individuals residing close to gutters and bushes were the most susceptible (85.6%) to Plasmodium infection.

Keywords: Prevalence, Malaria, Plasmodium falciparum, Kano

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Prevalence of malaria infection among patients attending Murtala Muhammed specialist hospital Kano, Nigeria