Population and Individual-Level Double Burden of Malnutrition Among Adolescents in Two Emerging Cities in Northern and Southern Nigeria: A Comparative Cross-Sectional Study

Background

Over the past three decades, double burden of malnutrition (DBM), a situation where high levels of undernutrition (stunting, thinness, or micronutrient deficiency) coexist with overnutrition (overweight and obesity), continues to rise in sub-Saharan Africa. Compared to other countries in the region, the evidence on DBM is limited in Nigeria.

Objective

This paper aimed to determine the comparative prevalence of population-level and individual-level DBM among adolescents in two emerging cities in northern and southern Nigeria.

Methods

This was a comparative cross-sectional study among apparently healthy secondary school adolescents aged 10-18 years in Gombe (northern Nigeria) and Uyo (southern Nigeria) between January 2015 and June 2017. A multistage random sampling technique was implemented to recruit adolescents from 24 secondary schools in both cities. Measures of general obesity (body mass index) and stature (height-for-age) were classified and Z-scores generated using the WHO AnthroPlus software, which is based on the WHO 2006 growth reference. Population-level DBM was defined as the occurrence of thinness and overweight/obesity within the population. Individual-level DBM was defined as the proportion of individuals who were concurrently stunted and had truncal obesity or stunted and were overweight/obese.

Findings

Overall, at the population-level in both settings, 6.8% of adolescents had thinness, while 12.4% were overweight/obese signifying a high burden of population-level DBM. Comparatively, the population-level DBM was higher in Gombe compared to Uyo (thinness: 11.98% vs 5.3% and overweight/obesity: 16.08% vs 11.27% in Gombe vs Uyo respectively). Overall, at the individual level, 6.42% of stunted adolescents had coexisting truncal obesity, while 8.02% were stunted and had coexisting general overweight/obesity. Like the trend with population-level DBM, individual-level DBM was higher in Gombe (northern Nigeria) compared to Uyo (southern Nigeria).

Conclusion

High levels of population-level and individual-level DBM exist in Gombe and Uyo. However, the level of DBM (under- and over-nutrition) is higher in Gombe located in northern Nigeria compared to Uyo in southern Nigeria.

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria

AIMS AND OBJECTIVES

The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population.

PATIENTS AND METHODS

This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur.

RESULTS

A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000.

CONCLUSIONS

Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

Safety of Artemisinin-Based Combination Therapies in Nigeria: A Cohort Event Monitoring Study

BACKGROUND

A pilot programme of Cohort Event Monitoring (CEM) was conducted across the six geopolitical zones of Nigeria on patients treated for uncomplicated malaria with artemisinin-based combination therapy (ACT). The emergence and spread of malaria parasites resistant to commonly available antimalarial drugs necessitated a shift in policy for malaria treatment by the Federal Government from the use of chloroquine and sulphadoxine-pyrimethamine (SP) as first-line treatments to ACTs. Initial reports following deployment of ACTs in clinical settings raised safety concerns regarding their use. Although artemisinin and its derivatives are generally thought to be safe, there are currently few or no data on their safety among populations in Nigeria.

OBJECTIVES

The main objectives of the CEM programme were to proactively determine the adverse event (AE) profile of artesunate/amodiaquine (AA) and artemether/lumefantrine (AL) in real-life settings and to find out the factors predisposing to AEs.

METHODS

The CEM study was observational, longitudinal, prospective, and inceptional. Patients were observed in real-life situations. It was conducted in six public health facilities in Nigeria on patients with a clinical diagnosis of uncomplicated malaria treated with ACTs. Patients were prescribed one of the ACTs on an alternate basis as they enrolled into the programme. Follow-up reviews were undertaken on days 3 and 7 following commencement of ACT treatment. At follow-up, patients were evaluated for any clinical event that they might have experienced following the use of the ACTs. We report the result of this initial pilot in which 3,010 patients treated for uncomplicated malaria with AA or AL were enrolled.

RESULTS

The seven most common AEs seen were general body weakness 25.0/36.6% (AL/AA); dizziness 11.9/17.2% (AL/AA); vomiting 8.0/10.2% (AL/AA); abdominal pain 8.5/7.2% (AL/AA); insomnia 6.3/5.9% (AL/AA); body pains 3.4/5.2 (AL/AA) %; anorexia 8.5/4.6% (AL/AA). Most adverse events occurred from day 1 and peaked by day 2 and 3 of medication with the mean duration of events being 3 days. By the end of the follow-up visit on day 7, the AEs had resolved in the majority of patients. Adverse events were more common in the AA group than AL revealing a better safety profile for AL (p < 0.001). Both ACTs demonstrated good ability to resolve the clinical symptoms of uncomplicated malaria.

CONCLUSION

In conclusion, this pilot CEM programme suggests that adverse events with ACTs were common. However, serious life-threatening events were not common. It appears that ACTs have a tolerable safety profile among Nigerians.

PREVALENCE, CO-PREVALENCE AND RISK FACTORS OF PULMONARY PARAGONIMIASIS AND PULMONARY TUBERCULOSIS IN NIGERIAN CHILDREN IN THE NIGER DELTA AREA

BACKGROUND

Nigeria has the highest burden of paragonimiasis in Africa and it is also among the high burden countries with tuberculosis. The true prevalence of these reemerging diseases is unknown in the country.

OBJECTIVE

To determine the prevalence and co-prevalence of thesere-emerging diseases among children in a rural Nigerian community.

DESIGN

Descriptive cross-sectional study.

SETTING

Ewang, a rural fishing community in Mbo Local government Area of Akwa Ibom State, Nigeria.

SUBJECTS

Primary and secondary school children aged 5-18years living in Ewang village, Mbo Local government Area of Akwa Ibom State, Nigeria.

RESULTS

A total of 204 children were examined: 91(44.6%) were males, while 113(55.4%) were females. Ten of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 4.9%,while six children were sputum positive for pulmonary tuberculosis with a prevalence rate of 2.9%. There was no case of co-infection. The peak age prevalence of paragonimus ova-positive and Acid and Alcohol fast positive subjects was recorded in the five to nine year old age group with prevalence rate of 5.6% and7.4% respectively. There was a female preponderance among the paragonimus ova-positive subjects (90%) and the AAFB positive subjects (66.7%).

CONCLUSIONS

The findings show that paragonimiasis is an emerging/re-emerging disease in southern Nigeria and further confirmed that the prevalence of tuberculosis is still on an upward rise.