A parasitological mapping of urinary schistosomiasis using filtration method was conducted in Biase and Yakurr LGAs of Cross River State, Nigeria by the Neglected Tropical Diseases Control unit in collaboration with the schistosomiasis/soil transmitted helminths unit of the Federal Ministry of Health, Nigeria in November 2012.The results of the study revealed a mean urinary schistosomiasis prevalence of 49% for the six schools under study in Biase and 30% for the six schools under study in Yakurr LGA.The mean ova load was 0.9 for males and 0.8 for females in the two LGAs.Integrated control measures put in place, included chemotherapy of infected individuals with praziquantel and health education on the predisposing factors responsible for the transmission of urinary schistosomiasis.An evaluation of the interventions was carried out in November 2014, after two rounds of treatment with Praziquantel and intensive education were given.Urine samples were collected from 600 school children, 300 from each of the two LGAs.The evaluation study using the urine filtration technique revealed a mean schistosomiasis prevalence of 0% for the six schools under study in Biase and 0.02% for the six schools under study in Yakurr LGA with mean ova load reduced to 0.3 for males and 0 for females in the two LGAs.Data analysis with SPSS package revealed a 100% participation of all selected school children in 12 schools (6 in each LGA).Statistical analysis showed that there was no significant difference in the prevalence between male and female (p>0.005).A student t-test showed a significant difference between prevalence rates in 2012 and the results in 2014 (p>0.005).The spatial distribution showed that endemic schools were distributed within marshy areas where rice was cultivated in the two LGAs.These results showed that with wide scale integrated control measures, urinary schistosomiasis can be eliminated or reduced to a disease of no public health importance.

BACKGROUND:The acceleration of the control of soil-transmitted helminth (STH) infections in Nigeria, emphasizing preventive chemotherapy, has become imperative in light of the global fight against neglected tropical diseases. Predictive risk maps are an important tool to guide and support control activities.METHODOLOGY:STH infection prevalence data were obtained from surveys carried out in 2011 using standard protocols. Data were geo-referenced and collated in a nationwide, geographic information system database. Bayesian geostatistical models with remotely sensed environmental covariates and variable selection procedures were utilized to predict the spatial distribution of STH infections in Nigeria.PRINCIPAL FINDINGS:We found that hookworm, Ascaris lumbricoides, and Trichuris trichiura infections are endemic in 482 (86.8%), 305 (55.0%), and 55 (9.9%) locations, respectively. Hookworm and A. lumbricoides infection co-exist in 16 states, while the three species are co-endemic in 12 states. Overall, STHs are endemic in 20 of the 36 states of Nigeria, including the Federal Capital Territory of Abuja. The observed prevalence at endemic locations ranged from 1.7% to 51.7% for hookworm, from 1.6% to 77.8% for A. lumbricoides, and from 1.0% to 25.5% for T. trichiura. Model-based predictions ranged from 0.7% to 51.0% for hookworm, from 0.1% to 82.6% for A. lumbricoides, and from 0.0% to 18.5% for T. trichiura. Our models suggest that day land surface temperature and dense vegetation are important predictors of the spatial distribution of STH infection in Nigeria. In 2011, a total of 5.7 million (13.8%) school-aged children were predicted to be infected with STHs in Nigeria. Mass treatment at the local government area level for annual or bi-annual treatment of the school-aged population in Nigeria in 2011, based on World Health Organization prevalence thresholds, were estimated at 10.2 million tablets.CONCLUSIONS/SIGNIFICANCE:The predictive risk maps and estimated deworming needs presented here will be helpful for escalating the control and spatial targeting of interventions against STH infections in Nigeria.

Urinary schistosomiasis is a serious disease in Cross River State, Nigeria. Dearth of information on its distribution has hampered the implementation of focused control of the disease. The availability of a rapid method for mapping the disease necessitated this research to provide data for control of Urinary schistosomiasis in Cross River State, Nigeria. The study used a rapid validated school-based questionnaire method in mapping schistosomiasis. Geographical information system (GIS) software tools were used to produce a spatial map for prevalence of infection and areas at risk for urinary schistosomiasis in Cross River State. Data analysis with SPSS package revealed that 9,993 (10.2%) female and 10,328 (10.0%) male pupils in 218 schools passed blood in urine in one month out of 199,794 pupils interviewed. There was no statistically significant difference in the prevalence between male and female pupils with infection (p < 0.005). The prevalence of urinary schistosomiasis using questionnaire method correlated positively with the filtration method used in determining the egg output (r = 0.71, p < 0.001). Endemic schools were distributed in thirteen Local Government Areas of Cross River State, Nigeria. Yala and Yakurr LGAs had the highest number of schools that reported schistosomiasis with 39 (59%) and 13 (59%), respectively. Odukpani LGA had the lowest prevalence of 1 (0.2%). The overall results showed a mean urinary schistosomiasis prevalence of 10.2% for Cross River State, Nigeria. The findings of this study would guide Government and other relevant agencies in the implementation of control strategies for the treatment of urinary schistosomiasis in Cross River State, Nigeria.

Schistosomiasis prevalence data for Nigeria were extracted from peer-reviewed journals and reports, geo-referenced and collated in a nationwide geographical information system database for the generation of point prevalence maps. This exercise revealed that the disease is endemic in 35 of the country's 36 states, including the federal capital territory of Abuja, and found in 462 unique locations out of 833 different survey locations. Schistosoma haematobium, the predominant species in Nigeria, was found in 368 locations (79.8%) covering 31 states, S. mansoni in 78 (16.7%) locations in 22 states and S. intercalatum in 17 (3.7%) locations in two states. S. haematobium and S. mansoni were found to be co-endemic in 22 states, while co-occurrence of all three species was only seen in one state (Rivers). The average prevalence for each species at each survey location varied between 0.5% and 100% for S. haematobium, 0.2% to 87% for S. mansoni and 1% to 10% for S. intercalatum. The estimated prevalence of S. haematobium, based on Bayesian geospatial predictive modelling with a set of bioclimatic variables, ranged from 0.2% to 75% with a mean prevalence of 23% for the country as a whole (95% confidence interval (CI): 22.8-23.1%). The model suggests that the mean temperature, annual precipitation and soil acidity significantly influence the spatial distribution. Prevalence estimates, adjusted for school-aged children in 2010, showed that the prevalence is <10% in most states with a few reaching as high as 50%. It was estimated that 11.3 million children require praziquantel annually (95% CI: 10.3-12.2 million).

BACKGROUND The overall prevalence of blindness from Onchoceriasis in Bushenyi is relatively low, most of which is to be found in the elderly. Onchoceriasis is a major health problem in Africa. The Community-Directed treatment with invermectin is a control strategy to address the problem, but baseline data are generally lacking in several countries. OBJECTIVE To describe baseline ophthalmological data in order to assess the impact of Community-Directed with Ivermectin (CDTI) in Uganda. METHODS The study site was in Bushenyi, Western Uganda. In a cross-sectional study, 367 persons aged 10 years or older from seven selected villages received eye examination using a standardised protocol and Wu-Jones Motion Sensitivity Testing (MSST). Besides MSST, other information sought included visual acuity, slit lamp examination, testicular opacities and intraocular presence. RESULTS Of the 367 subjects, 219(57.2%) were males. Subjects less than 25 years of age were 104(28.3). The prevalence of blindness were 1.9% while 4.1% was visually impaired by acuity criteria alone. A further 9.1% had moderate visual field loss while 2.8% had severe field loss. There was no case of anterior chamber microfilaria but dead microfilariae were seen in two cases. Punctate keratitis was present in 1.8% with sclerosing keratitis was twice as common at 3.8%. Optic atrophy was also relatively common at 12.4%, while chorioretinitis was present in 3.3%. CONCLUSION There was an apparent paucity of acute onchocerciasis-related lesions but a significant presence of irreversible onchocerciasis-related lesions. The most significant problem requiring intervention would appear to be cataract.

SummaryObjectives To assess the long‐term impact of the African Programme for Onchocerciasis Control on itching and onchocercal skin disease (OSD).Methods Seven study sites in Cameroon, Sudan, Nigeria and Uganda participated. Two cross‐sectional surveys were conducted of communities meso‐ and hyper‐endemic for onchocerciasis before and after 5 or 6 years of community‐directed treatment with ivermectin (CDTI). Individuals were asked about any general health symptoms including itching and underwent full cutaneous examinations. Onchocercal skin lesions were documented according to a standard classification.Results Five thousand one hundred and ninety three people were examined in phase I and 5,180 people in phase II. The presence of onchocercal nodules was a strongly significant (P < 0·001) risk factor for all forms of onchocercal skin disease: APOD (OR 1·66); CPOD (OR 2·84); LOD (OR 2·68); reactive skin lesions (OR 2·38) and depigmentation (OR 3·36). The effect of community‐directed treatment with ivermectin was profound. At phase II, there were significant (P < 0·001) reductions in the odds of itching (OR 0·32), APOD (OR 0·28); CPOD (OR 0·34); reactive skin lesions (OR 0·33); depigmentation (OR 0·31) and nodules (OR 0·37). Reduction in the odds of LOD was also significant (OR 0.54, P < 0.03).Conclusions This first multi‐country report of the long‐term impact of CDTI reveals a substantial reduction in itching and OSD. APOC operations are having a major effect in improving skin health in poor rural populations in Africa.

A rapid assessment of Loa loa prevalence (RAPLOA) in 19 communities of Akoko-Edo and Etsako East LGAs located in the northern part of Edo State, Nigeria was conducted to determine the endemicity of the disease and to classify the communities according to the level of risk to loiasis related adverse reactions. Local names for “eye worm” were in use in six communities of Akoko-Edo LGA while in Etsako-East LGA only three communities had local names for the condition. “Calabar swelling” was a recognized entity in some of the villages surveyed. In the villages where the vector, Chrysops spp. could be recognized upon description, the local names for the flies was also provided. A total of 1514 persons were interviewed according to RAPLOA guidelines; 794 from Akoko Edo LGA and 720 from Etsako East LGA. The age of the respondents in Akoko-Edo ranged from 15- 95 years (mean, 40±19.9) while in Etsako East the respondents’ age ranged from 15 to 90 years (mean, 37.5±18.5). The overall prevalence of eye worm in Akoko-Edo LGA was 3.9% and 5.3% in Etsako East LGA while the rates recorded in communities surveyed ranged from 0–21.3%. The prevalence of eye worm increased with age in both LGAs and prevalence of the disease was found to be slightly higher amongst males in both LGAs. From the results obtained in this survey, none of the communities investigated is at risk of Loa loa related adverse reactions. Ivermectin distribution in these CDTI communities should therefore be continued.

Observations on seasonal variations in onchocerciasis transmission by Simulium damnosum sensu lato were made in a study carried out in Kwa Falls, Aningeje in Akamkpa LGA (a typical forest area) of Cross River State, Nigeria. The study was carried out for three months of the rainy season (August, September and October, 1999) and three months in the dry season (November, December, 1999 and January, 2000). Black flies were caught on five consecutive days of each month by two flycatchers working alternate hours for a total of eleven hours in a day (07 hr. – 1800 hr.). The black flies caught were dissected fresh in the field to determine the physiological age (parity). Parous flies were stained with Mayer\'s Haemalum and dissected to determine the infection\\infectivity rates (percentages) due to Onchocerca volvulus. During 30 days of black flies catching, a total of 7,403 S. damnosum s. l. vectors were attracted to man. Out of this figure, 230 (3.1%) black flies were parous. More black flies were caught in the rainy season than in the dry season. This was also true of the parous black flies identified. The infection\\infectivity rates (percentages) averaged 9.4\\5.7. The problem of onchocerciasis in the study area is more of a biting nuisance by the vector. Keywords: Simulium damnosum, Black flies, Human onchocerciasis, Dry Season, Rainy Season, Forest AJAZEB Vol. 7 2005: pp. 14-18

The rapid assessment procedure for loiasis (RAPLOA) was used to assess the prevalences of loiasis among 4800 subjects in 60 villages in Ondo state, south-western Nigeria. Coverages for community-directed treatment with ivermectin (CDTI) were assessed in the same communities, which were located in the Owo, Akure North, Ifedore, Akure South, Ondo East and Ondo West local government areas (LGA). In addition, fingerprick blood samples were collected from 80 individuals in each of six villages (i.e. one village in each LGA investigated) and checked for Loa loa microfilaraemia. Microfilaraemias were only detected in three of the villages where blood samples were collected and then only at low prevalences (1.25%-5.0%) and intensities (267-1600 microfilariae/ml). No serious adverse events were or ever had been related to the CDTI but mild or moderate adverse reactions were quite common, especially in Akure North (55.0%) and Owo (40.2%). A female subject was more likely to report an history of eye worm than a male subject (20.3%-35.7% v. 20.8%-26.5%, according to LGA). Although the subjects aged 41-50 years formed the age-group most likely to report an history of eye worm (32.7%), the highest CDTI coverage was recorded in the subjects aged 61-70 years (54.7%). The results indicated that CDTI had helped to reduce the prevalence and intensity of Loa microfilaraemia and that ivermectin can continue to be used for mass administrations in Ondo state with little risk of serious adverse events.

Rapid Assessment of Loaisis (RAPLOA) was conducted in a total of 13 meso-endemic and hyper-endemic villages in Ini and Ibiono Ibom Local Government Areas of Akwa Ibom State, Nigeria, to identify villages that could be at risk of Severe Adverse Events (SAEs) following treatment with ivermectin in areas where onchocerciasis and loaisis are co endemic. Common names for loiasis namely Utung Eyin (eye worm) and Ubiak Eyin (eye pain) were found to exist in all the 13 villages. A total of 970 people aged 15 years and above were interviewed according to RAPLOA guidelines. Eleven of the 13 villages had RAPLOA rates of less than 40% and are therefore at low risk of experiencing SAEs. Two villages, Anananmong and Ikot Adaha, with RAPLOA rates of 40% and 40.5% respectively, are at high risk of Loa loa SAEs following treatment with ivermectin. Parasitological screening of blood samples showed that only 10 (1.03%) of 970 persons examined were positive for Loa loa microfilariae with prevalence range of 0-3.8% (median 1.25%). Intensity of infection was low with individual microfilariae load ranging from 20 to 3,200 mf/ml while Community Microfilariae Load (CMLF) was 0-8.9 mf/ ml (1.61mf/ml). There was no demonstrated relationship between RAPLOA > 40% and Very High Microfilarial Loads (VHML) in the two communities with RAPLOA of 40% and above. Based on the above results, it is advice that provision must be made to ensure that severe adverse reactions are quickly detected and managed during mass treatment with ivermectin in Anananmong, Ikot Adaha, and neighbouring villages. Keywords: ochocerciasis, loasis, co-endemic, treatment, ivermectin. Nigerian Journal of Parasitology Vol. 27 2006: pp. 85-90

Factors affecting the transmission of human onchocerciasis by Simulium damnosum sensu lato were the focus of a study carried out in River Lewa, Etikpe, a fringe savanna village in Ikom LGA in Cross River State, Nigeria. The duration of the study was six months (August 1999 to January 2000). The thrust of the study was on ecological parameters that affected the transmission of this human scourge. Some entomological indices/parameters that are useful criteria in planning and evaluating the progress of onchocerciasis control programme were also considered. Trained flycatches working alternate hours (0700hr.-1800hr.) caught black flies used for the study. The black flies caught were either dissected fresh in the field to determine parity (physiological age) or processed in the laboratory to determine the infection/infective rates due to Onchocerca volvulus. Out of 844 black flies collected in the 30 days catching, 425 (50.4%) flies were parous. The monthly ecological parameters (that is, water pH and temperatures, dissolved oxygen, iron content, atmospheric temperatures, rainfall, relative humidity and conductivity) measured and recorded in the study area/site had no significant differences in their values (P>0.05). These observed parameters however, had fluctuations, changes and variations in values. The findings in this study, if corroborated with those of related studies based on parasitologic, ophthalmologic and socioeconomic monitoring will be useful for planning of effective treatments with ivermectin. Keywords: transmission, human onchocerciasis, savannah, Cross River State Mary Slessor Journal of Medicine Vol. 5(2) 2005: 59-64

The aim of the study was to investigate the feasibility of mobilizing Philadelphia chromosome negative (Ph-) blood stem cells (BSC) with intensive chemotherapy and lenograstim (G-CSF) in patients with CML in first chronic phase (CP1). During 1994-1999 12 centers included 37 patients <56 years. All patients received 6 months' IFN, stopping at median 36 (1-290) days prior to the mobilization chemotherapy. All received one cycle of daunorubicin 50 mg/m2 and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m2 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 microg s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34+ cells was >5/microl blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m2/day and 1 hour i.v infusion, etoposide 100 mg/m2/day and 1 hour i.v. infusion and ara-C 1 g/m2/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 microg s.c once daily from day 8 after the start of chemotherapy. Twenty-seven patients received one cycle of chemotherapy and G-CSF, whereas 10 were mobilized twice. Twenty-three patients (62%) were successfully (MNC >3.5 x 10(8)/kg, CFU-GM >1.0 x 10(4)/kg, CD34+ cells >2.0 x 10(6)/kg and no Ph+ cells in the apheresis product) [n = 16] or partially successfully (as defined above but 1-34% Ph+ cells in the apheresis product) [n = 7] mobilized. There was no mortality during the mobilization procedure. Twenty-one/23 patients subsequently underwent auto-SCT. The time with PMN <0.5 x 10(9)/l was 10 (range 7-49) and with platelets <20 x 10(9)/l was also 10 (2-173) days. There was no transplant related mortality. The estimated 5-year overall survival after auto-SCT was 68% (95% CI 47 - 90%), with a median follow-up time of 5.2 years.We conclude that in a significant proportion of patients with CML in CP 1, intensive chemotherapy combined with G-CSF mobilizes Ph- BSC sufficient for use in auto-SCT.

Patients with relapsed aggressive lymphoma after high dose chemotherapy have a very poor prognosis and long-term survival is rare. Most patients are not eligible for allogeneic stem cell transplantation in this setting and treatment, therefore, becomes palliative. A few studies have shown that trofosfamide, an oral alkylating agent, may be effective as palliative treatment in non-Hodgkin's lymphoma. Trofosfamide therapy is considered rather non-toxic with an overall response rate from 50 to 80%. Most responses are, however, partial and their duration is short. We report a patient with a very aggressive ALK+ anaplastic large cell lymphoma (ALCL), relapsing shortly after high dose chemotherapy. Unrelated allogeneic transplantation was not possible. After several radio/chemotherapy regimens trofosfamide was started as palliative treatment. This therapy resulted in a complete remission, still ongoing, 27 months after termination of intravenous cytotoxic therapy and 16 months after withdrawal of trofosfamide. Thus, in this particular case, trofosfamide turned out to be an unexpectedly effective salvage therapy for an otherwise very aggressive relapsing ALCL.