The study determined the prevalence of malaria parasitemia among pregnant women using Sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPT) and assessed Plasmodium falciparum dihydropteroate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) resistance genes among the subjects. Three hundred and ninety consenting pregnant women attending antenatal clinics in Nnewi, Anambra State, Nigeria were recruited. Of this, 336 of the women were using SP for IPT, while fifty-four of the women were non-users of SP. Polymerase Chain Reaction was used in the characterization of Plasmodium species while the Sanger sequencing method was used in sequencing assay. Of the 336 pregnant women SP users, 73 (21.7%) and, 41 (12.2%) of the neonates had malaria parasitemia while 29 (53.7%) of the 54 non-users of SP and 14 (25.4%) of the babies had malaria parasitemia (p=0.022). Plasmodium falciparum and Plasmodium vivax parasitemia among subjects on IPTp-SP was 38 (11.3%) and 30 (8.9%) respectively. The prevalence of Pfdhfr and Pfdhps resistance genes in pregnant women was 11 (3.3%) and 10 (2.9%) respectively. Malaria parasitemia was significantly higher among non-users of SP. The presence of P. falciparum resistance genes among IPTp-SP users could lead to treatment failures. Therefore, novel drugs should be sought to replace SP.

Background: Africans exhibit great diversity in cytochrome P450 2B6 isoenzyme (CYP2B6), the major enzyme in efavirenz metabolism. Aim: We examined the frequency of two functional single nucleotide polymorphisms (SNPs) of the CYP2B6 pharmacogene in HIV-infected Nigerians on efavirenz-based antiretroviral therapy. The potential implications of the SNPs for HIV therapy were discussed. Materials and Methods: A cross-sectional study conducted from July 2018 to December 2018 in a tertiary health facility in Nigeria. A random sample of a clinic cohort of HIV-infected adult Nigerians of different ethnicities was characterized for two key SNPs; CYP2B6:516G>, and CYP2B6:983T > C, defining the alleles CYP2B6*6 and CYP2B6*18, respectively. Hardy–Weinberg equilibrium was calculated to evaluate the genotype frequency distribution. Results: Genotyping was successful for 262 (83%) of the 316 study participants. Of those with genotype results, mean age was 41 ± 8 years and 182 (69.5%) were female. The CYP2B6:516 G/G (extensive metabolizers), CYP2B6:516 G/T (intermediate metabolizers), and CYP2B6:516 T/T (poor metabolizers) genotype frequency was 35.9%, 46.6%, and 17.6%, respectively. Also, 88.9% and 11.1% of participants were carriers of the CYP2B6:983 T/T and CYP2B6:983 T/C (poor metabolizers) genotypes, respectively. There were no gender or age-related differences in the genotype distribution. The CYP2B6:516G >T allele frequencies showed no significant deviations from the Hardy-Weinberg equilibrium ( P = 0.66). Conclusions: The intermediate metabolizer genotype was more common than the extensive and poor metabolizer genotypes in our study sample. We recommended further studies to investigate the risk of efavirenz underexposure and overexposure in carries of the extensive and poor metabolizer genotypes respectively in our patient population.

It is well documented in the literature that there is poor treatment outcome in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to the observed interference of drugs for Tuberculosis (TB) treatment on anti-diabetic drugs and elevated glucose level reduces the efficacy of anti- tuberculosis drugs leading to poor TB treatment outcome, and that insulin therapy is not affected by this drug interaction. Importantly, access to Insulin is a challenge due to its prohibitive out-of-pocket cost. The only alternative sustainable treatment for TBDM patients in resource-limited communities is lifestyle-based intervention. This study evaluated the impact of lifestyle intervention on TB treatment outcomes in patients with TBDM comorbidity. This study is a quasi-experimental intervention involving two cohorts of 25 TBDM patients each, as control and experimental cohorts. Their enrolment was from Tuberculosis patients from health facilities in Lagos and Oyo states. The questionnaires were administered before the commencement of the Intervention and at 8 weeks. The sputum Acid Fast Bacillus (AFB) was checked, and chest x-ray (CXR) done before Intervention and Sputum AFB at 8 weeks. The Control group showed no difference in the means of the sputum AFB 95%CI: 0.12(- 0.12 – 0.36; p>0.05), which was an indication of poor treatment outcome. The difference in the means of the sputum AFB in the intervention group was statistically significant 95%CI: -0.8(-0.9 - -0.6; p<0.05). The intervention with educational and behavioral lifestyle modifications significantly improved the outcome of treatment of TB in TBDM comorbidity. Keywords: Behavioral change, Tuberculosis, Diabetes, comorbidity, Treatment outcome.

There is an observed poor treatment outcome of Diabetes mellitus (DM) in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to interference of drugs used in the treatment of Tuberculosis (TB) with first- line drugs used in the treatment of DM. Insulin does not interact with TB drugs, but it is not accessible and affordable to low–resource communities due to high cost. Hence a lifestyle-based intervention, which this study evaluated to determine its effect on Diabetes control in these individuals. It is a quasi-experimental intervention with two groups of 25 participants each as experimental and control cohorts, enrolled from Tuberculosis Healthcare centers in Lagos and Oyo states. The questionnaires were administered after the baseline Glycated hemoglobin (HBA1c) has been measured, repeated after 12 weeks, and analyzed with SPSS software. In the control cohort, the difference in the means of HBA1c was statistically significant at 95%CI: 1.1(0.2 – 2.1; p<0.05), indicating a worsening of blood glucose control. The difference in the means of educational scores was not significant 95%CI: -0.04(-2.8 – 2.7; p<0.05), showing no uptake. In the intervention group, the difference in the means of the HBA1c was statistically significant 95%CI: -2.4(-3.1 – 1.6: p<0.05), indicating improvement in glucose control. The difference in the means of the educational and behavioral score was significant statistically 95%CI: 40.6(37.7 – 43.6; p<0.05) indicating uptake of behavioral changes. The intervention with educational and behavioral lifestyle modifications improved the blood glucose control as an adjunct to the conventional treatment with drugs compared to the control group. Keywords: Behavioral change, Lifestyle, Treatment, Tuberculosis-Diabetes comorbidity.

Background: Following the World Health Organization (WHO) recommendations for 4-weekly antenatal intermittent preventive treatment of malaria in pregnancy using sulphadoxine-pyrimethamine (IPTp-SP), there is a need to evaluate the drug performance in order to determine their effectiveness as tools in malaria control policy. Objectives: To determine prevalence of cord blood malaria, compliance gap and adverse pregnancy outcomes (anaemia, preterm delivery, spontaneous abortion, intra-uterine foetal death and low birth weight) among antenatal IPTp-SP users compared with non-users. Methods: A cross-sectional analytical study was conducted among consenting 390 participants who were administered a questionnaire, and paired blood samples were collected from the venous blood of participants and neonatal cord immediately after delivery. The participants were categorised as IPTp-SP users and non-users. Adverse pregnancy outcomes were assessed. Neonatal birth weights were also measured within 1 h after delivery. Malaria parasitaemia and anaemia were analysed using standard parasitological and haematological methods of examination. Data were analysed using SPSS version 25 for Windows and p-value of < 0.05 considered significant. Results: Of 390 women, 336 (86.2%) were IPTp-SP users, while 54 (13.8%) were non-users. The compliance gap was 13.8%. Malaria parasitemia in pregnant women (21.7% versus 53.7%; p < 0.001) and their babies (12.2% versus 25.4%; p = 0.002) were observed for IPTp-SP users and non-users, respectively. The prevalence of maternal anaemia was 27(8.0%) in IPTp-SP users and 5 (9.3%) in non-users ( p = 0.789). Mean parasite density was reduced in IPTp-SP users than in non-users ( p < 0.001). Correlation of birth weight according to their sex showed a weak correlation [correlation coefficient ( r) = 0.027; p = 0.736]. Pregnant women with preterm delivery, spontaneous abortion, intra-uterine foetal death, and low birth weight were significantly lower ( p < 0.001, for all) in IPTp-SP users compared with non-users. Conclusion: Although the compliance gap was low, IPTp-SP users had significantly better pregnancy and foetal outcomes compared with non-users. Efforts should be intensified towards achieving total compliance in IPTp-SP usage by pregnant women.