A project testing the efficacy of insecticide (permethrin)-impregnated bed nets, compared with impregnated door and window curtains, residual house spraying, and a control group was implemented in 12 village clusters in the Nsukka Local Government Area of Enugu State, Nigeria, using epidemiologic and entomologic indicators. The appropriate materials and services were given free to all families. During the first year of study, three monitoring exercises were carried out in a random selection of homes where children under 5 years of age resided. Information was collected on perceived effectiveness of the interventions, condition of nets and curtains, reasons for not sleeping under nets, and recall of steps required in caring for nets and curtains. Bed nets were perceived as more effective in reducing mosquito bites compared with the two other interventions. At the last monitoring period, which occurred a few weeks before a re-impregnation exercise, respondents also perceived bed nets to be most effective in preventing malaria. These findings coincided with epidemiologic evidence. Curtains, especially those at doors, were more likely to be torn and dirty than bed nets. Although holes would not reduce the effectiveness of the insecticide, they could reduce the 'beauty' of the curtains, a perceived benefit that initially attracted villagers to both curtains and nets. Bed net owners reported significantly less frequent use of other mosquito control measures in their homes than did members of the other groups. Finally, bed net users demonstrated increased knowledge of use and care steps than did those with curtains. These findings suggested a high level of social acceptability of bed nets, and point to the need to test their acceptability further under conditions where people would pay for nets and communities would manage distribution and re-impregnation systems.

Insecticide impregnated bed nets are being tested in many tropical areas as a major tool to control malaria. In a few African countries, there is a history of local bed net production and use, while in most others, ownership of commercially-produced nets is rare due to high costs relative to local income. Such variations in pre-existing bed net use behavior must be studied prior to designing new intervention trials. A "baseline" diagnostic study in Nsukka Local Government of Enugu State, Nigeria, found that local beliefs about malaria causation, which include heat from the sun and hard work, may reduce the perceived efficacy of bed nets as an appropriate malaria control action. While the belief that mosquitos can cause malaria increased with level of formal education, the study also documented that educated people simultaneously hold both indigenous and scientific perceptions about malaria. Although the project provided bed nets, curtains and residual house spray for free, long-term sustainability may be influenced by the main constraint to current ownership of a bed net, i.e., cost. Issues, such as concern about feeling hot under the nets, a tendency to sleep outside during the hot dry season, and variations in people's ideas about what constitutes a malaria episode, point to the need to monitor the bed net intervention. This is recommended as a means of learning how people perceive the efficacy of the nets, whether they use them correctly and whether the intervention can be sustained and integrated into local primary health care programs.

The efficacy of amodiaquine against Plasmodium falciparum malaria was assessed in an area of confirmed chloroquine resistance in the cool, north-central plateau of Nigeria, using a 14-day protocol. The patients were all children aged <5 years of age. The drug proved highly efficacious, giving a cure 'rate' of 100% on day 14 and mean fever- and parasite-clearance times of 1.11 and 3.11 days, respectively. It was also well tolerated. Following treatment, packed-cell volumes (PCV) generally increased (65% of patients) but remained constant (12%) or even decreased (23%) in some patients; the overall improvement in PCV was not statistically significant (P >0.05). The results justify the use of amodiaquine to treat P. falciparum malaria in those who have failed treatment with chloroquine and the second-line drugs (e.g. sulfadoxine-pyrimethamine) currently used in Nigeria. As the amodiaquine would be better employed as one part of a combination than on its own, there is a need to identify suitable partner compounds.

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Abstract. The efficacy and tolerability of single, low-dose mefloquine, sulfadoxine-pyrimethamine (MSP) combination was compared with chloroquine (CQ) for malaria treatment in a malaria-endemic area of Nigeria with multiple drug-resistant Plasmodium falciparum. The two drug regimens (MSP and CQ) were tested in a 12-month prospective population study. The patients were divided into two groups. Group 1 patients were treated presumptively, based on malaria symptoms. Group 2 patients were treated based on a parasitologic diagnosis using the World Health Organization seven-day in vivo test and extended to a 28-day follow-up period. Tolerability was assessed by the incidence and intensity of adverse events. One thousand nine hundred thirty-five patients visiting 10 health facilities, including the University of Calabar Teaching Hospital, were enrolled. The study showed that the low-dose MSP was efficacious, with day 7 response rates of 95% and 91% for (presumptive) Group 1 and (in vivo) Group 2, respectively, while CQ had day 7 response rates of 82% and 66% in Groups 1 and 2, respectively. The low-dose MSP was significantly (P Ͻ 0.0001) more efficacious, with faster fever and parasite clearance times than CQ in this area of CQ-resistant P. falciparum malaria. Eight patients treated with CQ, including seven severe cases (RII-RIII) were successfully re-treated with MSP. Adverse events were generally more common among those treated with MSP (29%) than those treated with CQ (17%). However, the adverse events caused by both drugs were mild to moderate and self-limited. The MSP combination appears to be a good substitute for CQ, in view of multiple drug resistance, especially in areas with severe (RII-RIII) malaria.