Papers by George Emechebe
Malaria Journal, 2021
Background Malaria remains a public health burden especially in Nigeria. To develop new malaria c... more Background Malaria remains a public health burden especially in Nigeria. To develop new malaria control and elimination strategies or refine existing ones, understanding parasite population diversity and transmission patterns is crucial. Methods In this study, characterization of the parasite diversity and structure of Plasmodium falciparum isolates from 633 dried blood spot samples in Nigeria was carried out using 12 microsatellite loci of P. falciparum. These microsatellite loci were amplified via semi-nested polymerase chain reaction (PCR) and fragments were analysed using population genetic tools. Results Estimates of parasite genetic diversity, such as mean number of different alleles (13.52), effective alleles (7.13), allelic richness (11.15) and expected heterozygosity (0.804), were high. Overall linkage disequilibrium was weak (0.006, P < 0.001). Parasite population structure was low (Fst: 0.008–0.105, AMOVA: 0.039). Conclusion The high level of parasite genetic diversity...
Additional file 1 of Genetic diversity and population structure of Plasmodium falciparum in Nigeria: insights from microsatellite loci analysis
Additional file 1. Shows the Number of different and effective alleles in parasite populations ac... more Additional file 1. Shows the Number of different and effective alleles in parasite populations according to study location.
Additional file 2 of Genetic diversity and population structure of Plasmodium falciparum in Nigeria: insights from microsatellite loci analysis
Additional file 2. Shows the allelic richness values in parasite populations per microsatellite l... more Additional file 2. Shows the allelic richness values in parasite populations per microsatellite loci.
Additional file 1: of Parasite reduction ratio one day after initiation of artemisinin-based combination therapies and its relationship with parasite clearance time in acutely malarious children
Multilingual abstracts in the five official working languages of the United Nations. (PDF 340 kb)
Hepatitis B Virus infection in Nigeria – a review
Nigerian Medical Journal, 2009
Background:Hepatitis B virus infection is a pandemic and chronic infection may lead to chronic li... more Background:Hepatitis B virus infection is a pandemic and chronic infection may lead to chronic liver diseases which are often lethal. This review was done to assess the status of hepatitis B virus infection in Nigeria. Materials and Method:Source of information was mainly from published works in Nigeria and elsewhere. The information was extracted over period of 5 months from May to December 2007. Result: Since over 30years when pioneer works were done in Nigeria to the recent tunes the prevalence of hepatitis B virus infection has remained very high. In Nigeria, the transmission of hepatitis B virus occurs mainly during childhood and all the risk factors (like blood transfusion, sexual promiscuity, lower socioecomic status etc) implicated elsewhere in the spread of the virus in the general population also play role in Nigeria. Conclusion: Reduction in the of hepatitis B virus infection could be achieved by public enlightenment campaign, mass immunization of the children and adults ...
Microorganisms, 2019
Drug-resistant-diarrhoeagenic bacteria are currently emerging healthcare challenge. This study in... more Drug-resistant-diarrhoeagenic bacteria are currently emerging healthcare challenge. This study investigated the effects of Vernonia amygdalina, Garcinia kola, tetracycline and metronidazole combinations on such bacteria. Agar well diffusion method was employed to determine the inhibitory effects of the herbal extracts on diarrhoeagenic bacteria while Time-Kill Assay was used to determine bactericidal effects of the extracts against test isolates. Interactions between plant extracts and antibiotics were investigated using Checkerboard assay. Minimum inhibitory concentrations of the extracts against the bacterial isolates ranged between 3.125–50 mg/mL, while those of tetracycline and metronidazole ranged from 30–50 μg/mL. Synergism was observed against B. cereus and S. aureus for metronidazole + aqueous G. kola at all ratios. Generally, the combinations aqueous G. kola + ethanolic G. kola and aqueous G. kola + ethanolic V. amygdalina showed more pronounced synergism against the Staphy...
Additional file 1: of Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria
Multilingual abstracts in the five official working languages of the United Nations. (PDF 259 kb)
BMC Infectious Diseases, 2016
Late-appearing anaemia (LAA) following treatment with artemisinins for severe malaria has been re... more Late-appearing anaemia (LAA) following treatment with artemisinins for severe malaria has been reported and well described, but there are limited clinical and parasitological data on LAA in African children with uncomplicated falciparum malaria following oral artemisinin-based combination therapies (ACTs). This was an open label study with the main objectives of evaluating the clinical features, the risk factors for, the temporal changes in haematocrit and the outcomes of a LAA in malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP). The diagnosis of LAA was made using the criteria: clearance of parasitaemia, fever and other symptoms within 1 week of commencing treatment; adequate clinical and parasitological response at 4-6 weeks after treatment began; haematocrit ≥30 % 1 and/or 2 weeks after treatment began; and haematocrit &amp;amp;lt;30 %, parasite negativity by microscopy and polymerase chain reaction and absence of concomitant illness 3-6 weeks after treatment began. LAA occurred in 84 of 609 children, was mild, moderate or severe in 77, 6 or 1 child, respectively and was relatively asymptomatic. Mean time elapsing from commencement of treatment to LAA was 27.1 days (95 % CI 25.3-28.9). In a multivariate analysis, an age &amp;amp;lt;3 years (adjusted odd ratio [AOR] = 2.6, 95 % CI 1.3-5.2, P = 0.005), fever 1 day after treatment began (AOR = 3.8, 95 % CI 1.8-8.2, P &amp;amp;lt; 0.0001), haematocrit &amp;amp;lt;25 % at presentation (AOR = 2.2, 95 % CI 1.3-3.7, P = 0.003), haematocrit &amp;amp;lt;30 % 1 day after treatment began (AOR = 2.1, 95 % CI 1.0-4.3, P = 0.04), parasite reduction ratio &amp;amp;gt;10(4) 2 days after treatment began (AOR = 2.1, 95 % CI 1.1-3.9, P = 0.03) and spleen enlargement at presentation (AOR = 2.0, 95 % CI 1.1-3.9, P &amp;amp;lt; 0.0001) were independent predictors of LAA. During 6 weeks of follow-up, uneventful recovery from anaemia occurred in 56 children [mean recovery time of 11.8 days (95 % CI 10.3-13.3)]. The only independent predictor of failure of recovery was LAA occurring 4 weeks after starting treatment (AOR = 7.5, 95 % CI 2.5-22.9, P &amp;amp;lt; 0.0001). A relatively asymptomatic LAA with uneventful recovery can occur in young malarious children following ACTs. Its occurrence may have implications for case and community management of anaemia and for anaemia control efforts in sub-Saharan Africa where ACTs have become first-line antimalarials. Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http://www.pactr.org .
Additional file 3 of Genetic diversity and population structure of Plasmodium falciparum in Nigeria: insights from microsatellite loci analysis
Additional file 3. Shows expected heterozygosity (He) values of microsatellite loci from parasite... more Additional file 3. Shows expected heterozygosity (He) values of microsatellite loci from parasite populations in the nine States.
Journal of Pathogens
Background. Neonatal infection refers to the infection of the newborn during the first twenty-eig... more Background. Neonatal infection refers to the infection of the newborn during the first twenty-eight days of life. It is one of the causes of infant morbidity and mortality worldwide. The aim of the study is to determine the relative contribution of the different pathogens to the overall disease burden. It will also determine the mechanisms of virulence of these pathogens that cause neonatal infections at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Awka.Methods. Biological samples were collected from 30 neonates admitted at the special care baby unit (SCBU) of COOUTH and cultured using selective media and nutrient agar. The isolates were identified using microbiological and biochemical tests. The antibiogram study was determined using Kirby-Bauer disc diffusion method on Mueller Hinton Agar. Several methods previously reported in literature were used for the characterization of the virulence factors.Results. From the 30 blood samples collected,Pseudomonasspp. (...
Journal of Multidisciplinary Healthcare
Background: Immunization programs suffer recurrent setbacks in developing countries. Purpose: We ... more Background: Immunization programs suffer recurrent setbacks in developing countries. Purpose: We evaluated the knowledge and opinion of parents towards childhood immunization. Materials and Methods: A cross-sectional study was conducted among 2400 parents/ guardians in two major Anambra cities. Results: The male:female ratio was 1:1 and about two-third (64.3%) of respondents were aged 21-40 years. The majority were married (85.0%), Christians (88.3%), and had heard about childhood immunization (92.3%) mainly from formal settings (56.5%). A little above half (56.2%) of them correctly cited "disease prevention" as reason for childhood immunization. A larger proportion of those that gave this correct response worked in tertiary institutions and had post-secondary school education (p<0.001). The majority of the respondents appropriately agreed or disagreed with opinions that can influence immunization uptake. However, some of them did not agree that immunization was important during the first year of life (16.7%) or afterwards (23.1%); to ensure full immunization (22.8%) or maintain proper immunization records (25.6%) of their children; and to actively support childhood immunization (33.9%). Likewise, some respondents would withhold immunization for perceived fear of adverse reactions (30.7%) or if naturally acquired infection was perceived to confer better protection (28.2%). Respondents who worked in tertiary institutions, and had higher education or family income were more likely to agree or disagree appropriately to opinions. Males had comparable opinions with females although females seemed to do better in opinions that reflect actual vaccination practice. Conclusion: Awareness of the term "immunization" was high although knowledge of its indication did not measure up with this awareness, especially among the less educated. Most parents, especially those who worked in tertiary institutions,r had higher income, or education, were favorably disposed towards opinions that could positively influence immunization uptake. Efforts should be intensified at improving awareness on the indication, benefits and safety of immunization, and improving public opinions in order to optimize childhood immunization.
Journal of Blood Disorders & Transfusion
Background: Sickle cell Diseases (SCD) is a genetic disorder. It is the most common genetic disor... more Background: Sickle cell Diseases (SCD) is a genetic disorder. It is the most common genetic disorder affecting black race worldwide. It carries a high mortality and morbidity when not promptly and properly managed. Early detection is key to improving the quality of life of people living with sickle cell disease especially in childhood. It has resulted in reduction in mortality rate of SCD to <1% in developed countries through newborn screening but this reduction is yet to be achieved in developing countries. Objective: To share the experience of newborn screening of SCD at COOUTH Awka. To determine the prevalence of Sickle cell disease among neonates in Anambra State. Methodology: A retrospective study of screening for SCD in new-borns carried out at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka from 1 st September 2013 to 27 th October 2017. This was done using isoelectric focusing machine. Results: A total of 4961 children were screened, 2410 were males, while 2551 were females. 75% (3733) of the neonates had their hemoglobin genotypes as AA, while 0.3% (16) were Hb SS genotype. Prevalence of Hb SS genotype amongst newborns was 0.32%. Conclusion: This study found the prevalence of sickle cell disease in newborns to be 0.32%. Newborn screening using Isoelectric focusing machine is very valuable for early diagnosis and prompt management of SCD. There is therefore need for increased awareness of this in Anambra State.
ImmunoTargets and Therapy
The use of vaccines have resulted in a remarkable improvement in global health. It has saved seve... more The use of vaccines have resulted in a remarkable improvement in global health. It has saved several lives, reduced treatment costs and raised the quality of animal and human lives. Current traditional vaccines came empirically with either vague or completely no knowledge of how they modulate our immune system. Even at the face of potential vaccine design advance, immune-related concerns (as seen with specific vulnerable populations, cases of emerging/reemerging infectious disease, pathogens with complex lifecycle and antigenic variability, need for personalized vaccinations, and concerns for vaccines' immunological safety-specifically vaccine likelihood to trigger non-antigen-specific responses that may cause autoimmunity and vaccine allergy) are being raised. And these concerns have driven immunologists toward research for a better approach to vaccine design that will consider these challenges. Currently, immunoinformatics has paved the way for a better understanding of some infectious disease pathogenesis, diagnosis, immune system response and computational vaccinology. The importance of this immunoinformatics in the study of infectious diseases is diverse in terms of computational approaches used, but is united by common qualities related to host-pathogen relationship. Bioinformatics methods are also used to assign functions to uncharacterized genes which can be targeted as a candidate in vaccine design and can be a better approach toward the inclusion of women that are pregnant into vaccine trials and programs. The essence of this review is to give insight into the need to focus on novel computational, experimental and computation-driven experimental approaches for studying of host-pathogen interactions and thus making a case for its use in vaccine development.
Medical Sciences
Extended-spectrum β-lactamase (ESBL)-producing organisms have become a serious challenge in healt... more Extended-spectrum β-lactamase (ESBL)-producing organisms have become a serious challenge in healthcare delivery globally. The prevalence of ESBL carriage in healthy and sick children in Enugu, Nigeria, was bacteriologically investigated in this study. Four hundred and twenty-two biological samples (mid-stream urine and feces) were bacteriologically analyzed. The isolates were screened for ESBL production using Clinical and Laboratory Standards Institute (CLSI) breakpoints. The suspected ESBL producers were confirmed using double disc synergy test method. Out of the 162 isolates screened, 32 (19.8%) were confirmed as ESBL positive, with a prevalence of 25.32% among sick children in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu and 13.89% in apparently healthy children in a community setting. Klebsiella spp. and Escherichia coli had the highest prevalence of 34.6% and 28.6%, respectively; Citrobacter spp. and Enterobacter spp. were 18.2% and 16.7%, respectively. Th...
Antibiotics
The emergence and spread of Carbapenem-resistant Enterobacteriaceae (CRE) is seriously posing thr... more The emergence and spread of Carbapenem-resistant Enterobacteriaceae (CRE) is seriously posing threats in effective healthcare delivery. The aim of this study was to ascertain the emergence of CRE at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka. Biological samples were collected from 153 consenting patient from 5 clinics in the hospital. The isolates were identified using standard microbiological protocols. Susceptibility to meropenem was done using Kirby-Bauer disc diffusion method on Mueller Hinton Agar. A total of 153 patients were recruited in this study. About one half of those from rural, 63.64% from Sub-urban and 42.27% from urban areas had significant E. coli and Klebsiella spp infections. The male: female ratio of the Enterobacteriaceae infection was 1:1. Almost as much inpatient as outpatient study participants had the infections. The infections were observed mostly on participants with lower educational status. The unmarried individuals were most ...
Parasite
In non-anaemic children with malaria, early-appearing anaemia (EAA) is common following artemisin... more In non-anaemic children with malaria, early-appearing anaemia (EAA) is common following artemisinin-based combination treatments (ACTs) and it may become persistent (PEAA). The factors contributing to and kinetics of resolution of the deficit in haematocrit from baseline (DIHFB) characteristic of ACTs-related PEAA were evaluated in 540 consecutive children with malaria treated with artemether-lumefantrine, artesunate-amodiaquine or dihydroartemisinin-piperaquine. Asymptomatic PEAA occurred in 62 children. In a multiple logistic regression model, a duration of illness ≤3 days before presentation, haematocrit <35% before and <25% one day after treatment initiation, drug attributable fall in haematocrit ≥6%, and treatment with dihydroartemisinin-piperaquine independently predicted PEAA. Overall, mean DIHFB was 5.7% (95% CI 4.8–6.6) 7 days after treatment initiation and was similar for all treatments. Time to 90% reduction in DIHFB was significantly longer in artemether-lumefantri...
Journal of Case Reports
Background: With improvement in the control of infection and malnutrition, noncommunicable diseas... more Background: With improvement in the control of infection and malnutrition, noncommunicable diseases such as cancer may account for significant proportion of morbidity and mortality amongst under five children in future. We are hoping through this paper to drive home the reality and extent of the problem that patients, families, healthcare providers are confronted within the management of children with cancer. Case Report: A 3 year old male from poor socioeconomic status presented with inability to pass urine, abdominal mass, generalized body swelling, fecal incontinence and rectal prolapse. Abdominopelvic CT scan, cystoscopy revealed a bladder mass involving both ureters, hydronephrosis and pelvicalyceal dilatation. Histological report showed sheets of rounded and spindle cells in a myxoid stroma with tumor cells showing visible cross striations, suggesting diagnosis of bladder rhabdomyosarcoma. Patient was jointly managed with the paediatric surgical team. Conclusion: Late presentation, ignorance, poverty, lack of appropriate equipments and manpower were notable constrains against effective management of this patient with bladder rhabdomyosarcoma.
Infectious Diseases of Poverty
Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in ... more Background: The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in
The Open Microbiology Journal
Background: Urinary Tract Infection (UTI) is a common contagion among men and women with the inci... more Background: Urinary Tract Infection (UTI) is a common contagion among men and women with the incidence relatively higher among women due to their differing anatomy. An understanding of the kind of pathogens implicated in urinary tract infections as well as antibiotic susceptibility profiling may help the clinician make rationally correct empirical choice in their treatment. Objective: This study is aimed at determining the type and antibiotic susceptibility pattern of bacterial uropathogens isolated from female patients attending Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Awka, Nigeria. Method: Two hundred and forty patients with clinically diagnosed UTI and who were on at least 5 days’ antibiotic holiday were recruited into the study. Their demographic characteristics were captured using pre-tested questionnaire. Their clean catch mid-stream urine samples were collected using sterile universal container and sent to the Microbiology Department for processing....
Infectious Diseases of Poverty
Background: In acute falciparum malaria, asexual parasite reduction ratio two days post-treatment... more Background: In acute falciparum malaria, asexual parasite reduction ratio two days post-treatment initiation (PRRD2) ≥ 10 000 per cycle has been used as a measure of the rapid clearance of parasitaemia and efficacy of artemisinin derivatives. However, there is little evaluation of alternative measures; for example, parasite reduction ratio one day after treatment initiation (PRRD1) and its relationship with parasite clearance time (PCT) or PRRD2. This study evaluated the use of PRRD1 as a measure of responsiveness to antimalarial drugs. Methods: In acutely malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP), the relationships between PRRD1 or PRRD2 and PCT, and between PRRD1 and PRRD2 were evaluated using linear regression. Agreement between estimates of PCT using PRRD1 and PRRD2 linear regression equations was evaluated using the Bland-Altman analysis. Predictors of PRRD1 > 5000 per half cycle and PRRD2 ≥ 10 000 per cycle were evaluated using stepwise multiple logistic regression models. Using the linear regression equation of the relationship between PRRD1 and PCT previously generated in half of the DHP-treated children during the early study phase, PCT estimates were compared in a prospective blinded manner with PCTs determined by microscopy during the later study phase in the remaining half.
Uploads
Papers by George Emechebe