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Thursday, April 25, 2024
Malaria

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GEORGE FREY/AFP via Getty Images

Research is currently underway to determine whether it is possible to repurpose existing medications to prevent or treat COVID-19.

To guide healthcare professionals through this ever-evolving wave of new evidence, the World Health Organization (WHO) is creating a ‘living’ guideline outlining the most complete, accurate, up-to-date information on COVID-19 management.

This guideline also offers patients the chance to consider their best treatment options. The WHO have called it a ‘living’ guideline because they will continuously update it to reflect new knowledge.

To create this living guideline, experts, doctors, patients, and methodologists from around the world are assessing existing studies to produce a set of universal recommendations.

On March 1, 2020, the panel released the first installment of the living WHO guideline on drugs to prevent COVID-19 in the British Medical Journal.

In this first installment, the panel evaluates whether hydroxychloroquine can help prevent COVID-19.

These findings could focus research efforts on more effective, safer treatment and prevention options for COVID-19. It could also discourage doctors and patients from using a medication that is likely to do more harm than good.

Why focus on hydroxychloroquine?

Scientists developed hydroxychloroquine in 1946 to reduce the risk of getting malaria and help treat it. Today, doctors use the drug to treat several autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus.

Some early in vitro studies suggested that hydroxychloroquine may help reduce the risk of developing COVID-19 in several ways.

Hydroxychloroquine raises the pH inside of endosomes, a group of organelles inside cells that regulate the exchange of proteins and lipids. This may make it difficult for SARS-CoV-2 to fuse with cell membranes.

Some studies have also shown that hydroxychloroquine appears to block the release of SARS-CoV-2 viral particles from infected cells.

Once viruses enter cells, they take over the cell’s machinery to reproduce its own genetic material, ribonucleic acid (RNA). The cell typically releases these new viral particles with help from late-stage or mature endosomes.

Hydroxychloroquine appears to prevent the transport of new viral particles into these special endosomes, preventing their release.

But scientists have not confirmed most of these findings in humans, only in cells from organisms.

In one study, hydroxychloroquine had some antiviral effect in African green monkey kidney cells, but not in cell models from the lining of human airways.

Another study using macaque monkeys also concluded that hydroxychloroquine was not effective in preventing infection with SARS-CoV-2.

A few early studies, including small human studies without a control group, suggested that hydroxychloroquine could treat patients with COVID-19.

The FDA issued an emergency use authorization in March 2020 that allowed healthcare professionals to use hydroxychloroquine in teens and adults hospitalized for COVID-19 who weigh more than 110 pounds.

And doctors in many hospitals starting using hydroxychloroquine routinely in COVID-19 patients.

But even at the time of its issuing, the FDA noted that a person should only use the drug when a healthcare professional feels the possible benefits outweigh the risks.

That is because hydroxychloroquine carries substantial health risks, including:

  • serious heart rhythm problems
  • anemia
  • low blood sugar
  • damage to the tissues in the inner eye that may cause a vision problem
  • worsening of neurological problems or seizures
  • drug interactions, such as with some beta-blockers, antidepressants, antipsychotics, and methadone

Dangers outweigh potential health benefits

By mid-June, the FDA formally revoked this emergency issue, claiming the potential benefits of the drug in cases of COVID-19 did not outweigh existing and potential health risks.

There were reports of serious cardiac side effects and other adverse effects at the doses doctors used for treating people hospitalized with Covid-19.

Hydroxychloroquine typically has few severe side effects when used to treat conditions such as rheumatoid arthritis and systemic lupus erythematosus.

Possible reasons why the drug is more toxic in people with COVID-19 include:

  • people hospitalized with COVID-19 received higher doses of the drug
  • the cardiac inflammation caused by COVID-19 may have increased the cardiac side effects of the drug
  • interaction with other medications, such as azithromycin, exacerbated the risk of potentially lethal cardiac rhythm abnormalities

A few days later, the National Institute of Health (NIH) halted its clinical trial evaluating the efficacy and safety of using hydroxychloroquine in adults hospitalized for COVID-19.

Creating a ‘living guideline’

To create the living WHO guideline, collaborators from the MAGIC Evidence Ecosystem Foundation first analyzed six randomized, controlled trials. The six trials included 6,059 participants with or without exposure to COVID-19.

Making GRADE the Irresistible Choice (MAGIC) is a non-profit foundation that creates reliable, evidence-based digital tools to share guidelines with healthcare professionals and patients.

The acronym GRADE stands for Grading of Recommendations, Assessment, Development and Evaluations. It describes a popular framework for assessing and sharing summaries of scientific evidence that help guide clinical recommendations.

The WHO panel reviewed the MAGIC team’s findings to determine the accuracy of the findings and form their recommendations for the guideline.

Researchers often describe how confident they are in study findings by defining the level of certainty of the evidence supporting it. Typically, the more positive research to support an idea, the higher the certainty of the evidence and the more likely it is to be true in the real world.

In the new review of trials testing hydroxychloroquine for preventing COVID-19, the team found high certainty evidence indicating hydroxychloroquine has no significant impact on the risk of COVID-19 death or hospital admission.

The WHO panel also found moderate certainty evidence that the drug does not significantly impact the risk of developing COVID-19.

The panel concludes that using hydroxychloroquine may increase the risk of experiencing side effects severe enough to stop taking the drug when compared with a placebo.

People in the trials taking hydroxychloroquine had many more minor side effects, such as diarrhea and headaches, than those in the placebo group (56% vs. 6%). However, only marginally more people had side effects serious enough to stop taking the drug compared with a placebo.

Reconsidering priorities and resources

Based on these findings, the panel recommends that researchers shift their priority and resources to explore other medications.

This new guideline could help uncover more effective COVID-19 therapies by focusing research efforts and funding on prevention and treatment options with more promising results.

It may also bust the widespread myths and misconceptions that led to some people accessing or taking hydroxychloroquine to prevent or treat COVID-19 without medical advice.

And this is good news given the long-list of adverse side effects associated with taking hydroxychloroquine unnecessarily.

It could also be very good news for people with autoimmune diseases, such as lupus, who need the medication to stay healthy and who have been facing drug shortages.

The panel encourages researchers, doctors, and patients to check back for more information as they include new recommendations within the existing published document.

This review is a good reminder that drugs showing promise in the laboratory and in initial observational, non-randomized human studies may not deliver the hoped-for results in well-conducted randomized trials.

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Over the past decade, the world has witnessed unprecedented scale-up of antiretroviral therapy (ART), which has saved the lives of tens of millions of people. As of December 2019, 25.4 million people out of an estimated 38 million people living with Human Immuno-deficiency Virus (HIV) were receiving ART globally.

Increased use of ART has, not unexpectedly, been accompanied by the emergence of some degree of HIV drug resistance, the levels of which have steadily increased in recent years.

HIV drug resistance can jeopardise the efficacy of antiretroviral drugs used for both HIV treatment and prevention of the infection and is associated with an increased number of HIV infections and HIV-associated morbidity and mortality.

Combating antimicrobial resistance (AMR), including resistance to HIV medicines, is a global priority that demands coordinated action across all government sectors and levels of society.

The Global Action Plan on HIV drug resistance 2017–2021, aligned with World Health Organisation’s (WHO’s) global action plan on antimicrobial resistance, defines key actions for the country and global stakeholders to prevent, monitor, and respond to HIV drug resistance and to accelerate progress towards achieving the global targets for HIV epidemic control by 2030.

The key actions are:
Prevention and response: implement high-impact interventions to prevent and respond to HIV drug resistance.

Monitoring and surveillance: obtain quality data on HIV drug resistance and HIV service delivery from periodic surveys, while expanding routine viral load and HIV drug resistance testing.

Research and innovation: encourage relevant and innovative research, which will have the greatest public health impact in minimising HIV drug resistance.

Laboratory capacity: support and expand the use of viral load testing and build capacity to monitor HIV drug resistance.

Governance and enabling mechanisms: ensure country ownership, coordinated action, advocacy, and sustainable funding are in place to support action on HIV drug resistance.

Also, antimalarial drug resistance has emerged in recent years as a threat to global malaria control efforts, particularly in the Greater Mekong sub-region. The much-anticipated Report on antimalarial drug efficacy, resistance, and response: 10 years of surveillance (2010–2019) will present a decade’s worth of data on drug efficacy and surveillance and recommendations to protect the efficacy of malaria treatments in the decades to come.

Meanwhile, a study has warned that children may be more likely to suffer from chronic illnesses like allergies, asthma, eczema, and obesity if given antibiotics before the age of two.

The full findings of the study were published in the journal Mayo Clinic Proceedings.

United States (U.S.) researchers analysed the health records of 14,500 children and found a correlation between chronic illness and early antibiotic use.

The team has speculated that the antibiotics — while used to help fight off ‘bad’ bacteria — can impact the beneficial microbes that make up our gut microbiome.

Allergies — which are the most common chronic disorder among children — affect more than one-in-four people in the United Kingdom (U.K.) at some point in their lives.x

Antibiotics are used to treat bacterial infections like urinary tract infections but are not effective against viruses such as the common cold or coronavirus.

“We want to emphasise that this study shows association not causation of these conditions,” said paper author and physiologist Nathan LeBrasseur of the Mayo Clinic in Minnesota.

“These findings offer the opportunity to target future research to determine more reliable and safer approaches to timing, dosing, and types of antibiotics for children in this age group,” he added.

In their study, Professor LeBrasseur and colleagues analysed the health records of more than 14,500 children — around 70 per cent of who had been treated with antibiotics before the age of two.

The team found that these children appeared more likely to develop chronic illnesses — including asthma, attention deficit hyperactivity disorder, celiac disease, eczema, food allergies, hay fever, obesity, and weight issues.

“While recent data show an increase in some of the childhood conditions involved in the study, experts are not sure why,” said LeBrasseur.

“Other than the issue of multidrug resistance, antibiotics have been presumed safe by most pediatricians.”

Those babies who had received multiple courses of antibiotics were more likely to have more than one chronic condition during their childhood, the team also noted.x

The types of illness suffered varied dependent on the child’s age, the kind of antibiotics they were on, and how many doses they were given.

“The ultimate goal is to provide practical guidelines for doctors on the safest way to use antibiotics early in life,” LeBrasseur added.

Although there are over 100 types of antibiotics, one of the most commonly prescribed is amoxicillin — used to treat assorted conditions including middle ear infections, strep throat, skin infections, pneumonia, and urinary tract infections.

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Although the sun has been quite scorching and temperature low, especially in the evenings, making many people to be indoors so as to keep warm. To avoid coming down with health conditions such as cold associated with this type of weather, medical experts have advised that necessary precautions be taken.

Children are especially vulnerable, as they easily succumb to certain ailments brought about by the weather. So, parents have been advised to ensure their children are well cared for, to protect against common cold.

To avoid the discomfort instigated by these ailments, some of the recommended safety measures include eating healthy foods that contain lots of vitamins, going to bed early, as well as wearing appropriate and comfortable clothes.

Former President, Association of Resident Doctors at the Lagos State University Teaching Hospital, Dr. Olubunmi Omojowolo, said common cold could be diagnosed by certain symptoms.

He said: “If your doctor suspects you have a bacterial infection or other condition, he or she may order a chest x-ray or other tests to exclude other causes of the signs and symptoms. Commonly used cold remedies include pain relievers.

“For a fever, sore throat and headache, many people turn to acetaminophen, tylenol, or other mild pain relievers. Acetaminophen should be used for the shortest time possible, and people should follow label directions to avoid side effects.

“It is important to use caution, when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin, which has been linked to Reye’s syndrome, a rare but potentially life-threatening condition in children.

“Consider giving your child over-the-counter (OTC) pain medications designed for infants or children. These include acetaminophen, children’s Tylenol, ibuprofen, children’s Advil and children’s Motrin, among others, to ease symptoms.

“Adults can use decongestant drops or sprays for up to five days, as prolonged use could cause rebound symptoms. Children younger than six years should not use decongestant drops or sprays.”

A Family Physician, Dr. Chukwuma Ogunbor, said the Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly kick against giving OTC cough and cold medicines to children younger than four years, as they may be harmful.

He said: “There is no good evidence that these remedies are beneficial or safe for children. It is not typically recommended that you give cough or cold medicines to an older child, but if you do, follow the label directions. Do not give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever.

“Too much of a single ingredient could lead to an accidental overdose.

You may know that cold and flu season is here with us, but that does not make it easier, when you see your little one struggling with a cough and stuffy nose. Children under the age of five, and particularly under two years are, at high risk during cold and flu season.”

He explained that colds and flus are viral infections. And antibiotics won’t help to clear up infection. However, there are steps that can be taken to help children feel better, while their immune system battles the virus.

He said: “Keep your child hydrated to help reduce cold and flu symptoms, and make them feel better. Fever can result in dehydration. Your child may not feel as thirsty as, he or she normally would, and may be uncomfortable when drinking. So, it’s important to encourage him or her to drink plenty of fluids.

“Dehydration can be very serious in babies, especially if they’re under three months. Call your pediatrician, if you suspect your baby is dehydrated. Some signs may include no tears when crying, dry lips, soft spots that seem sunken in, decreased activity and urinating less than three to four times in 24 hours.

“Attempt to breastfeed infants more frequently than usual. Babies may be less interested in breastfeeding, if they’re sick. So, you may have to give several short feeding sessions for them to consume enough fluid.

“Ask the doctor if an oral rehydration solution like pedialyte is appropriate. Remember that you should not give little ones sports drinks. Older children have more hydration options, which may include sports drinks, popsicles, juice, broth and flat white soda.”

According to him, medicated nasal sprays are not recommended for young children. However, there are several easy ways to clear up a stuffy nose without medication.

“Use a cool mist humidifier in the child’s room,” he said. “This will help break up mucus. Be sure to carefully clean the humidifier between uses to keep mould from developing in the machine.

“Another option is using a saline nasal spray or drops, which make thin mucus easier to blow out or remove with a bulb syringe. This is especially helpful before feeding and bedtime.”

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Medical experts have warned that non-communicable diseases (NCDs) such as hypertension, diabetes, cancer, cardiovascular diseases are responsible for the majority of Coronavirus disease (COVID-19) deaths in the country.

President, NCD Alliance Nigeria, Olorogun Dr. Sonny F. Kuku, in his opening remarks during a webinar on, “Non-communicable Diseases and COVID-19 in Nigeria – The response”, held Tuesday, July 21, 2020, said: “… We are only seeing the tip of the iceberg and unfortunately, people with NCDs are at greater risk. It is impacting the poorest people and most vulnerable. People with hypertension, diabetes and heart disease are the most vulnerable. We are now seeing stroke as symptom. This means COVID-19, which is an infectious disease is manifesting as an NCD in the form of stroke…”

Vice President, Scientific Affairs, NCDs Alliance Nigeria, Dr. Kingsley Akinroye, has said blamed the situation on the nation’s years of lack of commitment to the course of NCDs. The cardiologist said NCDs account for 29 per cent of deaths in Nigeria.

Akinroye, at the launch of the New Civil Society Solidarity Fund on NCDs in response to COVID-19, harped on the need to strengthen the healthcare system, intensify awareness, increase access to care and treatment, and vote more money for NCDs care and management.

However, the NCD Alliance Nigeria and 19 other global and national NCD Alliances have been awarded $300,000.

Akinroye added that regional and national NCD Alliance including NCD Alliance Nigeria would get $15,000 to address the critical needs of people living with NCDs during the pandemic through advocacy and communication activities that would support stronger organisational stability and resilience

According to the cardiologist, COVID-19 shows many connections between it and NCDs stating that people living with NCDs are more vulnerable to COVID-19 with a substantially higher risk o becoming severely ill or dying from the virus.

The expert said that actions taken to control NCDs in Nigeria include the launch o the First Multi-Sectoral Action Plan or Prevention and Control o NCDs by the Federal Ministry of Health (FMoH) and the NCD Alliance Nigeria Publication of the Handbook on Civil Society Organisation in NCDs.

“Activities in Nigeria will include the development of a database of people living with NCDs in Lagos, Osun, and Federal Capital Territory and by NCD area of focus. Also, establishment and support for people living with NCDs with skills and knowledge, and connect them to NCD Alliance Nigeria, federal Ministry o Health, World Health Organisation and State Ministry of Health in the four states,” he added.

Akinroye further stated that they would build capacity for people living with NCDs on advocacy for their rights to health, prevention, access to treatment and care; provision of support and empowerment

He explained that NCD Alliance Nigeria would develop a directory and a database in the states by area of focus cardiovascular disease, diabetes, cancer, sickle cell disease, respiratory diseases and mental health and also develop advocacy communication materials targeting Lawmakers, Policymakers and opinion leaders that are persuasive and effective to improve prevention, care and access to treatment for people living with NCDs.

The expert, however, tasked the Presidential Taskforce on COVID-19 to mobilise for more testing and awareness amongst the grassroots and also provide free hypertensive and diabetic drugs or the vulnerable population.

Executive Director, NCD Alliance Nigeria, Prof. Akin Osibogun, also presented a paper on “NCDs in Nigeria and COVID-19: The Nigerian experience.”

Osibogun is a consultant public health physician/epidemiologist, a member of Lagos State COVID-19 Response Team and former Chief Medical Director (CMD), Lagos University Teaching Hospital (LUTH) Idi Araba.

Member, Nutrition Committee, Nigerian Heart Foundation (NHF) and Food Scientist, Prof. Isaac Adebayo Adeyemi, spoke on “COVID-19 and Nutrition: Gathering evidence.”

Akinroye delivered a paper on “People Living with NCDs in Nigeria and COVID-19.”

Adeyemi, who is Vice chancellor of Bells University of Technology Ota, Ogun State, and the pioneer Deputy Vice-Chancellor, Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Oyo State, said functional foods are important to boost the immune system.

Adeyemi said that a well functioning immune system is key to providing robust defence against pathogenic organisms. Adeyemi noted that mortality in people living with NCDs is likely the result of immune decline or impaired immune response.

The expert said that energy is required to fight the virus likewise, protein to produce essential antibodies.

He encouraged intake of Phytochemicals like quercetin from onions, phloretin and also Epigallocatechin gallate (EGCG) as well as conventional foods containing bioactive food compounds like vegetables, fruits, grains, dairy, fish and meat.

“Eat fresh and unprocessed food every day like fruits and vegetables, legumes and whole grains and animal products. Eat a moderate amount o fats and oils. Eat at home to reduce your rate of contact with other people,” he added.

Adeyemi urged the consumption of plant food such as grains, legumes and oilseeds, fruits and vegetables containing vitamins, minerals, fibre and phytochemicals.

He, however, stressed on the need to avoid the intake of caffeine, trans fat while also limiting the intake of salt because they are predisposing factors that contribute to morbidity o patients with COVID-19.

According to a study published in Scholars Journal of Applied Medical Sciences and titled “COVID-19 and Nutrition: Review of Available Evidence”, nutritional support is indicated for depleted patients with respiratory diseases because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance.

The researchers noted: “A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Furthermore, weight loss and malnutrition opens the door of infection reoccurrence. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism.

“Dietary management of pre-existing diseases has been suggested as a strategy to minimise the potential risk of COVID-19 infection in conditions such as irritable bowel syndrome, Crohn’s and Colitis. WHO, dietetic associations and dietitians have been calling for patients with pre-existing conditions to continue abiding by their dietary advice and nutritional therapy steps received from their dietician if tested positive for COVID-19.”

Meanwhile, according to a World Health Organisation (WHO) survey, prevention and treatment services for NCDs have been severely disrupted since the COVID-19 pandemic began. The survey, which was completed by 155 countries during a three-week period in May, confirmed that the impact is global, but that low-income countries are most affected.

This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.

Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, said: “The results of this survey confirm what we have been hearing from countries for a number of weeks now.

“Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

The main finding is that health services have been partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.

Rehabilitation services have been disrupted in almost two-thirds (63 per cent) of countries, even though rehabilitation is key to a healthy recovery following a severe illness from COVID-19.

In the majority (94 per cent) of countries responding, ministries of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.

The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50 per cent of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic.

But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20 per cent) reporting disruptions, one of the main reasons for discontinuing services was a shortage of medicines, diagnostics and other technologies.

Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country. Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.

Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72 per cent of high-income countries reported inclusion compared to 42 per cent of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports.

Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan.

Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at the highest risk to continue receiving treatment for NCDs. Among the countries reporting service disruptions, globally 58 per cent of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries, this figure is 42 per cent. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting.

Also encouraging is that more than 70 per cent of countries reported collecting data on the number of COVID-19 patients who also have an NCD.

Director of the Department of NCDs at WHO, Dr. Bente Mikkelsen, said: “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with NCDs.

“What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses. It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 – but that innovative ways are found to implement those plans. We must be ready to ‘build back better’- strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”

According to the WHO, NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85 per cent of these “premature” deaths occur in low- and middle-income countries.

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The federal government has received $890 million as grants from the Global Fund to fight HIV/AIDS, tuberculosis and malaria.

The Minister of Health, Dr. Osagie Ehanire, said yesterday that the fund would be used to implement programmes aimed at eradicating the diseases over a three year period, from 2021 to 2023.

Ehanire said that the Global Fund also approved a grant of US$21.9 million to support Nigeria’s COVID-19 response.

He said: “The purpose of this press briefing today is to announce the receipt of a grant, made to the Federal Republic of Nigeria by The Global Fund to fight HIV/AIDS, tuberculosis and malaria, amounting to $890 million, over an implementation period of three years, beginning from 2021 to 2023.”

The minister noted that the grant, which is the largest given to any country in this funding cycle, is sequel to a successful funding request made by the Nigeria Country Coordination Mechanism (CCM).

The Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria (GF) is an innovative international financing mechanism that was established by the United Nations in 2002, with its headquarters in Geneva, Switzerland.

The fund is made up of global partnership of governments, civil societies and private donors and established for the purpose of attracting, leveraging and investing resources to fund public health interventions that would accelerate the eradication of HIV, tuberculosis and malaria in affected high burden countries to further goals of Sustainable Development Goals (SDGs).

The Global Fund has committed the sum of USD$2.586 billion since 2002 to operations in Nigeria, which are split into four program areas: HIV/AIDS, tuberculosis, malaria and the Resilient Systems Strengthening for Health, (RSSH).

Nigeria has accessed $2.436 billion, which represented 94 percent of the committed amount.

The minister said the grant would complement the investment of the government of Nigeria and of other Development Partners in HIV/AIDS, tuberculosis and malaria programmes, including the Resilient and Sustainable System for Health, over the period 2021-2023.

He said the approval of the grant came following the review of the proposal that the CCM Nigeria submitted on March 23, 2020, which was adjudged to be technically sound and strategically focused by the independent Technical Review Panel of the Global Fund.

Ehanire said: “This grant will support access to malaria prevention, diagnostic and treatment services in 13 states. The States include Adamawa, Delta, Gombe, Jigawa, Kaduna, Kano, Katsina, Kwara, Niger, Ogun, Osun, Taraba and Yobe States.

“Access to HIV/AIDS and tuberculosis services across all the 36 states and the FCT; Improvements in our health system, particularly, provision of infrastructure for warehousing and distribution of health commodities, laboratory services, data management and capacity building for our healthcare providers, including support to community system.”

The minister said the implementation of the grant would specially target the poor, the most vulnerable and disadvantaged, and those at higher risk of the target diseases, to promote equity in access to health care services.

He further said: “With regard to Nigeria’s COVID-19 response effort, The Global Fund gave approval to repurpose the sum of US$6.2 million out of our on-going grants for HIV, tuberculosis and malaria to support the implementation of our initial Incident Action Plan (IAP) for COVID-19.

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Concerned that malaria may become untreatable and the vector, mosquito, uncontrollable, scientists have alerted on the dramatic increase in resistance of mosquitoes to five mainstream insecticides.

In a step toward better control of mosquitoes that transmit malaria, researchers have mapped the patterns of insecticide resistance in Anopheles gambiae mosquitoes across Africa. The new study, published June 25, 2020 in the open-access journal PLOS Biology by Catherine Moyes and Penelope Hancock of the University of Oxford, United Kingdom (U.K.), and collaborators, found that resistance to five mainstream insecticides increased dramatically between 2005 and 2017.

There are more than 400,000 deaths due to malaria worldwide each year, with more than half of all cases occurring in just six countries in Sub-Saharan Africa. In recent years, progress in reducing the burden of malaria in these areas has resulted from expanded mosquito control programs. However, field studies have suggested an increase in insecticide resistance among the mosquitoes that transmit malaria. This could lead to a decrease in the effectiveness of interventions such as insecticide-treated bednets, which are a mainstay of malaria prevention across the continent.

In the new study, researchers analyzed a published database of information on mosquitoes collected throughout mainland Sub-Saharan Africa between 2005 and 2017. The study looked at 6,423 observations across 1466 different locations. They used the data to map and model when and where insecticide resistance had arisen in populations of Anopheles gambiae mosquitoes.

According to the study, in West Africa, resistance to pyrethroids, the only class of insecticides used in all treated bednets, increased drastically over the timeframe. For instance, 15 per cent of West Africa had mosquitoes with resistance to deltamethrin in 2005, but by 2017 this had risen to 98 per cent. In East Africa, resistance to pyrethroids increased to a lesser degree, expanding from nine per cent to 45 per cent of the region. Similar increases were seen among populations of mosquitoes resistant to DDT, a chemical often used for indoor spraying to kill malaria-transmitting mosquitoes.

Dichlorodiphenyltrichloroethane, commonly known as DDT, is a colorless, tasteless, and almost odorless crystalline chemical compound, an organochlorine. Originally developed as an insecticide, it became infamous for its environmental impacts.

The authors said: “The rapid spread of resistance across large parts of the Sub-Saharan Africa signals an urgent need to quantify the efficacy of different resistance management strategies, and to understand the impact of resistance on malaria transmission and control.

“Relationships between insecticide resistance and malaria prevalence are currently poorly understood, but there is evidence that resistance can reduce the efficacy of standard pyrethroid-treated bednets which have played a key role in achieving reductions in malaria prevalence in Africa over 2000-2015.”

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Female doctor talking with patient along coworker in ICU. Man is lying on bed amidst essential workers. Healthcare workers are in protective workwear.

The antimalaria drug hydroxychloroquine has generated significant controversy. A new study suggests that if it is given early, it can reduce mortality in people with severe COVID-19. But our expert points out weaknesses in the study’s design.

Amid an ongoing search for an effective COVID-19 treatment, the debate about the antimalaria drug hydroxychloroquine (HCQ) continues.

There was plenty of hype about the drug during the early months of the pandemic. On March 28, 2020, the Food and Drug Administration (FDA) granted Emergency Use Authorization (EUA), allowing doctors to use HCQ and chloroquine (CQ) products in situations where clinical trials were not an option.

Last month, the FDA withdrew the EUA. The agency explains that it “has determined that CQ and HCQ are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other serious side effects, the known and potential benefits of CQ and HCQ no longer outweigh the known and potential risks for the authorized use.”

Clinical trials using the drug have shown mixed results and been marred with controversy. After an investigation by The Guardian into the quality of data analysis provided by a company called Surgisphere, the authors of one high-profile study in The Lancet retracted the paper.

Several institutions have since halted their HCQ studies, including the World Health Organization (WHO) and the National Institutes of Health (NIH).

Now, a new study in the International Journal of Infectious Diseases — by researchers from the Henry Ford Health System, in Michigan — reports that treatment with HCQ alone and in combination with the antibiotic azithromycin reduced the number of deaths among people in the hospital with severe COVID-19.

Comparing mortality rates

The corresponding author is Dr. Marcus J. Zervos, an infectious disease specialist at Henry Ford Hospital and the Wayne State University School of Medicine, both in Detroit, MI.

For their study, the team retrospectively reviewed the medical records of 2,541 individuals who received treatment for COVID-19 in Henry Ford Health System hospitals.

The aim of the research was to compare how many people with COVID-19 died while in the hospital after receiving either HCQ, HCQ and azithromycin, azithromycin on its own, or “other treatments for COVID-19,” as the authors explain in their paper.

Treatment with HCQ, azithromycin, or both began within 24 hours of hospital admission in 82% of cases, and within 48 hours of admission in 91% of cases.

Among the 2,541 patients in the study, 460 died, which equates to an overall mortality rate of 18.1%. In the group of 409 patients who received neither HCQ nor azithromycin, 108 died, representing a mortality rate of 26.4%.

A total of 1,202 patients received only HCQ, of whom 162 died, a mortality rate of 13.5%, while out of the 147 patients who received only azithromycin, 33 died, equating to a mortality rate of 22.4%.

Among the 783 patients who received a combination treatment of HCQ and azithromycin, 157 patients died. This reflects a mortality rate of 20.1%.

While these results sound encouraging, Dr. Hanh Le, who is the senior director of medical affairs at Healthline Media, shared her concerns about the study with Medical News Today.

“As an observational study, it would have been good to have insights into what factored into the treatments that the patients received. For example, of the patients who received neither drug, why were most of them 65 or older?” Dr. Le pointed out. “Unfortunately, the study authors did not address that.”

Study limitations

Dr. Le explained that the average age of those who received neither HCQ nor azithromycin was significantly higher than those who received HCQ.

Specifically, the average age in the group who received other COVID-19 treatments was 68.1 years, the median age was 71 years, and 64.1% were over the age of 65. In the HCQ group, on the other hand, the average age was 63.2 years, the mean age was 53 years, and 48.9% were over 65.

Patients in the HCQ group were also significantly more likely to receive steroids in addition to the drug. While 78.9% of patients in this group received steroids, only 35.7% of patients in the other COVID-19 treatment groups did.

“In addition, white race is a risk factor they identified, and it too was unbalanced,” Dr. Le added.

In the group receiving other COVID-19 treatments, 45.5% were white, while in the HCQ group, 27.6% were white.

“We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring,” Dr. Zervos comments in a press release.

“Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations, or other differences from our patients,” he continued.

The study authors do urge caution in light of their findings:

“Our results should be interpreted with some caution and should not be applied to patients treated outside of hospital settings,” they write in the paper. “Our results also require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety, and efficacy of [HCQ] therapy for COVID-19 in hospitalized patients.”

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It is common during festive seasons to over-indulge in food and drinks. But this is not good, especially for those that care about their fitness. So, now that the end-of-year festivities are winding down, it is important to create a healthy living plan. Esta Morenikeji, a fitness instructor and founder of Zonefitness Ng said January is usually the time of year, when many people make commitments and promises to lose weight and get fit. “That’s why detox and cleansing programmes sell like water in January. New fad diets will pop up everywhere, and one or two magic teas might catch your attention. Please, don’t allow yourself to get caught in the web of fad diets,” she said.

The following are steps to guide you in the quest for a healthy living:
Stick to the Fundamentals
THERE are no magic formulas for weight loss; there are only fundamentals. Fad diets will come and go, but the fundamentals will remain.
The Fundamentals:
• Practise time-restricted feeding (Don’t eat in-between meals)
• Eat real food (It’s even better, if you can grow or kill it) ​
• Eliminate or avoid highly processed foods
• Avoid added sugar
​• Eat more nutrient dense food and less calorie dense food
• Do not overeat
• ​Drink enough water

A dietary strategy that works for you today may not work tomorrow, but the fundamentals will always work. So, stick to the fundamentals. They always work!

Prioritise Sleep
ONE of the worst things you can do to your health and well-being is staying awake, when your body is supposed to be resting and rejuvenating. Studies have shown that sleep is the master regulator of our hormones. Therefore, you must prioritise sleep in 2020.

If you’re one of those people that are always on their phones or watching television until midnight, you need to stop! Being awake when you’re supposed to be sleeping is disruptive to your circadian rhythm, and can increase your risk factors for certain lifestyle-related diseases. For every hour you spend on your phone at night, the production of melatonin is suppressed by 30 minutes.

Melatonin is the sleep hormone. The human body begins to secrete melatonin as darkness begins to fall. The appearance of darkness signals the body to wind down and prepare for rest.

The blue light from electronic devices suppresses the production of melatonin, thereby, confusing our brain and messing up our circadian rhythm. For the human body, darkness means rest and light means to be alert.

So, you’re sending confusing signals to your brain, when you stay up late at night scrolling through social media or watching television. Several studies have shown that sleep deprivation disrupts the appetite-regulating hormones, thereby causing unnecessary weight gain. Nighttime is for sleep. So, don’t spend it staring at your phone or watching television. Get off your electronic devices at least two hours before bedtime.

Do Regular Breathing Exercises 
Incorporating regular breathing exercises into your day can be beneficial to your overall health. In a study that involved 21,563 participants, researchers found that systolic blood pressure, diastolic blood pressure and pulse rate significantly reduced after six cycles of deep breathing exercise.

Yes, you read that right: deep breathing exercise causes a reduction in blood pressure and slows down the heart rate. Make it a habit to take six to 20 deep breathes throughout the day. Breathing exercises can be done anywhere, so no excuses not to do them.

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Neem oil is an extract of the neem tree. Some practitioners of traditional Chinese and Ayurvedic medicine use neem oil to treat conditions ranging from ulcers to fungal infections.

This type of oil contains several compounds, including fatty acids and antioxidants, that can benefit the skin.

Below, find out about the uses and potential benefits of neem oil, as well as the risks. We also provide tips for using neem oil on the skin.

What is neem oil?

Neem oil derives from the fruits and seeds of the neem tree. These trees grow mainly in the Indian subcontinent.

Neem oil is rich in fatty acidsTrusted Source, such as palmitic, linoleic, and oleic acids, which help support healthy skinTrusted Source. The oil is, therefore, a popular ingredient in skin care products.

The leaf of the plant also provides health benefits. The leaves contain plant compounds called flavonoids and polyphenols, which have antioxidant, anti-inflammatory, and antibacterial properties.

Also, the Environmental Protection Agency (EPA) note that neem oil contains azadirachtin, a natural pesticide.

Benefits for the skin

Researchers have only recently begun to examine how plant compounds influence health and disease. As a result, few scientific studies have investigated the use of neem oil in general skincare or as a treatment for skin conditions.

Authors of a 2013 reviewTrusted Source of the available research into medicinal uses of neem concluded that its extracts can help treat a variety of skin conditions, including:

  • acne
  • psoriasis
  • eczema
  • ringworm
  • warts

The following are some benefits of neem oil and the evidence behind these claims.

First, however, it is important to note that most of the studies involved cell lines or animals. Those that did involve humans only included small numbers of participants. This makes it difficult to draw conclusions about the effectiveness of neem in the general population.

Anti-aging effects

A 2017 study investigated the anti-aging effects of topical neem leaf extract in hairless mice. The researchers first exposed the mice to skin-damaging ultraviolet B radiation. They then applied neem oil to the skin of some of the rodents.

The team concluded that the oil was effective in treating the following symptoms of skin aging:

  • wrinkles
  • skin thickening
  • skin redness
  • water loss

The researchers also found that the extract boosted levels of a collagen-producing enzyme called procollagen and a protein called elastin.

Collagen gives the skin structure, making it look plump and full, while elastin helps retain the skin’s shape.

Production of these compounds decreases as people age. This eventually leads to dry, deflated-looking, thin skin and the formation of wrinkles.

Promoting wound healing

Research suggests that neem oil may help enhance wound healing.

In one 2010 animal study, researchers discovered that neem oil showed superior wound healing effects, compared with Vaseline. Specifically, the rats that received topical neem oil healed more quickly. They also developed stronger and more resilient tissue at the sites of their wounds.

A similar 2013 study compared the effects of saline and neem oil on wound healing in rats. Those that received neem oil healed faster and did not develop raised scars.

The researchers speculated that compounds in neem oil may promote blood vessel and connective tissue growth, thus enhancing wound healing.

A 2014 study investigated whether a gel containing neem oil and St. John’s wort could help reduce skin toxicity from radiation therapy. The study involved 28 human participants who were receiving radiation therapy for head and neck cancer.

All participants experienced some reduction in skin toxicity following treatment with the gel. However, it is important to note that this study did not include a placebo control.

Fighting skin infections

A 2019 studyTrusted Source examined the antibacterial properties of cosmetic products containing neem compounds. The authors found that soaps containing extracts of neem leaf or neem bark prevented the growth of several strains of bacteria.

Risks

Most people can use neem oil safely. However, the EPA consider the oil to be a “low toxicity” substance. It can, for example, cause allergic reactions, such as contact dermatitis.

Also, while ingesting trace amounts of neem oil will likely not cause harm, consuming large quantities can cause adverse effects, especially in children. These may include:

  • vomiting
  • liver damage
  • metabolic acidosis
  • encephalopathy, a term for brain disease, disorder, or damage

How to use it

People should use organic, cold-pressed neem oil. The oil should have a cloudy, yellow-brown color and a strong odor.

Neem oil is generally safe to apply to the skin. However, it is very potent, so it may be a good idea to test it on a small patch of skin before applying it more extensively.

To perform a patch test, mix a couple drops of neem oil with water or liquid soap. Apply the mixture to a small area of skin on the arm or the back of the hand.

If the skin becomes red, inflamed, or itchy, dilute the neem oil further by adding more water or liquid soap. Test this mixture on a different area of skin and watch for any signs of irritation.

People who are allergic to neem oil may develop hives or a rash after a patch test. If this happens, stop using the oil — and any products that contain it — immediately.

Treating skin conditions

Some people use neem oil to treat various skin conditions, including infections and acne.

To use it as a spot treatment, apply a small amount of diluted oil to the affected skin. Let the mixture soak into the skin, then rinse it off with warm water.

Neem oil has a particularly strong odor. To disguise it, try mixing neem oil with a carrier oil, such as jojoba, coconut, or almond oil. Carrier oils also help the skin absorb neem oil.

Summary

Neem oil has a long history of use in traditional Chinese and Ayurvedic medicine. Despite this, researchers have only recently begun exploring the potential applications of neem oil in Western medicine.

Neem oil contains fatty acids, antioxidants, and antimicrobial compounds, and these can benefit the skin in a range of ways. Research shows that these compounds may help fight skin infections, promote wound healing, and combat signs of skin aging.

To use neem oil as part of a skincare routine, mix it with water or a carrier oil. It is important to do a patch test when trying neem oil for the first time.

Neem oil is available for purchase online.

Some people experience a reaction to neem oil, such as contact dermatitis. If this occurs, stop using the oil.

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MOSQUITO
MOSQUITO

As leaders from donor and malaria-affected countries, governments, business, philanthropic and international organisations come together today to reignite efforts to beat malaria, the United Kingdom is set to commit £50 million (N25,757,154,000.00) to malaria programme in Nigeria even as it pledged £9.2 million to fund new research on development of new triple Artemisinin Combination Treatments.

Ahead of the Malaria Summit London 2018, co-hosted by the governments of Rwanda, Swaziland and the UK, the UK government re-affirmed its commitment to spend £500 million a year on malaria through to 2020 to 2021.

As part of this, the UK announced a further £100 million match fund commitment to the Global Fund to match new contributions from private donors pound for pound. The Bill & Melinda Gates Foundation will extend its investments in malaria with additional $1 billion through to 2023 by fund R&D efforts and reduce the burden of the disease towards ending malaria for good.

The commitment was in response to the global malaria community appeal to Commonwealth leaders to make a game-changing commitment to halve malaria across the Commonwealth within the next five years.

This they said would prevent 350 million cases of malaria and save 650,000 lives, predominately children and pregnant women who are most at risk.

Findings show that Nigeria has the largest funding gap in malaria elimination in Africa.

Nigeria faces a financial gap of N504 billion ($1.4 billion) to implement its national malaria strategy by 2020, according to the 2017 World Malaria Report, a publication by the World Health Organization (WHO).

In addition to constituting 27 percent of malaria cases worldwide, out of 30 African countries analysed in the report, Nigeria alone accounts for 53 percent of the $1.3 billion funding gap for essential commodities that include 76 percent of the funding gap in Artemisinin Combination Therapy (ACT) and 86 percent of the funding gap for Rapid Diagnostic Test kits (RDTs).

Revelation

The WHO made known that in 2016, for the first time in a decade, the number of malaria cases in the world was on the rise and in some areas there was resurgence.

“Malaria is fighting back as the mosquito and the parasite develop resistance to the interventions we use to fight them. This has been compounded by a plateau in global funding for malaria since 2010, climate change, which intensifies incidences of malaria, and acute malaria outbreaks found in areas of crisis, war and conflict.

“To accelerate the fight against this disease there needs to be better deployment of existing tools and development of new and innovative solutions.

The commitments focus on three important areas to fight resurgence of the disease. The effective tools (nets, sprays and treatments) in the fight against malaria are under threat from drug and insecticide resistance. The malaria parasite and the mosquitoes that carry it are evolving resistance to existing interventions – malaria is fighting back.

The Malaria Summit calls for new tools to stay ahead of the disease, announcing commitments to invest in future innovations.

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