Twenty-four sheep were subjected to the treatment with antifungal agents after dividing into four groups equally. There were 6 sheep in each group. Group 1 (G1) was treated with tioconazole 1% cream (Trozal 1% cream, Egyptian group for pharmaceutical industries) as a local cream. Group 2 (G2) was treated with clotrimazole 1% topical aerosols (Candistan, ADCO) as a local spray, and group 3 (G3) was treated with capsules (Fungican150mg capsule, Amoun) as 5 mg/ Kg/Bw. There were two doses given in10-day intervals while topical drugs were applied daily for 10 successive days. Finally, Group 4 (G4) was kept as a positive control without treatment. All sheep groups were kept under observation for ten weeks with monitoring once weekly. Each of the sheep with dermatophytes was assessed by using a modified clinical scoring index from zero to three (0= not affected, 1=mild, 2=moderate, and 3=intense) previously designed by Mugnaini et al. (16). Skin lesions included alopecia, scaling, crust, and the entire affected area. The total score for each animal was the sum of the scores assigned to each clinical lesion (Table 1). The evaluation of the successful treatment was carried out by the reduction of means and standard deviations of score lesions for the treated groups. In addition, the mycological cure was considered when two consecutive fungal cultures in between one-week intervals were negative.
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In terms of disease burden, malaria accounted for over 20% of all illness in the Republic of Niger, making it one of the leading causes of illnesses in the country (IHME 2020; PMI 2020). In a study by Doudou et al. (2012), it was noted that the overestimation of malaria incidence in the Republic of Niger was due to the fact that presumptive diagnosis was predominantly used. The presumptive diagnosis of malaria is a situation whereby diagnosis is based on clinical symptoms rather than a specified diagnostic tool. Although malaria is endemic throughout the country, some gains (7.9% reduction) were recorded in the number of illnesses between 2015 and 2019 (World Health Organisation 2020a). Like most endemic countries, microscopy and RDT formed the basis of malaria diagnosis in the Republic of Niger, with the national treatment guideline requiring every suspected malaria case to have either RDT or microscopy (PMI 2020). A significant uptake in the use of RDT at the health facility level was recorded in 2019 compared with preceding years among health personnel available in about 61% of the health facilities (SMO 2020).
By way of complying with WHO guidelines on malaria tests and treatment, it was in 2017 that the Mozambique national health system mandated RDTs as part of the diagnostic method in malaria case management and surveillance (Candrinho et al. 2019; Galatas et al. 2020). In a bid to improve diagnosis, a field study compared ultra-sensitive RDT and conventional RDT (using PCR as a reference method), it was noted that there was no substantial difference in terms of diagnostic output between the two RDTs in terms of sensitivity and detection of false positives (Galatas et al. 2020). The issue of RDT stock-out arising from supply chain bottlenecks and inadequacies is a major challenge identified as a hindrance to the successful implementation of test and treat based on the use of RDT (Hasselback et al. 2014).
Many African countries have implemented guidelines for testing and diagnostics, but they are not always followed in local settings. This may, in part, be due to a lack of training for health care workers and medical laboratory professionals. In Ghana, it has been shown that providing microscopy training improved the ability of medical laboratory professionals to correctly identify malaria parasites from 64 to 87% (Tetteh et al. 2021) - this is indicative of a great improvement in diagnostics as the result of a relatively short training program. There is also evidence from another study in Ghana that the integration of RDTs at the informal private drug retailers will result in a reduction in the prescription of antimalarials for malaria-negative individuals. This is important to consider as many febrile individuals would approach a private drug trailer as opposed to hospitals or clinics. With the availability of RDTs in malaria-endemic regions, antimalarials are less likely to be prescribed in a fever-presenting patient who is not infected with malaria (Ansah et al. 2015). It has also been shown in Tanzania that the rollout of RDTs drastically improved diagnostic tests and reduced the incorrect usage of ACT (Bruxvoort et al. 2013). These regional training program and implementation of more RDT sites would therefore be greatly beneficial to both patients and the efforts toward malaria elimination. 2ff7e9595c
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