Mortality among mine and mill workers exposed to respirable crystalline silica

BACKGROUND

Millions of workers are potentially exposed to respirable crystalline silica (RCS) which has been associated with several diseases. We updated the mortality experience of a cohort of 2,650 mine and mill workers at four manufacturing facilities to assess cause-specific mortality risks associated with estimated cumulative RCS exposure.

METHODS

Study eligibility was defined as any employee who had ≥1 year of service by 2000, with work history experience available from 1945 through 2004. Vital status and cause of death were ascertained from 1945 through 2015. RCS exposure was estimated across plant-, department-, job-, and time-dependent categories using historic industrial hygiene sampling data and professional judgment. Associations between cumulative RCS (mg/m3-years) and cause-specific mortality were examined using Cox proportional hazard regression models.

RESULTS

In the exposure-response analysis defined on quartiles of cumulative RCS exposure, no increasing trend (ptrend = 0.37) in lung cancer mortality (n = 116 deaths) was observed (Hazard ratio (HR) = 1.00 (referent), 1.20, 1.85, 0.92). Mortality risk for non-malignant respiratory disease was increased across quartiles (HR = 1.00, 1.35, 1.89, 1.70; ptrend = 0.15), based on 83 deaths. Non-malignant renal disease mortality was increased across quartiles (HR = 1.00, 6.64, 3.79, 3.29; ptrend = 0.11), based on 26 deaths.

CONCLUSIONS

After nearly seven decades of follow-up, the exposure-response analyses showed no evidence of a positive trend for lung cancer, and limited evidence of a trend for non-malignant respiratory disease, and non-malignant renal disease mortality as a result of cumulative RCS exposure in this occupational cohort.

Odontogenic tumours in Nigeria: A multicentre study of 582 cases and review of the literature

BACKGROUND

The objective of this study was to classify the various types of odontogenic tumours (OTs) using the newly updated 2017 world health organization (WHO) histological typing and to analyze the prevalence of these tumours among Nigerians as well as to compare the results obtained with reports from world-wide studies.

MATERIAL AND METHODS

The records of four major tertiary hospitals in Nigeria were reviewed over a 12-year (2004-2015) period. Lesions diagnosed as odontogenic tumours were classified into four groups according to the 2017 WHO histological typing. Data which consisted of age, sex and site were analyzed using SPSS for Window (version 20.0; SPSS Inc., Chicago, IL) and frequency tables were computed.

RESULTS

A total of 582 OTs were recorded and reviewed, benign OTs were 573 (98.5%) cases and malignant OTs were 9 (1.5%) cases. Of the benign OTs, the epithelial OTs were the commonest (500; 86%) while the benign mixed OTs were the least frequent (21; 3.6%). The mean age was 30±14 years (age range of 3-77years) and the peak age was in the third decade (197; 33.8%) of life. There was slight male gender and strong mandibular site predilection. Ameloblastoma, was the most frequent OT and it accounted for 75.5% of the OTs, followed by adenomatoid odontogenic tumour (8.1%) and odontogenic myxoma (7.2%). Malignant OTs accounted for 1.5% of the OTs.

CONCLUSIONS

OTs show a geographic variation with tendency for prevalence of the epithelial OTs in Africa. Ameloblastoma has a high prevalence among Nigerians and is the most common OTs in Africa. Prevalence of odontoma is relatively low in developing African countries like Nigeria when compared to the prevalence in developed countries.

Acoustic neuroma: potential risk factors and audiometric surveillance in the aluminium industry

OBJECTIVES

To look for an association between acoustic neuroma (AN) and participation in a hearing conservation programme (HCP) and also for an association between AN and possible occupational risk factors in the aluminium industry.

METHODS

We conducted a case-control analysis of a population of US aluminium production workers in 8 smelters and 43 other plants. Using insurance claims data, 97 cases of AN were identified between 1996 and 2009. Each was matched with four controls. Covariates included participation in a HCP, working in an aluminium smelter, working in an electrical job and hearing loss.

RESULTS

In the bivariate analyses, covariates associated with AN were participation in the HCP (OR=1.72; 95% CI 1.09 to 2.69) and smelter work (OR=1.88; 95% CI 1.06 to 3.36). Electrical work was not significant (OR=1.60; 95% CI 0.65 to 3.94). Owing to high participation in the HCP in smelters, multivariate subanalyses were required. In the multivariate analyses, participation in the HCP was the only statistically significant risk factor for AN. In the multivariate analysis restricted to employees not working in a smelter, the OR was 1.81 (95% CI 1.04 to 3.17). Hearing loss, an indirect measure of in-ear noise dose, was not predictive of AN.

CONCLUSIONS

Our results suggest the incidental detection of previously undiagnosed tumours in workers who participated in the company-sponsored HCP. The increased medical surveillance among this population of workers most likely introduced detection bias, leading to the identification of AN cases that would have otherwise remained undetected.

Process of care compliance is associated with fewer diabetes complications

OBJECTIVE

To examine the association between processes measures of diabetes care and time to progression for 4 diabetes complications: coronary artery disease (CAD), stroke, heart failure (HF), and renal disease (RD).

STUDY DESIGN

This retrospective study followed outcomes from 2003 through 2009 in a cohort of 1797 employees with diabetes who worked for a large US manufacturer and were enrolled in the same health insurance plan.

METHODS

Quality of care was measured by consensus standards for testing glycated hemoglobin, lipids, and microalbuminuria. Employees with diabetes who received all 3 measures of care in the baseline year (2003) were compared with those who received less complete testing. Cox proportional hazard regression models were used to assess potential associations between diabetes care and time to complications, controlling for potential confounders.

RESULTS

Observed differences between the 2 groups in time to event were significant for 2 of the 4 complications: HF (hazard ratio [HR] = 0.39, 95% confidence interval [CI], 0.19-0.81; P = .0117) and RD (HR = 0.48, 95% CI, 0.24-0.95; P = .0339) and any of the 4 complications (HR = 0.66, 95% CI, 0.48-0.91; P = .0101). Differences in time to complication for CAD (HR = 0.70, 95% CI, 0.49-1.02; P = .0635) and stroke (HR = 0.63, 95% CI, 0.38-1.07; P = .0891) showed the same trend but were not significant.

CONCLUSIONS

Employees with diabetes who received all 3 quality measures experienced fewer complications, risk-adjusting for other factors. These results provide support for the importance of care quality.

Piecewise exponential models to assess the influence of job-specific experience on the hazard of acute injury for hourly factory workers

Background

An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.

Methods

Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.

Results

We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.

Conclusions

Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models.

Oral lesions, HIV phenotypes, and management of HIV-related disease: Workshop 4A

The workshop considered 5 questions related to oral lesions, HIV phenotypes, and the management of HIV-related disease, with a focus on evidence and challenges in resource-poor settings. First, are oral lesions unique with respect to geographic location or phenotype? Second, how useful would an oral lesion index be to predict HIV in resource-poor countries with no access to CD4 counts or viral load? Third, what are the latest methods and delivery modes for drugs used to treat oral lesions associated with HIV? Fourth, what is the role of the oral health care worker in rapid diagnostic testing for HIV? Fifth, what ethical and legal issues are to be considered when managing the HIV patient? The consensus of the workshop was the need for additional research in 4 key areas in developing countries: (1) additional investigation of comorbidities associated with HIV infection that may affect oral lesion presentation and distribution, especially in pediatric populations; (2) the development of region-specific algorithms involving HIV oral lesions, indicating cumulative risk of immune suppression and the presence of HIV disease; (3) well-designed clinical trials to test new therapies for oral lesions, new treatments for resistant oral fungal and viral diseases, effectiveness of therapies in children, and new drug delivery systems; and (4) the role of the oral health care worker in rapid diagnostic testing for HIV in various regions of the world.

Intestinal helminthiases among rural and urban schoolchildren in south-western Nigeria

The prevalences and intensities of intestinal helminthic infection among primary schoolchildren were determined in rural and urban communities of the Ife Central local government area, in south-western Nigeria. After the schools in the study area had been stratified into urban and rural, a random sample from each stratum was selected for further study. In each study school, a single fresh stool specimen was obtained from each pupil in randomly selected classes and checked, using a quantitative method (Stoll's dilution egg-count technique), for helminth eggs and larvae. Overall, 366 rural and 383 urban schoolchildren were investigated and 30.0% of them (36.1% of the rural and 24.3% of the urban; P<0.001) were found to be harbouring at least one species of intestinal helminth. The mean intensities of infection, in terms of excreted eggs/g faeces of those infected, were 2371.4 for Ascaris, 1070.6 for hookworm, and 500 for Trichuris. Although the mean intensities of Ascaris infection were significantly lower among the infected rural children than among the infected urban (2025.7 v. 2791.4; P=0.014), the corresponding difference in the hookworm infections did not reach statistical significance (1458 v. 666.7; P=0.063). The means of the log-transformed egg outputs, in eggs/g faeces of those infected, also showed similar trends: a significant difference between the rural and urban Ascaris infections (3.1877 v. 3.3340; P=0.002) but not between the rural and urban hookworm infections (2.9667 v. 2.8027; P=0.453). Intestinal helminthiases still clearly represent a common childhood health problem in the study area, particularly in the rural communities.

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND

Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries.

METHODS

Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants.

RESULTS

Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job.

CONCLUSIONS

Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.

Extended work hours and risk of acute occupational injury: A case-crossover study of workers in manufacturing

OBJECTIVE

This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week.

METHODS

A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response.

RESULTS

Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P < 0.05.

CONCLUSION

The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury.

Association between Body Mass Index and Acute Traumatic Workplace Injury in Hourly Manufacturing Employees

In this study, the authors examined the distribution and odds of occupational injury among hourly employees of a US aluminum manufacturing company by body mass index (weight (kg)/height (m)(2)). In 2002, height and weight data on 7,690 workers at eight plants were extracted from medical records from annual physicals, and body mass index was categorized. Information on traumatic injuries recorded between January 1, 2002, and December 31, 2004, was obtained from a company injury surveillance system. Twenty-nine percent of the employees (n = 2,221) sustained at least one injury. Approximately 85 percent of injured workers were classified as overweight or obese. The odds of injury in the highest obesity group as compared with the ideal body mass index group were 2.21 (95% confidence interval: 1.34, 3.53), after adjustment for sex, age, education, smoking, physical demands of the job, plant process and location, time since hire, time in the job, and significant interaction terms. Injuries to the leg or knee were especially prevalent among members of this very obese group. Research findings support an association between body mass index and traumatic workplace injuries among manufacturing employees. Workplace safety personnel might consider adding policies or programs that address weight reduction and maintenance as part of ongoing comprehensive workplace safety strategies.

Comparative study of nutritional status of urban and rural Nigerian school children

Nutritional assessment in the community is essential for accurate planning and implementation of intervention programmes to reduce morbidity and mortality associated with under-nutrition. The study was, therefore, carried out to determine and compare the nutritional status of children attending urban and rural public primary schools in Ife Central Local Government Area (ICLGA) of Nigeria. The schools were stratified into urban and rural, and studied schools were selected by balloting. Information obtained on each pupil was entered into a pre-designed proforma. The weight and height were recorded for each pupil, and converted to nutritional indices (weight for age, weight for height, height for age). A total of 749 pupils (366 and 383 children from the rural and urban communities, respectively) were studied. The overall prevalent rates of underweight, wasting and stunting were 61.2, 16.8 and 27.6%, respectively. In the rural area these were 70.5, 17.8 and 35.8%, while in the urban they were 52.2, 15.9 and 19.8%, respectively. The mean nutritional indices (Weight for Age, Weight for Height and Height for Age) were found to be significantly lower among the rural pupils than urban pupils (P < 0.001 in each case). The present study shows that malnutrition (underweight, wasting and stunting) constituted major health problems among school children in Nigeria. This is particularly so in the rural areas. Therefore, prevention of malnutrition should be given a high priority in the implementation of the ongoing primary health care programmes with particular attention paid to the rural population.

Use of medical insurance claims data for occupational health research

OBJECTIVE

The objective of this study was to demonstrate that health claims data, widely available due to the unique nature of the U.S. healthcare system, can be linked to other relevant databases such as personnel files and exposure data maintained by large employers. These data offer great potential for occupational health research.

METHODS

In this article, we describe the process for linking claims data to industrial hygiene exposure data and personnel files of a single large employer to conduct epidemiologic research.

RESULTS

Our results demonstrate the ability to replicate previously published findings using commonly maintained data sets and illustrate methodological issues that may arise as newer hypotheses are tested in this way.

CONCLUSIONS

Health claims files offer potential for epidemiologic research in the United States, although the full extent and guidelines for successful application await further clarification through empiric research.

Physician hearing loss

PURPOSE

Hearing is an important sense for physicians, making communication and stethoscope use possible, yet not much is known about the impact of hearing loss on professional function. The purpose of this study was to explore hearing-related issues affecting physicians.

MATERIALS AND METHODS

We administered a hearing test and questionnaire to 107 physicians and medical students.

RESULTS

The proportion of physicians reporting trouble with their hearing increased with age, reaching almost 100% in those older than 60 years. Audiometric hearing loss also increased with age. Perceived hearing trouble was significantly associated with audiometric hearing loss, yet 46% of physicians with hearing loss described their hearing as good. Older physicians more frequently reported difficulty communicating with patients, staff, and colleagues owing to hearing problems (P = .007). Reported stethoscope difficulties did not significantly increase with age; there was no association with hearing thresholds. No physician reported use of electronic stethoscopes or hearing aids. Noise exposures were common, yet 51% of respondents never used hearing protection. Younger physicians were less likely to use protection (P = .002).

CONCLUSION

Physicians lose hearing with age but may not notice or report the loss. Physician hearing loss is associated with difficulty communicating with patients, staff, and colleagues. Neither age nor hearing level predicts problems with stethoscope use; possible explanations include a training effect or denial. Many physicians, especially younger ones, never use hearing protection around noise. Strategies to recognize and reduce the impact of hearing loss on professional function throughout a physician's career deserve greater attention.

Glomerular filtration rate in Nigerian children with homozygous sickle cell disease

The study proposed to assess glomerular filtration rate as determined by endogenous creatinine clearance in steady state Nigeria children with homozygous sickle cell disease and normal controls. Twenty-four hours urinary creatinine clearance was estimated over a 6-month period in 54 steady-state homozygous sickle cell disease and 57 normal control children aged 5 to 13 years. Each child was admitted and a 24-hour urine sample (8.00 am to 8.00 am) was collected both for volume measurement and creatinine concentration determination. Blood was also collected from each child 30 minutes to end of urine collection for plasma creatinine concentration determination, haematocrit and reticulocyte counts. The results were compared between the two groups of children using student's t-test and the chi (X2) square test where necessary. The mean glomerular filtration rates +/- SD (ml/min/1.73 M2) for homozygous sickle cell disease children and normal controls were not significantly different (p > 0.05). Glomerular filtration rate did not differ significantly between the age groups in both patients and normal controls; haematocrits correlated weakly with glomerular filtration rates in the patients (r = +0.213; p < 0.001). Nigerian children with homozygous sickle cell disease who are in steady states have normal glomerular filtration rate that is hardly influenced by increasing age and low haematocrit level.

Septicaemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria

OBJECTIVES

To determine the incidence, predisposing factors, clinical features, bacteriological pattern and antibiotic sensitivity in septicaemia in high-risk newborns.

DESIGN

A prospective study.

SETTING

Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.

SUBJECTS

All newborns admitted with clinical features and/or risk factors suggestive of neonatal septicaemia from February 1994 to March 1995.

MAIN OUTCOME MEASURES

Culture results and mortality rates.

RESULTS

The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths. The predisposing perinatal factors were low socio-economic status, lack of antenatal care, maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria were found to be the most prevalent causative organisms (59.4%). Staphylococcus aureus (36.2%), Pseudomonas aeruginosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were the commonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7% and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a high degree of in-vitro antimicrobial resistance. However, all the isolates were sensitive to ofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance. The overall mortality rate was 33.3%.

CONCLUSION

Improvement in the socio-economic status of the populace and availability of affordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria. Continuous surveillance in every unit, as well as close attention to preventive strategies would be necessary to reduce morbidity and mortality from neonatal septicaemia. We recommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatal unit of OAUTHC, Ile-Ife, Nigeria.

Antibacterial activities of extracts from Nigerian chewing sticks

Ten aqueous extracts from wooden chewing sticks widely used in Nigeria for teeth cleaning were studied for antibacterial activities against 25 different bacteria using an agar diffusion assay. The extracts from five sticks, namely Garcinia kola, Anogeissus leiocarpus, Terminalia glaucescens, Sorindeia warneckei and Vitex doniana, exhibited strong activities against a wide spectrum of bacteria including medically and dentally relevant bacteria. Notably, these five chewing stick extracts showed potent activities against methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and multidrug-resistant Burkholderia cepacia and Pseudomonas aeruginosa. Extracts from Vernonia amygdalina, Fagara zanthoxyloides and Massularia acuminata also showed activities against bacteria significant to periodontal disease. Methanol extracts prepared from G. kola, A. leiocarpus and V. doniana were further fractionated by solvent extraction. Results showed that the antibacterial activities were distributed into different fractions suggesting that the sticks contain different active antibacterial principles. In conclusion, the results showed that most of the Nigerian chewing sticks do contain antibacterial activities which may contribute to the reported anticaries effect of chewing sticks. These sticks may be sources for new lead antibacterial agents for therapeutic or preventive applications.

Haematogram and serum iron status of malnourished Nigerian children

Haematological parameters, total serum iron, and total iron binding capacity (TIBC) concentrations were estimated in twenty protein energy malnourished (PEM) children, five kwashiorkor (K), five marasmus (M), five marasmic-kwashiorkor (M-K), and five undernourished (U) aged between one and five years on admission and after 18 days hospitalisation at Obafemi Awolowo University Teaching Hospital Complex. The Hospital diet for K and M-K consisted of 8% protein and 802 calories per litre while that for M and U consisted of 30% protein and 1350 calories per litre. After the period of 18 days of rehabilitation there was no significant (p > 0.05) difference (Student's t-test) in the weight for age. None of the haematological parameters was significantly different after rehabilitation for all the four types of PEM. Of the four types only Kwashiorkor with mean serum iron values of 15.6 +/- 1.51 micrograms/100 ml and 21.17 +/- 0.33 micrograms/100 ml on admission and after rehabilitation respectively was significantly (P < 0.05) different. More attention by the OAUTHC authorities needs to be paid to the management, feeding and diet given to these children so that there will be a greater and more rapid improvement in their rehabilitation.

Severe anemia: a risk factor for glomerular injury in sickle cell disease

Approximately 15% to 20% of patients with sickle cell disease have proteinuria. Proteinuria, particularly albuminuria, is the hallmark of glomerular injury. This study examines risk factors for glomerular injury as indicated by urinary albumin excretion (UAE) 30 microgram/minute, directly related to sickle cell disease. A total of seven patients were enrolled between September 1992 and March 1993. Fasting blood chemistries, complete blood cell count, 24-hour urine for protein and creatinine clearance, and glomerular filtration rate determined by 125 I-iothalamate were obtained for each patient. The results indicated that the lower the hematocrit, the higher the UAE rate. Low hematocrits have served as a protective mechanism in sickle cell disease by reducing blood viscosity and thus decreasing the number of vaso-occlusive crises. However, severe anemia appears to have an indirect adverse effect on the kidney in sickle cell disease.

A study of urinary tract infections at Ile-Ife, Nigeria

Clinical laboratory records and case files of 1,038 cases of urinary tract infections (UTI) were examined for the spectrum of bacterial and candida isolates for age and sex distribution of the UTI cases and antibiotic susceptibility pattern of isolates. The results show that 867 (83.5%) of the cases were aged 21 years and above, of which 81.3% in that age group were females. While only 20.7% of the cases were males, 74.0% of those in that category were also 21 years and older. Eleven organisms were isolated, with E. coli, Klebsiella spp and Staphylococcus aureus respectively representing 36.1%, 22.8% and 15.4% of the total bacterial isolates. The prevalence of S. aureus isolates in cases of UTI in this centre suggests the increasing role of these microorganisms in the aetiology of urinary tract infections in Nigeria.

Electrocardiographic changes after recovery from measles

Children with measles seen at our hospital had an initial electrocardiogram (ECG) and a repeat after 3 months. The patients were aged 5 months to 8 years (mean 19 months). The ECG changes observed after clinical recovery included T-wave inversion in eight patients (16%), flattening in eight patients (16%), prolonged PR interval in six (12%), prolonged Q-Tc in three (6%) and low QRS amplitude in four (8%). At least one ECG change was present in 18 patients (36%) after recovery, 14 of these were due to persistence of the changes noted during measles. The implication of above findings and the need for a longer-term follow-up study are discussed.

Bacterial isolates involved in cases of septicaemia in a Nigerian hospital

Of the nine hundred and twenty patients clinically diagnosed of having septicaemia at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between 1980-1987, 233 (25.3%) had blood samples positive by culture. Thirteen different bacterial species were identified from positive blood cultures of which six predominated: Staphylococcus aureus (30.5%), Coliforms (17.6%), Klebsiella spp. (14.2%), Pseudomonas aeruginosa (9.2%), Escherichia coli (7.9%) and Salmonella typhi (5.9%). The in vitro antibiotic, disc sensitivity pattern of the isolates showed they were relatively resistant to ampicillin and penicillin G but comparatively sensitive to antibiotics commonly used in the treatment of infections caused by these organisms. Septicaemia cases were recorded in all age groups but incidence in females was slightly but not significantly higher than in males (p less than 0.05). The study reveals the predominance of S. aureus strains in case of septicaemia in Nigeria.

Electrocardiographic changes in measles

Electrocardiograms (ECGs) were recorded in 100 Nigerian children with measles admitted to our paediatric wards or treated on an out-patient basis. The patients were aged 5 months-8 years (mean, 19 months) and the male:female ratio was 1.3:1. Similar recordings were obtained in 100 age- and sex-matched controls. The electrocardiographic changes observed include T wave inversion in 28 patients and prolonged P-R interval in 22. Other changes are prolonged Q-Tc (13 patients), low QRS amplitude (13 patients), abnormal QRS axes in the frontal plane (5 patients) and T wave flattening (4 patients). A statistically significant difference between patients and controls with respect to the above changes was demonstrated in T wave inversion and prolonged P-R interval--the latter in the 5 months-1 year age group. Hence, 35 patients had at least one statistically significant ECG change, giving a prevalence rate of 35%. The implications of the above findings are discussed and the need to intensify efforts aimed at immunizing all children against measles is stressed.

Class-specific antibodies to Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis in human breast-milk and maternal-infant sera

Children under 2 years of age are most susceptible to acute respiratory infections caused by Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis. We analysed milk samples and sera from mother-infant pairs for specific antibodies that may enhance protection against the bacterial pathogens. The results show that the breast-milk samples contained significant titres of specific IgG and IgA antibodies to the four organisms, although the mean IgG antibody levels were higher in maternal sera than in breast-milk. On the other hand, the mean IgA antibody levels to the four organisms were higher in breast-milk than in both maternal and infant sera. IgM antibodies to these organisms were relatively low or absent in many milk and serum samples. Nevertheless, the significant concentrations of specific IgG and IgA antibodies in milk samples may indicate a protective role for breast-milk against the four infections in early childhood.

Plant protein rehabilitation diets and iron supplementation of the protein-energy malnourished child

Thirty-eight children admitted to the paediatric ward of Obafemi Awolowo University Teaching Hospital, Ile-Ife, were treated using a local therapeutic regimen for protein-energy malnutrition (PEM). Serum transferrin concentration was measured at weekly intervals to determine the response to and nutritional adequacy of the dietary component of this therapeutic regimen. At discharge, weight for height measurements in the children showed a significant (P less than 0.001) increase in growth although the expected weight for height was not attained. Serum transferrin concentration rose significantly from a mean basal level of 132.1 +/- 17.2 mg/dl to 222.0 +/- 24.6 mg/dl at the end of the first week of hospitalization and at discharge was 403.2 +/- 27.8 mg/dl. Although not statistically significant, mortality was highest amongst children for whom iron supplementation started early on admission. Earlier studies on the aetiology and treatment of anaemia in PEM have argued in favour of routine treatment with iron to prevent the development of anaemia during the recovery phase, but data from this study suggest that iron therapy should not be instituted during the first week of treatment.

Plasma somatomedin-C in Nigerian malnourished children fed a vegetable protein rehabilitation diet

Plasma somatomedin-C (pSm-C) was measured by immunoassay in Nigerian malnourished children treated with a mainly vegetable diet. In oedematous children, the mean intake was 4.31 +/- 0.23 g protein and 611 +/- 46 kJ per kg body weight per day, and in marasmic children 5.22 +/- 0.62 g protein and 795 +/- 131 kJ/kg body weight/d. PSm-C concentration (U/ml) was measured at weekly intervals to determine the response to this rehabilitation diet. By our assay the value for 39 normal children (age range 6-36 months) was 0.315 +/- 0.035 U/ml. The average initial level of pSm-C in the malnourished children was 0.19 +/- 0.03 (n = 24). The values were higher (P less than 0.05) in the 7 marasmic children (0.26 +/- 0.1) than in the 11 with oedema (0.15 +/- 0.02). Eight days after admission pSm-C had risen to 0.20 +/- 0.02 (n = 24) and at discharge after approximately 19 d, pSm-C concentration was normal, 0.30 +/- 0.05. In oedematous malnutrition, pSm-C level at discharge was lower than in marasmus, 0.27 +/- 0.06 (n = 17) compared with 0.37 +/- 0.06 (n = 7) (P less than 0.05). Because the childrens' stay in hospital was short (average 19 d), they were far from attaining normal weight for height by the time of discharge. However, they had gained on average 0.9 kg and their clinical condition was satisfactory. It is concluded that the vegetable-based diet produced satisfactory recovery, at least in the initial stages. Increases in pSm-C compared well with those found in an earlier study with milk-based diets.

Rotavirus as an aetiological agent of acute childhood diarrhoea in Ile-Ife, Nigeria

Of the 456 urban children aged 14 days and 4 years examined for rotavirus in this study, 376 had diarrhoea while 80 were without diarrhoea and serve as control. Among the 376 diarrhoeic children, 57 (15.2%) had rotavirus while none of the 80 control children had the virus. Rotavirus was significantly higher (p less than 0.05) among the in-patients (19.8%) than in the out-patients (10.3%) and among children of 7-12 months compared with other aged groups. The majority of the children that had the rotavirus lived in areas without pipe-borne water and similarly belonged to the low-socio-economic level. It is therefore possible to deduce from this work that rotavirus is still a major aetiology of acute childhood diarrhoea in Nigeria and its incidence can be affected by hygienic practices, the environment and socio-economic level.