Paediatric paranasal sinus fibrous dysplasia

Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.

Genome-Wide Scan for Parent-of-Origin Effects in a sub-Saharan African Cohort With Nonsyndromic Cleft Lip and/or Cleft Palate (CL/P)

OBJECTIVE

Nonsyndromic cleft lip and/or cleft palate (NSCL/P) have multifactorial etiology where genetic factors, gene-environment interactions, stochastic factors, gene-gene interactions, and parent-of-origin effects (POEs) play cardinal roles. POEs arise when the parental origin of alleles differentially impacts the phenotype of the offspring. The aim of this study was to identify POEs that can increase risk for NSCL/P in humans using a genome-wide dataset.

METHODS

The samples (174 case-parent trios from Ghana, Ethiopia, and Nigeria) included in this study were from the African only genome wide association studies (GWAS) that was published in 2019. Genotyping of individual DNA using over 2 million multiethnic and African ancestry-specific single-nucleotide polymorphisms from the Illumina Multi-Ethnic Genotyping Array v2 15070954 A2 (genome build GRCh37/hg19) was done at the Center for Inherited Diseases Research. After quality control checks, PLINK was employed to carry out POE analysis employing the pooled subphenotypes of NSCL/P.

RESULTS

We observed possible hints of POEs at a cluster of genes at a 1 mega base pair window at the major histocompatibility complex class 1 locus on chromosome 6, as well as at other loci encompassing candidate genes such as ASB18, ANKEF1, AGAP1, GABRD, HHAT, CCT7, DNMT3A, EPHA7, FOXO3, lncRNAs, microRNA, antisense RNAs, ZNRD1, ZFAT, and ZBTB16.

CONCLUSION

Findings from our study suggest that some loci may increase the risk for NSCL/P through POEs. Additional studies are required to confirm these suggestive loci in NSCL/P etiology.

Genome-wide Gene-by-Sex Interaction Studies Identify Novel Nonsyndromic Orofacial Clefts Risk Locus

Risk loci identified through genome-wide association studies have explained about 25% of the phenotypic variations in nonsyndromic orofacial clefts (nsOFCs) on the liability scale. Despite the notable sex differences in the incidences of the different cleft types, investigation of loci for sex-specific effects has been understudied. To explore the sex-specific effects in genetic etiology of nsOFCs, we conducted a genome-wide gene × sex (GxSex) interaction study in a sub-Saharan African orofacial cleft cohort. The sample included 1,019 nonsyndromic orofacial cleft cases (814 cleft lip with or without cleft palate and 205 cleft palate only) and 2,159 controls recruited from 3 sites (Ethiopia, Ghana, and Nigeria). An additive logistic model was used to examine the joint effects of the genotype and GxSex interaction. Furthermore, we examined loci with suggestive significance (P < 1E-5) in the additive model for the effect of the GxSex interaction only. We identified a novel risk locus on chromosome 8p22 with genome-wide significant joint and GxSex interaction effects (rs2720555, p_2df = 1.16E-08, p_GxSex = 1.49E-09, odds ratio [OR] = 0.44, 95% CI = 0.34 to 0.57). For males, the risk of cleft lip with or without cleft palate at this locus decreases with additional copies of the minor allele (p < 0.0001, OR = 0.60, 95% CI = 0.48 to 0.74), but the effect is reversed for females (p = 0.0004, OR = 1.36, 95% CI = 1.15 to 1.60). We replicated the female-specific effect of this locus in an independent cohort (p = 0.037, OR = 1.30, 95% CI = 1.02 to 1.65), but no significant effect was found for the males (p = 0.29, OR = 0.86, 95% CI = 0.65 to 1.14). This locus is in topologically associating domain with craniofacially expressed and enriched genes during embryonic development. Rare coding mutations of some of these genes were identified in nsOFC cohorts through whole exome sequencing analysis. Our study is additional proof that genome-wide GxSex interaction analysis provides an opportunity for novel findings of loci and genes that contribute to the risk of nsOFCs.

Novel GREM1 Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate

OBJECTIVE

Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate.

PATIENTS AND METHOD

We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature.

RESULTS

The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene.

CONCLUSION

Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P.

Loss-of-Function GRHL3 Variants Detected in African Patients with Isolated Cleft Palate

In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.

Association Studies and Direct DNA Sequencing Implicate Genetic Susceptibility Loci in the Etiology of Nonsyndromic Orofacial Clefts in Sub-Saharan African Populations

Orofacial clefts (OFCs) are congenital dysmorphologies of the human face and oral cavity, with a global incidence of 1 per 700 live births. These anomalies exhibit a multifactorial pattern of inheritance, with genetic and environmental factors both playing crucial roles. Many loci have been implicated in the etiology of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in populations of Asian and European ancestries, through genome-wide association studies and candidate gene studies. However, few populations of African descent have been studied to date. Here, the authors show evidence of an association of some loci with NSCL/P and nonsyndromic cleft palate only (NSCPO) in cohorts from Africa (Ghana, Ethiopia, and Nigeria). The authors genotyped 48 single-nucleotide polymorphisms that were selected from previous genome-wide association studies and candidate gene studies. These markers were successfully genotyped on 701 NSCL/P and 163 NSCPO cases, 1,070 unaffected relatives, and 1,078 unrelated controls. The authors also directly sequenced 7 genes in 184 nonsyndromic OFC (NSOFC) cases and 96 controls from Ghana. Population-specific associations were observed in the case-control analyses of the subpopulations, with West African subpopulations (Ghana and Nigeria) showing a similar pattern of associations. In meta-analyses of the case-control cohort, PAX7 (rs742071, P = 5.10 × 10(-3)), 8q24 (rs987525, P = 1.22 × 10(-3)), and VAX1 (rs7078160, P = 0.04) were nominally associated with NSCL/P, and MSX1 (rs115200552, P = 0.01), TULP4 (rs651333, P = 0.04), CRISPLD2 (rs4783099, P = 0.02), and NOG1 (rs17760296, P = 0.04) were nominally associated with NSCPO. Moreover, 7 loci exhibited evidence of threshold overtransmission in NSOFC cases through the transmission disequilibrium test and through analyses of the family-based association for disease traits. Through DNA sequencing, the authors also identified 2 novel, rare, potentially pathogenic variants (p.Asn323Asp and p.Lys426IlefsTer6) in ARHGAP29 In conclusion, the authors have shown evidence for the association of many loci with NSCL/P and NSCPO. To the best of this knowledge, this study is the first to demonstrate any of these association signals in any African population.

Basal insulin resistance and secretion in Nigerians with type 2 diabetes mellitus

AIM

The objective of this study was to estimate basal insulin resistance (IR) and insulin secretion (IS) in Nigerians with type 2 diabetes mellitus (T2DM).

METHODS

The homeostasis model assessment (HOMA) method was used to estimate basal IR and IS in 146 Nigerians with T2DM and in 33 controls at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Correlations and multiple regression analysis between Box-Cox-transformed IR and log-transformed IS and anthropometric indices were carried out.

RESULTS

IR and reduced IS were present, respectively, in 139 (95.5%) and 109 (74.7%) of the diabetic subjects and in 25 (75.8%) and 4 (12.1%) of the controls. In the diabetic subjects, age at diagnosis, duration of diabetes, waist circumference (WC), and body mass index (BMI) correlated significantly with IR (r = -0.2399, P = 0.0035; r = 0.1993, P = 0.0166; r = 0.2267, P = 0.0059; r = 0.2082, P = 0.0120; respectively), whereas duration of diabetes, WC, and BMI correlated significantly with IS (r = -0.2166, P = 0.0091; r = 0.3062, P = 0.0002; r = 0.2746, P = 0.0008; respectively). Age at diagnosis, WC, and duration of diabetes were significant predictors of IR (beta = -0.0161, P < 0.001; beta = 0.0121, P = 0.002; beta = 0.0138, P = 0.042; respectively), whereas duration of diabetes and WC significantly predicted IS (beta = -0.0159, P = 0.025; beta = 0.0155, P < 0.001).

CONCLUSIONS

This study shows that both IR and reduced IS are major features of T2DM in Nigerians and that WC consistently correlated and predicted IR. WC measurement is simple and ideal in resource-poor settings for the detection of IR and abdominal obesity. The apparent rarity of coronary heart disease (CHD) in black Africans with T2DM despite a high prevalence of IR warrants further investigation.

Childhood sexuality and child sexual abuse in southwest Nigeria

There is paucity of information and research on childhood sexuality and child sexual abuse in Nigeria. This low level of information may not be unconnected with the fact that generally discussions on sexual matters still remain a taboo in our culture. It is almost abominable to discuss sex with children. There is need for a radical departure from this position in view of the fact that at least 5% of the respondents in this study admitted having had sex between 6 and 10 years of age and 81 respondents (2.1%) were sexually abused in childhood. The urgent need for more research and a multidisciplinary problem resolution approach to childhood sexuality and child sexual abuse is stressed.

Agouti-related protein promoter variant associated with leanness and decreased risk for diabetes in West Africans

OBJECTIVE

The role of the central melanocortin system in the development of obesity has been extensively studied. Single-nucleotide polymorphisms (SNPs) within several candidate genes have been associated with food intake and obesity-related phenotypes; however, few of these associations have been replicated. SNPs in the agouti-related protein (AGRP) gene coding (Ala67Thr, 199G/A) and promoter (-38C/T) have been reported to be associated with body mass index (BMI), fat mass (FM) and percent body fat, in populations of European and African descent. In this study, we evaluated the association between the functional AGRP -38C/T promoter SNP and weight-related traits, namely BMI, FM and fat-free mass (FFM), as well as diabetes status.

DESIGN

An association study of the AGRP -38C/T SNP and indices of obesity and diabetes status.

SUBJECTS

A well-characterized population of 538 West Africans from Ghana and Nigeria recruited in the AADM (Africa America Diabetes Mellitus) study (mean age 52 years, 41.3% males, 71% diabetic).

MEASUREMENTS

Genotyping of the AGRP -38C/T SNP, BMI, FM, FFM and fasting plasma glucose.

RESULTS

Women carrying two copies of the variant T allele had significantly lower BMI (OR=0.47; 95% CI, 0.25-0.87). Also, men with at least one copy of the variant T allele were over two times less likely to be diabetic than other men (OR=0.44; 95% CI, 0.22-0.89).

CONCLUSION

Our results replicate previous findings and implicate the AGRP -38C/T SNP in the regulation of body weight in West Africans.

Genetic diversity of the msp-1 locus and symptomatic malaria in south-west Nigeria

Genetic characteristics of Plasmodium falciparum may play a role in the clinical severity of malaria infection. We have studied the association between diversity at the merozoite surface protein-1 (msp-1) locus and the severity of disease in childhood malaria in Ibadan, south-west Nigeria. Two hundred and twenty-three children (median age of 34.5 months) presenting with malaria were enrolled into the study. They comprised 53 children with asymptomatic malaria (ASM), 101 with acute uncomplicated malaria (UM) and 69 with severe malaria (SM). Genotyping of the msp-1 locus was by polymerase chain reaction. The distribution of msp-1 alleles was significantly different between the three groups. Asymptomatic malaria samples had a higher median number of alleles than the other two groups. The type of msp-1 allele detected was significantly associated with the clinical category of malaria. The absence of K1 alleles was associated with a three-fold increase risk of UM and a four-fold increased risk of SM when compared with asymptomatic malaria. The absence of MAD20 alleles was associated with a five-fold increase risk of UM and an eight-fold increase of SM. We have found an association between the msp-1 locus of P. falciparum and clinical severity of malaria in a sample of Nigerian children. Our findings show that the presence of the K1 and MAD20 alleles was significantly associated with ASM and consequently a reduced risk of developing the symptomatic disease.

Plasmodium falciparum malaria in south-west Nigerian children: is the polymorphism of ICAM-1 and E-selectin genes contributing to the clinical severity of malaria?

Plasmodium falciparum malaria remains a major public health hazard in sub-Saharan African children. While the factors that determine the variations in clinical outcome of a malaria have not been completely defined, both host and parasite factors, as well as the complex molecular interactions between them have been implicated. The cyto-adherent properties of the P. falciparum-infected red blood cells are considered as key properties in the pathogenesis of malaria and the polymorphisms of the host adhesion molecules could contribute to the severity of malaria. Clinical information and blood samples were collected from 223 children from Ibadan (south-west Nigeria), median age of 34.5 months, presenting with different clinical manifestations of malaria--clinically asymptomatic parasitism (ACP), acute uncomplicated malaria (UM) and severe malaria (SM)--as defined by WHO criteria. The polymorphisms of genes coding for four human adhesion molecules at six different loci (ICAM-1 exons 2, 4 and 6, E-selectin exon 2, CD36 exon 10, and PECAM exon 3) were studied. DNA samples were prepared for further genotyping of the six exons mentioned above by PCR-RFLPs using the appropriate restriction digests for each loci. The ICAM-1 exon 4 locus was monomorphic. All the other loci were at Hardy-Weinberg equilibrium (HWE). The E-selectin locus had very low heterozygosity (approximately 0.06) in contrast to the other loci under study (0.23-0.44). Once the data was further processed for covariates (age and parasite density) and taking as the reference category the ACP group, results show that in the presence of the G allele at the ICAM-1 exon 6 there is an increased risk (3.6 times) of severe malaria. As far as the T allele in the E-selectin exon is concerned, the number of sampled DNAs with the T allele within both the UM and SM categories is too low for drawing any relevant conclusion at this stage. In conclusion, these results suggest that genetic polymorphisms at host adhesion molecules loci are an important variable in the susceptibility to severe malaria. Further studies of host loci are needed to further delineate which polymorphisms are associated with severe malaria and increase our knowledge of the biology of host-parasite interactions.

Beta cell function and response to treatment in Nigerians with Type 2 diabetes mellitus

There are scant data from African populations on the association between beta-cell function and response to treatment with oral hypoglycaemic agents in Type 2 diabetes mellitus (T2DM). Fasting plasma C-peptide (FCP) and glucagon-stimulated C-peptide (GSCP) levels were measured in 116 Nigerians with T2DM at a university teaching hospital. After 9 months of follow-up and treatment, they were categorized into three groups based on response to treatment: (A) good control but not on maximum sulphonylurea (SU) therapy, (B) inadequate control but not on maximum SU therapy and (C) on maximum SU therapy+/-insulin or biguanide. Logistic regression models were used to investigate how well C-peptide levels predicted the subjects belonging to Group C who are likely to require insulin. The mean FCP and mean GSCP levels of Group C were significantly lower than in the other groups (p=0.024; p= <0.001 respectively). A GSCP cut-off value of < or =1.3 ng/mL predicted membership of Group C with 85% sensitivity and 89% specificity while a cut-off of < or =1.8 ng/mL was associated with 91% sensitivity and 66% specificity. In resource-poor settings where inadequate treatment are common, estimation of GSCP may be useful in predicting treatment response and should be weighed against the cost of inadequate therapy with higher morbidity and mortality.

SNP haplotypes in the angiotensin I-converting enzyme (ACE) gene: analysis of Nigerian family data using gamete competition models

Gamete competition models were used to explore the relationships between 13 ACE gene polymorphisms and plasma ACE concentration in a set of Nigerian families. Several markers in the 5' and 3' regions of the gene were significantly associated with ACE concentration (P < 10(-4)). Multi-locus genotypes comprising different combinations of markers from the 5' UTR and the 3' region of the gene were also analysed; in addition to G2350A, in the 3' region, two markers from the 5' UTR (A-5466C and A-240T) were found to be associated with ACE concentration. These results are consistent with reports that have suggested the presence of at least two ACE-linked QTLs, and demonstrate the utility of gamete competition models in the exploratory investigation of the relationship between a quantitative trait and multiple variants in a small genomic region.

A genome-wide scan for quantitative trait loci linked to obesity phenotypes among West Africans

OBJECTIVE

To identify quantitative trait loci (QTL) for three obesity phenotypes: body mass index (BMI), fat mass (FM) and percent body fat (PBF) in West Africans with type 2 diabetes (T2DM).

DESIGN

An affected sibling pair (ASP) design, in which both siblings had T2DM. Obesity was analyzed as a quantitative trait using a variance components approach.

SUBJECTS

Sib-pairs affected with T2DM from the Africa America Diabetes Mellitus (AADM) study, comprising 321 sibling pairs and 36 half-sibling pairs.

MEASUREMENTS

Weight was measured on an electronic scale to the nearest 0.1 kg, and height was measured with a stadiometer to the nearest 0.1 cm. Body composition was estimated using bioelectric impedance analysis (BIA). Genotyping was carried out at the Center for Inherited Disease Research (CIDR) with a panel of 390 trinucleotide and tetranucleotide repeats.

RESULTS

The obesity-related phenotype showing the strongest linkage evidence was PBF on chromosome 2 (LOD 3.30 at 72.6 cM, marker D2S739). Suggestive linkage to FM was found on chromosomes 2 (LOD 2.56 at 80.4 cM) and 5 (LOD 2.25 at 98 cM, marker D5S1725). The highest LOD score for BMI was 1.68 (chromosome 4, 113.8 cM). The areas of linkage for the three phenotypes showed some clustering as all three phenotypes were linked to the same regions of 2p13 and 5q14, and our study replicated linkage evidence for several regions previously reported in other studies.

CONCLUSION

We obtained evidence for several QTLs on chromosome 2, 4 and 5 to three obesity phenotypes. This study provides data on the genetics of obesity in populations that are currently under represented in the global effort directed at understanding the pathophysiology of excess adiposity in free living individuals.

Energetic determinants of glucose tolerance status in Jamaican adults

As type 2 diabetes mellitus (DM2), obesity and sedentary lifestyles are increasing in developing countries, this observational study investigated the role of physical activity on DM2 in Jamaica. Anthropometry, body composition (by bioelectrical impedance analysis) and glucose tolerance status was assessed in 722 adults in 1993 and 1997. Energy expenditure was estimated in a subset using measured resting energy expenditure in combination with self-reported activity recalls. The rates of impaired glucose tolerance (IGT) were 23.7 and 27.3%, and DM2 were 16.3 and 23.7% among men and women, respectively. After adjusting for body composition, a one-unit increase in physical activity significantly reduced the odds of having diabetes (OR = 0.05; 95% CI: 0.004, 0.66), but not IGT. Hence, decreased physical activity is a significant independent contributor to the high rates of glucose intolerance in Jamaica. Efforts must be directed at minimizing obesity and increasing physical activity in developing countries.

Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children

There is little data on the range of variation of knee angle, intermalleolar and intercondylar distances in African children. Such measurements are needed to assist determining whether a child legs are normal or not. Knee angle intermalleolar and intercondylar distances were measured in 2166 Nigerian children aged one year to 10 years to establish normal values for these measurements. In the study we discovered that knees were maximally bowed at ages 1-3 years and reduced to neutral of 0 degrees at age five (5 years) in girls and age seven (7) in boys. Both sexes had no bowing after age (7 years) in boys. Both sexes had no bowing after age of 7 years. The valgus angle was found to be constant at about 11 degrees between ages 1-10 years in both sexes. Mean intercondylar distance was 0.2 cm at 1 year of age and did not vary significantly at 10 years of age. The greatest intermalleolar distances of 2.5 cm and 2.2 cm were noted between the ages of 2 and 4 years. Normograms of these measurements are presented as diagnostic aids in clinical settings.

Anti-sickling potential of a Nigerian herbal formula (ajawaron HF) and the major plant component (Cissus populnea L. CPK)

The anti-sickling activities of the extracts of the roots of a plant Cissus populnea L. (CPK) (a major constituent of a herbal formula Ajawaron HF used in the management of sickle cell disease in south-west Nigeria) has been examined. Phytochemical examination of the extract showed the presence of anthraquinone derivatives, steroidal glycosides and cardiac glycosides. Alkaloids and tannins were completely absent in the CPK extracts. Evaluation of the anti-sickling activity involved the use of both positive (p-hydroxybenzoic acid, 5 microg/mL) and negative control (normal saline) for each set of experiments aimed at the inhibition of sodium metabisulphite-induced sickling of the HbSS red blood cells obtained from confirmed non-crisis state sickle-cell patients. The chloroform and water partitioned fractions of the cold methanol extracts of CPK exhibited a 62.2% and 52.9% inhibition of sickling, respectively, at 180 min. The herbal formula (HF) aqueous extract showed the highest anti-sickling activity on a weight by weight basis of all the extracts and fractions tested, giving a 71.4% inhibition of sickling at the end of 180 min incubation when compared with the normal saline control. The maximum percentage inhibition of sickling exhibited by the p-hydroxybenzoic acid control was 46.0% at 90 min incubation.

Aetiological agents, clinical features and outcome of septicaemia in infants in Ibadan

The present study sought to determine the prevalence, clinical features and bacterial aetiological agents of septicaemia in post-neonatal infants (age 1-12 months) presenting with fever at the University College Hospital, Ibadan, Nigeria.

STUDY SETTING

It was carried out at the Otunba Tunwase Children Emergency Ward (OTCHEW) (a 40 bedded ward) of the Department of Paediatrics, University College Hospital, Ibadan, Nigeria.

PATIENTS

All postneonatal infants aged 1-12 months presenting with fever and who had not had antibiotic treatment in the week prior to presentation during the period June to November 1998 were enrolled in the study. Each child had a full clinical evaluation followed by a blood culture.

RESULTS

The infants comprised 56 (54.9%) males and 46 (45.1%) females. The mean age was 5.6 (SD 0.3) months. The prevalence of septicaemia in the infants studied was 38.2%. Clinical features associated with increased risk of septicaemia among these infants were age < or = 6 months, restlessness and a total white cell count > or = 15000/mm3. The organisms isolated in the infants studied were Escherichia coli (35.9% of positive cultures). Staphylococcus aureus (33.3%), Klebsiella species (10.3%), Streptococcus species (7.7%), Proteus species (5.1%), Pseudomonas species (5.1%) and Salmonella species (2.6%). Mortality was significantly higher in patients with septicaemia (25.7% compared with those without septicaemia (7.9%).

CONCLUSIONS

Thirty eight percent of febrile infants presenting in this study had positive bacteria blood cultures, the most common organisms being Escherichia coli and Staphylococcus aureus. Few clinical features distinguished febrile infants with septicaemia from those without. It is recommended that febrile infants in our setting with clinical features associated with increased risk of septicaemia should be treated emprically with antibiotics since the probability of having septicaemia is significant.

Low plasma bicarbonate predicts poor outcome of cerebral malaria in Nigerian children

Malaria remains a major cause of morbidity and mortality in many sub Saharan countries and cerebral malaria is widely recognised as one of its most fatal forms. We studied the predictive value of routine biochemical laboratory indices in predicting the outcome of cerebral malaria in 50 Nigerian children ages 9 months to 6 years with cerebral malaria at the University College Hospital, Ibadan, Nigeria. Of the 50 children studied, 43 (68%) made a full recovery, 5 (105) developed neurological sequelae while 11(22%) died. Biochemical derangements observed among the children included azotaemia (29%), elevated plasma creatinine (20%), metabolic acidiosis (22%) and hyponatraemia (16%). Metabolic acidosis and elevated plasma creatinine on admission were significantly associated with a poor outcome (p < 0.05). Hyponatraemia and hypokalaemia were not significantly associated with outcome. On multivariated analysis, metabolic acidosis and elevated plasma creatinine on admission to hospital remained independent predictors of poor outcome after adjusting for other known risk factors. Patients with these findings require prompt referral for adequate treatment in centres equipped to manage such critically ill patients.

Chloroquine resistance of Plasmodium falciparum is associated with severity of disease in Nigerian children

Chloroquine resistance of Plasmodium falciparum in vitro was significantly higher in isolates from patients with severe malaria than those with uncomplicated disease. This association may be due to either progression of uncomplicated to severe disease following chloroquine failure or increased virulence of chloroquine-resistant parasites. The implication of this for antimalarial treatment policy is discussed.

Beliefs and perceptions about HIV infection and AIDS among mothers of infants in Ibadan, Nigeria

In view of the growing importance of the human immunodeficiency virus (HIV) infection and the Acquired Immunodeficiency Syndrome (AIDS) in Nigeria, 221 mothers were interviewed by means of semi-structured questionnaires in an infant welfare clinic in Ibadan, Nigeria, about their perceptions and beliefs about HIV/AIDS infection with particular emphasis on how the infection could be acquired, how the risk of its acquisition can be reduced and whether how children could be infected. The findings revealed that 81% of the respondents believe that HIV infection does exist in Nigeria but only 17.6% think they have seen an AIDS patient. About two-thirds (68.8%) believe that children can be infected with HIV, 70.6% believe that a mother can transmit the infection to her child and 58% believe that HIV can be transmitted through breast milk. Eighty percent believe that people can protect themselves from having the infection by various means, including avoiding sharing needles or reusing hypodermic needles (83.3%), receiving unscreened blood (79.2%), mutual fidelity with a single sexual partner (73.8%), use of condoms (67.9%), avoiding the use of public toilets (56.1%) and avoiding mosquito bites (35.3%). Those with higher education showed better knowledge than those with lower education. In spite of the strong correlation with formal education, some misconceptions existed in all groups. For example, those without any formal education compared with those with some formal education believed that use of public toilet can cause HIV to be transmitted, the difference was not statistically significant (chi2 = 8.87; p = 0.064). Interestingly more of the highly literate women believed that HIV infection can be acquired by mosquito bites (chi2 = 16.82; p = 0.002). It was concluded that awareness of HIV infection and AIDS is high among mothers of infants attending the infant welfare clinic of the Institute of child Health, Ibadan. Whatever educational interventions is planned for this facility should take these findings into account and specially target those with none or little formal education.

Human immunodeficiency seropositivity among mother-child pairs in South West Nigeria: a community-based survey

A community based survey to determine the prevalence of human immunodeficiency infection in Nigerian women and children in South Western Nigeria is reported. A multi-stage cluster random sampling procedure was used to select mother-child pairs from 35 enumeration areas in South western Nigeria. The final study sample consisted of 460 mothers and 476 children (including 16 sets of twins). A commercially available recombinant antigen-based ELISA method was used to test for HIV-1 and HIV-2 antibody in sera and Western blotting was used as a confirmatory test for initially reactive samples. Only one mother-child pair (out of 460 mother-child pairs) was found to be positive for HIV antibody giving a mother-child concordance for HIV infection of 0.22%. Antibody to either HIV-1 or HIV-2 was detected in 3.8% (18/476) of the children's sera and in 43% (20/460) of mothers sera. HIV-1 reactivity was commoner than HIV-2 reactivity (2.9% versus 0.8% among children and 2.8% versus 1.5% among mothers). There were many more positive samples in the rural than in urban areas among children (7.1% versus 1.1%) and also among mothers (6.8% versus 2.4%), (p<0.001). Thus, HIV infection appears to be a real problem in South western Nigeria. The lack of concordance between mother-child sera suggests that vertical transmission may not be a major route of transmission of HIV infection in children in South western Nigeria. It is suggested that certain high risk practices (such as the re-use of unsterilised hypodermic needles for injections and surgical knives in local scarification) which are common practices, especially in rural areas, need to be investigated as potential major modes of transmission of the infection. Control programmes need to take note of these findings in order to adequately plan comprehensive health education which will cover the whole population, including children.

Heritability of obesity-related traits among Nigerians, Jamaicans and US black people

OBJECTIVE

The mean values for anthropometric traits vary across population groups and this variation is clearly determined for the most part by the environment. The familiarity of anthropometric traits also varies in reports from different populations, although this variation has not been shown to follow a consistent pattern. To examine whether heritability is influenced by socio-cultural factors, we conducted a cross-cultural study of populations of the African diaspora.

PARTICIPANTS

Data were collected on 1868 family members from Nigeria, 623 from Jamaica and 2132 from metropolitan Chicago, IL, USA.

MEASUREMENTS

Height and weight were measured and body mass index (kg/m(2)) calculated. Fat-free mass, fat mass and percentage body fat were estimated using bioelectrical impedance analysis. Plasma leptin concentrations were also measured. The proportion of variance attributable to additive genetic and non-shared environmental components was estimated with the maximum likelihood variance decomposition method.

RESULTS

Mean values for all anthropometric traits increased along the socio-cultural gradient, and obesity increased from 5% in Nigeria to 23% in Jamaica and 39% in the USA. Within populations the relationships among traits both within individuals and within families were highly consistent. Heritability estimates for weight, body mass index, fat mass and percentage body fat were approximately 50% for all groups. Heritability for height was lower in Nigeria (62%) than in Jamaica (74%) or the US (87%).

CONCLUSION

The familial patterns of body size and energy storage appear to be consistent in these genetically related populations across a wide range of environmental conditions.

NUTRITIONALCONSEQUENCES OF THEAFRICANDIASPORA

Along with their foods and dietary customs, Africans were carried into diaspora throughout the Americas as a result of the European slave trade. Their descendants represent populations at varying stages of the nutrition transition. West Africans are in the early stage, where undernutrition and nutrient deficiencies are prevalent. Many Caribbean populations represent the middle stages, with undernutrition and obesity coexisting. African-Americans and black populations in the United Kingdom suffer from the consequences of caloric excess and diets high in fat and animal products. Obesity, non-insulin-dependent diabetes mellitus, hypertension, coronary heart disease, and certain cancers all follow an east-to-west gradient of increasing prevalence. Public health efforts must focus not only on eradicating undernutrition in West Africa and the Caribbean but also on preventing obesity, hypercholesterolemia, and their consequences. Fortunately, a coherent and well-supported set of recommendations exists to promote better nutrition. Implementation of it founders primarily as a result of the influence of commercial and political interests.

Treatment of childhood diarrhoea in Nigeria: need for adaptation of health policy and programmes to cultural norms

A community survey of treatment regimens for acute diarrhoea in children was carried out in 10 villages in the Ona Ara Local Government Area of Oyo State, Nigeria, using a combination of qualitative (focus-group discussions) and quantitative (weekly surveillance of diarrhoea) methods. Focus-group discussions were conducted with parents of children aged less than 5 years, while a surveillance of diarrhoea among 550 children of same age was carried out during a 6-month period. The findings of the study showed that not all types of diarrhoea were recognized as illnesses, and only those considered to be illnesses were treated. Treatment often involved an adhoc group which comprised adults who were present at the time the illness occurred (including parents, neighbours, relatives, and elders). Certain beliefs and practices, such as associating types of diarrhoea with occupation or ethnic groups, categorizing the severity on perceived causes, and withholding certain foods during episodes of diarrhoea, were common factors in decision-making for seeking treatment. Antimicrobial agents were used in the case of 46.8% of 205 diarrhoeal episodes, and 28.5% were not at all treated. The usual practice of focusing on a target group, such as mothers, during educational interventions may need to be modified in communities where nearly every adult has a role in decision-making in relation to health. The need to adapt health policy and programmes to cultural norms should be addressed to improve the impact of programmes.

A first high-density map of 981 biallelic markers on human chromosome 14

As the largest set of sequence variants, single-nucleotide polymorphisms (SNPs) constitute powerful assets for mapping genes and mutations related to common diseases and for pharmacogenetic studies. A major goal in human genetics is to establish a high-density map of the genome containing several hundred thousand SNPs. Here we assayed 3.7 Mb (154,397 bp in 24 alleles) of chromosome 14 expressed sequence tags (ESTs) and sequence-tagged sites, for sequence variation in DNA samples from 12 African individuals. We identified and mapped 480 biallelic markers (459 SNPs and 21 small insertions and deletions), equally distributed between EST and non-EST classes. Extensive research in public databases also yielded 604 chromosome 14 SNPs (dbSNPs), 520 of which could be mapped and 19 of which are common between CNG (i.e., identified at the Centre National de Génotypage) and dbSNP polymorphisms. We present a dense map of SNP variation of human chromosome 14 based on 981 nonredundant biallelic markers present among 1345 radiation hybrid mapped sequence objects. Next, bioinformatic tools allowed 945 significant sequence alignments to chromosome 14 contigs, giving the precise chromosome sequence position for 70% of the mapped sequences and SNPs. In addition, these tools also permitted the identification and mapping of 273 SNPs in 159 known genes. The availability of this SNP map will permit a wide range of genetic studies on a complete chromosome. The recognition of 45 genes with multiple SNPs, by allowing the construction of haplotypes, should facilitate pharmacogenetic studies in the corresponding regions.

Comparability of resting energy expenditure in Nigerians and U.S. blacks

OBJECTIVE

To determine the influence of environmental factors on resting energy expenditure (REE) and its relationship to adiposity in two populations of West African origin, Nigerians and U.S. blacks.

RESEARCH METHODS AND PROCEDURES

REE and body composition were measured in a cross-sectional sample of 89 Nigerian adults (39 women and 50 men), and 181 U.S. black adults (117 women and 65 men). Both groups represent randomly selected population samples. REE was measured by indirect calorimetry after an overnight fast in both sites using the same instrument. Body composition was estimated using bioelectrical impedance analysis (BIA) in 72 Nigerians and 156 U.S. participants. Multivariate regression analysis was used to determine the significant predictors of REE. The analyses were repeated in a set of 17 Nigerians and 28 U.S. blacks in whom body composition was measured using deuterium dilution.

RESULTS

U.S. black adults were significantly heavier and had both more fat-free mass (FFM) and body fat than Nigerians. FFM was the only significant determinant of REE in both population groups, whether body composition was measured using BIA or deuterium dilution. The relationship between REE and body composition did not differ by site. There was no relationship between REE and adiposity.

DISCUSSION

Differences in current environmental settings did not impact REE. The differences observed in mean levels of body fat between Nigerians and U.S. blacks were not the result of differences in REE adjusted for body composition.

Betke's and elution methods in estimation of haemoglobin F in sickle cell anaemia

OBJECTIVE

To compare the effect of the type of spectrophotometer and method used in the estimation of HbF.

DESIGN

Two sets of experiments were done. In the first set, paired blood samples were obtained from 28 adult sickle cell anaemia subjects. One of each pair of samples was analysed for HbF by Betke's method and the other by the elution method and the values obtained were compared. In the second set of experiments, ten other paired samples were analysed for HbF, one using an analogue spectrophotometer and the other using a digital spectrophotometer and the results compared.

SETTING

Adult sickle cell clinic, University College Hospital, Ibadan, Nigeria.

SUBJECTS

Thirty eight sickle cell anaemia patients.

RESULTS

HbF levels estimated by the two methods showed good agreement as estimated by the Bland-Altman plot. HbF levels obtained by Betke's method correlated well with those obtained by the elution method (r = 0.59, p = 0.0015) and the mean values were similar (14.9% versus 13.5%, p=0.215). The values obtained by the analogue spectrophotometer showed poor agreement with those obtained by the digital instrument, with the mean value of the former being much lower than that of the latter.

CONCLUSION

Both Betke's method and the elution method give similar results in the estimation of HbF so that for practical purposes, the two methods are interchangeable. The type of spectrophotometer used may have a major influence on HbF values obtained. Therefore, such information should be stated in any study reporting HbF values to facilitate interpretation.

Neurological features of cerebral malaria in Nigerian children

Cerebral malaria is one of the commonest causes of an acute neurological syndrome in malaria-endemic areas. However, there are few detailed reports of findings on clinical neurological examination of the condition. The neurological features of cerebral malaria in 103 children aged 5 years or less were studied in Ibadan, Nigeria, an area of high malaria transmission. The correlation of these features with prognosis was also studied. Convulsions occurred in 87% of subjects and were in most cases of a generalized tonic-clinic nature. Abnormalities of posture were observed in 41%, abnormal tone in 70% and abnormal deep tendon reflexes in 74%. Absent corneal reflexes were found in about 14%. The time interval between the last seizure episode and presentation in hospital, abnormal posture (decerebrate or decorticate), absence of corneal reflex and depth and duration of coma were indicators of poor prognosis. In this study, cerebral malaria presented with non-specific features of diffuse, symmetrical, upper motor neurone dysfunction, and some specific neurological features were associated with poor prognosis. It is important that cerebral malaria be considered in any child with features of acute encephalopathy in a malaria-endemic area. Careful clinical examination of such children is essential as neurological features of the condition may provide a clue to prognosis.

Comparative efficacy of intramuscular artemether and intravenous quinine in Nigerian children with cerebral malaria

The efficacy of a 5-day treatment with intramuscular artemether (3.2-mg/kg loading dose followed by 1.6 mg/kg daily) was compared to that of the standard 7-day treatment with quinine (20-mg/kg loading dose followed by 10 mg/kg every 8 h) in a randomised clinical trial including 103 children aged 12-60 months with cerebral malaria between 1994 and 1996. No statistical difference of immediate efficacy was found between the two treatments. There were 11 (20%) deaths in the artemether group and 14 (28%) in the children who received quinine. The respective artemether versus quinine median fever clearance times (h) were 39 (interquartile ranges [IQ] 30-54) vs. 48 (IQ 30-60), and parasite clearance 42 (IQ 24-60) vs. 36 (IQ 30-48). However, one patient who received artemether had a recrudescence on day 14, which was successfully treated with sulphadoxine-pyrimethamine. Times to recovery from coma were 24 h (IQ 18-45) and 33 h (IQ 19-57), respectively. The occurrence of transient neurological sequelae including motor disabilities, cortical blindness, and afebrile seizures was also similar in the two groups. No adverse reactions to the two drugs were recorded during the study period. Artemether represents an important option in the management of cerebral malaria in Nigeria especially in rural areas where facilities for intravenous administration may not yet be optimal.

Gene frequencies of ABO and Rh (D) blood group alleles in a healthy infant population in Ibadan, Nigeria

The ABO and Rhesus blood group systems remain the most important blood group systems clinically. In order to provide gene frequency values for the ABO and Rh (D) alleles in a healthy infant population in south west Nigeria, 4748 healthy infants were typed for ABO and Rh (D) blood groups over a five year period (1988-1992). Overall, 2575 (54.2%) were blood group O, 1023 (21.6%) were blood group A, 1017 (21.4%) were blood group B and 133 (2.8%) were blood group AB. The distribution of the ABO blood groups did not differ significantly from those expected under the Hardy Weinberg equilibrium (Goodness-of-fit X2 = 6.09, df = 3, p = 0.1075). The proportions of the infants belonging to the various ABO blood groups did not vary significantly over the period of the study (X2 = 14.53, df = 12, p = 0.268). Overall gene frequencies for the O, A and B genes were 0.7398, 0.1305 and 0.1298 respectively. For the Rh (D) gene, 4520 (95.2%) were Rh-positive while 228 (4.8%) were Rh-negative. However, the proportions of Rh (D) negative infants varied significantly over the period of the study, with a particular year (1991) having nearly twice the usual frequency of Rh-negative individuals (X2 = 31.17, df =, p < 0.001). The frequency of the Rh (D) gene was 0.7809. These figures are reported in the hope that they may find some use as reference for studies of ABO blood groups in health and disease, especially since they were obtained in an infant population in which it is expected that selection pressures should not have started to act to any significant extent.

The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria

The histological findings in renal biopsy specimens obtained from 41 children with the nephrotic syndrome in Ibadan, Nigeria, between July, 1989 and June, 1996 are presented. The patients consisted of 26 male and 15 female children and their ages ranged from 2-13 years. The predominant histological type was membranoproliferative glomerulonephritis (MPGN) which occurred in 21 (51.2%). Membranous nephropathy and minimal change nephropathy (MCN) accounted for 4 (9.8%) patients each. The prevalence of MPGN was 33.3% in children less than 5 years of age compared with 56.2% amongst children who were > or = 5 years. All the three patients with MCN who were treated with a course of prednisolone had complete remission of the disease. It is concluded that MPGN is the predominant histological lesion seen in childhood nephrotic syndrome in Ibadan and that MCN remains an uncommon lesion. Therefore, renal biopsy is recommended as a prelude to a trial of steroid therapy in these patients since MCN (which is generally associated with steroid-responsiveness) is an uncommon finding among them.

Variation in fontanelle size with gestational age

There is scanty data in the literature on the variation of fontanelle size with gestational age. This relationship was studied in 250 neonates delivered at gestational ages of 29-41 weeks at the University College Hospital, Ibadan, Nigeria. Anterior fontanelle size showed a low positive correlation with gestational age (r = 0.15). However, controlling for occipitofrontal circumference reduced this correlation to 0.12. Mean anterior fontanelle size increased with increasing gestational age but the anterior fontanelle size: occipitofrontal circumference ratio remained remarkably constant over the range of gestational age studied. The posterior fontanelle size did not show a significant correlation with gestational age and the prevalence of closed posterior fontanelles at birth did not differ significantly between term and preterm neonates. It is concluded that anterior fontanelle size does show a low positive correlation with gestational age but maintains the same ratio with head circumference at least during the third trimester of intrauterine life. Posterior fontanelle size shows no linear relationship with gestational age.

Human T-cell lymphotropic virus types I and II infections in mother-child pairs in Nigeria

A community-based survey to determine the prevalence of human T-cell lymphotropic type I (HTLV-I) and type II (HTLV-II) virus infections in mothers and children in south-western Nigeria was carried out using blood samples collected in 1993. A multistage cluster, random sampling procedure was used to select 460 mother-child pairs (476 children because there were 16 sets of twins) from 14 enumeration areas. A commercially available, whole HTLV-I lysate antigen-based ELISA method was used to screen for HTLV-I and HTLV-II antibodies in the samples. A synthetic peptide antigen-based ELISA was then used to differentiate between antibody reactivity to either HTLV-I or HTLV-II. Reactivity to HTLV-I or HTLV-II antibodies was found in 4.3 per cent (20/460) of mothers and in 1.1 per cent (5/476) of children in both rural and urban communities and all the positive children were males. None of the 16 sets of twins in this study was positive for either HTLV-I or HTLV-II. Also none of the mother-child paired sera tested showed concordance for either HTLV-I or HTLV-II antibody positivity. The lack of concordance between mother and child sera suggests that vertical transmission may not be the major route of transmission of HTLV infection to children in south-western Nigeria. Other modes of transmission, such as the re-use of unsterilized needles for injections and surgical knives in local scarification, which are common practices in the region, need to be investigated as they may prove to be more important than vertical transmission. These findings have important implications for any control programme for diseases that can be spread by the same routes as HTLV infection (the human immunodeficiency viruses, hepatitis B, and hepatitis C infections).

Fontanelle sizes in term neonates in Ibadan, Nigeria

Fontanelle sizes were studied in 200 term and appropriate-for-gestational age neonates delivered at the University College Hospital, Ibadan, Nigeria with the aim of determining their normal range of variation. The anterior and posterior fontanelle sizes were described using the range, mean, standard deviation and selected (3rd, 25th, 50th, 75th and 97th) percentiles. The anterior fontanelle size ranged from 1.0 to 6.4 cm with a mean of 4.0 (SD 1.0) cm. The posterior fontanelle size ranged from 0.0 to 5.5 cm with a mean of 1.4 (SD 1.7) cm. The posterior fontanelle was not palpable in 99 (49.5%) of the neonates and there was no association between the sex of the neonate and posterior fontanelle closure (X2 = 0.97, p = 0.325). The findings of the study are consistent with those of other workers who have documented larger anterior fontanelle sizes in the Negro neonate compared to his caucasian counterpart. However, the anterior fontanelle size in this study was larger than previously reported Nigerian figures, a fact which may be due to the exclusion of neonates who still had overriding cranial bones (from excessive moulding) at the time the measurements were taken. It is suggested that local values derived from well-defined populations be used as reference in the evaluation of the child with dysmorphic features in order to avoid errors of classification due to racial differences in the normal range of variation. Further studies of this nature are needed in order to delineate such differences where they exist.

Facial and ear dimensions in term Nigerian neonates

A study of selected facial and ear dimensions in 200 term and appropriate-for-gestational age neonates delivered at the University College Hospital, Ibadan, Nigeria, was carried out with the aim of describing their normal range of variation and providing reference values for clinical use. The features studied included inner canthal distance, outer canthal distance, palpebral fissure length, nasolabial distance, oral intercommissural length, total ear length and ear length above the eyeline. The inner canthal distance ranged from 1.6 to 2.5 cm with a mean of 2.1 (SD 0.2) cm while the outer canthal distance ranged from 5.2 to 7.2 cm with a mean of 6.1 (SD 0.4) cm. The oral intercommissural length ranged from 2.5 to 4.0 cm with a mean of 3.1 (0.3) cm and the total ear length ranged from 2.4 to 4.0 cm with a mean of 3.2 (SD 0.3) cm. Three per cent of the neonates had the whole ear located completely below the eye line. No significant sex differences in the mean values of any of the dimensions studied were found. The findings of the study are consistent with those of other workers who have documented shorter ears in the Negro neonate compared to his Caucasian counterpart. It is suggested that local values derived from well-defined populations be used as reference in the evaluation of the child with dysmorphic features in order to avoid errors of classification due to racial variations in the range of normal.

Cultural Perceptions of Diarrhea and Illness Management Choices among Yoruba Mothers in Oyo State, Nigeria

Home management of childhood illness is a norm throughout most of the world. Decisions about treatment are influenced by cultural perceptions of the illness, and diarrheal illnesses are no exception. A group of 473 mothers and their pre-school age children in rural communities outside Ibadan metropolis in Nigeria were followed over a two-month period. Data were collected on actual diarrhea illness episodes: mothers' names for these illnesses were recorded, and reported treatment actions were noted. Six major ethno-medical diarrheal illnesses were identified and were grouped broadly into watery diarrheas and dysentery-like diarrheas. Although few (40%) women used home-made sugar-salt solution (SSS) in case management, those who labeled their child's illness as a watery diarrhea were more likely to use SSS. Modern and herbal medicines were commonly and equally applied to both groups of diarrheal illnesses. While very few mothers reported decreased fluid intake by their children, many said the child had reduced appetite, especially if the child had a watery diarrhea. The findings indicate that twelve years after the national Oral Rehydration Therapy (ORT) Program was launched, few mothers practice the recommended actions of giving SSS, increasing food intake and avoiding drugs. Lack of attention to studies that describe the cultural basis for mothers' decisions could be part of the reason why the ORT has not been more successful.

Routine screening for sickle cell haemoglobinopathy by electrophoresis in an infant welfare clinic

The experience of a Nigerian infant welfare clinic in offering sickle cell haemoglo-binopathy (SCH) screening by electrophoresis to its clinic population over a 12-year period is reported. Overall 10,115 children were screened. Homozygous haemoglobin S was detected in 3.1% and haemoglobin S + C in 1.1%. Carriers of the sickle cell gene (haemoglobin A + S) comprised 23.7% of the children screened. Gene frequencies for the A, S and C genes were 0.814, 0.155 and 0.031 respectively. The gene frequencies of the S and C genes were higher than those reported in infants and under-five children from other parts of Nigeria. Screening for sickle cell haemoglobinopathy in the first year of life through infant welfare clinics and 'well-baby' clinics as described in this report is suggested as a viable approach to the problems of detection (and genetic counselling) of SCH in developing countries with their scant resources. The advantages and limitations of this approach are discussed.

Squamous cell carcinoma of the cervix simulating an advanced malignancy of the ovaries

A 40-year-old woman was diagnosed as having stage II squamous cell cervical carcinoma and managed with radiotherapy. Three months after treatment, she presented with features suggestive of an advanced ovarian tumour including gross abdominal swelling, bilateral ovarian tumours, multiple tumour seedlings in the abdominal cavity and ascites. There was also pleural effusion. Operative findings revealed widespread intra-abdominal metastases whose histology, contrary to expectations, showed squamous cell carcinoma of cervical origin. Distant metastases from squamous cell carcinoma of the cervix are rare. A high index of suspicion is necessary to detect this unusual mode of presentation.

Awareness and use of family planning methods among married women in Ibadan, Nigeria

A study of awareness and use of family planning methods among 1188 married women aged 15-40 years, attending antenatal clinic in four different locations, conducted in Ibadan, Nigeria between May to December 1995 is reported. Most respondents (94.3%) were aware of the use of family planning but only 12.0% had ever visited a family planning clinic. Awareness of specific methods was 82.6% for condoms, 75.7% for oral contraceptives, 75.5% for injectable contraceptives and 65.3% for intrauterine device. Current use of family planning methods was low with 10.0% using withdrawal, 8.1% oral contraceptives, 5.2% using intrauterine devices and 4.7% using condoms. Perceived constraints to the use of family planning methods included husband's opposition, fear of complications and perceived insufficient knowledge about family planning methods. It is concluded that there is a knowledge-practice gap in the use of family planning methods among married women in Ibadan, Nigeria. Improved education strategies and better access to services are needed to solve these problems.

Infertility and other fertility related issues in the practice of traditional healers and Christian religious healers in south western Nigeria

Traditional healers have been an established source of health care delivery in Africa for centuries while Christian religious healers (193 traditional healers and 99 Christian religious healers) with respect to infertility and some other fertility-related issues. The findings show that both types of healers believe that infertility is most commonly due to the past life of the woman, physical problems related to the womb or to male potency, and imcompatibity between the man and the woman. Traditional healers also believed that being bewitched or being cursed can lead to infertility. Both groups of healers threat infertility by sacrifices, prayer and fasting, and timing of intercourse to coincide with the fertile period. Also 61% of traditional healers and 87% of religious healers advice their-clients with infertility to do nothing at least initially. To those clients seeking advice on preventing pregnancy, traditional healers tend to recommend herbal concoctions, beads and rings while Christian healers tended to recommend condoms, withdrawal method and the safe period. Both groups are consulted on premarital sex, premarital conception, sex during pregnancy and influencing the sex of an unborn baby. It was concluded that both traditional healers and Christian faith healers are involved with infertility and other fertility-related issues in their practices. There is an overlap in beliefs about causes and treatment of such conditions among both groups although areas of differences in beliefs and practices are clearly identifiable.

Haematological values in pregnancy in Ibadan, Nigeria

Haematological values were studied in 495 apparently healthy pregnant Nigerian women receiving antenatal care in a maternity hospital in Ibadan, Nigeria. Means, standard deviations and ranges of haematrocrit, total and differential white cell counts, absolute platelet count, erythrocyte sedimentation rte, prothrombin time (PT) and partial thromboplastin time (PTTk) were determined. The mean haematrocrit was 0.311 (SD 0.033), mean total leucocyte count was 5.765 x 10(9)/L (SD 1.753 x 10(9)/L) and mean platelet count was 193 x 10(9)/L (SD 46 x 10(9)/L). The mean erythrocyte sedimentation rate was 18.6 (SD 7.4) mm/hour, mean prothrombin time was 12.3 (SD 2.5) seconds and mean partial thromboplastin time was 38.4 (SD 2.0) seconds. There were significant differences between the second and third trimesters of pregnancy in nay of the haematological values studied. The study has presented the range of variations in haematological values (including those that measure coagulation) in apparently healthy pregnant Nigerian women. It would appear that in the population studied, there were no significant differences in these haematological values between the second and third trimesters in otherwise healthy women receiving regular antenatal care.

Intraleucocytic malaria pigment and clinical severity of malaria in children

Intraleucocytic malaria pigment has been suggested as a measure of disease severity in malaria. We have tested this hypothesis by studying 146 children aged 6 months to 14 years in 4 categories--cerebral malaria, mild malaria, asymptomatic malaria and 'no malaria'--in Ibadan, Nigeria, an area of intense malaria transmission in Africa. Children with cerebral malaria were studied at the university hospital, those with mild malaria at 2 primary health centres and the other 2 groups were studied in a primary school. The proportion of pigment-containing neutrophils showed a clear rise across the spectrum no malaria--asymptomatic malaria--mild malaria--cerebral malaria (median values 2.0%, 6.5%, 9.0% and 27.0%, respectively; P < 0.0001). The proportion of pigment-containing monocytes did not differ significantly between the mild malaria, asymptomatic malaria and no malaria groups but the cerebral malaria group had a higher median value than the other 3 groups. The ratio of pigment-containing neutrophils to pigment-containing monocytes showed the same trend across the groups of subjects as was observed with the number of pigment-containing neutrophils. It is concluded that the pigment-containing neutrophil count is a simple marker of disease severity in childhood malaria in addition to the parasite count.