Calcium and phosphate levels in Nigerian children with malaria

Calcium and phosphate levels were investigated in 39 children with malaria (six severe and 33 uncomplicated) and in 39 healthy children. Hypocalcaemia (calcium <2.13 mmol/L, adjusted for albumin level) was detected in 23.1% of malaria cases and in 5.1% of controls, and hypophosphataemia (<1 mmol/L) in 38.5% of cases and in 15.4% of controls. Mean (SD) calcium levels in cases [2.26 (0/15)] were similar to those in controls [2.24 (0.12)]. In Nigerian children, hypocalcaemia and hypophosphataemia are associated with malaria.

Complexity of the msp2 locus and the severity of childhood malaria, in south-western Nigeria

As the genetic diversity of Plasmodium falciparum infections in humans is implicated in the pathogenesis of malaria, the association between P. falciparum diversity at the merozoite surface protein-2 (msp2) locus and the severity of childhood malaria was investigated in Ibadan, in south-western Nigeria. The 400 children enrolled had acute uncomplicated malaria (144), cerebral malaria (64), severe malarial anaemia (67) or asymptomatic infections with P. falciparum (125). Nested PCR was used to investigate the msp2 genotype(s) of the parasites infecting each child. In terms of the complexity of infection and frequency of polyinfection, the children with asymptomatic infection were significantly different from those with uncomplicated malaria or severe malaria. The median number of FC27 alleles detected was higher in the asymptomatic children than in the symptomatic. After controlling for age and level of parasitaemia (with 'asymptomatic infection' as the reference category), a child in whom no FC27 alleles were detected was found to be at five-fold greater risk of uncomplicated malaria, and a child without polyinfection was found to have a three-fold increased risk of severe malarial anaemia and a six-fold increased risk of cerebral malaria. It therefore appears that msp2 genotypes are associated with asymptomatic carriage and that children with mono-infections are more likely to develop severe malaria than children with polyinfection.

Bioethics in the medical curriculum in Africa

Many new innovations and advances are introduced into life and the sciences at a pace faster than any single individual can keep up with but human beings adjust to these changes at a much slower pace. Development is at snail speed in many developing countries and supersonic in the developed world and yet these have to interrelate. The introduction of medical technology and advances into developing countries is sometimes done haphazardly and often without prior appropriate education and decision making process. This has the potential to create dilemmas among stakeholders and engender conflicts with culture, religion and societal norms. A good grounding in the study of bioethical principles and theories is relevant to addressing current and evolving issues with changing biotechnology and shifting landmarks in today's highly technical clinical medicine. The knowledge and utilization of these principles should limit the occurrence of many scandals in the form and magnitude already recorded in the history of biomedical research and practice. While the debate as to whether ethics can be taught will continue, bioethics education provides the requisite knowledge and skill that are applicable at the bedside and in biomedical research. Some evidence has shown that formal teaching of ethics impacts positively on physicians and medical students' attitudes in the care of patients. In this paper we propose that bioethics as a distinct course should be incorporated into medical curriculum in Africa. The integration of bioethics as a required subject in the medical curriculum would have a positive impact on all aspects of health care and research. Real or assumed obstacles are not justifiable reasons for further delay in implementing this initiative

Seroconversion of children following natural measles infection and vaccination

OBJECTIVE

To evaluate the relationship between measles virus (MV) antibodies (abs) in sera and breast milk of nursing mothers, their contributions in seroconversion of children (0-9 months) post vaccination, prevalence of prevaccination measles abs in sera of children brought for measles vaccination and seroconversion rate in vaccinees from nursing and lactating mothers. Also to determine the potency of vaccines available in Nigeria in relation to seroconversion.

METHODS

One hundred and twenty pre- and post-vaccination sera and breast milk samples were collected from each nursing mother while corresponding number of finger prick pre- and post-vaccination sera samples were collected from children on filter papers. These were tested for mv abs using serological techniques.

RESULTS

Eighty (20.0%) mothers had measles haemagglutination inhibition (HI) abs in sera and 88 (27.2%) had mv HI abs in breast milk. Eight (2.0%) children who had prevaccination mv abs in sera came from mv ab negative mothers. Forty-four (37.0%) came back for post vaccination sera, sero-converted while 76 (63.3%) gave low sero-conversion rate of 37.0%. Results showed that mv abs in sera or breast milk of mothers did not interfere with mv vaccination in children. The low sero-conversion rate obtained was due to low vaccine potency with titres ranging between (log10-10 - log10-2.5)TCID/per dose, besides non-specific antiviral substances exhibited virus neutralizing activity.

CONCLUSION

Poor sero-conversion due to loss of passive immunity arose from undernourishment while low ab titres came with natural infection. This suggested mv vaccination did not immunize following natural mv infection or any other previous immune status.

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.

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.

Vitamin A status and nutritional intake of carotenoids of preschool children in Ijaye Orile community in Nigeria

This study was carried out to determine the vitamin A status and nutritional intake of carotenoids of 213 children between the ages of 6 months and 6 years in a rural community in Nigeria. There were 109 males and 104 females. A total of 57 (26.8 per cent) children were deficient in serum retinol levels (< 10 microg/dl) while 102 (47.9 per cent) had low levels (10-19 microg/dl). The highest prevalence of serum retinol deficiency was in the 6-12 months age group, most of whom were breastfeeding and there was poor correlation between duration of breastfeeding and serum retinol levels. The prevalence of night-blindness was 1.5 per cent; however, none of the children had xerophthalmia. Chronically malnourished children had lower mean serum retinol levels than well nourished children. There was a high consumption of carotenoid-containing food, but despite this there was a high prevalence of vitamin A deficiency. We therefore suggest that measures to combat vitamin A deficiency should include vitamin A supplementation on a short-term basis. On a long-term basis parents should be educated on the importance of the consumption of locally available sources of provitamin A and pre-formed vitamin A rich foods, and the avoidance of overcooking. Parents should also be encouraged to grow more beta-carotene containing foods.

The feasibility of implementing a dietary sodium reduction intervention among free-living normotensive individuals in south west Nigeria

High sodium intake is associated with high levels of blood pressure, both among and within populations. However, there have been few intervention studies from Africa reporting blood pressure changes with dietary reduction of sodium. In this study, we tested the feasibility of achieving a reduction in dietary sodium intake in free-living individuals using a dietary intervention among 82 free-living normotensive adults in southwest Nigeria. The participants, 49 men (mean age 47.2 years) and 33 women (mean age 43.6 years), received dietary advice to reduce sodium intake and maintained the reduced sodium diet for a 2-week period. Blood pressure and 24-hour urinary excretion of sodium were measured at baseline and after two weeks on the reduced sodium diet. Baseline 24-hour urinary sodium excretion was 140.5 (SD 53.4) mmol/24 hours among men and 132.6 (SD 48.0) mmol/24 hours among women. Twenty-four hour urinary sodium excretion fell by 76.9 (95% Cl 59.7, 94.1) mmol/24 hours among men, and by 79.4 (95% Cl 59.4, 99.1) mmol/24 hours among women. On the low sodium diet, systolic blood pressure fell by 4.7 (95% CI 1.9, 7.4) mm Hg among men, and by 7.0 (95% CI 2.6, 11.4) mm Hg among women while diastolic blood pressure fell by 1.9 (95% CI -0.3, 4.1) mm Hg among men and by 1.6 (95% CI -1.8, 5.0) mm Hg among women. It is concluded that a significant reduction in sodium intake may be achievable in free-living individuals in this setting using a simple dietary intervention. The findings of this pilot study should encourage more sophisticated intervention studies (such as cross-over trials and double blind randomized clinical trials) in Africans for the elucidation of mechanisms and consequences of hypertension in Blacks.

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.

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.

The nutrient content and effectiveness of rice flour and maize flour based oral rehydration solutions

The effectiveness of rice flour and maize flour based oral rehydration solution (ORS) in treating mild and moderate dehydration was studied among 88 children aged to 6 to 42 months at the Oni Memorial Children Hospital, Ibadan. In this randomized clinical trial, fifty children were treated with rice-based ORS while fifty-three received the maize-based ORS, over a four hour period. There was clinical improvement in the signs of dehydration with a significant increase in body weights and a significant fall in the packed cell volume following the administration of the two preparations. The maize-ORS contains 4.3 g protein, 179.3 Kilocalories and rice-ORS contains 3.6 g protein and 152.1 Kilocalories per litre of the preparation, respectively. It is concluded that rice and maize based ORS were acceptable and effective in oral rehydration of diarrhoea patients. They may also contribute to the nutrient intake of patients with (mild to moderate) 'some' dehydration. However other sources of energy, protein and mineral intake should be continued in these patients.

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.

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.

Major congenital malformations among neonatal referrals to a Nigerian university hospital

Major congenital malformations are unrecognised as a major cause of neonatal morbidity in many African countries. We have studied the contribution of major congenital malformations to morbidity among neonates referred to the University College Hospital, Ibadan, Nigeria over a four year period (1992-1995). Major congenital malformations were found in 11.1% of 1276 neonatal referrals and ranked fourth among the most common problems in such neonates (after sepsis, jaundice and tetanus but ahead of prematurity and perinatal asphyxia). The commonest malformations seen included spina bifida (22.5%), anorectal malformation (13.4%), omphalocoele (9.9%) and tracheo-oesophageal fistula (8.5%). Neonates with major congenital malformations presented significantly earlier than other neonates but mortality during the first admission was similar in the two groups. It is concluded that major congenital malformations pose a significant burden of morbidity in referred neonates to the hospital. Health services planners should take this into account in order to allocate the necessary resources for the diagnosis and management of such children.

Isolation of Nigerian strains of measles virus

We have recently succeeded in isolating two measles viruses, Ibn H13153 and Ibn H13154 from the peripheral lymphocytes of two unvaccinated 9 and 12 month old outpatient children at the Institute of Child Health, University College Hospital Ibadan, Nigeria. The viruses have undergone six serial passages in B95a and Vero cell lines where characteristic measles cytopathic effects (CPE) have been noticed. The viruses have been confirmed to be measles by Haemagglutination Inhibition (HI) test and the Indirect Immunofluorescent antibody Test (IFT). Both isolates agglutinated 0.75% monkey rbc. The HA titres were 1:40 and 1:80 respectively. Antigens from the known positive Edmonston strain and uninoculated Vero cell line gave an HA titre of 1:160 and 1:0 respectively. Further characterisation with respect to the polypeptide and DNA components is under way.

Height and weight measurements of Ibadan school children

Height and weight measurements were carried out on three groups of Nigerian primary school children aged 6-12 years, in and around Ibadan. A total of 1,192 children was examined from three social classes as follows: (1) the educated elite group (n = 444); (2) the urban low socio-economic group (n = 366), and (3) the rural village group (n = 382). The school children from the educated elite group had the highest mean height and weight values while the school children from the rural group had the lowest values and the urban low socio-economic came in between the two. In the children of the educated elite class, mean heights and weights were higher than those of the international reference population (though not significantly so) only at ages 6-9 years. Malnutrition as indicated by wasting and stunting was prevalent among both rural and urban low socio-economic school children. The prevalence of wasting was 75.9% among the rural school children, while it was 62.5% among the urban low socio-economic children. The prevalence of stunting was 79.1% among the rural school children, while it was 62.9% among the urban low socio-economic school children. Neither stunting nor wasting was observed among the children of the elite educated group. This study has demonstrated that there has been no change with time in the pattern of differences of height and weight with respect to school children of various social classes.

Field trial of combined yellow fever and measles vaccines among children in Nigeria

The compared tolerance and immunogenecity of yellow fever and measles vaccines administered separately or combined were evaluated in Nigerian children aged between six to eight and nine to twelve months. The vaccines were well tolerated by both age groups of children, however pyrexia which responded to analgesic was the commonest post vaccination reaction in all the groups of the vaccinated children. Immune response to the vaccines either when given separately or combined was excellent in all the vaccinated groups. Antibody titre and seroconversion rate were always higher in the group that received the combined vaccines together. Our results confirmed that combined yellow fever and measles vaccines are safe for children aged between six to twelve months and we therefore recommend that yellow fever be incorporated into the EPI programme and be given together with measles at the age of nine months.

Observations on handwashing practices of mothers and environmental conditions in Ona-Ara Local Government Area of Oyo State, Nigeria

During baseline survey before developing an educational intervention programme for modifying behaviours toward improved home management of diarrhoea, handwashing practices and environmental conditions of 549 mothers and health care-providers of 638 children aged less than 5 years in Ona-Ara Local Government Area (LGA) were observed. The aims of the study were to describe the patterns of maternal handwashing behaviour in relation to disposal of faeces and feeding of children, and to describe environmental conditions of the households. Handwashing behaviours after cleaning a child who has just defecated and after disposal of faeces were observed in 29.3% episodes, while handwashing before feeding the child occurred in 12.4% of observations. Handwashing in relation to these events occurred more frequently in periurban than in rural villages (p < 0.001). These differences may be due to higher education of the periurban women compared to their rural counterparts. Handwashing was apparently not associated with distance from the water source or with the age groups of the children. Environmental observation revealed the presence of uncovered food (13%), human faeces (17%), animal dung (71%), animals (82%), and unprotected pit latrines (11%) in and around the house. There were significant rural-periurban differences in environmental conditions of the rural and periurban areas. It is recommended that the characteristics of areas selected for intervention be considered and important sub-group differences be identified before planning and implementing of such interventions.

Comparison of the genome ds RNA of human rotavirus strains shed in parts of Ibadan, Nigeria

The incidence and genome electropherotypes of human rotavirus detected in a hospital and in a community within Ibadan, Nigeria were compared by polyacrylamide gel electrophoresis. On the whole, 13% (31/239) rotavirus was detected; 14.7% (15/102) from the community and 11.7% (16/137) from the hospital. The incidence was significantly higher (P < 0.01) in the community than in the hospital. There were 11 (80.0%) long and 3 (20.0%) short forms observed in the community, whereas 14 (87.5%) long and 2 (12.5%) short froms were detected in the hospital. On co-electrophoresis, however, only 4 and 6 distinct electropherotypes were demonstrated in the hospital and the community respectively. Three of these were common to both places with 1 and 3 electropherotypes being unique to the hospital and the community, respectively.

Perception of sickle cell haemoglobinopathy among 'would-be' counsellors

Fifty-six paramedical personnel in training as Community Health Officers (CHO) and Nurse Tutors were interviewed by a self administered questionnaire as to personal information and what they know and believed about sickle cell haemoglobinopathy. Even after the normal course of lectures on the haemoglobinopathies as given for their training as CHO's, many of them still did not fully understand the topic as shown by mixed up and confusing answers given to questions. As a result of the maturity and exposure as community health workers, they are being proposed for retraining as counsellors with regards to the haemoglobinopathies. From our findings to this study it appears that using a formal lecture schedule would not be adequate in intimating this group with the problems they would likely encounter as CHO's in practice. A training programme should also include organised group discussions designed to detect biases and prejudices and correct them before certification as community health officers.

Anterior fontanelle size in Nigerian children

Anterior fontanelle (AF) dimensions were studied in 337 normal and apparently healthy Nigerian infants aged from 1 week to 12 months in Ibadan, Nigeria. Mean anterior fontanelle size fell from 3.4 cm in neonates to 2.5 cm at 4-6 months and to 0.8 cm at 10-12 months. The anterior fontanelle was closed in 11% of 4-6-month-olds and 53% of 10-12-month-olds. The mean AF size in neonates was larger than published figures from Caucasian and Chinese populations, but at 12 months mean AF size in Nigerian infants was smaller than published Caucasian and Chinese figures. The quartiles of the distribution of the AF size are also presented. It is concluded that there may be important racial differences in AF sizes and closure and closure frequencies in the 1st year of life and that appropriate local references should be used when attempting to classify a given AF size as normal or abnormal.

Major congenital malformations among paediatric admissions at University College Hospital, Ibadan, Nigeria

The pattern of major congenital malformations seen at University College Hospital, Ibadan, Nigeria among admitted children over a period of 5 years is reported. Their ages at presentation ranged from a few hours to 13 years, and the majority (72.7%) presented in infancy. The male:female ratio was 1.6:1. Cardiovascular, central nervous and gastro-intestinal malformations accounted for 71.6% of all malformations. The commonest individual system malformations were congenital heart lesions, spina bifida, anorectal malformation and omphalocoele, while the highest case fatality rates were recorded in cases of oesophageal atresia, hydrocephalus, biliary atresia and posterior urethral valve. Overall mortality was 19.4%. The importance of both longitudinal and cross-sectional studies of congenital malformations in developing countries, while infectious diseases and malnutrition are being controlled, is emphasized.

Viral agents associated with infantile gastroenteritis in Nigeria: relative prevalence of adenovirus serotypes 40 and 41, astrovirus, and rotavirus serotypes 1 to 4

Sixty-six stool specimens from infants with diarrhoea in Nigeria were examined for the presence of viral pathogens. Rotaviruses were found in 25.8% of specimens and astroviruses in 1.5%. Serotypes were determined for 47.1% of the rotavirus positive specimens, all of which were serotype 1. RNA analysis revealed no unusual electrophoretic profiles. No enteric adenoviruses were detected. In contrast, in a parallel study conducted in the UK, rotaviruses (including serotypes 1, 2 and 4) accounted for 21.9% of infections, adenovirus serotypes 40 and 41 13.6%, and astroviruses 4.5%.

Facial measurements in the newborn (towards syndrome delineation)

Inner and outer canthal distances, palpebral fissure length, occipitofrontal circumference, and canthal index values were determined and compared between 252 white newborns in Cardiff and 256 black newborns in Ibadan, Nigeria. The study showed that the white and black newborns had the same inner canthal distance while the outer canthal distance and palpebral fissure length were significantly smaller in the white newborns than in their black counterparts. A simple instrument was also constructed and advocated for use. It is concluded that for facial measurements local values should be used in the evaluation of dysmorphic states.