Assessment of the implementation of respectful maternity care charter in North Central Nigeria (Federal Capital Territory and Kwara State): study protocol

Respectful Maternity Care (RMC) charter is one of the tools for ensuring quality of care in maternity services. Nigeria is a signatory to RMC charter; therefore, the charter is expected to be the standard of care. However, in Nigeria and other countries, reports of disrespectful maternity care abound; this discourages women from accessing facility-birth. Therefore, to improve the quality of care towards increase in uptake, it is expedient to assess the level of implementation of the RMC charter by key stakeholders for sustainability, impact and scale-up of charter-compliant maternity care in Nigeria. The study aims to assess the implementation of RMC charter in North-central Nigeria. The study is a mixed-method, cross-sectional study; the expected participants are key stakeholders in healthcare (Healthcare workers, Healthcare Administrators, Project Managers, Policy makers) in North-Central Nigeria (Federal Capital Territory and Kwara state). A multistage sampling technique would be used to enroll participants from 18 healthcare facilities (Primary, Private, Secondary and Tertiary) in rural and urban areas and Ministries of Health officials at local and state government levels. Expected outcomes: The study is expected to provide information on the current status of knowledge and implementation of the RMC charter in Nigeria. It would also identify the enablers and barriers to the implementation process and provide evidence for effective scale-up of the process in Nigeria. The outcomes will be widely disseminated to healthcare workers, health administrators and decision-makers in healthcare services through post-study meetings, conference presentations, journal publications and policy briefs for effective RMC charter implementation in Nigeria.

Access, perceived quality and uptake of antenatal services in urban communities of Osun state, Southwest Nigeria

Quality antenatal care (ANC) is one of the key interventions to improve intrapartum care uptakes and to reduce the menace of maternal deaths globally. Yet, ANC coverage has remained low in many developing countries like Nigeria. It becomes imperative to contextually understand factors associated with ANC uptake in Nigeria. The study assessed level of utilization, perceived quality, level of satisfaction and determinants of ANC utilization among women of reproductive age-group in Oshogbo, South-west Nigeria. Cross-sectional study design was employed and cluster sampling method was used to recruit 420 consenting respondents. Data were collected using pretested interviewer-administered, semi-structured questionnaire. Both descriptive and inferential statistics were done at p<0.05. The mean (±SD) age of the respondents was 30.84±6.0 years. Almost three-quarters (73.9%) of the respondents had at least 4 ANC visits. Main reasons for non-ANC usage were high cost of care, long waiting time at the clinic, long distance to the clinic and unsatisfactory service quality. Only 59.9% of respondents were satisfied with services received while 63.1% of them rated the service quality as excellent. Main determinants of ANC uptake were respondents' age (AOR=2.35;95%CI=1.34-5.89), level of education (AOR=0.56;95% CI= 0.42-0.71), socio-economic status (AOR=5.22; 95%CI=2.02-6.65) and monthly family income (AOR=0.89; 95%CI=0.02-0.90). Although the rate of ANC use was high in the study setting, the proportion of women who were satisfied with service quality was sub-optimal. There is need for implementation of multi-pronged intervention to make ANC services more available, accessible, affordable and acceptable to the Nigerian women

Socio-economic drivers and effects of contraceptive usage on breast cancer among women in Nigeria

Certain types of contraceptives might have adverse effects on women's health including the possibility of causing breast cancer (BC). Furthermore, the types of contraceptives used might depend on the socioeconomic status of women. The triangular linkage of socioeconomic factors, contraceptives, and some factors causing BC among women are scarce in the literature, especially in developing countries. Consequently, the objectives of the study are to investigate the socio-economic drivers of BC and assess effects of contraceptive on BC among women in Nigeria. Cross-sectional data were collected on a one-off participant at a particular point in time using questionnaires on 200 women with confirmed cases of BC in Southwest, Nigeria, on a continuous visitation to the hospitals over six months. Structural equation modeling (SEM) with strong evidence from path analysis was adopted to achieve the objectives. Exploratory factors analysis was adopted to identify the socio-economic factors. The study analysed certain socioeconomic pre-determinants of BC through the use of contraceptives among women in Southwest Nigeria. The study provided evidence that some tested socioeconomic factors influence women in the use of contraceptive implants (C2) and oral contraceptives (C3), at a 1% level of significance. While about 76.8% of variations in socio-economic factors cause women to adopt a contraceptive implant, 81.1% of socioeconomic factors cause women to adopt oral contraceptives. Again, the result further provided evidence that socioeconomic factors (CCT) are strong determinants of BC at a 1% level of significance. Given the women-specific peculiarities, implanted contraceptives and oral contraceptives should be carefully administered by medical scientists.

Prevalence of oral mucosal lesions and oral health related quality of life among adolescents in a rural Nigerian population

Background: Oral mucosal lesions affect people of all age groups, and vary in presentation; from asymptomatic to severely debilitating. Studies reporting the prevalence and effects of these lesions in adolescents are generally few compared to those describing the demography of dental caries and other oral diseases. Objective: To determine the prevalence of oral mucosal lesions, factors that contribute to the prevalence, and the association with the oral-health related quality of life (OHRQoL) of adolescents in the population. Methods: A cross-sectional survey was done on 240 secondary school students aged 10-19 from three secondary schools selected using multi-stage cluster random sampling. A pre-designed questionnaire was used to collect demographic information, presence of systemic illness, and oral habits. Oral-health related quality of life was assessed using the oral-health impact profile (OHIP-14), and intraoral examination was performed within the school premises by a single trained investigator. Results: A total of 33 participants (13.7%) had oral mucosal lesions. Overall, commissural lip pits (5.0%) were the most prevalent, while geographic tongue and irritation fibroma (0.4% each) were the least prevalent lesions. The mean OHIP-14 score of the participants in this study was 7.17+8.64. Participants with systemic diseases and cheek biting habits had statistically significant worse scores than those without either. Conclusion: The most prevalent oral mucosal lesions in the adolescent age group are those of developmental origin. Quality of life was negatively impacted by the presence of systemic diseases as well as cheek biting habit.

Evaluation of prescription pattern of analgesic use among ambulatory elderly in South-Western Nigeria

Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria.Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05.Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents' occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001)Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority

Knowledge of blood donation among adults in north-central Nigeria

Background: About half of the population in Nigeria is medically fit for blood donation but only four in one thousand are voluntary donors. The low level of blood donation has been attributed to poor knowledge, misconceptions, myths, bias, poverty, fear, malnutrition among the population. Therefore, this study assessed the knowledge of blood donation among adults in two selected North Central States of Nigeria. Methods: It was a descriptive cross-sectional study. A total of 3104 respondents comprising of adults between 18 and 60 years were involved in the study. A multistage sampling technique was used and the research tool was interviewer-administered questionnaire. The data generated were entered into the computer and subjected to appropriate statistical analysis using EPI INFO computer software package (version 3.5.3). Pearson Chi Square (χ2) was used to test statistical significance and p-value was set at < 0.05. Results: Majority of the respondents 2565 (82.5%) knew that blood donation save lives. More than three-quarters, 2468 (79.5%), knew where to go for voluntary blood donation. About one-third, (37.1%), demonstrated good knowledge of voluntary blood donation. Older respondents (>60 years) had poor knowledge of blood transfusion compared with younger age groups (p<0.001). Respondents' occupation and educational status were significantly associated with knowledge of blood transfusion (p<0.001). Conclusion: Periodic awareness programme on voluntary blood donation in rural and urban areas across Nigeria is needed. In addition, sensitization of the informal sector on the significance of non-remunerated voluntary blood donation should be given priority

Attention deficit hyperactivity disorder in Ilorin: screening with the conner's teachers' rating scale

Background: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) or its risk in North Central Nigeria has not been adequately reported. The consequences of missing the disorder and its co-morbidities are usually costly to the society. Method: Using a multi-stage sampling technique, nine primary schools from where a total of 1,480 pupils were selected across the three local government areas within Ilorin metropolis (two public and one private school from each LGA) we selected. An ADHD assessment tool - the short version of Conner's Teacher Rating Scale was administered on the pupils through their respective class teachers after training the teachers on how to administer the tool. They were classified into Inattention ADHD and Hyperactive/impulsive ADHD. Results: Of the 1480 (741 males and 739 female) pupils recruited, public schools contributed 1033 (69.8%) pupils while 447(30.2%) were from the private schools. A prevalence of 15.8% was found for ADHD risk. Statistically significant differences were present in the male to the female distribution of the Inattention ADHD, Hyperactivity ADHD (each with p< 0.05) but not in the overall ADHD index(p> 0.05). The ADHD Index was higher in the public schools. Conclusion: Prevalence of primary pupils aged 6-12 years in Ilorin at risk of ADHD is 15.8%, no significant gender variation was found. It is hereby recommended that Pre-primary school entry screening for ADHD should be instituted considered to enhance early recognition and prompt intervention so as to save the country from bad childhood that develops into bad adulthood with its myriads of anti-social and behavioural consequences

A Survey of Plants used in Treatment of Hypertension and Diabetes Mellitus in Ilorin, Kwara State, Nigeria

Background: Hypertension and Diabetes mellitus have emerged as the leading non-communicable disease worldwide, thus, the increasing need to continuously explore more and better ways of treating these diseases.Objectives: To carry out a survey of plants used in the treatment of hypertension and Diabetes mellitus in Ilorin, Kwara State, Nigeria. Materials and methods: Interview was conducted among respondents using semi-structured questionnaires and asking open-ended questions. Descriptive statistics were used for data analysis.Result: A total of 30 respondents comprising of 60.0% male and 40.0% female with the highest distribution of age range at above 50 years old (50.0%) was reported. Forty (40) medicinal plant species belonging to thirty-one (31) plant families were cited with the Apocynaceae family having the highest number of medicinal plants, followed by Asteraceae. For hypertension, 32 plant species were reported of which the most cited were Allium sativum (4) and Ficus asperifolia (2) while for Diabetes mellitus, 20 plant species were mentioned, of which the most cited were Hunteria umbellata (10) and Vernonia amygdalina (9). Of particular interest in this study were the plants that appeared for both hypertension and Diabetes treatment.Conclusion: This survey has helped to increase available medicinal plants knowledge and documentation in the management of hypertension and Diabetes. However, further work on the pharmacological activity of these plants as well as formulation in proper dosage form is recommended

Medicine use among HIV/AIDS Patients in public hospitals, Kwara State

Background: The prognosis of HIV/AIDS and HIV-related comorbidities has been revolutionized by the use of medicines. However, World Health Organization reported that 50% of patients do not use their medicines as prescribed.Objective: To assess HIV/AIDS patients' knowledge of the use of medicines dispensed to them.Method: This study was conducted in seven public hospitals in six local government areas, Kwara State. Exit interviews of 780 eligible HIV/AIDS patients were conducted through use of structured questionnaire. Additionally, there were exit observational checks of medicines dispensed to these patients. Descriptive statistics and Fisher Exact test were used for data analyses.Results: Of the 780 study participants, 36.1% had no formal education, 99.9% knew the 'quantity' of medicines to be administered, while 99.2% knew the frequency of administration. All the patients knew the route of administration, 96.7% and 94.3% knew the general precautions to avoid concomitant use of dispensed medicines with alcohol or herbal products respectively, while 93.7% of those who received co-trimoxazole knew of the precaution to use "plenty of water" as the vehicle for its administration. There were no significant associations between the patients' knowledge of these precautions and duration of antiretroviral therapy (P>0.05). However, the patients lacked knowledge of specific precautions of some dispensed medicines.Conclusion: Most of the patients knew of the administration and the general precautions of dispensed medicines. However, lack of knowledge of specific precautions of some dispensed medicines calls for intervention

Effect of Hepatitis B Virus Co-Infection on CD4 Cell Count and Liver Function of HIV Infected Patients

Background: Human immunodeficiency virus (HIV)and Hepatitis B virus (HBV) share similar routes of transmission; making it possible for an individual to have a co-infection. HBV infection is well known to be a major cause of chronic liver diseases worldwide. The aim of this study was to determine the prevalence of HBV infection among HIV infected HAART naive patients and investigate the effect of co-infection on CD4 count and liver function. Study design: This was a hospital based descriptive cross sectional study of one hundred consecutive therapy-naive HIV-infected individuals. The CD4 count; Hepatitis B surface antigen; Serum albumin; total Protein; and liver enzymes were determined using standard techniques. Results:The prevalence of HIV and HBV co-infection was 37. The mean serum ALT and ALP were significantly higher in the co- infected patients (Pvalues 0.05). The mean CD4 count of the mono infected patients was significantly higher (p-value of 0.014). The mean serum ALT; AST and ALP of mono and co-infected patients with CD4 count200/?l were significantly higher than those with count ? 200 cells/?l. (p-value of 0.01). The mean ALT and AST of the co -infected patients and all patients with CD4 count 200 cells/?l were higher than the normal reference range. Conclusion : Approximately one third of HIV positive patients had hepatitis B virus co-infection. Coinfection and CD4 count 200 cells/?l are likely to result in abnormal ALT and AST. We recommend that co-infected patients and those with CD4 count 200 cells/?l should be given non-hepatotoxic antiretroviral drug

Knowledge; Attitudes and Perceptions of Epilepsy among Secondary School Teachers in Osogbo South-West Nigeria: A Community Based Study

Background: The attitudes toward people with epilepsy are influenced by the degree of knowledge of the condition. The social problems encountered by school children with epilepsy as a result of negative attitude and beliefs are quite enormous. Objectives The study therefore looked at the knowledge; attitudes; and perceptions of teachers; who see a lot of epileptics; relate to them on a daily basis and have influence on them. Materials and Methods: A cross-sectional survey; using a self-administered questionnaire obtained from the author of a similar study in the United States; was carried out among 269 school teachers randomly selected from various secondary schools in Osogbo; the Osun State capital in South-West Nigeria. The questionnaire included the scale of attitudes toward persons with epilepsy and knowledge about epilepsy as well as demographic and teaching experience survey among others. Results Despite the high level of education of the teachers ranging from Masters Degree to National Certificate in Education; there were significant deficits in terms of general knowledge about epilepsy (70 of the respondents reported their general knowledge about epilepsy in the lower half of the scale). There was also poor knowledge of the first aids measures in the classrooms. Below one-third (29.2) felt it was contagious and 40 of respondents reported that sufferers should not be kept in regular classes. However; their attitudes toward epilepsy were generally positive. Conclusions and Recommendations: We concluded that teachers need to have health education courses on common disease conditions such as epilepsy that are prevalent in school age; this might help to reduce the prejudice and increase the acceptance of epileptic individuals in the classrooms. Also; generally public health campaigns should be encouraged in this field

Behavioral Pattern of Menopausal Nigeria Women

Context : Menopause is one area that has been shrouded in myths and taboos and the way women perceive menopause depends largely on the social belief about menopause in their society. Objective : The aims of this study are to assess how women perceived the physical changes during menopause; what the social as well as the individual adjustment practice to menopausal changes might be. Materials and Methods : Qualitative focal group study among women aged 40 years and above where eight to ten volunteers formed a group. Six sessions were held for different focal group; each lasting 1-2 h. A tape recorder and a notepad were used to record the discussions. Opinions of the women were sought on socio-cultural differences in the perception of aging; perception of menstruation; perceived causes and consequences of menopause; sexual intercourse after menopause; social support networks for menopausal women; and types of care and treatment for women in menopause. Results: The participants in the FGDs used various phrases to describe menopause in local term; while some of the participants attributed disease to be a cause of menopause; others believed that it be could be caused by witchcraft or sorcery. However; younger and old women whose menstrual flow stops prematurely seek assistance; often from traditional or spiritual healers. Conclusion: This study reveals the poor menopausal knowledge among the study group with more than half of the respondents having negative attitude towards menopause in addition to mixed feelings about religious obligation and cohabitation

Psychological and Social Adjustment to Blindness: Understanding from two groups of Blind People in Ilorin; Nigeria

Background: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often personalized and depends on nature and quality of prevailing psychosocial support and rehabilitation opportunities. This study was aimed at identifying the pattern of psychosocial adjustment in a group of relatively secluded and under-reached totally blind people in Ilorin; thus sensitizing eye doctors to psychosocial morbidity and care in the blind. Materials and Methods: A cross-sectional descriptive study using 20-item Self-Reporting Questionnaire (SRQ) and a pro forma designed by the authors to assess the psychosocial problems and risk factors in some blind people in Ilorin metropolis. Result: The study revealed that most of the blind people were reasonably adjusted in key areas of social interaction; marriage; and family. Majority were considered to be poorly adjusted in the areas of education; vocational training; employment; and mobility. Many were also considered to be psychologically maladjusted based on the high rate of probable sychological disorder of 51; as determined by SRQ. Factors identified as risk factors of probable psychological disorder were poor educational background and the presence of another medical disorder. Conclusion: Most of the blind had no access to formal education or rehabilitation system; which may have contributed to their maladjustment in the domains identified. Although their prevailing psychosocial situation would have been better prevented yet; real opportunity still exists to help this group of people in the area of social and physical rehabilitation; meeting medical needs; preventive psychiatry; preventive ophthalmology; and community health. This will require the joint efforts of medical community; government and nongovernment organizations to provide the framework for delivery of these services directly to the communities

Determinants of referral practices of clients by traditional birth attendants in Ilorin, Nigeria

A sizeable number of deliveries still take place with the assistance of Traditional Birth Attendants in Nigeria. This study aims to determine the factors that determine the referral practices of the TBAs in Ilorin of high risk and complicated pregnancies. This descriptive study was conducted among all the 162 registered TBAs in Ilorin that were traceable using pre-tested semi-structured interviewer-administered questionnaire. About 90%, whose source of skill acquisition was by inheritance did not refer their clients appropriately compared with 48% of those whose source of skill acquisition was through formal training (p<0.05). The more the numbers of trainings, the more appropriate the referral (p<0.05). Having supervisory visit by qualified personnel is associated with appropriate referral practices (p<0.05). Regular training and re-training of TBAs with routine monitoring and supportive supervision will promote prompt referral of high risk and complicated pregnancies and deliveries (Afr. J. Reprod. Health 2010; 14[2]:77-84)

Prevalence of Schistosoma haematobium Infection in a Neglected Community, South Western Nigeria

Purpose: Schistosomiasis ranks second to malaria among parasitic diseases of socio-economic and public health importance. In Nigeria; urinary schistosomiasis caused by Schistosoma haematobium is endemic. This study aimed at producing an accurate data on the prevalence of urinary schistosomiasis in Apojula; a neglected community located around Oyan Dam; southwest Nigeria; using parasitological and molecular techniques. Methods: Parasitological examinations were carried out on urine samples from 63 participants whose ages ranged between 7 and 63 years. Matched blood and urine samples were also screened for S. hematobium infection by polymerase chain reaction (PCR) amplification of the schistosome Dra1 repeat. Results: of the 63 participants; 33 (52.4) were positive for heamaturia while 6 (9.5) had S. haematobium ova in their urine. PCR amplification of S. haematobium Dra1 repeat from their urine and blood samples showed that 59 (93.65) and 62 (98.4) were infected respectively. Conclusion: There was a high prevalence of S. haematobium infection as detected by PCR amplification of schistosome Dra1 repeat from the urine and blood samples of the study participants. In addition; the PCR was able to detect schistosome infection in cases otherwise shown to be negative by parasitological examinations thereby making them also to receive chemotherapy

Family communication on HIV/AIDS among secondary school students in a northern state of Nigeria

Most Adolescents in Nigeria; like many others in Africa; are potentially at risk for contracting HIV through unprotected sexual intercourse. Yet the issue of how to help youth avoid risky sexual behaviour through family communication / education on HIV/AIDS is still of serious arguments within the society. This study examines the practice of family communication on HIV / AIDS among secondary school students. A descriptive study using 420 secondary school students selected by multi-stage random sampling was done. Self administered semi-structured questionnaire was used to collect relevant data. Only 48 (12.1) reported family as the first source of information. However; most of the students 315 (79.7) had family communication on HIV/AIDS with their family members. There is a gender difference in practice of family communication. Significantly higher proportion of the female students had family communication more than their male counterparts. The educational status of the parents significantly determined whether or not a student had family communication on HIV/AIDS. There is considerable level of family communication in the study population which should be encouraged further to cut across all members of the family

Glycaemic Response to Different Preparations of Yam in Diabetic and Non-Diabetic Nigerians

Post-pandial glycaemic responses to food can be affected by the method involved in the preparation of the food. Dietary intervention with food modification forms the corner- stone of management of type 2 diabetes worldwide. The effect of processing on yam; a staple food in Nigeria; was studied among diabetic and non-diabetic Nigerians. Despite undergoing more processing; amala prepared from yam flour had a better post-pandial glycaemic response index (PGRI) compared to other yam preparations; and this was also significantly higher among the diabetic subjects. Yam-based products; particularly amala; should be encouraged among diabetic Nigerians

Effects of dietary protein quality and quantity on albino rat tissue serum protein ; erythrote fragility and bone mineral content

The study was to ascertain the effect of quality and quantity of dietary protein on body growth; organ cellular and cytoplasmic size; serum protein concentration and molecular weights; erythrocyte fragility and bone mineralisation. Diets containing 20; 17 and 15protein were fed to Sprague Dawley Albino rats weighing about 90g for 21 days. The 20protein diet was a commercial diet better in nutrient composition and quality than the diet containing 17 and 15protein formulated in our laboratory. At the end of 21 days; kidney; testes; brain; pancreas; spleen and long bones ere taken for analysis. Results showed that the diet containing 20protein supported higher body weight; liver and testes cell size (Protein/DNA and weight/DNA ratios) and cytoplasmic size (RNA/DNA ratio). The pancreas cell size; heart; brain; pancreas and spleen cytoplasmic size were not changed by dietary protein level. Plasma protein concentration and the molecular weights; percent bone cash and percent calcium in it were the same at the three levels of dietary protein. TCA soluble plasma amino acid concentration was higher at 20dietary protein. Erythrocyte fragility was higher but erythrocyte ghost protein was lower at dietary protein below 20