Splenic enlargement and abdominal scarifications in childhood malaria: beliefs, practices and their possible roles in management as seen in Benin City, Nigeria.

AIMS AND OBJECTIVES: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. To evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control. This was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaires in a cross-sectional and descriptive study. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26-30 years. (Range, 18 - 56 years) Respondents were mainly Binis, Esan, and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood", 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (chi(2) = 40.0, p< 0.005), women over 40 years of age (chi(2) = 13.5, p < 0.05) and Esan/Bini ethnic groups (chi(2) = 15.6, p < 0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%; neighbours, 25.1%; and friends/colleagues, 16.7%. CONCLUSION: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.

Splenic enlargement and abdominal scarification in childhood malaria. Beliefs, practices and their possible roles in management in Benin City, Nigeria.

BACKGROUND: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. AIMS AND OBJECTIVES: This was a cross-sectional and descriptive study to evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control; It was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaire. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26 - 30 years (Range, 18 - 56 years) Respondents were mainly Binis Esan and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood" 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (X2 = 40.0, p<0.005), women over 40 years of age (X2 = 13.5, p< 0.05) and Esan/Bini ethnic groups (X2 = 15.6, p <0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%, neighbours, 25.1%; and friends/colleagues, 16.7% CONCLUSION/RECOMMENDATIONS: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.

Aspects of the epidemiology of intestinal parasitoses (IP) in children: knowledge, practices and perceptions of mothers.

BACKGROUND: Intestinal parasitoses (IP) have been demonstrated to pose a major public health problem in the tropics. It is hypothesized that children are continually exposed to re-infection despite interventions. We conducted this hospital-based study to investigate knowledge, practices and perceptions among mothers of children seen at the hospital. METHOD: The study focused on knowledge, practices and perceptions of mothers concerning intestinal parasitoses in children. Questionnaires, which were interviewer administered, were used to generate qualitative data. Stool samples were collected from the study participants into labelled bottles for examination. RESULTS: Majority of mothers belonging to the lower classes did not have access to good drinking water as demonstrated by 39%, 32% in classes III and II respectively while no mother in class V got water from reliable sources: The low level of knowledge about IP was demonstrated by the claim that it was inevitable with the following 68.9% , 56.5%, 44.0% of mothers in social classes V, IV and III respectively. Infection rates increased with lowering social status. More males than females were infected but the difference was not significant (P> 0.05). Peak infection was among children aged between 3 + and 4 years. CONCLUSION: The low level of knowledge, practices and perceptions of mothers concerning IP is a major cause for worry. Urgent consideration should therefore be given in order to periodically treat infected children, enlighted mothers about mode of transmission of IP and also to improve sanitation in deprived areas so as to reduce the rate of transmission.

Hepatitis B surface antigen and antibody to hepatitis C virus among accident and emergency patients.

OBJECTIVE: To determine the sero-prevalence and epidemiology of antibody to hepatitis C virus (anti-HCV) and hepatitis B surface antigen in accident and emergency patients. DESIGN: A descriptive study was performed on 150 accident and emergency patients. Sera was screened for anti-HCV and HbsAg, using enzyme linked immunosorbent assay. Personal information and risk factors involved were obtained using a questionnaire. SETTING: Haematology laboratory of the University of Benin Teaching Hospital, Nigeria. SUBJECTS: One hundred and fifty adults consisting of 122 males and 28 females who were above the age of 21 years. Patients were randomly selected from all adults including dental patients attending the emergency department for both surgical, dental and medical emergencies. The age range was between 21-58 years. In order to ascertain the epidemiology of both viruses a questionnaire was used detailing the possible risk factors for transmission. These included history of previous blood transfusion; history of life time occurrence of multiple sexually transmitted diseases; history of heterosexual exposure to partners at risk (for example prostitutes); history involving the use of unsterilized blades; presence of scarification marks and tattooing; low socio-economic status (low annual income or unemployed): history of intravenous drug use and heterosexual activity. Anti-HCV and HBsAg were both assayed using different assay kits, based on the enzyme linked immuno absorbent assay (ELISA) tests from different manufacturers. RESULTS: The sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCV positivity was significantly associated with a past history of blood transfusion and heterosexual exposure to partners at risk. The study also revealed a significant association between HBsAg positivity and all the risk factors. CONCLUSION: The high prevalence rate for anti-HCV and HbsAg in accident and emergency patients increases the likelihood of further spread from patients to health care providers especially if adequate precautions are not observed.

Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian children.

Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36 month(s), admitted to the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital, Benin city, Nigeria, during July 1993-June 1996, were reviewed to document the relationship between dehydration and malaria parasitaemia. There was a significant association between severity of dehydration and malaria parasitaemia (p < 0.0001). Association of parasitaemia (p < 0.006) with dehydration (p < 0.0001) was significantly more marked in patients with acute watery diarrhoea than in those with persistent and bloody diarrhoea. Parasitaemia was demonstrated in 50.5% of those not initially suspected to have malaria. Parasitaemia was also significantly associated with fever (p < 0.001) and fever coexisting with vomiting (p < 0.01). The prevalence of malaria-associated diarrhoea was 61.7%. More infants (75.6%) than older children had diarrhoea. It was concluded that the prevalence of malaria-associated diarrhoea was high and that children with dehydration are more likely to manifest malaria parasitaemia.