Sickle cell anaemia: awareness among health professionals and medical students at the Lagos University Teaching Hospital, Lagos.

BACKGROUND: Sickle cell anaemia (SCA) is a chronic haemolytic disorder caused by homozygous inheritance of abnormal haemoglobin called 'haemoglobin S' (HbS). The disease burden is enormous to the patient, family and community. One potential weapon in its prevention is health information and awareness among the populace. OBJECTIVE: The study is to detrmine the awareness of sickle cell anaemia among health professionals and medical students at the Lagos University Teaching Hospital Idiaraba, Lagos. METHODS: Part of a large study which was cross-sectional and descriptive study, carried out at the Lagos University Teaching Hospital (LUTH), between the months of August and September 2006. Data were collected from 403 health professionals and students using structured questionnaires. RESULTS: Majority (98.7%) of the respondents had heard about SCA. Only 211 (55%) of the respondent felt genotype screening should be done at pre-school age. 128 (33.7%) felt it should be done during childhood. Doctors had a statistically significantly better knowledge of best time for detecting genotype. In all, 85% of the respondents had been involved in the management of sickle cell anaemia with the highest proportion among nurses (p = 0.02). Only 93 (24.3%) of the respondents knew most of the complications of sickle cell anaemia, 176 (46.3%) knew some of it, while 111 (29.2%) knew only a law complications. Nurses had a statistically significantly poorer knowledge of the complication of sickle cell anaemia. More nurses felt that engagement should be ended if there was a risk of having a child with sickle cell anaemia. CONCLUSION: Continuing medical education for health professionals about sickle cell anaemia, its management and complication is necessary.

Upgrading obstetric care at a secondary referral hospital, Ogun State, Nigeria. The Lagos PMM Team.

PRELIMINARY STUDIES: A 1991 inventory at the State Hospital, Ota, in Ogun State, Nigeria, showed inadequate surgical equipment, drugs, blood and power supply. A time-motion study indicated substantial delays in receiving obstetric care. INTERVENTIONS: In 1994, medical officers and midwives were given refresher courses in emergency obstetric skills. In 1995, the surgical theater, labor ward and laboratory were provided with the necessary supplies and equipment. A reliable electrical supply was set up, but problems were encountered in establishing blood services. Subsequent community interventions focused on improving access and reducing delay in seeking care. RESULTS: The annual number of women with complications seen, which had been declining--from 123 in 1992 to 55 in 1994--increased to 91 in 1995. Case fatality rate (CFR) due to major direct obstetric complications did not change appreciably, i.e. it was 6.6% in 1995, as compared with 7.3%, 8.3% and 7.3% for the years 1992-1994, respectively. COSTS: The cost of hospital improvements was approximately US $46,000. CONCLUSIONS: The facility improvements were completed only recently in mid-1995. It is hoped that improved services will result in reductions in CFR and motivate more women with complications to seek hospital care, despite difficult economic conditions prevailing in Nigeria.

Environmental and behavioural risk factors for prolonged diarrhoea in Nigerian children.

Prolonged diarrhoea is a particular health concern because it contributes significantly to diarrhoea-related deaths. Studies of risk factors for prolonged or persistent diarrhoea are virtually nonexistent in Africa. In the present study conducted in a semi-urban area of Lagos, we used a case-control design to evaluate the roles of household environment, mothers' food hygiene behaviour, and child-care practices as possible risk factors for prolonged diarrhoea in children 6-36 months old. A total of 628 children were studied. During the 3 1/2 months surveillance period, 166 children became ill with diarrhoea and 20 of the 166 (12.0%) had prolonged episodes (> 7 days). Persistent diarrhoea (> 14 days) accounted for only 2.4% (6 of 251) of all episodes. This analysis of risk factors is focussed on the 20 cases of prolonged diarrhoea and 206 randomly selected controls who experienced no diarrhoea during the surveillance period. A significantly high risk of prolonged diarrhoea was found among children who were given ogi, a maize pap, as the main diet (odds ratio = 4.13). Children who were fed mainly with foods bought from street vendors also had a significantly higher risk (odds ratio = 2.91) of prolonged diarrhoea. No association was found between domestic, environmental, and personal hygiene practices and prolonged diarrhoea. Foods from street vendors may serve as one source of diarrhoeal illnesses in Lagos and such episodes could be prolonged following repeated exposure, especially in children who are fed mainly with a low-energy and low-nutrient-density diet such as ogi.

A quantitative assessment of the Nigerian mothers' ability to prepare salt-sugar solution for the home management of diarrhoea.

This study aimed at assessing qualitatively and quantitatively the ability of Nigerian mothers to prepare salt-sugar solutions (SSS) (according to the Nigerian standard formula) under the usual home environment. Mothers were provided with the ingredients but not with measurement spoons nor containers. 274 mothers randomly selected from a peri-urban community participated in the study. Of the 192 (70.1%) who claimed knowledge on SSS preparation, only 47 (24.5%) gave a correct description of its constitution and 103 (54.2%) were willing to prepare the solution. Of the 103 who prepared the solution, 34 (33.0%) used the correct number of teaspoons of salt and of sugar. The composition of the solutions prepared by the mothers varied greatly with sodium levels ranging from 0-760 mmols/l (mean 225.8 +/- 155.3, median 177.3) and glucose, 0-262.6 mmols/l (mean 68.7 +/- 54.4, median 52.0). Only 7 mothers (6.8%) prepared solutions with acceptable sodium and glucose levels. It is concluded that salt-sugar solutions prepared by Nigerian mothers are not safe. There is a great need to review the oral rehydration therapy (ORT) promotion strategies and messages in order to avoid the dangers associated with improperly constituted solutions.

PIP: In June-August 1989, in Nigeria, the College of Medicine at the University of Lagos conducted qualitative and quantitative assessments to determine mothers' ability to make salt-sugar solutions (SSS) under typical home conditions to manage diarrhea in their children. 234 (85.4%) of the 274 mothers knew about oral rehydration therapy (ORT) and 192 (70.1%) said that they knew how to prepare SSS. Just 47 (24.5%) of the mothers who knew the recipe for and how to prepare SSS could actually describe the correct recipe. Only 103 (37.1%) of the mothers claiming to know the recipe were willing to prepare SSS. Just 34 (33%) of these mothers used the right number of teaspoons of salt and sugar to prepare SSS. Most mothers (92.2%) used the correct amount of water (600 ml equal to the volume of 1 standard beer bottle or 2 bottles of soft drink). Considerable variability occurred in both the sodium and glucose levels of the SSS prepared by mothers (range = 0-760 mmols/l, mean = 225.8 mmols/l, median = 177.3 mmols/l, and range = 0-262.6 mmols.l, mean = 68.7 mmols/l, median = 52 mmols/l, respectively). High sodium content ( 100 mmols/l) and low glucose content ( 50 mmols/l) were the norm for SSS that mothers prepared (92% and 49.5%, respectively). Just 7 (6.8%) of the mothers made SSS within the acceptable range for sodium and glucose. These findings showed that SSS prepared at home in Nigeria is dangerous, indicating a need to reexamine ORT promotion strategies and messages to prevent the risks linked to incorrectly prepared solutions. The Nigerian Federal Ministry of Health could also target ORT messages to primary school pupils and teachers to expand SSS knowledge and correct preparation. Standard plastic measurement cups clearly marked and indicating salt and sugar levels could help achieve compliance.

Ethnographic study on childhood diarrhoeal diseases in a rural Nigerian community.

Mothers in thirty households in a rural Nigerian community were subjected to ethnographic studies on food handling practices as they relate to diarrhoeal diseases in children. The study had a first phase of three open-ended unstructured interviews each lasting about 2 hours and a second phase of direct observations on food handling practices during preparation, administration and storage by mothers. Results indicated that as many as 20 (66.7%) of the mothers identified diarrhoea as a common cause of childhood diseases. Diarrhoea due to food contamination was recognized by as many as 18 (60.0%) respondents. Four important food handling practices relating to water treatment, handwashing before preparation and feeding, administration and storage were recognized in the first phase but the claimed practices in the first phase differed significantly from the observed practices in the second phase (p < 0.025). Many (32.1%) mothers had contaminating food handling behaviours. The low literacy level, poverty and lack of good personal hygiene among the studies population were the most likely causes of the behaviours observed.

Bacteriological study of cooked ogi (fermented cereal weaning food) and its potential safety in a rural Nigerian community.

Thirty households with children receiving the fermented cereal food ogi were selected randomly from Ajara, a rural community in Lagos State, Nigeria. Eighty-one samples of ogi were collected from these households at the time of administration to the children. The degree of bacteriological contamination and pH values of the cooked ogi samples were determined. The mean pH was 3.6 +/- 0.2. Faecal coliform contamination levels of 3 to > or = 2400/ml were recorded in 26 (31.3%) of the 81 ogi samples. Levels of faecal coliforms increased significantly (P < 0.025) during storage of cooked samples for 9 h. The high contamination rate is unacceptable and is a potential health hazard. Although fermenting food like ogi, resulting in a low pH, may reduce bacterial contamination, hygienic practices during handling and preparation should be emphasized as adjuncts in intervention for control of diarrhoeal disease in developing countries.

Food hygiene behaviour and childhood diarrhoea in Lagos, Nigeria: a case-control study.

We investigated food hygiene-related behaviour as well as other risk factors for diarrhoea in children 6-36 months of age in Iwaya community in Lagos, Nigeria. Between April and July 1989, a bi-weekly diarrhoea surveillance was maintained in 672 households. Following the surveillance, 273 (case = 67 and control = 206) families were visited twice, each visit lasting for 3-4 hours. Detailed observations on food hygiene, water sanitation, and sanitary conditions of the home were made. There was no significant association between any of the observed food hygiene behaviours and the occurrence of diarrhoea. The presence of faeces in and around the toilet area (RR = 1.79), habit of defecating and urinating in chamber pots in dwelling units (RR = 1.80), indiscriminate disposal of waste (RR = 2.48), and source of domestic water (RR = 2.94) were the main factors significantly associated with the occurrence of diarrhoea in this community. These findings imply that diarrhoea might be reduced through an education programme which focuses on the proper care, handling and storage of defecation pots and proper disposal of waste.

Study on the pH of ogi, Nigerian fermented weaning food, and its effect on enteropathogenic Escherichia coli, Salmonella typhi and Salmonella paratyphi.

The pH values of both cooked and uncooked ogi samples were determined and the survival of nalidixic acid-resistant enteropathogenic Escherichia coli OB 26 34/20, Salmonella typhi and Salmonella paratyphi A when seeded into cooked ogi were studied. The pH values of ogi ranged from pH 3.0 to 3.9. Cooked ogi had a slightly lower pH value than uncooked ogi. Our survival experiments showed that the inoculated enteric pathogens were considerably inhibited in cooked ogi during storage for 24 h. The antibacterial effect of cooked ogi was more pronounced on enteropathogenic E. coli with a log10 5 decline in bacterial count within 6 h.

Faecal contamination level; survival of salmonella typhi and pH changes in 'Gari' and its potential public health hazard in Lagos

The pH changes; faecal contamination level; survival of nalidixic-acid resistant salmonella typhi in 'gari' soaked in water was examined. The pH values showed that 'gari' had a range of pH 3.76 to pH 6.24. The mean pH values showed that there were no appreciable change for gari types from various sources within the studied time period of 120 minutes. Faecal coliform contamination of 4 to 2;400/g using the MPN technique were recorded in 33of the 36 'gari' samples. This high faecal coliform contamination rate of gari; a popular fermented cassava food is unacceptable and it is of public health importance. Our survival experiment showed that the seeded enteric pathogen slightly decreased in colony-forming unit (cfu) with log(0.3 10) 0.3 within the studied 120 minutes. It is concluded that our local foods should be monitored regularly for public health safety; and improved hygienic practices should be emphasized as an intervention for diarrhoeal diseases in developing countries

Child feeding by Nigerian mothers during acute diarrhoeal illness.

A study was conducted among mothers in a suburban community in Lagos to ascertain child feeding patterns during episodes of diarrhoea. Two hundred women with children of 6 to 36 months were selected randomly from 672 who were participating in a diarrhoea surveillance study. The vast majority restricted the consumption of yams and sugar (greater than 90%) and substantial numbers (40/50%) restricted bread and rice. On the other hand other carbohydrate foods were increased--plantain (73%) ogi-maize pap (53%) amala (56%). Of the protein foods the vast majority restricted beans (94%) and milk formula (69%) with 35% restricting meat but not fish. Few increased the intake of such foods. Beverages, fruit and vegetables were restricted by the majority; water intake was maintained. These dietary restrictions are apparently based on tradition but can have serious consequences.

A study on female circumcision in Nigeria.

A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February 1984 to September 1984. Of these, 84.7% were aged between 25 and 44 years and most of them are Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised but examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised amongst the respondents, 76.7%, followed by the Ibos, 61%, and least of all the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% had theirs as adults, however, the Ibos and Yorubas had high rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers except one and she had to circumcise her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses, nevertheless, the complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications and other attendant health hazards should be embarked upon by health authorities especially amongst the tribes practising it.

PIP: A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February-September 1984. Of these, 84.7% were between 25-44 years of age and most of them were Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised by examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised among the respondents, 76.75 followed by the Ibos, 61% and lastly the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% has theirs when adult; the Ibos and Yorubas had the highest rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers with the exception of 1 and she circumcised her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses. Nevertheless, complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications, and other attendant health hazards should be issues dealt with by health authorities, especially among the tribes who practice it. (author's modified)