P2X7-related modulation of pathological nociception in rats.

Growing evidence supports a role for the immune system in the induction and maintenance of chronic pain. ATP is a key neurotransmitter in this process. Recent studies demonstrate that the glial ATP receptor, P2X7, contributes to the modulation of pathological pain. To further delineate the endogenous mechanisms that are involved in P2X7-related antinociception, we utilized a selective P2X7 receptor antagonist, A-438079, in a series of in vivo and in vitro experiments. Injection of A-438079 (10-300 micromol/kg, i.p.) was anti-allodynic in three different rat models of neuropathic pain and it attenuated formalin-induced nocifensive behaviors. Using in vivo electrophysiology, A-438079 (80 micromol/kg, i.v.) reduced noxious and innocuous evoked activity of different classes of spinal neurons (low threshold, nociceptive specific, wide dynamic range) in neuropathic rats. The effects of A-438079 on evoked firing were diminished or absent in sham rats. Spontaneous activity of all classes of spinal neurons was also significantly reduced by A-438079 in neuropathic but not sham rats. In vitro, A-438079 (1 microM) blocked agonist-induced (2,3-O-(4-benzoylbenzoyl)-ATP, 30 microM) current in non-neuronal cells taken from the vicinity of the dorsal root ganglia. Furthermore, A-438079 dose-dependently (0.3-3 microM) decreased the quantity of the cytokine, interleukin-1beta, released from peripheral macrophages. Thus, ATP, acting through the P2X7 receptor, exerts a wide-ranging influence on spinal neuronal activity following a chronic injury. Antagonism of the P2X7 receptor can in turn modulate central sensitization and produce antinociception in animal models of pathological pain. These effects are likely mediated through immuno-neural interactions that affect the release of endogenous cytokines.

Characterization of a novel ATP-sensitive K+ channel opener, A-251179, on urinary bladder relaxation and cystometric parameters.

BACKGROUND AND PURPOSE: ATP-sensitive K(+) channels (K(ATP)) play a pivotal role in contractility of urinary bladder smooth muscle. This study reports the characterization of 4-methyl-N-(2,2,2-trichloro-1-(3-pyridin-3-ylthioureido)ethyl)benzamide (A-251179) as a K(ATP) channel opener. EXPERIMENTAL APPROACH: Glyburide-sensitive membrane potential, patch clamp and tension assays were employed to study the effect of A-251179 in vitro. The in vivo efficacy of A-251179 was characterized by suppression of spontaneous contractions in obstructed rat bladder and by measuring urodynamic function of urethane-anesthetized rat models. KEY RESULTS: A-251179 was about 4-fold more selective in activating SUR2B-Kir6.2 derived K(ATP) channels compared to those derived from SUR2A-Kir6.2. In pig bladder smooth muscle strips, A-251179 suppressed spontaneous contractions, about 27- and 71-fold more potently compared to suppression of contractions evoked by low-frequency electrical stimulation and carbachol, respectively. In vivo, A-251179 suppressed spontaneous non-voiding bladder contractions from partial outlet-obstructed rats. Interestingly, in the neurogenic model where isovolumetric contractions were measured by continuous transvesical cystometry, A-251179 at a dose of 0.3 micromol kg(-1), but not higher, was found to increase bladder capacity without affecting either the voiding efficiency or changes in mean arterial blood pressure. CONCLUSIONS AND IMPLICATIONS: The thioureabenzamide analog, A-251179 is a potent novel K(ATP) channel opener with selectivity for SUR2B/Kir6.2 containing K(ATP) channels relative to pinacidil. The pharmacological profile of A-251179 is to increase bladder capacity and to prolong the time between voids without affecting voiding efficiency and represents an interesting characteristic to be explored for further investigations of K(ATP) channel openers for the treatment of overactive bladder.

A test of the reliability and validity of a diabetes specific quality of life scale in a Nigerian hospital.

The purpose of this study was to test the reliability of the Well-being and Diabetes Treatment Satisfaction Questionnaires among clinic patients with type 2 diabetes as well as determine the clinical correlates of these measures. A cross-sectional survey was conducted using the Well-being Questionnaire and the Diabetes Treatment Satisfaction Questionnaire. Other demographic and clinical indices of age, sex, body mass index, disease duration and blood glucose levels were also recorded. 83 responses were analysed. Subjects were aged between 25 and 75 years, mean 55.5+/-11.1 years. 50.6% were males while 49.4% were females. Mean diabetes duration was 4.9+/-6.5 years. 67 (80.7%) were receiving oral agents and dietary modification while 16 (19.3%) were on insulin therapy. The internal consistency for responses to the well-being subscales and treatment satisfaction scale produced satisfactory alpha coefficients ranging from 0.73 to 0.88 and 0.74 respectively. Inter-item correlations were ranged between 0.19 and 0.45 for depression subscale; 0.22-0.78 for anxiety subscale; 0.33-0.58 for energy subscale; 0.33-0.79 for positive well-being subscale; and -0.22 to 0.79 for the treatment satisfaction scale. Item-total correlations ranged between 0.39 and 0.87 across the two scales: well-being (0.59-0.87) and treatment satisfaction (0.39-0.78). Mean scale scores were similar in both insulin and oral hypoglycaemic drug treated patients. Positive well-being was higher in males 13.4+/-4.1 vs. 11.5+/-4.3 in females p = 0.04. None of the well-being subscale scores, or treatment satisfaction correlated with age, disease duration, body mass index or glycaemic control. The well-being and treatment satisfaction scales are reliable instruments for the measurement of diabetes specific quality of life and treatment satisfaction in Nigerians although they were originally designed and developed among a UK population. It is hoped that our data would provide the basis for future comparisons and improving diabetes care.

In vivo evaluation of the potency and bladder-vascular selectivity of the ATP-sensitive potassium channel openers (-)-cromakalim, ZD6169 and WAY-133537 in rats.

OBJECTIVE: To compare in vivo the potency and bladder-vascular selectivity of ATP-sensitive potassium channel openers (KCOs) (-)-cromakalim, WAY-133537 and ZD6169 and a muscarinic antagonist, tolterodine in rats. MATERIALS AND METHODS: Bladder and arterial pressures were monitored simultaneously, before and after increasing intravenous doses of compounds, in each of two urethane-anaesthetized rat bladder hyperactivity models: spontaneous non-voiding myogenic contractions secondary to partial outlet obstruction and volume-induced neurogenic contractions. RESULTS: (-)-Cromakalim, WAY-133537 and ZD6169 caused a dose-dependent suppression of spontaneous contractions in the obstructed model, with a 50% inhibition of the contraction area under the curve at doses of 0.06, 0.14 and 2.4 micro mol/kg (intravenous), respectively. Corresponding decreases in mean arterial pressure at these effective doses were 24%, 15% and 15%, respectively. The KCO potency rank order was the same and their relative potency highly comparable in the neurogenic model. There was complete inhibition of spontaneous contractions in obstructed rats at doses corresponding to approximately 50% inhibition of the neurogenic contractions. While tolterodine caused a dose-dependent inhibition of contractions in the neurogenic model, it was ineffective at inhibiting non-voiding contractions in obstructed rats. CONCLUSIONS: All KCOs tested caused significant decreases in arterial pressure at doses effective on the bladder in the model of obstructive instability, suggesting a lack of bladder-vascular selectivity. Similar KCO potency in both assays suggests no appreciable changes in KATP channel function as a result of partial outlet obstruction.

Breastfeeding training improves health worker performance in rural Nigeria.

The training of health workers in breastfeeding and lactation management is to enable them make correct breastfeeding recommendations to mothers. This study aims to provide answers to two research questions: what components of breastfeeding training are easily achieved with extension health workers, and what health worker variables affect these outcomes. Multivariable analysis of the outcomes of a controlled breastfeeding training programme for community health workers (CHW) in rural communities of Osun State, Nigeria, was performed by logistic regression. The results show that the training was the most powerful predictor of correct CHW recommendations on breastfeeding (OR = 60.25, p-0.0000), and of 'perfect' breastfeeding knowledge (OR = 192.49, p = 0.0000). Younger CHWs (in the age bracket 20 to 29 years) were significantly more likely to make correct recommendations on exclusive breastfeeding (OR = 3.02, p = 0.0304). Other CHW variables such as sex, experience, job status, and marital status did not make consistently significant independent contributions to the outcomes. The results suggest that breastfeeding education can enhance CHW professional recommendations on breastfeeding and should be extended to all categories of health workers.

PIP: Health worker training is a key component of Nigeria's National Breast Feeding Program. Problematic, however, have been situations where the current recommendation of exclusive breast feeding conflicts with local knowledge and practices. This conflict can be resolved only by convincing rural community health workers (CHWs) of the legitimacy and benefits of exclusive breast feeding. A study conducted in the Ife South Local Government area of Nigeria's Osun State evaluated the impact of intensive breast feeding training on CHWs. The intervention was guided by focus group discussions among health workers, lactating mothers, and grandmothers. A total of 66 CHWs received the Ife South Breast Feeding Project (ISBFP); another 67 CHWs were not exposed to the training. Logistic regression analyses indicated that ISBFP training was the strongest predictor of CHW recommendations of exclusive breast feeding and against early supplementation (odds ratio, 60.25). Younger CHWs (20-29 years) were 3.02 times more likely than their older counterparts to promote exclusive breast feeding, but no other sociodemographic characteristics of health workers were significant. Recommended, in light of these findings, is expansion of health worker training to include breast feeding and lactation management and on-the-job retraining of current CHW cadres. If outreach to pregnant women is handled in a culturally sensitive way, clients of trained CSWs should be able to overcome the constraints of local tradition.

Breast-feeding promotion in a diarrhoea programme in rural communities.

Breast-feeding promotion is an important intervention for the control of infant diarrhoea. This study assesses the impact of a breast-feeding counselling programme on the prevalence of exclusive breast feeding in rural communities in Nigeria. Mothers attending primary care facilities because their infants had acute diarrhoea were randomised into two groups. The study group (n = 82) received individual, focused breast-feeding counselling, while the controls (n = 79) had routine advice for diarrhoea. Both groups were monitored and followed with home visits to determine infant-feeding practices. The results showed marked increases in exclusive breast-feeding prevalence for the intervention group at day 7 (49% vs. 6% control; p < 0.0001) and day 21 (46% vs. 8%; p < 0.0001). Moreover, diarrhoea re-occurrence at day 21 was less in the intervention group (12%) than controls (18%). It is concluded that focused breast-feeding counselling can increase exclusive breast feeding and reduce the prevalence of diarrhoea in rural communities.

Urinary schistosomiasis: options for control within endemic rural communities: a case study in south-west Nigeria.

A preliminary investigation was conducted into factors that may bring about control of morbidity due to endemic urinary schistosomiasis in rural communities. A Knowledge, Attitudes, Practices and Beliefs (KAPB) study was conducted among primary schoolchildren (those with more than four years elementary education) in Ogbagba village, Osun State, Nigeria, from October 1990 to December 1993, to ascertain their understanding of urinary schistosomiasis. The study further assessed the potential of subjective haematuria, i.e. asking children with haematuria in the recent past to so indicate, in detecting urinary schistosomiasis. It was established that subjective haematuria is both sensitive and specific for detecting urinary schistosomiasis in endemic communities. The study also established that subjective haematuria offers a valid, easy to recognize target for morbidity control in endemic situation. It is proposed that with appropriate health education; availability of safe, effective, easy-to-administer drugs, such as praziquantel, morbidity control of urinary schistosomiasis is feasible within the primary health care system with the lower cadre health worker or even a volunteer village health worker (VVHW) at the centre of the control effort.

PIP: During October 1990 to December 1993, in Ife-Central Local Government Area of Osun State, Nigeria, interviews with and physical and laboratory examinations of 106 grade 4-6 pupils aged 8-16 were conducted in Ogbagba village so the researchers could determine their knowledge, attitudes, practices, and beliefs about urinary schistosomiasis as well as the factors that offer opportunities for morbidity control of urinary schistosomiasis in an endemic area. There was no health facility in Ogbagba. 89.5% of the children had urinary schistosomiasis. 75.5% of all pupils knew the local name for urinary schistosomiasis. 66% had previously passed blood in their urine. 85.7% of these pupils believed hematuria was serious. 70.8% gave a positive history of current episode of hematuria. 62.7% of these pupils did not seek any treatment. Symptoms associated with past hematuria included abdominal pain, weakness, weight loss, and fever. 65.7% of all pupils did not know what causes urinary schistosomiasis. 67.1% believed that urinary schistosomiasis was acquired via some form of contact with water, especially swimming (57.1%). The leading types of water contact included washing clothes (95.3%), fetching water (94.3%), bathing (87.7%), and swimming (74.5%). 74.5% of all pupils urinated deliberately in the river. The sensitivity, specificity, predictive values, and efficiency of alternative methods of detecting urinary schistosomiasis revealed that subjective hematuria was comparable to gross/microscopic hematuria. These findings will be used to design information, education, and communication materials for a health education program on urinary schistosomiasis using the primary health control approach. The researchers propose that both subjective and gross hematuria be used as the basis for treating children aged 4-19 living in areas endemic for urinary schistosomiasis. Praziquantel should be used as the only drug for treating urinary schistosomiasis. Health education in the schools' curriculum and information, education, and communication developed by health authorities should promote better water contact practices. Teachers need to regularly ask their pupils about hematuria and encourage them to seek medical treatment.

An assessment of the knowledge of AIDS of undergraduates of Obafemi Awolowo University, Ile-Ife, Nigeria.

PIP: Questionnaire data were collected from 528 randomly sampled undergraduate students from various university faculties at Obafemi Awolowo University, Ile-Ife, Nigeria to determine what they knew about HIV and AIDS. The 1986 undergraduate population at the university was 12,128. 68.2% of the study participants were aged 20-24 years. 31.8% had first heard of AIDS in 1987, with newspapers and magazines being the source of information for 59.1% of students. All but 1.5% of the sample had heard of AIDS between 1982 and 1986. 95.5% of students identified sexual contact as a mode of HIV transmission, although only 64.9% and 68.2% identified the avoidance of multiple sex partners and condom use, respectively, as ways to prevent the transmission of HIV. 10.6% of the students did not know that AIDS kills. On the basis of these study findings, a comprehensive AIDS education program should be included in the undergraduate general studies curriculum.^ieng

Childhood diarrhoea in rural Nigeria. I. Studies on prevalence, mortality and socio-environmental factors.

This population-based study was conducted to determine the prevalence, mortality, and socio-environmental determinants of diarrhoeal diseases in children less than 5-years of age in a rural area of Akoko North, Ondo State, Nigeria. A total of 856 households with children less than 5-years old were randomly selected for the questionnaire and observational investigations. A two-week prevalence rate of the diseases among the children was 8.1%. The rate was highest among children 0-11 months old and slightly higher among the boys than girls. The infant mortality rate was 102/1000 and the mortality rate in less than 5-year old children was 62.1/1000 in the area. The majority of these deaths took place in the homes and health centres and were never reported. Social and environmental factors including dirty feeding bottles and utensils, inadequate disposal of faeces and household refuse, and poor storage of drinking water were found to be significantly related to the high incidence of the diseases. Educational interventions recommended for the control of the disease focused on these factors.

Health education in Nigerian secondary schools.

A survey of 600 secondary school teachers and 120 secondary school administrators was conducted in Oyo State, Nigeria, to identify their attitudes and practices regarding school health education. Nearly all teachers and administrators felt that health education is important and should be an integral part of the curriculum. Nonetheless, there were few resources and little curriculum time devoted to health education. Since many of the health problems of developing countries can be addressed by enhancing the health knowledge of the populace, health education in the schools of such countries deserves more emphasis.

Safety and efficacy of yellow fever vaccine in children less thanone-year-old.

In a clinical trial of stabilized yellow fever vaccine from Institute Pasteur in 77 children aged seven to eight months, fever was the most significant immediate and delayed side effect. Fever occurred in 12 (15.6%) children with in 48 hours of vaccination while it occurred in 10 (12.9%) children within ten days of vaccination. Other recorded side effects were pain at innoculation site in four (5.2%) children and vomiting in one (1.3%) child. Temperature recorded in 20 of the 22 febrile episodes ranged from 37.8 degrees C to 38.6 degrees C. One of the two patients who had temperatures of 39 degrees C and above had malaria parasites in her blood film. All episodes of fever except one responded to antipyretic. There was no episode of febrile convulsion and no feature suggestive of encephalitis. Of the 20 children who had neutralization test carried out against yellow fever virus six weeks after vaccination, the test was positive in post vaccination sera of 12 (60%) children whose pre-vaccination sera were negative. Two others showed evidence of partial protection. Although the seroconversion rate of 60% is less than reported in adults and older children, the result of this study shows that yellow fever vaccine is safe and fairly effective in infants. It is our suggestion that if a larger trial confirms our findings, the vaccine may be incorporated into the expanded programme on immunization (EPI) to be given at the age of seven months after completion of diptheria, tetanus, pertussis and poliomyelitis vaccinations and before measles vaccination is due.

Viral hemorrhagic fever antibodies in Nigerian populations.

Using the immunofluorescence test, a serosurvey for antibodies to five viral agents associated with hemorrhagic febrile infections was conducted with 1,677 human sera from different parts of Nigeria. Three hundred fifty-seven (21.3%) were positive for Lassa virus antibody, while antibodies to Rift Valley fever virus were detected in 42 (2.5%) of the sera. Testing for Rift Valley fever virus antibody was confirmed by plaque reduction neutralization test. Antibodies to Ebola and Marburg viruses were detected in 30 and 29 sera, respectively. Of the 357 Lassa virus antibody-positive sera, 297 (83.2%) were positive for Lassa only. In contrast, sera positive for Marburg were positive in combination with Lassa, Ebola, or Rift Valley fever viruses. Antibodies to Lassa and Rift Valley fever viruses were found in all locations in Nigeria, whereas Ebola and Marburg antibodies were found mainly in the northern savanna zones of Benue and Gongola, but not in the rain forest area of Ondo.

Epidemic yellow fever in eastern Nigeria, 1986.

An epidemic of yellow fever occurred in the eastern part of Nigeria during the second half of 1986. Oju, in Benue State, was the most heavily affected region, but yellow fever also occurred in surrounding areas, particularly Ogoja, in Cross River State. In Oju, the mean attack and mortality rates were 4.9% and 2.8%, respectively. Sex and age specific rates were highest in males and in the 20-29 yr age group. The overall case fatality rate was approximately 50%. Diagnosis was confirmed by IgM capture enzyme-linked immunosorbent assay (ELISA) and complement fixation (CF) tests. Entomological investigations implicated Aedes africanus as the epidemic vector. Oju alone probably had about 9800 cases of yellow fever with jaundice, and some 5600 deaths. Outbreaks of this nature could be prevented by inclusion of yellow fever in the Expanded Programme on Immunisation, in areas subject to recurrent epidemics.

The health knowledge of ninth grade students in Oyo State, Nigeria.

A stratified random sample of 540 ninth grade (Class 3) students in Oyo State, Nigeria, were administered the 60-item Health Education Test Form 3A. The purpose of the study was to obtain baseline data concerning the health knowledge of the students for use in the development of Health Education curricula in Oyo State. Subjects from the metropolitan area, from medium-size towns, and from rural areas recorded composite mean scores of 29.02, 24.78, and 25.01, respectively; indicating a general deficiency of health knowledge among the subjects. Recommendations are offered concerning curriculum, teacher preparation, and international cooperation to assist in the development of quality Health Education programs for Nigerian students.

Prevalence of antibodies to parasitic infections in Nigerian children.

Sixty-six sera from Nigerian children who attended a paediatric clinic at University College Hospital, Ibadan were tested with Plasmodium falciparum, P. brazilianum, Entamoeba histolytica, Toxoplasma gondii and Schistosoma mansoni antigens using indirect fluorescent antibody technique. These sera were tested using ELISA technique for Schistosoma antibodies. Sera from all proven cases of infections gave positive results. Highest antibody prevalence rate was for P. falciparum (69.6%), followed by P. malariae (63.6%) and E. histolytica (42.4%) infections. About 17% and 16% were reactive with Toxoplasma and Schistosoma antigens respectively. Only nine (13.6%) children were negative with all antigens. Forty-four (66.6%) children were positive to two or more parasitic antibodies indicating exposure to those diseases. The significance of these antibodies in children is discussed.

Yellow fever in the Gambia, 1978--1979: epidemiologic aspects with observations on the occurrence of orungo virus infections.

An epidemic of yellow fever (YF) occurred in the Gambia between May 1978 and January 1979. Retrospective case-finding methods and active surveillance led to the identification of 271 clinically suspected cases. A confirmatory or presumptive laboratory diagnosis was established in 94 cases. The earliest serologically documented case occurred in June 1978, at the extreme east of the Gambia. Small numbers of cases occurred in August and September. The epidemic peaked in October, and cases continued to occur at a diminishing rate through January, when a mass vaccination campaign was completed. The outbreak was largely confined to the eastern half of the country (MacCarthy Island and Upper River Divisions). In nine survey villages in this area (total population 1,531) the attack rate was 2.6--4.4%, with a mortality rate of 0.8%, and a case fatality rate of 19.4%. If these villages are representative of the total affected region, there may have been as many as 8,400 cases and 1,600 deaths during the outbreak. The disease incidence was highest in the 0- to 9-year age group (6.7%) and decreased with advancing age to 1.7% in persons over 40 years. Overall, 32.6% of survey village inhabitants had YF complement-fixing (CF) antibodies. The prevalence of antibody patterns indicating primary YF infection decreased with age, in concert with disease incidence. The overall inapparent:apparent infection ratio was 12:1. In persons with serological responses indicating flaviviral superinfection, the inapparent:apparent infection ratio was 10 times higher than in persons with primary YF infection. Sylvatic vectors of YF virus, principally Aedes furcifer-taylori and Ae. luteocephalus are believed to have been responsible for transmission, at least at the beginning of the outbreak. Eighty-four percent of wild monkeys shot in January 1979 had YF neutralizing antibodies, and 32% had CF antibodies. Domestic Aedes aegypti were absent or present at very low indices in many severely affected villages (see companion paper). In January, however, aegypti-borne YF 2.5 months into the dry season was documented by isolation of YF virus from a sick man and from this vector species in the absence of sylvatic vectors. Thus, in villages where the classical urban vector was abundant, interhuman transmission by Ae. aegypti occurred and continued into the dry season. A mass vaccination campaign, begun in December, was completed on 25 January, with over 95% coverage of the Gambian population. A seroconversion rate of 93% was determined in a group of vaccinees. This outbreak emphasizes the continuing public health importance of YF in West Africa and points out the need for inclusion of 17D YF vaccination in future programs of multiple immunication.

The multiplication of Dugbe virus in the Ixodid tick, Hyalomma rufipes Koch, after experimental infection.

Nymphs and adults of H. rufipes were inoculated intracoelomically with a Dugbe virus concentration containing 1.5 LD50/0.02 ml. The virus multiplied to a peak titre of 9.3 log10 +/- 0.03 in nymphs and 4.4 log10 +/- 0.02 in the unfed adults. Virus infection persisted during metamorphosis and was passed on to the adults. A blood meal significantly increased the titre of virus in the adults at a probability less than 0.001. Also the tire in the engorged females was significantly higher than that in the fed males at a probability less than 0.05. Dugbe virus persisted for a long time in the unfed adults and a titre of 2.4 log10 +/- 0.06 was obtained in 165 day old adults.

Schistosomiasis: assessment of the sensitivity, specificity and reproducibility of serological methods for the diagnosis of schistosomiasis in Nigeria.

Three groups of sera were tested by indirect fluorescent antibody (IFA), complement fixation (CF) and counter-current immunoelectrophoresis (CCIE) techniques; 56 (10.1%) of 554 sera from Nigerians were anticomplementary and so could not be tested by the CF. Crude antigen extract of adult Schistosoma mansoni was used in the CF and CCIE tests and cercarial antigen in the IFA test. IFA was the most sensitive test and CF the most specific. The reproducibility of both these tests was good. The CCIE was the least sensitive and specific, and its reproducibility was poor. The IFA test was the most suitable for Nigerian conditions. Cross-reactions to S. haematobium antibodies were consistently present in all three tests and it was not possible to differentiate serologically S. mansoni from S. haemotobium. The interpretations of the results presented some difficulties because of the frequency of cross-reactions and false-positives, but the data fell within the infection prevalence rate of 50% reported earlier from south-western Nigeria. The IFA test was more specific and is considered ideal for serodiagnosis.

Coxsackie B viruses and heart muscle disease in Nigerian adults.

In 44 Nigerians with heart muscle disease, the percentage of patients who had a fourfold rise or fall to at least one of the Coxsackie B viruses was greater than controls. Patients with heart muscle disease also had significantly higher levels of antibody titres. Antibodies to Coxsackie viruses B2, B3 and B6 were more frequent in their sera than in controls. While these results do not prove a Coxsackie B viral aetiology it is concluded that these viruses could be the cause of cardiac damage and heart failure in some Nigerians. It could also be one of the many adverse factors which produce repeated myocardial damage and thus weaken the heart to the point of failure.