Parasitic agents in childhood diarrhoea and malnutrition.

In a prospective survey, 1130 children were studied for parasitic infections associated with acute diarrhoea and/or protein energy malnutrition at the Jos University Teaching Hospital, Jos, Nigeria. Intestinal parasites were isolated in 29.2% of the children with E. histolytica, S. mansoni, Hookworm and A. lumbricoides predominating. Children with diarrhoea marginally harbour parasites more frequently than those without diarrhoea, particularly the diarrhoeagenic parasites. The prevalence and pattern of parasitic infections was similar between the malnourished children and their controls reflecting similar environmental influence. We therefore conclude that significant number of children are infected with intestinal parasites and these contribute to morbidity and mortality by precipitating or aggravating diarrhoeal disease or malnutrition. The need for improving sanitation, community awareness, and periodical mass treatment of pre-school and school age children with antiprotozoal and anti-helminthic drugs is advocated.

Breastfeeding pattern in Jos, Nigeria, before baby-friendly hospital initiative.

Interviews were conducted amongst 800 mothers attending Jos University Teaching Hospital, Nigeria, to obtain information on prenatal care, knowledge, attitudes, and practices relating to breastfeeding. Of the 653 women who had antenatal care, 75 per cent had breastfeeding education, though devoid of practical demonstration of breastfeeding techniques. Breastfeeding was universal, but only 439 (55 per cent) mothers started breastfeeding within 24 hours of delivery with a mean initiation time of 1.9 days. Prelacteal feeds were often offered. Only 51 (6 per cent) mothers exclusively breastfed at 3 months while early supplementation was common. Acquisition of secondary or post-secondary education was associated with significantly shorter duration of breastfeeding, P < 0.01 and P < 0.001, respectively, when compared with those with or without primary education. These problems are being effectively countered by appropriate health education, training of health workers, and effective lactation management.

Open clinical trial of roxithromycin amongst patients of Jos University Teaching Hospital with lower and upper respiratory tract infections.

An open non-comparative clinical study to determine the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with acute upper and lower respiratory tract infections. Twenty-four (24) patients (mean age 21.6 years, male 13; females 11 who completed the study presented with acute tonsillitis (33.3%, acute bronchitis (12.5%), lober pneumonia (12.5%), Otitis media (8%), acute pharyngitis (4%) and acute sinusitis (4%). Most of the patients had normal bacterial flora isolated (50.3%). Pathogens isolated included streptococcus pyogenes (21%), moraxella catarhalis (8.3%), streptococcus pneumonia (8.3%) and Klebsiella pneumonia (4%). The quick clinical response, lack of major adverse drug reactions and susceptibility of the bacterial isolates to Roxithromycin were very significant attributes of the drug. In addition, there was complete recovery in 95.8% of the patients. Roxithromycin is therefore a well tolerated and effective drug for the treatment of acute respiratory tract infections in Nigerian patients.

Mothers' attitudes towards donated breastmilk in Jos, Nigeria.

In many developing countries, the use of pooled human milk is not widely accepted. Six hundred eighty breastfeeding mothers were interviewed to ascertain their acceptance of donated breastmilk. Their attitudes toward stored breastmilk, human milk banking, and breastfeeding in the event of human immunodeficiency virus (HIV) positivity were solicited. About 71 percent would not accept donated breastmilk for their baby while the rest would consent only if the donor were a close family relative, owing to fear of transfer of diseases (28 percent), fear of transfer of genetic traits (22 percent), and religious and cultural taboos (14 percent). However, 60 percent were willing to donate breastmilk. Only 38 percent would accept milk from a breastmilk bank. None would breastfeed if she were HIV positive.

PIP: In the Jos community of Plateau state, Nigeria, a survey was conducted among mothers who were specifically questioned in relation to transmissible diseases such as HIV. Their attitudes regarding pooled breast milk, breast milk banks, and offering stored breast milk to their babies were also ascertained. 680 breast-feeding mothers attending the Jos University Teaching Hospital (JUTH) were interviewed at the Pediatric Outpatient Department, Postnatal and Immunization clinics using a structured pretested questionnaire. The ethnic distribution reflected the major tribes in Nigeria (Ibo, Yoruba, and Hausa). Most of the women had at least a primary school education, were Christians, were employed, and had nursed babies previously. 70% were unwilling to accept donated breast milk. The remaining mothers would accept it only if the donor was a close family relation. Among the 92 health workers (90 nurses and 2 doctors) included in the study, only 11 (12%) would consent to using donated breast milk. Mothers who were employed were less willing to accept donated breast milk when compared with unemployed mothers (p .001). Similarly, mothers with secondary or postsecondary education as a group were significantly less willing to accept donated breast milk in comparison to those with primary or no formal education (p .02). The majority of employed or well- educated mothers opted for manufactured baby milk feeds. Under HIV-positive status, none would breast feed regardless of their educational or employment status. 410 (60%) of the women were willing to donate breast milk, but they preferred to do so for a relative's baby; 25% feared producing insufficient breast milk to sustain their own infants if they had to donate milk. On the whole, 63% believed that stored breast milk was unsafe after 6 hours in a home refrigerator. Breast milk from a well- established human milk bank was acceptable to 38% of the respondents. Negative responses were due to religious injunction (27%), fear of transfer of genetic traits (17%), possible transfer of disease (11%), cultural inhibition (4%), and personal dislike (2%).

Performance of children on weaning foods in Jos, Nigeria.

A Nutritional survey on weaning foods used in Jos, Nigeria, was conducted on representative samples of 572 mothers of children between the ages of one and 18 months. The nutritional status of the children was determined by using weight for age. Four weaning foods were assessed, namely, commercial weaning food (CWF), family menu, Ogi (a sour maize beverage), ogi plus legumes and/or animal products. Only 147 (25.7%) of the mothers still depended on CWF with the rest,209 (36.5%) using fortified ogi; ogi alone by 112 (19.6%) and family menu by 104 (18.2%). No differences in weight were noticed in children, aged 6 months or under. Thereafter, the children on ogi or ogi based diet had significantly lower mean weights (p < 0.01) when compared with those on CWF. This could be attributed to lack of sufficient knowledge and exposure in preparing well balanced diet from locally available food stuff by mothers. While discouraging the use of CWF because of cost, efforts should be made to educate the mothers on how to prepare traditional multimix of good nutriture. Emphasis should be placed on how to increase the energy density by adding edible oil or using sprout grains.

Increase in total serum triglyceride and phospholipid in kwashiorkor.

Fasting serum lipids in children presenting with protein-energy malnutrition were studied in comparison with those of sex- and age-matched well nourished controls. There was no difference in serum total cholesterol between malnourished and well nourished children. However, serum triglyceride and phospholipid concentrations were significantly higher in children with kwashiorkor or marasmic kwashiorkor than in well nourished controls. It appears that serum concentrations of triglycerides and phospholipids increase with increasing severity of malnutrition, and that fasting serum triglyceride and phospholipid concentrations above 3 mmol/l are jointly predictive of a poor prognosis in malnourished children.

Diethylene glycol poisoning in Nigerian children.

Between June and September 1990, 47 children died at Jos University Teaching Hospital, Nigeria from ingestion of paracetamol syrup adulterated with diethylene glycol. Most of the children presented with anuria, fever, vomiting, diarrhoea and convulsions. Signs on admission were tachycardia, acidotic breathing, pallor, oedema and hepatomegaly. Laboratory findings included hyperkalaemia, acidosis, elevated creatinine level and hypoglycaemia. Management consisted of correction of dehydration and acidosis plus administration of antibiotics when indicated. None of the children had dialysis. All died within 2 weeks of admission. Proper government supervision of pharmaceutical companies and their agencies is urgently needed in order to prevent any future occurrence of such tragic deaths.