Correlation of Lead Poisoning and Intelligence Status of School Children in a Southern Nigerian Urban City.

BACKGROUND: Lead is a heavy metal of utmost public health significance in Nigeria. It is a known neurotoxin that impairs neurotransmission and brain function resulting in cognitive and motor deficits. Ingestion of lead contaminated food or water is the major route of exposure to lead manifesting as neurologic symptoms which can interfere with the intelligence of school children. AIM: To correlate the Intelligence quotient scores with the blood lead levels of primary school children in Southern Nigeria. METHODS: The study was a descriptive cross-sectional study amongst primary school pupils, conducted in Asaba, the capital of Delta state, Nigeria. Goodenough-Harris "Draw a Person Test" validated by Ebigbo and Izuora in Enugu, Nigeria was used to assess the intelligence of the pupils while blood lead levels was measured with Flame Atomic Absorption Spectrophotometer (FAAS). RESULTS: Three hundred and twenty subjects were recruited. Seventy-one subjects did not have lead poisoning (22%) while two hundred and forty-nine subjects had lead poisoning (77.8%). Mild, moderate and severe level lead poisoning constituted 22.5% (56/249), 28.1% (70/249) and 49.4% (123/249) respectively. Seventy percent (225) subjects had optimal IQ while 95 subjects had sub-optimal IQ and mean IQ score was 92.9 ± 25.1. There was no association and correlation between IQ status and levels of lead poisoning. CONCLUSION: A significant proportion of school children had optimal level of intelligence despite the high prevalence of lead poisoning seen among them. There was no association or correlation between different levels of childhood lead poisoning and Intelligence quotient status.

CONTEXTE: Le plomb est un métal lourd de la plus haute importance pour la santé publique au Nigeria. C'est une neurotoxine connue qui altère la neurotransmission et la fonction cérébrale entraînant des déficits cognitifs et moteurs. Ingestion de plomb contaminé la nourriture ou l'eau est la principale voie d'exposition au plomb qui se manifeste comme symptômes neurologiques, ce qui interfère avec l'intelligence des écoliers. OBJECTIF: Corréler les scores du quotient intellectuel avec letaux de plomb dans le sang des enfants des écoles primaires dans le sud du Nigéria. MÉTHODES: L'étude était une étude transversale descriptive parmi les élèves de l'école primaire, menée à Asaba, la capitale de l'État du Delta, Nigéria. Goodenough-Harris "Dessinez une personne Test" validé par Ebigbo et Izuora à Enugu, Nigeria a été utilisé pour évaluer l'intelligence des pupilles pendant que le sang mène les niveaux ont été mesurés avec l' Absorption Atomique de Flamme Spectrophotomètre (FAAS). RÉSULTATS: Trois cent vingt sujets ont été recrutés. Soixante et onze sujets n'avaient pas d'empoisonnement au plomb (22 %) alors que deux cent quarante-neuf sujets avaient une intoxication au plomb (77.8%). Intoxication au plomb légère, modérée et sévère constituaient 22,5 % (56/249), 28,1 % (70/249) et 49,4 % (123/249) respectivement. Soixante-dix pour cent (225) sujets avaient un QI optimal tandis que 95 sujets avaient un QI sous-optimal et le score de QI moyen était92,9 ± 25,1. Il n'y avait pas d'association et de corrélation entre État du QI et niveaux d'empoisonnement au plomb. CONCLUSION: Une proportion importante d'écolier savaient un niveau d'intelligence optimal malgré la forte prévalence de empoisonnement au plomb vu parmi eux. Il n'y avait pas d'association ou corrélation entre les différents niveaux de plomb infantile empoisonnement et statut du quotient intellectuel. Mots-clés: Empoisonnement au plomb, intelligence, enfance.

Retrospective assessment of neonatal morbidity and mortality in the special care baby unit of a private health facility in Benue State, North Central Nigeria

Background: Newborn morbidity and mortality have remained unacceptably high in developing countries despite consistent efforts at controlling the scourge. Unlike in developed countries where neonatal mortality rate ranges between 1 and 5 per 1000 live births, average neonatal mortality rate in Nigeria is 36 per 1000 live births. The majority of the causes of death are largely preventable with timely low cost interventions. This study was structured to determine the pattern of morbidity and mortality amongst babies admitted in the Special Care Baby Unit of Madonna hospital Makurdi, Nigeria.Methods: The records of neonates admitted into the Special Care Baby Unit (SCBU) over a tenyear period (2005-2015) were retrospectively reviewed. Information obtained included the sex, age at admission, gestational age, birth weight, reasons for admission and outcome of treatment.Results: A total of 1,121 babies were admitted during the period under review. The male female ratio was 1.2:1.The majority of the babies were aged between 2-7 days with a mean 6.17.+ 7.01 The mean weight on admission was 2807+907g. Neonatal sepsis, jaundice, low birth weight and birth asphyxia were the most common morbidities. The overall mortalityrate was 14.1%; however, proportionate mortality due to low birth weight was highest (26.4%), followed by tetanus (23.5%), asphyxia (20.8%), Respiratory tract infection (13.8%), meningitis (13.3%), sepsis (10.3%), jaundice (9.6%), and diarhoea (4.0%)Conclusion: Neonatal mortality rate in the study was high. The major causes of admission are preventable. Strengthening perinatal care, emergency obstetric care services and neonatal resuscitation skills are necessary to reduce the neonatal mortality

Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria.

BACKGROUND: Diarrhea is widely recognized as a major cause of childhood morbidity and mortality in many developing countries, particularly in sub-Saharan Africa. According to World Health Organization (WHO) report in the African region, diarrheal diseases are still leading causes of mortality and morbidity in children under five years of age. This same report indicates that each child in the said region has five episodes of diarrhea per year and that 800,000 die each year from diarrhea and dehydration. MATERIALS AND METHODS: This study examined diarrheal morbidity and associated risk factors in children under five years in Jos. A total of 340 children were seen in the Diarrhea Training Unit (DTU) of the Jos University Teaching Hospital (JUTH), Jos, over a period of 24 months (Jan 2008-Dec 2009). A semi-structured interviewer administered questionnaire was used to generate the data. All women whose children presented with diarrhea were interviewed and data generated analyzed using Epi info version 3.5.1 statistical software. RESULTS: During the study period, 13,076 children were seen in our facility, of which 340 were suffering from diarrhea, thus giving a diarrhea prevalence of 2.7%. There were 183 (54%) male and 157 (40%) female children seen with diarrhea. The mean age was 11 ± 8.5 months. The mean duration of diarrhea was found to be 4 ± 3.6 days. A majority of children were aged less than 6 months, consisting of 235 infants, 95 toddlers, and 10 pre-schoolers. Of the number of women seen, 242 (61%) had at least primary education, while 98 (29%) had no formal education. Diarrheal episodes were found to have a bivariate association with mothers' educational status, family type, family size, breastfeeding, and sex of child. However, only mother's educational status, diarrhea in other sibling, and breast feeding were significantly associated with the occurrence of diarrhea. Although there were more male children with diarrhea, the odds of having diarrhea was not significantly related to sex. CONCLUSION: Our study demonstrated an important relationship between diarrheal morbidity and low maternal education, nonexclusively breastfed infant, and previous diarrheal episode in a sibling. It thus meant that diarrhea morbidity is still an important problem for infants in our environment. Moreover, maternal education and exclusive breastfeeding are still relevant viable measures in curbing diarrhea in infants.

Histopathologic diagnoses of lymphadenopathy in children in Jos, Nigeria.

Histopatholgical findings in 242 lymph node biopsies received in Jos University Teaching Hospital over a 10-year period (1988-1997) were reviewed. Tuberculosis is the most predominant lesion (33.05%), followed closely by the non-Hodgkin's lymphoma (31.4%). Burkitt's lymphoma accounting for one-quarter of all the cases of non-Hodgkin's lymphoma had a peak age range of 8-10 years. Hodgkin's lymphoma, chronic non-specific lymphadenitis, sinus histiocytosis, reactive hyperplasia, metastatic carcinoma, dermatopathic lymphadenitis, Kaposis sarcoma and sarcoidosis accounted for 2.9%, 14.46%, 9.9%, 4.96%, 1.7%, 0.4%, 0.8% and 0.4% respectively. The cervical region was the commonest site affected (54.1%), followed by mesenteric (22.3%), axillary (13.2%) and inguinal (10.3%). BCG immunization was carried out only on 121(50%) of cases, out of which 60 had tuberculosis and 54(22.3%) received no BCG immunization, while 67(27.7%) had no records of BCG immunization. Only 5(2%) had HIV screening done, out of which one was positive.

Assessment of the bone status of Nigerian children and adolescents with sickle cell disease using calcaneal ultrasound and serum markers of bone metabolism.

Growth and skeletal maturation are impaired in sickle cell disease (SCD). SCD is also associated with decreased bone mineral density (BMD) as determined by dual X-ray and photon absorptiometry. Quantitative ultrasound (US), which is as good a predictor of fracture as absorptiometry, provides additional information about bone architecture and elasticity. It is not known if the quantitative US parameters, broadband ultrasound attenuation (BUA) and speed of sound (SOS), are affected in children and adolescents with SCD. We therefore compared the bones of 80 children with SCD in Nigeria to those of age- and gender-matched controls using calcaneal ultrasound and the serum bone markers N-telopeptide of type1 collagen (NTx) and bone-specific alkaline phosphatase (BSAP), which are indicators of bone resorption and formation, respectively. BUA, which is reflective of BMD, was significantly lower for both the male and female SCD subjects compared with controls (86 vs 113 dB/MHz, P < 0.001 and 87 vs 100 dB/MHz, P < 0.001, respectively). However, SOS, which is more indicative of bone elasticity, was significantly different only for the male SCD subjects. Both NTx and BSAP were significantly reduced in the serum of the male and female SCD subjects. Correlations between BUA and serum NTx were found for both female controls and SCD subjects (r = 0.58, P < 0.001 and r = 0.32, P = 0.05, respectively), but not for the male subjects or controls. Significant correlations between BUA and BSAP were observed only for the female controls. In summary, we have shown that US analysis, in combination with serum markers of bone metabolism, can be used to distinguish bone development in children with SCD from that of nonaffected controls.

Knowledge, attitude and practice of health workers in Keffi local government hospitals regarding Baby-Friendly Hospital Initiative (BFHI) practices.

OBJECTIVE: To assess the knowledge, attitude and practice of health workers towards Baby Friendly Hospital Initiative (BFHI) practices and thereafter plan an advocacy on BFHI training of the workers. DESIGN: A randomised cross-sectional study. SETING: Ten out of 16 health facilities reflecting all the levels of healthcare provision in Keffi Local Government Area in Nassarawa State, Nigeria, were selected. Staff of these health facilities had not received BFHI training, although breastfeeding is the norm in this population, exclusive breastfeeding is almost zero. SUBJECTS: A total of 250 health workers (six doctors, 160 nurses and 84 auxiliary staff) met in the health facilities at the time of interview. INTERVENTION: A structured questionnaire based on 10 steps to successful breastfeeding was administered by one of the authors and a Lactad nurse between July and October 1995. RESULTS: Fifty-two (20.8%) were aware of the need for initiating breastfeeding within 30 min of birth and 92 (36.8%) were aware of breastfeeding support groups. However, there were significant differences in the level of awareness among the doctors compared to the other categories of health staff (P<0.05). Also, 48 (19.2%) of the health workers believed that babies less than 6 months of age should not be given water (statistical difference (P<0.05) between doctors' attitude and that of the other health workers). Thirteen (5.22%) health workers could demonstrate correct positioning and attachment. CONCLUSION: There was general lack of awareness of some major recommended practices in the hospitals that will promote and sustain breastfeeding. There is therefore the need for policy changes and BFHI training for the staff of these health facilities to respond to the concern and growing need for proper infant/young child feeding.

Cardiovascular disease risk factors and diet of Fulani pastoralists of northern Nigeria.

BACKGROUND: The Fulani of northern Nigeria are seminomadic pastoralists who consume a diet rich in saturated fats, do not use tobacco, are lean, and have an active lifestyle. Little is known about their serum lipid profiles and corresponding risk of cardiovascular disease. OBJECTIVE: We measured serum lipid, homocysteine, folate, and vitamin B-12 concentrations in Fulani men and women and assessed the nutrient content of their diet. DESIGN: Blood samples from 42 men (18-64 y old) and 79 women (15-77 y old) living in the Jos Plateau of Nigeria were analyzed for cholesterol (total, HDL, and LDL), triacylglycerol, homocysteine, folate, and vitamin B-12 serum concentrations. Body composition was determined by bioelectrical impedance analysis. Dietary information was obtained with use of a 7-d dietary recall and a food-frequency questionnaire. Results were compared with US referent ranges. RESULTS: The mean energy content of the Fulani diet was relatively low (men, 6980 kJ; women, 6213 kJ) and the mean protein content was high (men, 20% of energy; women, 16% of energy). Nearly one-half of energy was provided by fat, and one-half of that was derived from saturated fatty acids. The diet provided marginal to adequate amounts of vitamins B-12, B-6, and C but only one-third of the US recommended dietary allowance for folate. The mean total cholesterol, HDL-cholesterol, and triacylglycerol concentrations of Fulani adults were within the referent ranges; the mean LDL-cholesterol concentration of Fulani adults below the range; and the mean serum homocysteine concentration of Fulani men above the range. Homocysteine and folate concentrations were inversely correlated for both men and women. CONCLUSIONS: Despite a diet high in saturated fat, Fulani adults have a lipid profile indicative of a low risk of cardiovascular disease. This finding is likely due to their high activity level and their low total energy intake.

Bile salt-stimulated lipase in the milk of Fulani and Kanuri women in Nigeria and native Nepalese women.

Human milk provides newborns with several physiologically important proteins not found in cow's milk, including bile salt-stimulated lipase (BSSL) that compensates for the reduced lipolytic capability of the newborn intestine. We analyzed the milk of two ethnically distinct groups of women in northern Nigeria and Nepal. The milk of the Nepalese women (n = 36) contained slightly more BSSL activity (mean, 38.8 units/mL) than that of Fulani (n = 48; mean, 30.3 units/mL) and Kanuri (n = 90; mean 27.6 units/mL) women in Nigeria. There was also a weak positive correlation between the BSSL content of the milk and the body mass index (BMI) of the lactating women. The BSSL activity declined with the length of lactation for both well-nourished and undernourished women. The presence of a heat-stable inhibitor of BSSL in cow's milk was also demonstrated. This finding, along with the decrease in BSSL activity postgestation, could be of significance to populations such as the Fulani of the western Sahel who supplement the diets of their infants with unpasteurized cow's milk.

Lead levels in the milk of Fulani women in Nigeria.

Levels of lead were determined in the milk of 34 Fulani women in Plateau State in northern Nigeria. The Fulani are nomadic, semi-pastoralists who inhabit the western Sahel, including the countries of Mali, Burkino Faso, the Republic of Niger, Nigeria and Chad. The mean age of the women in this study was 26.0 +/- 7.5 years and their mean body mass index (BMI, kg/m2) was 19.4 (range, 14.5-24.0). Their average parity was 4 (range, 1-10). Milk was collected 2-24 weeks postgestation (mean, 11 weeks). Fifteen of the 34 milk specimens contained measurable lead (limit of detection, 4.6 microg/dL); the milk of the other 19 women (56%) did not contain a detectable level of lead. The data were not normally distributed. The median lead concentration of all 34 milk specimens, determined by end on plasma-axial view spectrometry, was 6.7 microg/dL (range, < 4.6-130 microg/dL). Given the mean weight of the 34 infants in the study (4.6 kg) and assuming that each infant consumed 0.7 L/day of milk, the average lead intake of these exclusively breastfed infants was 9.9 microg/kg/day, a value which is twice the daily permissible intake (DPI) of 5.0 microg/g/day set by the World Health Organization in 1972. These data indicate that some exclusively breastfed Fulani infants in the Jos Plateau are at risk of injury from lead derived from their mothers' milk, and raise questions about the actual blood levels in these nursing infants and the source(s) of the maternal lead.

Fatty acid composition of the milk lipids of Fulani women and the serum phospholipids of their exclusively breast-fed infants.

We previously reported that, relative to milk of women elsewhere in the world, the lipid fraction of milk of Fulani women in northern Nigeria contained relatively low proportions of alpha-linolenic acid and docosahexaenoic acid (DHA). This led us to question the essential fatty acid status of Fulani infants and the relation between the proportion of critical n-3 and n-6 fatty acids in the serum phospholipids of the mothers, their milk, and the serum phospholipids of their exclusively breast-fed infants. We were also interested in the effect de novo intermediate chain length-fatty acids (C10-C14) had on the proportions of critical and non-essential fatty acids in milk. Capillary gas-liquid chromatography was used to analyze the fatty acid content of the total milk lipids of 34 Fulani women, as well as the fatty acid content of serum phospholipids of the women and their breast-fed infants during the first 6 months of life. The proportions of critical n-3 and n-6 fatty acids in the milk of the Fulani women were adequate, but the proportions of these same fatty acids were low in their exclusively breast-fed infants. The serum phospholipids of the infants contained 18.8% linoleic acid, 0.13% alpha-linolenic acid, 12.8% arachidonic acid, and 3.40% DHA, whereas, the mean percentages of linoleic, alpha-linolenic, arachidonic and DHA in the serum phospholipids of the Fulani mothers' were 21.4, 0.20, 9.79, and 1.97, respectively. There was a strong positive correlation between fatty acid content of serum phospholipids of Fulani women and the fatty acid content of their milk lipids. As the proportion of C10-C14 fatty acids in the milk lipids increased, the proportions of critical n-3 and n-6 fatty acids in milk remained relatively constant; however, proportions of three non-essential fatty acids decreased dramatically. C10-C14 fatty acids do not appear to displace critical n-3 and n-6 fatty acids in milk.

Factors influencing exclusive breast-feeding in Jos, Plateau State, Nigeria.

A study to elucidate the factors that influence successful Exclusive Breast Feeding (EBF) was carried out by administering a structured interview questionnaire prospectively on three hundred and thirty three nursing mothers attending Family Health Clinic, Jos University Teaching Hospital from October 1997 to June 1998. 136 (40.9%) of their 333 babies were exclusively breast fed for six months from birth. Mothers' literacy level of 75.6% had a statistically significant positive effect on the practice of EBF (P < 0.05). A high percentage (97.6%) attended Ante-natal clinic but 44% delivered at home. Home delivery was found to have a statistically significant negative effect on the practice of EBF P > 0.001. The drop-out rate on EBF for working nursing mothers was 58% (Discontinued EBF on resumption of duty from maternity leave). Students who had babies during school sessions also recorded a similar drop-out rate (57%). Although there was no statistically significant association between mothers occupation and the practice of EBF, full-time house wives practiced EBF least. The reason was attributed to environment (family influence). The study highlighted the need to get the mothers and mothers-in-law of nursing mothers involved in the promotion of EBF. They are known to command much respect and their opinion is well respected in the family when a new baby arrives. The extension of maternity leave to six months for a working mother is very necessary if she is expected to breast feed for six months and at the same time work to earn a living in an ailing economy.

Concentration of eight trace minerals in milk and sera of mother-infant pairs in northern Nigeria.

Breastmilk from 15 healthy lactating women (21-31 years of age) from the hot, semi-arid sahel of Africa were analysed for copper, iron, zinc, magnesium, manganese, sodium, potassium, and phosphorus. Relative to published data from other populations worldwide, the milk of the Jos women appeared to contain adequate levels of magnesium, manganese, sodium, potassium, phosphorus and iron, but relatively low concentrations of zinc (1.07 micrograms/ml) and copper (170 micrograms/l). The sera of the exclusively breastfed infants nursed by these mothers contained levels of all these minerals that are within the international reference range of values. No statistically significant correlation was observed between the level of a particular mineral in the mothers' milk and the sera of their nursing infants.

Bioelectrical impedance analysis of the body composition of Nigerian children with sickle cell disease.

We used bioelectrical impedance (BIA) to investigate the body composition of children with sickle cell disease (SCD) in northern Nigeria. A total of 48 children with SCD and 51 controls between 3 and 20 years of age were studied. A significant difference was found in the weights of male subjects over the age of 10 years compared to controls (p = 0.01), but not in height. Significant differences were also observed for SCD males in the 10-18-year-old age range in body mass index (p = 0.001), fat free mass (p = 0.001), per cent fat free mass, (p = 0.02), body fat (p = 0.02), and per cent body fat (p = 0.02). No significant differences in any of these parameters between SCD subjects and controls were obtained for males under the age of 10 years. There were no significant differences in the height, weight, body mass index, or fat free mass for female SCD subjects compared to controls over the age range we studied. However, there were significant differences in the per cent fat free mass (p = 0.006), body fat (p = 0.025), and per cent body fat (p = 0.01) for female SCD subjects over the age of 10 years compared to controls. In addition to documenting differences in the body composition of adolescent boys with sickle cell disease in Nigeria, this study also demonstrated the feasibility of using bioelectrical impedance to analyse the body composition of individuals under the hot, arid conditions which prevail in sub-Saharan Africa.

The fatty acid composition of human milk in northern Nigeria.

The authors previously reported that the milk of Yoruba women in southwestern Nigeria was deficient in alpha-linolenic acid and contained a high percentage (42%) of medium chain-length fatty acids (MCFA, C10-C14). In the present study, the authors used capillary gas-liquid chromatography to analyze the milk of Hausa women in the northern region of Nigeria. The milk of the Hausa women contained 27% MCFA, 10.6% linoleic acid, 0.41% alpha-linolenic acid, 0.52% arachidonic acid, and 0.32% docosahexaenoic acid. The proportion of alpha-linolenic acid in the serum phospholipids of a subset of exclusively breastfed infants (n = 15; mean age, 6.2 +/- 0.3 months) was below the limit of detection (< 0.03%). While the milk of women in northern Nigeria is adequate with regard to n-3 and n-6 fatty acids, to satisfy the requirements for alpha-linolenic acid, it may be necessary to supplement the infants of these women after the first 6 months of life.

Content of lipid nutrients in the milk of Fulani women.

Little is known about the nutrition of the infants of the Fulani, migratory nomads of the western Sahel of Africa. Milk was collected from 18 Fulani women 10 to 30 days postpartum and the fatty acid compositions of the triacylglycerol and phospholipid fractions were determined by capillary gas-liquid chromatography. De novo fatty acids (10:0-14:0) comprised 36.3 +/- 12.7% of fatty acids of the triacylglycerols. Compared to the milk of various populations worldwide, the milk of the Fulani women contained adequate proportions of alpha-linolenic acid (0.50 +/- 0.16%) and arachidonic acid (0.42 +/- 0.22%), but relatively low amounts of linoleic acid (9.95 +/- 2.13%) and docosahexaenoic acid (DHA) (0.15 +/- 0.08%). In addition, the milk of the Fulani women contained adequate concentrations of beta-carotene (1.58 +/- 0.69 micrograms/dl) and vitamin A (42.7 +/- 40.3 micrograms/dl), but very low levels of vitamin E (0.11 +/- 0.10 mg/dl). These data indicate that exclusively breasted infants of Fulani women were receiving relatively low amounts of critical fatty acids and vitamin E.

Selective retention of n-3 and n-6 fatty acids in human milk lipids in the face of increasing proportions of medium chain-length (C10-14) fatty acids.

This paper reports the results of our analysis of the impact high levels of de novo fatty acids have on the proportions of essential and non-essential fatty acids in human milk lipids. The data for seven fatty acids (linoleic, alpha-linolenic, arachidonic (AA), docosahexaenoic (DHA), palmitic, stearic and oleic) were derived from several studies conducted in Nigeria. The proportion by weight of each of these fatty acids was plotted versus the proportion of C10-14 fatty acids. As the proportion of C10-14 fatty acids increased from 15 to 65%, there was not a proportional decrease in the percentages of all seven fatty acids, but, instead, preferential incorporation of the essential fatty acids, AA and DHA into the triacylglycerol component of the milk. At the same time, the proportions of stearic and oleic acid declined by 69% and 86%, respectively. However, the proportions of linoleic acid, palmitic acid, DHA, AA and alpha-linolenic acid, in milk lipids decreased by only 44%, 40%, 39%, 28% and 2.3%, respectively. These observations indicate that as the contribution of C10-14 fatty acids increases, essential fatty acids are preferentially incorporated into milk triacylglycerols at the expense of oleic acid and stearic acid.

Current breastfeeding knowledge, attitude, and practices of mothers in five rural communities in the Savannah region of Nigeria.

The knowledge, attitude, and practices regarding breastfeeding of 310 mothers in five rural communities in Toto Local Government in Nassarawa State, Nigeria were investigated using a questionnaire. One hundred and sixty-two (52.3 per cent) mothers were illiterate while 148 (47.7 per cent) had either primary or secondary school education. Apart from giving babies colostrum, which was seen more amongst mothers with higher levels of education (p < 0.001), other practices investigated such as exclusive breastfeeding, demand feeding, 'rooming-in', and time of first breastfeed were not influenced by the mother's level of education. Fifty-four per cent of mothers did not give their babies colostrum. All mothers attended the antenatal clinic but only 103 (33.3 per cent) received instructions from the health worker on breastfeeding and 46.8 per cent delivered at home. Only 28.6 per cent of babies were breastfed within 24 hours of birth. The mean time after birth for the first breastfeed was 47.7 hours. Although breastfeeding is widely practiced, none of the babies was exclusively breastfed, and prelacteal feeds ranging from water, formula, or herbal tea were given by all the mothers. The practice of discarding colostrum and replacing it with a wide range of prelacteal feeds and late initiation of breastfeeding has implications for health education programmes and neonatal feeding strategies.

The prevalence of hepatitis Be antigen and anti-HBE in adults in Benin City.

Two hundred and seventy four adults in Benin City were screened for HBeAg in their sera using the ELISA method. The overall HBe-Antigenemia prevalence was 7.3%. 12.7% of adult males and 5.4% of 203 adult females were positive for HBeAg. Of the 91 samples available for screening for anti-HBe, an overall positivity rate of 8.8% was obtained. 10.3% of 68 adult males and 4.4% of 23 adult females were positive for anti-HBe. Reports of high carrier rate for Hepatitis B virus (HBV) markers in Nigeria is further confirmed. The high HBeAg positivity rate could further explain the high transmission rate of HBeAg from chronic carriers in this country. Compared to the Far East countries, Prevalence of HBe-antigenemia is relatively lower and may further confirm that the vertical, that is neonatal maternal infant hepatitis B virus transmission might play a less important role than the later horizontal transmission in this country. Therefore in considering immunization programme, the use of hepatitis B vaccine alone, without the additional, much more expensive hepatitis B Immunoglobulin (HBIG) might be an adequate prophylactic measure. The high HBe-antigenemia as well as the already well documented endemicity of hepatitis B virus in this country however calls for urgent steps to ensure introduction of this vaccine into neonatal practice in this country.