Subclinical vitamin B12 deficiency in pregnant women attending an antenatal clinic in Nigeria.

SUMMARY: Inadequate vitamin B12 status in a pregnant woman increases the risk for adverse maternal and fetal outcomes. The use of serum vitamin B12 concentration alone to assess vitamin B12 status in pregnant women is unreliable because of the decrease in serum vitamin B12 levels in normal pregnancy. The combination of serum vitamin B12 and methylmalonic acid (MMA) concentrations may provide a better estimate of vitamin B12 status. We obtained blood samples from 98 pregnant women in the third trimester at an antenatal clinic in Jos, Nigeria. All subjects were taking iron and folate supplements. Twelve of the subjects had a serum vitamin B12 concentration <148 pmol/l and 18 subjects had a serum MMA level >271 nmol/l. Using a combination of low serum vitamin B12 and elevated MMA concentrations, eight subjects were classified as having subclinical vitamin B12 deficiency. Because of the potential harmful consequences of vitamin B12 deficiency in pregnant women, it would be advisable to add vitamin B12 supplements to the existing regimen of folate and iron supplements currently provided to pregnant women in Nigeria.

A cross-sectional study of the growth characteristics of Nigerian infants from birth to 2 years of age.

Malnutrition compromises the growth of children in sub-Saharan Africa. In Nigeria, the prevalence of childhood malnutrition approaches 40%. There are few reports relating the growth characteristics of breast-fed Nigerian infants to the anthropometric properties of their mothers. A total of 100 urban and rural mother/baby pairs were recruited. The mean BMI values of the urban and rural mothers were 24.2 and 21.3 kg m(-2), respectively. The mean length, weight and head circumference of the rural infants were significantly lower than those of the urban infants. Z-scores based on World Health Organization standards showed: (i) length-for-age z-score <-2 in urban (27%) and rural (33%) children; (ii) a higher incidence of underweight and small HC in rural (33%; and 13%) versus urban children (12% and 0%); and (iii) positive correlations between all three z-scores and maternal BMI. Negative correlations were observed between infant age and z-scores for length-for-age, weight-for-age and HC-for-age.

Assessment of the bone quality of black female athletes using quantitative ultrasound.

AIM: The mean daily calcium intake of adult Nigerians is reportedly low, and animal studies have shown that exercise-induced changes in the bones of growing mice are gender specific. We therefore sought to describe calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI) and SI-based T-scores in a cohort of Nigerian female athletes; to assess the correlation of SI with energy expenditure; and to compare mean SI values between sports. METHODS: We recruited 52 female athletes in 10 sporting categories, and recorded their anthropometric data. Activity levels were estimated using a questionnaire. Bone density was assessed using calcaneal ultrasound. RESULTS: The mean age of athletes was 21+/-4 years (range 15-39 years). The mean body mass index (BMI) was 22.0+/-3.5 kg/m2, and was not different between the sub-group of footballers/runners (21.3+/-1.7 kg/m2) and other athletes (23.1+/-4.8 kg/m2, P=0.06). The mean energy expenditure was 32.2+/-9.5 kcal/kg/ day, and was not different between the sub-group of footballers/runners (30.8+/-9.2 kcal/kg/day) and other athletes (34.3+/-9.7 kcal/kg/day, P=0.19). The mean BUA of the athletes was 135+/-14 dB/MHz, the mean SOS was 1597+/-13 m/s, the mean SI was 118+/-15, and the median SI-based T-score was +1.1 (-1.6 to +3.53). The means of all ultrasound parameters were not significantly different between footballers/runners and other sportswomen. CONCLUSION: Consistent physical training may improve calcaneal SI of black females by one, and potentially by as much as three T-score units. Training intensity, rather than the qualitative aspects of a sport, appears to be a major determinant of SI in female Nigerian athletes.

Inadequacy of dialysis, chronic inflammation and malnutrition in Nigerian patients on chronic hemodialysis.

PURPOSE: To identify the extent of underdialysis, chronic inflammation and malnutrition and their interrelationships in Nigerian hemodialysis patients. METHODS: In a prospective study including 10 adult patients, (6 men, 4 women) on hemodialysis in North Central Nigeria, malnutrition was assessed by body mass index (BMI), serum albumin and prealbumin, and bioimpedance (BIA) pre-and post dialysis, inflammation was evaluated by C-reactive protein (CRP) and adequacy of dialysis was judged by frequency of the hemodialysis sessions and Kt/V urea. RESULTS: Post-dialysis BMI was 21.3 (19.9, 24.3) kg/m2 (< 20 kg/m2 in 4 patients), serum albumin 31.5 (24.0, 32.0) g/L (< 30.0 g/L in 5), serum pre-albumin 25.2 (15.3, 31.1) mg/dL (< 18.0 mg/dL in 4), serum CRP 4.8 (1.2, 11.5) mg/dL (> 1.0 mg/dL in 8), phase angle 4.2 (3.7, 5.1) degrees (< 3 degrees in 3) and body fat deficit was diagnosed by BIA in 4 patients. Weekly frequency of dialysis was 3 times in 2 patients, twice in 1 and 1.2 in one patient receiving dialysis only twice weekly). By combined frequency of dialysis and Kt/V urea values, no patient received an adequate dose of dialysis and, indeed, all patients had overt symptoms of uremia. Low body weight, low serological and BIA nutrition indices, and high CRP levels occurred in the same patients. Patients on dialysis for > 1 year had worse nutrition indices than those on dialysis for < 1 year. CONCLUSIONS: Underdialysis was universal, while poor nutrition and chronic malnutrition were found in the majority of the small number of patients studied. These three adverse conditions, which were interlinked, may be common in Nigerian hemodialysis patients, because their underlying socioeconomic causes are widespread.

Comparison of the clock test and a questionnaire-based test for screening for cognitive impairment in Nigerians.

BACKGROUND: Since it is projected that by 2020 seventy percent of the elderly will reside in developing countries, a reliable screening method for dementia and cognitive impairment in general in populations with diverse languages, culture, education and literacy will be needed. We sought to determine if the Clock Test, a screening test for dementia, was suitable for use in a Nigerian population. STUDY DESIGN: Cross-sectional survey of 54 men and 12 women from Northern Nigeria. Researchers administered two dementia screening tools: a questionnaire-based test adapted for use in a Nigerian population and the Clock Test. RESULTS: Overall, 53.0% of the subjects had an abnormal Clock Test whereas 10.6% of the subjects had an abnormal questionnaire score. Only 9.1% of the subjects had abnormal scores on both tests. Subjects with more schooling had a greater probability of having a positive clock concept (understanding that a circle represented a clock). Of those with more than 6 years of schooling, 91.0% had a positive clock concept. Subjects with a negative clock concept were more likely to have an abnormal Clock Test (93.3%) than a questionnaire (26.6%). CONCLUSIONS: The main finding of our study was the discrepancy between the results of the Clock Test and the questionnaire. Performance on the Clock Test appeared to have been heavily influenced by education level, indicating the test is not universally applicable across cultures. The questionnaire-based test appears to reduce the effects of illiteracy on assessing dementia in a Nigerian population. Larger studies should be done to control for how education affects the assessment of dementia.

Amino acid, mineral and fatty acid content of pumpkin seeds (Cucurbita spp) and Cyperus esculentus nuts in the Republic of Niger.

Dried seeds and nuts are widely consumed by indigenous populations of the western Sahel, especially those who inhabit rural areas. In light of the need for quantitative information regarding the content of particular nutrients in these plant foods, we collected dried pumpkin (Cucurbita spp) seeds and nuts of Cyperus esculentus in the Republic of Niger and analyzed them for their content of essential amino acids, minerals and trace elements, and fatty acids. On a dry weight basis, pumpkin seed contained 58.8% protein and 29.8% fat. However, the lysine score of the protein was only 65% relative to the FAO/WHO protein standard. The pumpkin seed contained useful amounts of linoleic (92 microg/g dry weight) and the following elements (on a microg per g dry weight basis): potassium (5,790), magnesium (5,690), manganese (49.3), zinc (113), selenium (1.29), copper (15.4), chromium (2.84), and molybdenum (0.81), but low amounts of calcium and iron. Except for potassium (5,573 microg/g dry weight) and chromium (2.88 microg/g dry weight), the C. esculentis nuts contained much less of these same nutrients compared to pumpkin seeds. In conclusion, pumpkin seeds represent a useful source of many nutrients essential to humans. The data in this report should of practical value to public health officials in rural areas of sub-Saharan Africa.

Maternal mortality among adolescent women in Jos, north-central, Nigeria.

The adolescent maternal mortality ratio is high in Jos, north-central Nigeria. The main causes of maternal deaths among the adolescents were unsafe abortion, eclampsia and sepsis. The Hausa/Fulani ethnic group constituted the largest ethnic group of adolescent maternal deaths in our study. The risk factors for adolescent maternal mortality found in our study were illiteracy, non-utilisation of antenatal services and Hausa/Fulani ethnic group.

Serum potassium and acid-base parameters in severe dialysis-associated hyperglycemia treated with insulin therapy.

We analyzed the changes in serum potassium concentration ([K]) and acid-base parameters in 43 episodes of dialysis-associated hyperglycemia (serum glucose level > 33.3 mmol/L), 22 of which were characterized as diabetic ketoacidosis (DKA) and the remaining 21 as nonketotic hyperglycemia (NKH). All episodes were treated with insulin therapy only. Age, gender, initial and final serum values of glucose, sodium, chloride, tonicity and osmolality did not differ between DKA and NKH. At presentation, serum values of [K] (DKA 6.2 +/- 1.3 mmol/L; NKH 5.2 +/- 1.5 mmol/L) and anion gap [AG] (DKA 27.2 +/- 6.4 mEq/L; NKH 15.4 +/- 3.5 mEq/L) were higher in DKA, whereas serum total carbon dioxide content [TCO2 ] (DKA 12.0 +/- 4.6 mmol/L; NKH 22.5 +/- 3.1 mmol/L), arterial blood pH (DKA 7.15 +/- 0.09; NKH 7.43 +/- 0.07) and arterial blood PaCO2 (DKA 26.2 +/- 12.3 mm Hg; NKH 34.5 +/- 6.7 mm Hg) were higher in NKH. At the end of insulin treatment, serum values of [K] (DKA 4.0 +/- 0.7 mmol/L, NKH 4.0 +/- 0.5 mmol/L), [AG] (DKA 16.3 +/- 5.4 mEq/L, NKH 14.9 +/- 3.0 mEq/L), [TCO2 ] (DKA 23.5 +/- 5.0 mmol/L, NKH 24.1 +/- 4.2 mmol/L), arterial blood pH (DKA 7.42 +/- 0.09, NKH 7.51 +/- 0.14) and arterial blood PaCO2 (DKA 31.8 +/- 6.7 mm Hg, NKH 34.2 +/- 8.3 mm Hg) did not differ between the two groups. Linear regression of the decrease in serum [K] value during treatment, (Delta[K]), on the presenting serum [K] concentration,([K]2 ), was: DKA, Delta[K] = 2.78 - 0.81 x [K]2 , r = -0.85, p < 0.001; NKH, Delta[K] = 2.44 - 0.71 x [K]2 , r = -0.90, p < 0.001. The slopes of the regressions were not significantly different. Stepwise logistic regression including both DKA and NKH cases identified the presenting serum [K] level and the change in serum [TCO2 ] value during treatment as the predictors of Delta[K] (R2 = 0.81). Hyperkalemia is a feature of severe hyperglycemia (DKA or NKH) occurring in patients on dialysis. Insulin administration brings about correction of DKA and return of serum [K] concentration to the normal range in the majority of the hyperglycemic episodes without the need for other measures. The initial serum [K] value and the change in serum [TCO2 ] level during treatment influence the decrease in serum [K] value during treatment of dialysis-associated hyperglycemia with insulin.

Lysosomal enzymes in preeclamptic women in northern Nigeria.

BACKGROUND: The incidence of preeclampsia is high in northern Nigeria, as it is in many other developing countries, and preeclampsia is associated with significant maternal and fetal morbidity and mortality. We inquired if proteinuria or hypertension alone could account for the altered concentrations of urinary lysosomal hydrolases that have been reported in preeclamptic women and pregnant women without preeclampsia. METHODS: The activities of urinary beta-hexosaminidase and beta-galactosidase were determined fluorometrically in pregnant women assigned to one of four groups: Group I: 41 preeclamptic women; Group II: 31 hypertensive aproteinuric women; Group III: 44 normotensive proteinuric women; and Group IV: 52 healthy pregnant women (controls). RESULTS: The urinary beta-hexosaminidase concentrations were decreased in the preeclamptic women (P<0.005) and proteinuric women (P<0.001) when compared to the healthy pregnant controls. There was no significant difference in beta-hexosaminidase concentrations between the hypertensive women and the healthy pregnant controls. The urinary beta-galactosidase concentrations for preeclamptic, hypertensive, and proteinuric women did not differ significantly versus healthy pregnant controls. CONCLUSIONS: The reduced urinary excretion of beta-hexosaminidase in preeclamptic women is associated with proteinuria, but not hypertension. Measuring urinary concentrations of lysosomal hydrolases alone or in conjunction with urinary protein concentrations is not likely to be useful in predicting or monitoring the clinical course of preeclampsia; however, it might prove important in gaining a more complete understanding of the pathogenesis of renal tubular epithelial cell injury and proteinuria that occurs in preeclampsia.

Comparison of the OptiMAL rapid test and microscopy for detection of malaria in pregnant women in Nigeria.

Malaria during pregnancy causes anaemia in pregnant women and low birthweight in infants. The purpose of this study was to evaluate the OptiMAL rapid malaria test in comparison with standard microscopy for malaria diagnosis in 268 pregnant women attending antenatal clinics at the Jos University Teaching Hospital and the Federal Medical Centre-Gombe in Nigeria. Positive results by either method were confirmed using a polymerase chain reaction assay for malaria. Although the OptiMAL assay did not detect malaria in the blood of pregnant women with low levels of parasitaemia, it may be useful for the detection of placental malaria which predisposes to low birthweight infants.

Factors contributing to maternal mortality in north-central Nigeria: a seventeen-year review.

Maternal mortality ratio in Nigeria is one of the highest in the world. This paper reports a facility based study in north-central Nigeria to determine the magnitude, trends, causes and characteristics of maternal deaths before and after the launch of the Safe Motherhood Initiative in Nigeria, with a view to suggesting strategic interventions to reduce these deaths. The records of all deliveries and case files of all women who died during pregnancy and childbirth between January 1, 1985 and December 31, 2001, in the maternity unit of Jos University Teaching Hospital, Jos, Nigeria, were reviewed. Data collected were analysed for socio-biological variables including age, booking status, educational level, parity, ethnic group, marital status, mode of delivery, duration of hospital stay before death occurred, cause (s) of maternal deaths. There were 38,768 deliveries and 267 maternal deaths during the period under review, giving a maternal mortality ratio (MMR) of 740/ 100,000 total deliveries. The trend fluctuated between 450 in 1990 and 1,010/100.000 deliveries in 1994. The mean age of maternal death was 26.4 (SD 8.1) years. The greatest risk of MMR was among young teenagers (> 15 years) and older women (< 40 years). Parity-specific maternal mortality ratio was highest in the grand multiparous women. Unbooked as well as illiterate women were associated with very high maternal mortality ratio. The Hausa - Fulani ethnic group contributed the largest number (44%) by tribe to maternal mortality in our study. The major direct causes of deaths were haemorrhage (34.6%), sepsis (28.3%), eclampsia (23.6%) and unsafe abortion (9.6%). The most common indirect causes of death were hepatitis (18.6%), anaesthetic death (14.6%), anaemia in pregnancy (14.6%), meningitis (12.0%), HIV/AIDS (10.6%) and acute renal failure (8.0%). Seventy-nine percent of the maternal deaths occurred within 24 hours of admission. Most of the deaths were preventable. A regional-specific programme should be planned to reduce the deplorably high maternal mortality in north-central Nigeria.

Comparison of pulmonary function between children living in rural and urban areas in northern Nigeria.

Children in northern Nigeria and elsewhere in the hot, arid western Sahel, are at risk of having their lung function compromised by a variety of factors, including undernutrition, environmental factors (e.g. airborne pollutants such as dust and smoke from wood fires), chronic upper-respiratory tract infections, and low socioeconomic class. We were interested in using spirometry to compare the pulmonary function of Nigerian children and adolescents aged 6-18 years who were living in urban and rural settings with the corresponding standards for African-American children. A total of 183 boys and girls in the rural village of Sabon Fobur on the Jos Plateau and another 128 boys and girls in the city of Jos were tested to determine their forced vital capacity (FVC), FVC at 1 s (FVC1), and peak expiratory flow (PEF). The nutritional status of the subjects was determined by measuring the body mass index (BMI), triceps skin-fold thickness, and mid-arm circumference, and fat-free mass (FFM) and fat mass (FM) by bioelectrical impedance analysis. According to the results of anthropometry, the subjects in Sabon Fobur and Jos were lean but generally adequately nourished. The mean FVC, FVC1 and PEF values for the rural males were 1.851,1.761, and 3.521, and for the urban males they were 1.971,1.791, and 3.471, respectively. The corresponding values for the rural females were 1.791,1.701, and 3.371, and for the urban females they were 1.761,1.671, and 3.091. These values were approximately 100 per cent of the corresponding values for African-American children. In general, strong correlations were found between each of the three lung function parameters and age, weight, height (only for the males), BMI, MAC, and FFM. These results show that: (1) the lung function of Nigerian children and adolescents living in either rural or urban areas were similar and compared favorably with African-American standards, and (2) weight was as important as height in determining pulmonary function. The inclusion of FFM as an explanatory variable did notfurther increase the accuracy of the prediction, even in a population where malnutrition may be prevalent. Therefore, we conclude that measurements of height and weight are all that are required for the assessment of lung function using spirometry in Nigerian children.

Assessment of the skeletal health of healthy Nigerian men and women using quantitative ultrasound.

The dietary intake of calcium by African populations, particularly in sub-Saharan Africa, is relatively low compared to the recommended intake for US adults. However, the rate of osteoporotic fractures in West African women is reported to be less than that for Caucasian populations. Because there is little published data regarding the skeletal status of African men and women, we used quantitative ultrasound (QUS) to assess the bone density of 435 Nigerian women and 321 Nigerian men between 16 and 89 years of age. A progressive decline in bone quality was observed beginning at about 40 years of age for both men and women. The mean stiffness index (SI) for the women between 20 and 35 years of age (n = 186) in this study was 102 +/- 17. The equation that best described the age versus SI relationship for women was SI = 79.7 + 1.887 (age) + -0.043 (age)2 + 0.00020 (age)3. For Nigerian men, the peak SI of 115 +/- 17 was seen in the 20- to 29-year-old age group. For men, the SI values remained above 100 until about age 60 years when a significant decline in SI was then observed. The best-fit curve of SI versus age for men was SI = 134.9 - 1.27 (age) + 0.019 (age)2 - 0.00014 (age)3. The broadband ultrasound attenuation (BUA), speed of sound (SOS), and SI values for the Nigerian men and women were comparable to or higher than those reported for Caucasian and Asian populations. These data should serve as reference values for adult men and women in sub-Saharan Africa.

Lung function and nutritional status of semi-nomadic Fulani children and adolescents in northern Nigeria.

The Fulani are semi-nomadic pastoralists of the western Sahel whose culture and economy are centered on cattle. We have shown previously that Fulani children and adolescents (5-18 years old) are stunted and underweight. Nutritional status and lung function were studied in Fulani children and adolescents (n = 70), aged 6-18, and compared with a non-Fulani, rural Nigerian control group (n = 153) of the same age. Participants were restricted to healthy individuals with no prior history of respiratory disease and no symptoms of an upper respiratory tract infection within the past 6 weeks. Significant deficits in forced vital capacity (FVC; Fulani males, 1.51 l; non-Fulani males, 1.86 l, p = 0.009; Fulani females, 1.36 l; non-Fulani females, 1.79 l, p < 0.001), forced expiratory volume in one second (FEV1; Fulani males, 1.44 l; non-Fulani males, 1.76 l, p = 0.02; Fulani females, 1.24 l; non-Fulani females, 1.69 l, p < 0.001), and peak expiratory flow rate (PEFR; Fulani males, 2.69 l/s; non-Fulani males, 3.48 l/s, p = 0.002; Fulani females, 2.29 l/s; non-Fulani females, 3.35 l/s, p < 0.001) were found in both the Fulani boys and girls compared with the non-Fulani controls. The diminished lung function in the Fulani group could be attributed to respiratory muscle weakness or an overall deficit in energy.

Effects of displacement resulting from ethnic/religious conflict on the growth and body composition of Fulani children in northern Nigeria.

This study, which was carried out in the Jos Plateau in Nigeria, analysed the changes in growth and body composition that occurred among 17 male and 13 female Fulani children (aged 4-13 years) in the 7-month period which followed their displacement from their homes into a temporary camp due to ethnic/religious violence. The heights and weights of the children, as well as their fat, fat-free mass, and phase angle were determined 3 weeks before the crisis and 7 months post-crisis using standard anthropometric methods and bioelectrical impedance analysis. In terms of mean values and relative to growth curves established during the tranquil period immediately preceding the crisis, all but one of the girls grew taller and gained more weight than predicted; two-thirds of the weight gained by the girls was due to fat. With regard to the male subjects, on average, while they grew taller, they gained 30 per cent less in height than predicted. However, the boys did gain 50 per cent more weight than predicted. Unexpectedly, fat accounted for one-half or more of the weight gain in both the boys and girls. In general, the boys did less well than the girls in the months following the crisis. The phase angle of all subjects did not decline significantly during the pre- and post-crisis interval. In general, from the nutritional perspective, the Fulani children coped relatively well during the 7-month period of displacement. The fact that neither the growth nor body composition of the Fulani children deteriorated significantly following the crisis was attributed to the fact that during that period they were receiving adequate and continuous supplies of food. Furthermore, the displacement camp into which the children and their families migrated was located in a secure region of the country and one that was controlled by people whose culture and ethnicity were similar to theirs. Finally, at no time during their 7 months as a displaced population were the children separated from their mothers. In conclusion, this study shows that displacement in general may not necessarily lead to deleterious effects on the growth of children.

Survey of the growth characteristics and body composition of Fulani children in a rural hamlet in northern Nigeria.

This paper reports the results of a cross-sectional study of the growth of Fulani children, aged 1-16 years, living in the Jos Plateau of northern Nigeria. This particular population of Fulani are semi-nomadic pastoralists whose economy and culture are centered on cattle. We measured the heights and weights of 176 girls and 164 boys and determined their body composition parameters (fat content, fat-free mass, and phase angle) using bioelectrical impedance analysis. The body mass index values for the boys and girls were 14.9 and 15.0 kg/m2, respectively. When the heights and weights of the Fulani children were compared against World Health Organization standards, the incidence of stunting and underweight was high: 46 per cent of the girls and 57 per cent of the boys, respectively, had weight Z-scores below -1.0, and 42 per cent and 57 per cent had height Z-scores below -1.0. Even when weight was adjusted for height, the boys and girls fell well below their age- and gender-matched standards. The percentage fat content of the children declined with age such that by age 16 years the fat content of the boys was 10 per cent and that of the girls 20 per cent. Although the Fulani children were significantly shorter and lighter than the international standards, their phase angle value (determined by bioelectrical impedance analysis), which is a measure of body cell mass and the overall vitality and health of tissue membranes, was comparable to those of similarly aged healthy children in the United States. These results indicate that although a large proportion of the Fulani children who inhabit the Jos Plateau are stunted and underweight, the bioelectrical properties of their tissue membranes suggest that they are relatively healthy. It is not known if the slow growth of the Fulani children has a genetic basis or if it is the result of nutritional shortcomings.

The fluidity of the serum phospholipids of Fulani pastoralists consuming a high-fat diet.

The semi-nomadic cattle Fulani of northern Nigeria consume a diet rich in saturated fatty acids. Since the quality of an individual's dietary fat can influence the fatty acid composition of their membrane phospholipids (PL), we investigated the effect consumption of relatively large amounts of saturated fat might have on the fatty acid composition and fluidity of the serum PL of the Fulani. We obtained blood serum from 112 Fulani pastoralists (38 males, 74 females) 15-77 years of age and determined the serum fatty acid composition of the total PL fraction of each specimen. Our results indicate that the PL of the Fulani were enriched for saturated fatty acids. The unsaturated/saturated fatty acid ratio was 1.02 for the Fulani PL compared to 1.22-2.08 for seven other reference groups drawn from published reports. In addition, the mean melting point (MMP) of the fatty acyl chains of the serum PL of the Fulani was considerably higher than that of the reference populations (MMP, 30.6 degrees C versus 21.3-26.1 degrees C, respectively). The double bond index (DBI) of the serum PL of the Fulani was much lower than that of the PL of the groups against which comparisons were made (DBI, 0.98 versus 1.24-1.43, respectively). Since serum PL and tissue PL are in dynamic equilibrium, these findings suggest that the tissue PL of the Fulani we studied has considerably less fluid character than those of other populations. Since a variety of membrane functions depend on the fluid property of the acyl chains of their constituent PL, it is conceivable that certain critical membrane-dependent systems, including receptor-ligand interactions, solute transport, enzyme activity and lateral movement of macromolecules, are affected in the Fulani.

Nutrient content of earthworms consumed by Ye'Kuana Amerindians of the Alto Orinoco of Venezuela.

For the Makiritare (Ye'Kuana) native people of the Alto Orinoco (Venezuela), earthworms (Anellida: Glossoscolecidae) are an important component of the diet. Two species in particular are widely consumed: 'kuru' (Andiorrhinus kuru n. sp.) and 'motto' (Andiorrhinus motto). We analysed eviscerated kuru body proper, and whole and smoked preparations of motto for their content of protein and amino acids, fatty acids and 20 minerals and trace elements. The samples contained large amounts of protein (64.5-72.9% of dry weight), essential amino acids, calcium and iron together with notable quantities of other important elements, indicating that these earthworms contain potentially useful quantities of many nutrients that are critical to the health of the humans who consume them.

Correlation of the fatty acid composition and fluid property of the cholesteryl esters in the serum of Nigerian children with sickle cell disease and healthy controls.

In a previous study conducted in Nigeria, we found that children with sickle cell disease (SCD) had exceedingly low total serum cholesterol levels (mean=100-102mg/dl). The fact that significant reductions in the levels of certain polyunsaturated fatty acids (PUFA) have been documented in the serum phospholipids of these same SCD subjects led us to inquire as to the fatty acid composition of the cholesteryl esters (CE) in their serum. Lecithin:cholesterol acyl transferase (LCAT), the enzyme in blood that catalyzes the reaction in which tissue cholesterol is acylated prior to its removal from cell membranes, is relatively specific for certain PUFA. CE in blood serum from 43 male and 42 female children with SCD, ages 4-18 years, and equal numbers of age- and gender-matched controls were analyzed for their fatty acid composition. Relative to the non-SCD controls, the CE of the SCD subjects contained 9% less linoleic acid, 16% less arachidonic acid, 40% less alpha-linolenic acid, 50% less eicosapentaenoic acid, and 36% less docosahexaenoic acid, but 15% more palmitic acid and 10% more oleic acid. Overall, the acyl chains of the CE of the SCD subjects were less fluid than those of the controls, as determined by comparison of their mean melting points (MMP) and double bond indices (DBI). MMP and DBI were both estimated from the individual constituent fatty acids comprising the CE acyl chains. The strongest correlations between MMP and fatty acid mole percent were seen with palmitic acid and linoleic acid. These results show that the fatty acid composition of the serum CE of children with SCD is abnormal relative to controls who do not have this hematologic disorder. We speculate that suboptimal fatty acid nutrition in Nigerian children with SCD compromises their ability to remove cholesterol from their tissues due to preference of the LCAT enzyme for PUFA, thereby accounting, in part at least, for the low total serum cholesterol levels one finds in children with SCD.

Chronic hemodialysis in a Nigerian teaching hospital: practice and costs.

The incidence of end-stage renal disease (ESRD) is on the rise in developing countries. To identify issues related to renal replacement therapy in ESRD patients in the developing world, we analyzed the practice and costs of hemodialysis in Nigerian ESRD patients. Ten ESRD patients were dialyzed at the Jos University Teaching Hospital, Jos, Plateau State, Nigeria, between June 15 and July 15, 2003. In these patients, we analyzed initiation, vascular access issues, frequency, duration, adequacy and economics of chronic hemodialysis. The Nigerian patients were referred to the nephrologist for the first time only when they had developed frank uremia. No patient had a permanent vascular access at the time dialysis was initiated. Only two patients had a functioning dialysis fistula, while the other eight patients were dialyzed through temporary femoral vein catheters that were removed after each dialysis. Frequency of dialysis was three times weekly in 2 patients, twice weekly in 1 patient and once weekly or less frequently in 7 patients. The duration of a dialysis session was prescribed to be 4 hours, but sessions often lasted for as long as 10 hours because of breakdowns of the antiquated dialysis machines. The urea reduction ratio was 45.3 +/- 8.6%. In every case, the cost of dialysis was borne by the patients and their families. Comparison of the cost of dialysis, with extensive re-use of supplies, to monthly incomes of Nigerians with different professions revealed that the great majority of Nigerians cannot afford three times weekly dialysis. Underdialysis in Nigerian ESRD patients is common and caused by socioeconomic factors and technologic deficits. One step towards correction of underdialysis could be sharing of the cost of dialysis by the public.