Wuchereria Bancrofti Infection in Children Living in a Rubber Plantation Estate in South-South Nigeria.

BACKGROUND: Chronic manifestations of bancrofti filariasis can be debilitating. There is paucity of description of this disease in the childhood population, yet early detection can prevent disability such as elephantiasis. OBJECTIVE: The objective of the study was to determine the prevalence and clinical features of this infection among children in a plantation estate in Cross River State, Nigeria. METHODS: It was a cross-sectional study in subjects aged 1 to 18 years, recruited from the nine camps of the settlement, using multistage sampling technique. The presence of Circulating Filarial Antigen (CFA) was tested for using Immunochromatographic Card Technique (ICT). Simple proportions, percentages, Chi square and Fisher's exact tests were used to analyse the data. RESULTS: A total of 342 subjects were recruited into the study. One hundred and sixty three (47.7%) were males. The mean age was 8.52± 4.41years. Majority of the subjects, 316(92.4%), were from families of low socioeconomic status. Twenty of the 342 children (5.8%) were positive for microfilaria antigenaemia. Increasing age (p=0.006) and duration of stay in the estate (p=0.005) were positively associated with antigenaemia. None (0%) of the 55 subjects who used insecticide treated nets was positive for CFA, while 20 (6.97%) of the 287 who did not, were positive (p=0.03). Only ten (3.95%) of the 253 subjects who used insecticide spray vs 10 (11.0%) of the 89 who did not use spray were positive for CFA (p=0.016). Itching was the only significant symptom identified. CONCLUSION: The prevalence of Wuchereria bancrofti in the subjects was 5.8%, with increasing prevalence with age. Itching was the only significant clinical feature. The use of insecticide treated nets and insecticide sprays significantly reduced the chances of being infected. There is a need for elimination programme to be extended to the childhood population and to sub-urban areas.

CONTEXTE: Les manifestations chroniques de la filariose de bancrofti peuvent être débilitantes. Il existe peu de descriptions de cette maladie dans la population infantile, mais une détection précoce peut prévenir des handicaps tels que l'éléphantiasis. OBJECTIF: L'objectif de l'étude était de déterminer la prévalence et caractéristiques cliniques de cette infection chez les enfants d'une plantation dans l'État de Cross River, au Nigéria. METHODES: Il s'agissait d'une étude transversale chez des sujets âgés de 1 à 18 ans, recrutés dans les neuf camps de la colonie, en utilisant la technique d'échantillonnage à plusieurs degrés. La présence d'antigène filarien circulant (CFA) a été testée à l'aide de la technique de carte immunochromatographique (ICT). Des proportions simples, des pourcentages, le Chi carré et des tests exacts de Fisher ont été utilisés pour analyser les données. RESULTATS: Un total de 342 sujets ont été recrutés dans l'étude. Cent soixante trois (47,7 %) étaient des hommes. L'âge moyen était de 8,52 ± 4,41 ans. La majorité des sujets, 316 (92,4 %), provenaient de familles de faible statut socio-économique. Vingt des 342 enfants (5,8 %) étaient positifs pour l'antigénémie des microfilaires. L'augmentation de l'âge (p = 0,006) et de la durée de séjour dans le domaine (p = 0,005) était positivement associée à l'antigénémie. Aucun (0%) des 55 sujets qui ont utilisé des moustiquaires imprégnées d'insecticide n'était positif pour le CFA, tandis que 20 (6,97%) des 287 qui n'en avaient pas étaient positifs (p=0,03). Seuls dix (3,95 %) des 253 sujets qui ont utilisé un insecticide contre 10 (11,0 %) des 89 qui n'ont pas utilisé de spray étaient positifs pour le CFA (p = 0,016). Les démangeaisons étaient le seul symptôme significatif identifié. CONCLUSION: La prévalence de Wuchereria bancrofti chez les sujets était de 5,8 %, avec une prévalence croissante avec l'âge. Les démangeaisons étaient la seule caractéristique clinique significative. L'utilisation de moustiquaires imprégnées d'insecticide et de pulvérisations d'insecticide a considérablement réduit les risques d'infection. Il est nécessaire d'étendre le programme d'élimination à la population infantile et aux zones suburbaines. Mots clés: Filariose de Bancrofti, Enfants, Zone d'Endémie.

Sonographic determination of normal subcutaneous fat thickness in children in Southern Nigeria.

BACKGROUND: Subcutaneous fat is a highly active metabolic tissue that exerts control on numerous biochemical and physiological processes in health and disease. Children are particularly susceptible to nutritional problems, hence the need to measure subcutaneous fat thickness (SFT) which can be used to determine their body composition. Ultrasonography provides an affordable, noninvasive, available technique of achieving this. OBJECTIVE: The aim of this study was to determine the normal values of SFT at the triceps, subscapular, and abdomen in children age 1-5 years using ultrasound in southern Nigeria. MATERIALS AND METHODS: This was a prospective study of 1750 healthy children age 1-5 years in nursery and primary schools in Calabar, Nigeria. Their body mass indexes were calculated from their weights and heights, while their triceps fat thickness (TFT), subscapular fat thickness (SuFT), and abdominal fat thickness (AFT) were measured using a 7.5-MHz linear array transducer of a Hitachi portable ultrasound machine. RESULTS: The mean TFT value for girls was 4.6 ± 2.0 mm and 3.99 ± 1.8 mm for boys. Girls had mean SuFT value of 2.37 ± 1.41 mm and boys 2.14 ± 1.02 mm. The mean AFT value for girls was 5.53 ± 2.94 mm and for boys 4.53 ± 2.37 mm. The values at all sites were generally higher in females than in males. CONCLUSION: This work has provided a sonographic normogram of SFT at various sites for preschool children in Nigeria.

Substance use and sexual behaviour among female students in Nigerian universities.

Substance use continues to constitute social and health problems, more so among adolescents and young adults. One consequence is risky sexual behavior, a major problem in sub-Saharan Africa already facing the synergistic problems of poverty and HIV/AIDS. This study of female students aged ≥ 18 years in two universities in Nigeria uses a multi-stage stratified random sampling method, and each subject that gave consent to the study was administered with a structured questionnaire by trained interviewers; 2,408 female students were studied (1,854 from the University of Ibadan and 554 from the Bayero University, Kano). The mean age of the respondents was 21.6 (SD = 2.9), and about two-thirds (65.7%) were aged between 20-24, with 2,204 (91.5%) being single and 4.3% married. In all, 23.4% of the subjects used one form of substance. Alcoholic drinks of palm wine, alcoholic wine, and beer were the most common of substances used (22.7%), followed by tobacco (2%) and cannabis (1%). Substance use was significantly associated with religious affiliation of the students (p < 0.001), as the prevalence of substance use was least among Muslim students (11.7%) and highest among those who professed traditional religion (39.4%). Alcohol use was also positively associated with sexual activity (p < 0.001). Among the 547 students who used alcohol, 147 (26.9%) had sex in the 4 weeks prior to the survey, while among the 1,861 non-users, only 8.9% did so. The practice of unprotected sex was found not to be associated with substance use: a slightly lower proportion (29.5% vs. 36.6%) of substance users engaged in unprotected sex in their last encounter compared to non-users. There is need to scale up public health education on the dangers of substance use and its associated sexual risk behavior.

Stray dog trade fuelled by dog meat consumption as a risk factor for rabies infection in Calabar, southern Nigeria.

BACKGROUND: Rabies is a preventable zoonosis with the highest case fatality of any disease in the world. In the developing world, it is transmitted mainly by dog bites. In parts of southern Nigeria, dog meat is a delicacy. OBJECTIVE: To highlight trade in stray dogs as a major risk factor for rabies in animals and humans in south-south Nigeria. METHOD: Patients admitted into the University of Calabar Teaching Hospital (UCTH) with a diagnosis of rabies between July and October 2012 were analysed for risk factors, post exposure prophylaxis (PEP), health seeking behaviour and outcome. Focused group interview were also conducted among traders/handlers of stray dogs. RESULTS: Ten cases of rabies in subjects aged 3 to 52 years were recorded in these five months period. Eight of the cases were male and apparently got infected directly or indirectly through the trade in stray dogs for human consumption. None had proper PEP and all patients died. CONCLUSION: Stray dog trade, fuelled by eating of dog meat, is a risk factor for human and animal rabies in Calabar, southern Nigeria. Culling of stray dogs, control of stray dogs' trade and public enlightenment on PEP is recommended.

PREVALENCE, CO-PREVALENCE AND RISK FACTORS OF PULMONARY PARAGONIMIASIS AND PULMONARY TUBERCULOSIS IN NIGERIAN CHILDREN IN THE NIGER DELTA AREA.

BACKGROUND: Nigeria has the highest burden of paragonimiasis in Africa and it is also among the high burden countries with tuberculosis. The true prevalence of these reemerging diseases is unknown in the country. OBJECTIVE: To determine the prevalence and co-prevalence of thesere-emerging diseases among children in a rural Nigerian community. DESIGN: Descriptive cross-sectional study. SETTING: Ewang, a rural fishing community in Mbo Local government Area of Akwa Ibom State, Nigeria. SUBJECTS: Primary and secondary school children aged 5-18years living in Ewang village, Mbo Local government Area of Akwa Ibom State, Nigeria. RESULTS: A total of 204 children were examined: 91(44.6%) were males, while 113(55.4%) were females. Ten of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 4.9%,while six children were sputum positive for pulmonary tuberculosis with a prevalence rate of 2.9%. There was no case of co-infection. The peak age prevalence of paragonimus ova-positive and Acid and Alcohol fast positive subjects was recorded in the five to nine year old age group with prevalence rate of 5.6% and7.4% respectively. There was a female preponderance among the paragonimus ova-positive subjects (90%) and the AAFB positive subjects (66.7%). CONCLUSIONS: The findings show that paragonimiasis is an emerging/re-emerging disease in southern Nigeria and further confirmed that the prevalence of tuberculosis is still on an upward rise.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria.

Summary Estimates of maternal mortality are crucial to inform the planning of reproductive health programmes and guide advocacy. The aim of this study was to obtain a population-based estimate of maternal mortality in Lagos State, Nigeria. The sisterhood method was used in 2008 to carry out the survey using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within 6 weeks after childbirth. The survey involved 4,315 respondents who provided information on 9,910 ever married sisters. The life-time likelihood (risk) of maternal death for women aged 15-49 years was found to be 0.0239 or 1 in 42. The estimated maternal mortality ratio was 450 per 100,000 live births with a 95% CI of 360 and 530. Out of 111 reported deaths, 35 (31.5%) occurred during pregnancy, 49 (44.1%) occurred during delivery and 27 (24.3%) within 6 weeks of delivery.

Academic performance of school children with behavioural disorders in Uyo, Nigeria.

INTRODUCTION: Behavioural disorders can have a negative influence on the academic performance of school children. There are no similiar published is no known studies in Nigeria. OBJECTIVE: To compare the academic performance of primary school children with behavioural disorders with that of their controls. METHODS: A total of 132 primary school pupils aged 6-12 years with behavioural disorders using Rutter scale for teachers (Scale B(2)) and their matched-controls were selected. Their academic performance was assessed and compared using the overall scores achieved in the first and second term examinations in the 2005/2006 academic sessions, as well as the scores in individual subjects. Number of days absent from school was documented. RESULTS: While 26.5% and 12.9% pupils with behavioural disorders had high and poor academic performance respectively, 38.6% and 9.1% pupils without such disorders had high and poor performances respectively. The difference in the ooverall academic performance was statistically significant (p=0.04). The mean scores of the pupils with behavioural disorders on four core subjects compared well with those of the controls. Pupils with antisocial behaviour underachieved more than others. School absence rate had no significant influence on their performance. CONCLUSION: Behavioural disorders are associated with poor academic performance in school children in Uyo.

Relationship between Schistosoma haematobium infection and urinary tract infection among children in South Eastern, Nigeria.

BACKGROUND: Reports of studies on the relationship between Schistosoma haematobium and urinary tract infection from different regions are conflicting. Hence, the need to determine the situation in each endemic area. OBJECTIVE: To determine if S. haematobium infection is associated with Urinary Tract Infection (UTI) among children in an endemic area of Cross River State, Nigeria. SUBJECTS AND METHODS: Mid-stream urine specimen was collected under strict aseptic procedures into wide-mouthed screw-capped sterile plastic containers. All the specimens were kept in a cooler at approximately 4 degrees C for 5-10 hr before delivery to the laboratory. Urine microscopy was carried out by gram staining and urine was cultured using blood agar and Mac Conkey agar plates. Collection of urine specimens for schistosoma ova was done between 10.00 am and 2.00 pm when ova count of S. haematobium is expected to be at its peak. RESULTS: Prevalence of urinary schistosomiasis was 51.0%. One hundred and seventy five (77.4%) of those infected had mild intensity of infection (<49 ova/10 ml). Significant bacteriuria was found in 2(0.9%) of the 226 children with urinary schistosomiasis and in 4(1.8%) of the 217 children without urinary schistosomiasis RR(95%CI) = 0.48 (0.089-2.59) P > 0.68. CONCLUSION: This study has found the prevalence rate of urinary Schistosomiasis in this community to be 51% and no significant difference in the prevalence of UTI among children with urinary schistosomiasis and those without. However, considering the high prevalence of urinary schistosomiasis seen in this study, urgent control measures should be instituted to address this public health problem.

Prevalence and intensity of Paragonimus uterobilateralis infection among school children in Oban village, South Eastern, Nigeria.

A survey of Paragonimus infection among primary school children aged 6-10 years in Oban village, Akamkpa Local Government Area of Cross River State, Nigeria, was conducted. A total of 198 children were examined:112 (56.6%) were boys while 86 (43.4%) were girls. Eleven of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 5.5%. The findings show that paragonimiasis is a significant health problem in South Eastern Nigeria; the risk of infection could be minimized by the proper cooking of fresh water crabs and crayfish before consumption.

Lipid profiles of apparently healthy adolescents in Calabar, Nigeria.

OBJECTIVE: To determine the lipid profiles of adolescents in Calabar, Nigeria. DESIGN: A cross sectional prospective study. SETTING: The study was carried out in Calabar, a city located on the south-eastern axis of Nigeria. Calabar is rapidly acquiring the status of a tourism destination in the country and as such the lifestyles of the city dwellers are changing rapidly. SUBJECTS: The subjects were apparently healthy students 10 to 18 years old attending day secondary schools in the city. A structured questionnaire was used to collect demographic and anthropometric data from the students. Blood samples were collected from 375 adolescents and used for analyzing their lipid profiles. MAIN OUTCOME MEASURES: Abnormal levels of serum lipids. RESULTS: The results showed that only one subject (0.3%) had an abnormally high total cholesterol (TC) level and 33% of the subjects had low levels of high density lipoprotein cholesterol (HDL-C). Borderline high levels of total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were found in 2.4%, 3.2% and 5.1% of subjects respectively. CONCLUSION: This study shows that the lipid profiles of Nigerians are low but gradually rising towards values seen in places where coronary heart disease occurs in epidemic proportions. This may point to an increased risk ofarteriosclerosis in future generations.

Knowledge and practice of emergency contraception among female undergraduates in the University of Lagos, Nigeria.

OBJECTIVES: To assess the level of knowledge and practice of emergency contraception among female undergraduates in University of Lagos and to determine the factors that influence knowledge and practice of emergency contraception among female undergraduates. DESIGN: Cross-sectional descriptive study. SETTING: The University of Lagos, Lagos, South-West, Nigeria between August 2003 and March 2004. SUBJECTS: Four hundred and eighty randomly selected female undergraduate students. RESULTS: The findings revealed that 67.8% of the respondents reported knowing about emergency contraception. More than half (56.1%) were sexually active and of this group, 96.8% had ever practiced contraception with only 33.9% having ever practiced emergency contraception. However, only 37.8% and 36.3% of respondents who had reported knowing about emergency contraception knew the correct time frame for effective use, and correctly identified emergency contraceptives respectively. Among those who were aware of, and had used emergency contraception, 34.1% obtained their information from health care providers, while the larger majority obtained from friends. Knowledge and practice of emergency contraception was found to be directly related to age, level of study, medical education, marital status, sexual activity, previous history of use of contraceptives and previous history of induced abortion. CONCLUSION: Education efforts that focus on the training of health care providers and young adults on emergency contraception with regards to available methods and correct timing of use would greatly improve women's access to and effective use of this method in Nigeria.

HIV infection among patients with pulmonary tuberculosis in Nigeria.

Respiratory problems like Pneumocystic carinni and Pulmonary tuberculosis (PTB) are among the common opportunistic infections in patients with HIV/AIDS. The risk of acquiring Mycobacterium tuberculosis in a community becomes greater with increase in the number of HIV positive persons with active tuberculosis. This study was carried out to determine the magnitude of HIV infection among PTB patients in different parts of Nigeria as part of the year 2000 national HIV surveillance programme. Blood samples were collected on blotting paper from a total of 2826 individuals attending TB clinics between 1st of September and 1st November, 2000. Samples were collected from patients with confirmed PTB from 12 states in the 6 geopolitical/health zone (2 states/zone) of Nigeria as part of high risk sentinel population groups. Samples were tested for the presence of HIV antibodies using commercial ELISA (Genescreen HIV-1/2, Sanofi Pasteur, Paris). All initially reactive samples were retested with a rapid EIA (Gene II, Sanofi Pasteur, Paris) according to the WHO recommendations (option II). HIV Prevalence in the states varied from 4.2% in Oyo to 35.1% in Benue States with a median prevalence of 17.0%. HIV Prevalence increased with age to a peak of 23.9% among PTB patients 30-39 years and then declined progressively to 12.8% among those 60 years and above. A relatively high HIV infection rate (13.8%) was found among the young adolescent age group 10-19 years. There was no significant difference in the rate among male and female PTB patients tested. Comparison with results of previous HIV sero-surveys shows a steady increase in HIV prevalence among PTB patients over the years. The high prevalence of HIV among young PTB patients aged 10-19 years in this study is worrisome and must be noted for intervention.

Sexual behaviour, HIV-related knowledge and condom use by intra-city commercial bus drivers and motor park attendants in Lagos, Nigeria.

A study was undertaken among 395 intra-city commercial bus drivers, conductors and motor park attendants in a sub-urban community in Lagos, Nigeria. It was aimed at ascertaining the level of knowledge of the participants on sexually transmitted diseases including AIDS, their sexual practices and perceived vulnerability to these diseases and, in particular, their attitude to and use of condoms. A semi-structured interview schedule was used for data collection. The men were found to have a strongly woven network of sexual relationships. Their sexual network included, apart from their wives and regular partners, commercial sex workers, young female hawkers, schoolgirls, and market women within and outside the motor parks. More than two thirds (74.3%) of the men had multiple sex partners and many of them had had sexually transmitted diseases at one time or another. Condom ever-use rate was 65.6% but consistent and regular use rate with casual partners was 11.6%. Almost all the respondents (96.4%) knew themselves to be at high risk of contracting STDs, while 87.6% felt that it was impossible for them to "catch" AIDS. Poor knowledge of risk factors for STDs was exhibited, as many of them attributed their previous STDs to excessive exposure to the sun, having sex in the sun, and their partners remaining in the bath for too long. Intra-city commercial bus operators and men at motor parks are a high risk group for acquiring HIV infection. Their sexual networking with a variety of women within and outside the parks also seems to suggest that they play a major role in transmitting HIV infection in urban communities in Nigeria. There is a need for intervention programmes with a focus on men at motor parks and similar high risk groups.

Contraceptive prevalence among young women in Nigeria.

In almost all societies in the world there is an increase in sexual activity among young persons (10-24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies. This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years. Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p<0.05) among the single sexually active women (38.5%) than among the married women (7.7%). Only 7.3% of respondents are currently using a contraceptive method. The main methods in use were condoms and pills. There is an unmet need for contraceptives among young women in Nigeria. It is necessary to improve these young women's abilities to protect themselves against unwanted pregnancies.

Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: a study on acceptability by Nigerian women attending antenatal clinics.

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.

Features of childhood hepatic failure in Calabar, Nigeria.

The features in 21 patients with childhood hepatic failure studies retrospectively over a seven year period at the University of Calabar Teaching Hospital, Calabar, Nigeria are presented. Of the 21 patients, 71.4 per cent were aged three years nd below. Fulminant hepatic failure occurred in 81.0 per cent of the patients while in 19.0 per cent, the failure resulted from chronic liver disease. Hepatitis B infection alone or in association with other factors was the major cause of the condition, occurring in 76.2 per cent of the cases. The main complications were severe anaemia (23.8%), septicaemia (23.8%) and pneumonia (19.0%), renal failure (9.5%). With only one survival, the case fatality rate was 95.2 per cent. For prevention of the condition in Nigeria, universal mandatory screening of blood and blood products for hepatitis B markers before transfusion and the integration of hepatitis B vaccination into the National Expanded Programme on Immunization are strongly recommended.

Unprecedented decline in measles morbidity and mortality in Calabar, south-eastern Nigeria.

The features of measles presenting at the University of CalabarTeaching Hospital, in south-eastern Nigeria between January 1992 to December 1996, were compared with those of a previous period (January 1984 to December 1987) in the same institution. The aim was to detect any changes in trends, morbidity and mortality from the infection in this environment. There were only 36 cases (7.2 per year) in the current period compared with 436 (109 per year) in the previous period (chi2=48.4, P<0.001). There were also highly significant falls in the incidence of malnutrition and bronchopneumonia (P<0.05) in the current period. Notably, there were no cases of dehydration or keratomalacia in the current period. The case fatality rate was 2.8% compared with 20.0% in the previous period (P<0.02). These unprecedented changes in the incidence, morbidity and mortality from measles are attributed to the continuing Expanded Programme on Immunization, oral rehydration therapy, appropriate nutritional management and vitamin A prophylaxis. With maintenance and strengthening of these strategies, the elimination of measles and measles deaths in the near future is feasible in this environment.

Factors affecting mortality and morbidity in patients with abdominal gunshot wounds.

Risk factors that may independently predict mortality and morbidity in patients with abdominal gunshot wounds have not been fully elucidated. We prospectively studied the effects of 12 potential risk factors on mortality and morbidity in 82 patients with abdominal gunshot wounds who required laparotomy. Univariate analysis of these factors revealed that shock on admission, presence of penetrating colon injury and number of intra-abdominal organs injured (NOI)>2 were associated with greater than threefold increased incidence of death (p<0.05). Penetrating abdominal trauma index (PATI) score>15 was associated with twentyfold increased incidence of death (P<0.0001). Multivariate analysis showed that only PATI (P=0.001), number of postoperative complications per patient (N(comp)) (P=0.023) and presence of shock on admission (P=0. 028) were independently significant in predicting mortality. PATI was the only risk factor that independently predicted the development of postoperative infectious complications and N(comp) (P<0.0001). The type of gun used was not a significant risk factor (P>0.05). The 15 (18.3%) non-survivors were significantly older than survivors (P=0.02), had longer operations (P=0.004) and their NOI, PATI and N(comp) were significantly higher (P<0.001). The uniformly prolonged injury to surgery time in all patients contributed to the high incidence of infectious complications (62.2%) and mortality. PATI score was the most important factor found to be independently associated with mortality and morbidity in our subset of patients with prolonged injury to surgery time and high rate of colon injury.

Evidence for obstructive and restrictive lung pathology among tetra-ethyl lead handlers and petrol tanker fillers at a petrochemical industry in Nigeria.

Described here is a computer predicted and computer measured pulmonary function in a randomly selected population sample of 111 men. These consisted of 36 primary school teachers (control), 35 Tetra-ethyl Lead handlers (TEL) and 40 Tanker Loaders (TL) at a petrochemical industry in Warri, Delta State, Nigeria. Productive cough and headache were commoner among the TL (45%, 38%) and the TEL handlers (43%, 31%). TEL handlers were 5 times likely to develop insomnia and other sleep disturbances than the control group. TL were more than 3 1/2 times more likely to develop nervousness than the control group. Measured FEF25-75% was significantly lower than its predicted value among the TEL handlers (56%) and TL (55%) when compared with the control group (36%) (P < 0.05 respectively). Although there were distinct reductions in the measured values of FEF75-85% among the TEL handlers (41%) and the TL (40%) compared to the control group (28%), this difference did not reach a level of significance when the TEL or the TL were compared individually to the control group. Predicted and measured forced mid expiratory flow time (FMFT) was not significantly varied among the cases and the control. There was statistically significant disparities (P < 0.005) in the values of predicted and measured maximum voluntary ventilation (litres) of the TEL handlers (47%) and of the TL (46%) compared with that of the control group (29%). The data suggest obstruction of the big and small airways of those occupationally exposed at a petrochemical factory in Nigeria especially the tetra-ethyl lead handlers and the tanker loaders. This data also suggests that pulmonary impairment may lead to an increased respiratory absorption of lead in its organic form. Efforts should be made to ascertain the degree of impairment and to treat the affected workers.

Social-environmental influences on the occurrence of neonatal tetanus in some riverine communities in Nigeria.

PIP: The factors associated with neonatal tetanus occurrence were rank ordered in a survey of 1867 children from a community in Nigeria with a previously documented high prevalence of this infection. The study, restricted to children born in 1992, 1993, and 1994, was conducted in the first 2 weeks of 1995. There were 28 cases of neonatal tetanus, for a rate of 15/1000 live births. Although cases and controls lived under similar social and environmental circumstances, three factors emerged as significant risk factors for neonatal tetanus: 1) lack of maternal education to the secondary level, 2) lack of antenatal care, and 3) delivery in a nonmedical establishment. Moreover, these three factors were linked. Mothers educated beyond the primary school level were more likely to understand the importance of antenatal care and to receive tetanus toxoid vaccination; if they received antenatal care, they were more likely to deliver in a medical establishment. Thus, eradication of illiteracy among women in Nigeria represents a priority in the effort to prevent neonatal tetanus.^ieng