Aspects of smoking in developing countries in Africa.

PIP: This discussion of smoking in developing countries in Africa focuses on the cultivation of tobacco and the economics of tobacco smoking. The cultivation of tobacco in Africa has been encouraged in recent years by multinational companies, especially British American Tobacco and Rothmans, thus avoiding import duty on raw materials and conservation of scarce foreign exchange. In Nigeria, 60,000 farmers now grow tobacco on 120,000 acres. The 3 major deleterious effects of cultivating tobacco are: competition with cultivation of staple food crops, such as rice, millet, cassava, and guinea corn; displacement of necessary cash crops, such as cotton; and loss of timber through tree felling and bush fires due to ignited cigarette stubs and promotion of erosion and Sahelian migration in areas with already sparse vegetation. In the Sokoto region of Nigeria, tobacco thrives in the flood plains where rice would normally be expected to grow. Because tobacco provides ready cash, rice is a 2nd choice for cultivation. The net result of such displacement of staple food crops is that rice is now imported into Nigeria. Any development economist would rather cultivate rice than tobacco. Forest reserve has been lost from clearing bush to promote cultivation of tobacco and using wood fuel in flue-curing of tobacco. The ecologic consequences in areas bordering on the desert are disastrous. Yet, the spinoffs to the grower of tobacco cannot be dismissed. Most obvious is that cash returns for cultivating tobacco are better than for food crops. Because tobacco growers are relatively prosperous, they tend to stay on during periods of drought whereas food growers tend to migrate to the urban areas. The acquisition of modern skills is associated with growing tobacco. The multinational tobacco companies take pains to teach local farmers modern methods of land preparation. The fight against cultivation of tobacco can be won only by planned action. Recently, tobacco companies introduced programs such as block farms among tobacco growers. Farmers are now encouraged to grow other crops as well as tobacco, especially those related to food, in small land holdings. In the past 5 years, the tobacco industry has begun active reforestation programs since 3.5% of wood-fuel consumption is devoted to flue-curing of tobacco. Governments in the 3rd world have been slow to arrest the tobacco smoking habit because of large government revenues derivable from sales and manufacture of cigareetes. The consumption of cigarettes is underestimated in government or commercial statistics because smuggling accounts for 25% of total cigarette consumption.^ieng

An analysis of skin prick test reactions on asthmatics in Lagos.

Skin tests were administered to 221 asthma patients at the Lagos University Teaching Hospital between 1977 and 1980. Of these, 168 patients (76 percent) had positive skin tests to one or more allergens and 53 (34 percent) had negative skin tests. Patients with positive tests tended to have a positive family history of asthma and an earlier age of onset of asthma.There was, however, no observed difference in the groups in the incidence of other allergies of urticaria, eczema, and allergic rhinitis. Results showed that 89 percent of asthmatics with positive skin tests were allergic either to house dust or to the house dust mite. Pollen allergy was comparatively rare. There is a need to prepare desensitizing antigens specific to this environment.

Stevens-Johnson's syndrome in Africans.

Three cases of Stevens-Johnson's syndrome seen at the Lagos University Teaching Hospital are reported. The clinical features did not differ from those described in temperature countries. Steroid therapy and intravenous infusion still form the major part of the management in this life-threatening condition.

Relation between age and respiratory response to inhaled carbon dioxide in healthy Nigerians.

The response of ventilation to hypercapnia was determined in 10 normal young Nigerians, aged 19 to 30 years, and in eight elderly Nigerians, aged 50 to 65 years. The elderly subjects were carefully screened to eliminate the possibility of cardiopulmonary disease. All the subjects had been born in low-altitude areas and had not had prior exposure to hypoxia. The ventilatory response to hypercapnia was found to be significantly decreased in the elderly subjects. It is concluded that the ventilatory response to hypercapnia decreases with age among Nigerians.

Comparison of the metabolic effects of salbutamol administered in a one-minute bolus and a continuous infusion in patients with bronchial asthma.

A 1-min i.v. bolus injection of 300 microgram salbutamol produced transient hypokalemia in asthmatic patients, whereas continuous i.v. infusion of 10 microgram/min salbutamol for 30 for 30 min produced significant and sustained hypokalemia. The 1-min bolus infusion of salbutamol has a distinct therapeutic advantage over continuous infusion of this drug, because the hypokalemia produced by the latter may predispose to serious cardiac arrhythmias.

Acid-base and gas tension of cerebrospinal fluid in Nigerians and tetanus patients.

The acid-base balance and gas tension of the cerebrospinal fluid of eight tetanus patients and twelve control subjects were studied. Tetanus patients had metabolic acidosis which was severely reflected in the cerebrospinal fluid. While the cerebrospinal fluid pH is lower than that of the arterial blood there was no difference between the acid-base and gas tension of the cerebrospinal fluid of Nigerians and the causasians. The severe metabolic acidosis of the cerebrospinal fluid of tetanus patients might be one of the causes of sudden deaths seen in these patients.

Favourable prognosis of prolonged coma associated with large doses of diazepam in severe tetanus.

A report is made of five tetanus patients who were treated with large repetitive doses of Diazepam and became comatose. The period of impaired consciousness varied from thirteen to twenty-one days. None had significant respiratory depression, and full recovery occurred in all. It is proposed that Diazepam-induced prolonged coma should be regarded as a side-effect rather than a toxic effect and should caution rather than contra-indicate further use of large doses of the drug in the management of tetanus.

Ventilatory response to carbon dioxide in patients with homozygous sickle-cell disease.

The ventilatory response to carbon dioxide was measured by a rebreathing technique in 21 Nigerians who had homozygous sickle-cell disease. The slope of the carbon dioxide response curve was obtained by plotting the ventilation at successive half-minute intervals against the corresponding mean end-tidal PCO2. Our results showed that sickle-cell patients are as sensitive to carbon dioxide as are normal subjects.

Incidence and variables contributing to onset of cigarette smoking among secondary school children and medical students in Lagos, Nigeria.

This paper reports the findings of a survey of smoking habits among secondary schoolchildren and medical students in Lagos, Nigeria. Altogether 40% of boys and 8.4% of girls at secondary school, and 72.4% of men and 22.2% of women at medical school were found to smoke. While the smoking habit of the secondary schoolboys was influenced by the smoking habits of their parents and friends, the smoking habit of the secondary schoolgirls and female medical students was mainly influenced by that of their friends. This study provides a baseline against which future studies on smoking habits in developing African countries may be measured, and the results show that health education on cigarette smoking must start in primary and secondary schools.

Ventilatory response to carbon dioxide in tetanus.

1. Ventilatory response to carbon dioxide was measured by the rebreathing technique in seven patients with mild tetanus during the disease state and after clinical recovery. 2. The ventilatory response to carbon dioxide was found to be decreased in the tetanus patients during the disease state with normal response after full clinical recovery. It is postulated that the restrictive ventilatory defect was responsible for the decreased ventilatory response to carbon dioxide.

Aerosol beclomethasone in steroid dependent asthmatics.

Aerosol beclomethasone dipropionate was effective in maintaining airway patency in 14 out of 16 steroid-dependent asthmatics. In 3 patients who had significant adrenal suppression on systemic corticosteroid therapy substitution with aerosol beclomethasone led to recovery of adrenal function. From the evidence obtained it is concluded that this aerosol steroid represents a modest advance in the therapy of asthma.

Value of determination of oxygen consumption in tetanus.

Oxygen consumption (VO2) was determined in 10 patients with moderate tetanus. The mean (+/- SE) VO2 of 425-2-2 +/- 50-3 ml/min on admission fell significantly to 249-9 +/- 13-1 ml/min standard temperature and pressure dry (STPD) after parenteral diazepam. There was also a significant fall in minute ventilation after administration of diazepam. The results suggest that the simple practical determination of VO2 will be of immense value in assessing the efficacy of muscle relaxants, assessing the severity of tetanus, and determining the calorie needs of patients.

Pulmonary embolism in Africans.

The clinical and autopsy records of 54 cases of pulmanary embolism seen at the Lagos University Teaching Hospital over the period 1966-1972 are analysed. The incidence of pulmonary embolism during this period was 0.1 per cent of all patients admitted, and there was a 78 per cent mortality. The primary medical condition associated with pulmonary embolism is heart disease. Sex has little influence on the liability to pulmonary embolism. Age has a pronounced influence, the incidence increases steadily after the age of 40. Medical cases are more liable than surgical cases to suffer from pulmonary embolism in each age group. The view is expressed that pulmonary embolism is not rare in Africans. Our results support the opinion that the possession of the haemoglobin S predisposes although the final veridct must await the result of a larger prospective study.

Ventilatory response of healthy Nigerians and Europeans to carbon dioxide.

Ventilatory response to carbon dioxide was measured by the rebreathing technique in 32 Nigerians and 20 Europeans resident in Lagos. Although the Europeans had larger physical characteristics and lung volumes than Nigerians, the responses to carbon dioxide were similar. The range of ventilatory response was 0,55 to 4,2 and 0,7 to 3,7 1/min/mm Hg for Nigerians and Europeans respectively. These results show that Nigerians are as sensitive to carbon dioxide as their European counterparts.

Ventilatory response to carbon dioxide in Nigerian asthmatics before and after aerosol salbutamol inhalation.

Patterns of response to carbon dioxide (CO2) inhalation in 12 Nigerian asthmatic patients before and after salbutamol aerosol inhalation are described. Ventilatory response to CO2 inhalation follows three patterns, viz,(1) an increase; (2) a decrease; (3) no change in response. While most of our subjects showed substantial improvement in forced expiratory volume in one second (FEV1) following bronchodialator therapy, there was no corresponding change in ventilatory response to CO2. On the whole. the mean values of the slope of response to CO2 inhalation of the asthmatics before and after bronchodilator were not significantly different from values obtained in normal patients in our laboratory.