Intestinal Helminthiasis: Risk factors and relationship with Nutritional status and Anaemia among Institutionalised Children in three States of South-East Nigeria.

BACKGROUND: Intestinal helminthiasis occurs in sub-optimal living conditions with poor hygiene practices and is more prevalent in rural, suburban and institutionalized centres. Heavy helminthic burden negatively affects the nutritional status and the severity of anaemia among children living in orphanages. AIM: To determine the risk factors and relationship of intestinal helminthiasis with nutritional status and anaemia among institutionalized children in three states of South-East Nigeria. METHODS: A cross-sectional study was conducted over seven months involving 198 children recruited from orphanages in Anambra, Ebonyi and Enugu states. Their stool samples were analyzed using the Kato-Katz and Ether concentration techniques, and packed cell volume and anthropometric indices were documented. Data were analyzed. RESULTS: Of the 198 children, 109 (55.1%) were females with a median age of 2.5 years and interquartile range (3 months - 17 years). The prevalence of intestinal helminthiasis was 2.5%. Among the children that had intestinal helminthiasis, 4 (80%) had mono-parasitism with Ascaris lumbricoides, while 1 (20%) had mixed infestation of Ascaris lumbricoides and Trichuris trichiura. There was a significant association (p=0.01) between being infested with intestinal helminthiasis and caregiver handwashing practices. The anthropometric indices demonstrated that 5.6%, 6.6% and 13.1% of the children were underweight, wasted and stunted respectively. No helminth-infested child had malnutrition and only 1 (20%) infested child had moderate anaemia. CONCLUSION: Caregivers' good handwashing practice was associated with reduced prevalence of intestinal infestations and should be encouraged. There was no relationship found between the presence of helminthic infestations and nutritional status or anaemia among the institutionalised children.

CONTEXTE: Les helmintiases intestinales surviennent dans des conditions de vie sous-optimales avec des pratiques d'hygiène médiocres et sont plus fréquentes dans les centres ruraux, périurbains et institutionnalisés. Une charge helminthique importante affecte négativement l'état nutritionnel et la gravité de l'anémie chez les enfants vivant dans des orphelinats. OBJECTIF: Déterminer les facteurs de risque et la relation entre les helmintiases intestinales, l'état nutritionnel et l'anémie chez les enfants institutionnalisés dans trois États du sud-est du Nigéria. MÉTHODES: Une étude transversale a été menée sur sept mois, impliquant 198 enfants recrutés dans des orphelinats des États d'Anambra, d'Ebonyi et d'Enugu. Leurs échantillons de selles ont été analysés à l'aide des techniques de Kato-Katz et de concentration à l'éther, et le volume globulaire et les indices anthropométriques ont été documentés. Les données ont été analysées. RÉSULTATS: Sur les 198 enfants, 109 (55,1 %) étaient des filles avec un âge médian de 2,5 ans et une plage interquartile (3 mois - 17 ans). La prévalence des helmintiases intestinales était de 2,5 %. Parmi les enfants atteints d'helmintiases intestinales, 4 (80 %) présentaient une mono-parasitose à Ascaris lumbricoides, tandis que 1 (20 %) présentait une infestation mixte à Ascaris lumbricoides et Trichuris trichiura. Il y avait une association significative (p=0,01) entre l'infestation par les helmintiases intestinales et les pratiques de lavage des mains par les aidants. Les indices anthropométriques ont montré que 5,6 %, 6,6 % et 13,1 % des enfants étaient respectivement sous-pondérés, émaciés et retardés en taille. Aucun enfant infesté par les helminthes n'était malnutri et seul 1 (20 %) enfant infesté avait une anémie modérée. CONCLUSION: La bonne pratique du lavage des mains par les aidants était associée à une prévalence réduite des infestations intestinales et devrait être encouragée. Aucune relation n'a été trouvée entre la présence d'infestations helminthiques et l'état nutritionnel ou l'anémie chez les enfants institutionnalisés. Mots-clés: Anémie, Enfants, Helminthes, Institutionnalisés, État nutritionnel.

The prevalence and intensity of intestinal helminths among institutionalized children in three states of South-East Nigeria.

Background: Intestinal helminthiasis is one of the most common and neglected diseases affecting all age groups, especially among school children. It is a disease condition of suboptimal environment and poor personal hygiene, and is more prevalent in children in institutionalized centers. Aims: This study was aimed to determine the prevalence, pattern, and intensity of intestinal helminthiasis among children in motherless babies' homes/orphanages and the relationship between the prevalence and demographic characteristics of the children. The outcome may be useful in strengthening these homes through advocacy to the appropriate authorities on general health promotion and awareness for the management of the homes. Subjects and Methods: It was a descriptive cross-sectional study carried out over 7 months (March-September 2017) in three states of the South-East Nigeria. Prior to the studies ethical clearance and permissions from relevant bodies were obtained. A total of 198 children aged 3 months to 17 years were recruited using multi-stage sampling methods from the homes and orphanages in Anambra, Ebonyi, and Enugu states. Their stool samples were collected and analyzed for ova of intestinal helminths using ether concentration and Kato-Katz techniques.Frequency tables were designed for relevant variables while quantitative variables were summarized using median and interquartile range (IQR). The relationship between demographic factors and presence of intestinal helminths amongst study participants was tested using Chi-square test and Fisher's exact test (FET) where appropriate. All analyses were done at the 5% level of significance, and a P value <.05 was considered statistically significant. Results: : Children aged 1-5 years constituting the highest proportion 110 (55.6%). The median age (IQR) of the participants was 2.5 years (3 months to 17 years). They comprised of 89 (44.9%) males and 109 (55.1%) females with a male: female ratio of 1:1.2. The overall prevalence of intestinal helminths among institutionalized children was 5/198 (2.5%). Ascaris lumbricoides only was seen in four out of five (80%) infested subjects while mixed infestation of A. lumbricoides and Trichuris trichiura was seen in one out of five (20%) subjects. All the infected subjects had light intensity of 100-300 EPG. It was noted that three out of five infested subjects were preschool children. However, the difference between the age groups and intestinal infestation was not statistically significant (P > 0.05). All the subjects with helminthic infection were females. Gender and location of motherless babies' homes/orphanages were not significantly associated with the presence of infestation (P > 0.05). Conclusion: This study showed that the prevalence and intensity of intestinal helminthiasis amongst the surveyed children in the South-Eastern Nigeria are 2.5% and more common among preschool aged children.

Changes in nutrient and antinutrient composition of Vigna racemosa flour in open and controlled fermentation.

This study was conducted to investigate the effect of open and controlled fermentation on the proximate composition, mineral elements, antinutritional factors and flatulence-causing oligosaccharides in Vigna racemosa. The open fermentation was carried out using the microorganisms present in the atmosphere while the controlled fermentation was carried out using Aspergillus niger as a starter. The proximate composition of the Vigna racemosa, some anti-nutrients and the mineral elements were analyzed using standard procedures. The protein content was increased by 12.41 ± 1.73 % during open fermentation while it decreased by 29.42 ± 0.1 % during controlled fermentation. The lipids, carbohydrates, crude fibre and ash content were all reduced in both types of fermentation except the moisture content which increased in controlled fermentation. Apart from calcium, the other elements (Fe, Na, Mg, Zn, and K) suffered reduction in both types of fermentation. The phytate, tannin, alkaloids, hydrogen cyanide, lectins, trypsin inhibitors and oxalate content all had drastic reductions in both types of fermentation. Open and controlled fermentation reduced the levels of both raffinose and stachyose. The percentages of reduction due to controlled fermentation were higher than those of open fermentation in the antinutrients studied. Fermentation is an efficient method for detoxifying the antinutrients in the Vigna racemosa studied in this work.

Two vaginal deliveries after a classical caesarean section--case reports.

It is standard practice to offer a parturient who has had a classical Caesarean section an elective repeat Caesarean section due to the fear of uterine rupture. The strong aversion of our women to operative delivery does not allow an appreciable number to avail themselves of hospital delivery even after Caesarean section. We report the case of a booked patient who had a classical Caesarean section but defaulted in two subsequent pregnancies to have vaginal deliveries in a private hospital. We therefore suggest a more liberal attitude to allowing attempt at vaginal delivery as an informed decision in well-equipped facilities capable of easy and prompt resort to appropriate intervention.

A 45-kDa midgut glycoprotein from Anopheles albimanus mosquito mediates the killing of trypanosomes.

Trypanosomes do not inhabit or grow in anopheles mosquitoes, the vector for the transmission of Plasmodium parasites the causative agent for malaria. The possession of lytic factors by the anopheline mosquito was thus considered. Head and midgut sections prepared in phosphate buffered saline were tested for trypanocidal action against T. congolense. While the head section was inactive towards the trypanosomes, the midgut extract at 0.2 mg ml(-1) diminished the motility of the parasites within 2 min of incubation; killing 50% of the population after 5 min. At 0.5 mg ml(-1) of the extract, about 90% of the parasites were killed within 2 min of incubation. The midgut fraction was subjected to a purification protocol involving successive chromatography on: octyl-sepharose, reactive brown agarose and fetuin-agarose columns. A final trypanocidal active fraction (gp45), which moved homogeneously during electrophoresis as a 45-kDa protein, was recovered from the fetuin-agarose column. The protein reacted positively with thiobarbituric acid, which suggests it is a sialoglycoprotein. Desialylation of the glycoprotein nullified its trypanocidal activity on T. congolense. Similarly, when the saccharides, lactose, methyl-beta-galactoside, lactulose, methyl-umbelliferyl-beta-galactoside (MU-Gal), were included in the culture medium, they inhibited the gp45 trypanocidal activity. Asialo-fetuin and asialo-RBC also inhibited the gp45-induced killing of T. congolense cells. The potential use of anopheline 45 kDa protein in the production of transgenic tsetse flies (Glossina spp.) in the control of trypanosomiasis is discussed.

Indigenous knowledge system for treatment of trypanosomiasis in Kaduna state of Nigeria.

A survey was carried out in Kaduna State of Nigeria to establish the indigenous knowledge system for treating trypanosomiasis in domestic animals. Questionnaire and interviews were, respectively, administered to, or conducted with about 200 livestock farmers and traders spread around the state. Data obtained revealed the use of several plants either alone or in combination, for the treatment and management of trypasonomiasis. The most common plants encountered were Adansonia digitata, Terminalia avicennoides, Khaya senegalensis, Cissus populnea, Tamarindus indica, Lawsonia inermis, Boswellia dalzielli, Pseudocedrela kotschi, Syzyium quinensis, Sterculia setigera, Afzelia africana, Prosopis africana, Lancea kerstingii. The method of preparation and mode of administration of some of these plants in the treatment of trypanosomiasis are reviewed and discussed.