Health benefits of selected global breastfeeding recommendations among children 0-6 months in Nigeria.

The survey examined the appropriateness of selected global breastfeeding recommendations in an environment where the recommendations contradicted local knowledge and culture. Specifically, the survey assessed the implications of pre-lacteal feeding, feeding of colostrum, exclusive breastfeeding for the first 6 months of life and the use of feeding bottles for child health. Eligible mother-infant pairs were recruited for the survey by cluster sampling technique. Data was collected about the mother-infant pairs with the aid of a pre-designed questionnaire that sought information on the social and demographic characteristics of the mothers and infants, current breastfeeding practices and illnesses that the index infants had in the 2 weeks preceding the survey day. Information was canvassed from 2466 mother-infant pairs. All the infants were aged 0-6 months. Compliance with the selected recommendations were: 74.4% reported exclusive breastfeeding; 87.5% did not give pre-lacteal feeds, 78.3% were not using feeding bottles while 92.9 gave colostrum. Mothers who reported compliance with the recommendations also reported fewer episodes of the common signs of illnesses surveyed. The study confirmed the appropriateness and relevance of the selected recommendations in the study area.

Prediction of nutritional status by chemical analysis of urine and anthropometric methods.

A combination of anthropometric and chemical indices was used to investigate the nutritional status of 26 healthy (H) and kwashiorkor (K) children aged 2-5 years and possibly predict the onset of malnutrition. The healthy children had significantly (p>0.05) higher values for weight, height, middle upper arm circumference and weight/height ratio than kwashiorkor children. The healthy children had significantly higher urinary concentrations of urea, inorganic sulphate and sulphate relative to creatinine, but significantly lower thiocyanate and thiocyanate relative to creatinine than the kwashiorkor children. The results of the present study would tend to indicate that a chemical analysis especially of urea, inorganic sulphate or thiocyanate alone or the urea/creatinine, inorganic sulphate/creatinine or thiocynate/creatinine ratio could be used to predict malnutrition after the initial anthropometric measurements. This study should however be repeated with a large population of volunteers to determine the specific cut-off points for each anthropometric and chemical analysis.

Congenital malaria in 8 hours old newborn: case report.

This report, presents a case of congenital malaria in an 8-hour-old female neonate. She responded well to oral chloroquine at a dose of 25 mg/kg in divided doses over a period of three days and was discharged home for follow-up, 24 hours after completion of the course of chloroquine. This case emphasized the need for routine screening for malaria in sick newborn infants in malaria endemic regions. This is particularly important in situations where clear evidence of sepsis cannot be established, either from history or physical examination of the sick newborn. Malaria and sepsis have similar clinical features in newborn infants.

Prevalence of Mongolian spots in Nigerian children in Ile-Ife, Nigeria.

Three hundred and sixty nine Nigerian neonates and 484 Nigerian children aged 1 month to 14 years were examined for the presence of Mongolian spots. The spots were observed in 381 children (189 boys and 192 girls) with an overall incidence of 44.7% regardless of sex or age. The colour of the Mongolian spots varied from pale blue to grayish blue. The most frequently involved sites were the gluteal, sacrococcygeal and lumbar areas respectively. In our study, Mongolian spots were present in 74.8% of neonates and in 13.6% of pre-school children. There was a rapid disappearance in the incidence of Mongolian spots with advancing age. No case of Mongolian spot was recorded in children aged 6 years and above. Primipara whose children have Mongolian spots should be reassured that the spots are harmless and would usually disappear in early childhood. Physicians should however be alert to marks resulting from child abuse as these could mimic the spots.

Inhibitory factors in breastmilk, maternal and infant sera against in vitro growth of Plasmodium falciparum malaria parasite.

Complications from falciparum malaria are responsible for over one million infant deaths annually. There is as yet no clinically protective vaccine that has been developed against human malaria parasites. While several studies have demonstrated the inhibitory properties of human sera against Plasmodium falciparum, there is no reported investigation that has examined the protective effects of human breastmilk against the malaria parasite. This study demonstrates the presence of significant antibody titers to ring, trophozoite, schizont and gametocyte stages of P. falciparum in 144 Nigerian maternal milk samples and also in paired maternal and infant sera. The study also demonstrates significant in vitro growth inhibition of P. falciparum by maternal and infant sera, but most notably by breastmilk samples and breastmilk constituents, such as lactoferrin and sIgA. The results therefore suggest a protective in vivo role for breastmilk in the possible modulation of malaria frequency, severity and complications.

Prognostic factors in neonatal tetanus.

OBJECTIVE: Neonatal tetanus (NNT) is the leading cause of neonatal deaths in developing countries. The objective of this study was to determine prognostic indicators in NNT. METHODS: We reviewed the clinical records of all neonates (n = 174) admitted to Ife State Hospital with the diagnosis of NNT from 1991 through 1995. RESULTS: Delivery had occurred at home in 73.3% of cases. Only 37/164 of the mothers had had adequate immunization with tetanus toxoid. The umbilical cord appeared to be the portal of entry in 58.6% of cases. Mean age of infants at presentation was 7.2 days. Mortality was 57.5%; non-survivors succumbed after mean stay in the hospital of 5.0 days. Mortality was significantly associated with an incubation period of 6 days or less (P = 0.0026), infant's weight of less than 2.5 kg (P = 0.0113), lack of antenatal care in a health facility (P = 0.0279), birth at home (P = 0.0455), but not with lack of adequate maternal immunization (P = 0.2081; not significant). Multivariable analysis showed that a short (< or = 6 d) incubation period was the strongest predictor of mortality (OR = 3.11, P = 0.0030) while low infant weight (< 2.5 kg) was also a significant predictor (OR = 2.46, P = 0.0408). CONCLUSIONS: Hygienic deliveries and adequate cord care are very important for the prevention of neonatal tetanus deaths, and universal prenatal care, including education programmes on appropriate perinatal and cord care, can significantly reduce NNT incidence and mortality in developing countries.

Parameters of thyroid function in the endemic goitre of Akungba and Oke-Agbe villages of Akoko area of southwestern Nigeria.

The parameters of thyroid function were determined in Akungba and Oke-Agbe communities of Akoko area, where goiter is endemic and compared to a control population of Erinmo and Ifewara in Ijesha area, both areas being in southwestern Nigeria. The two study areas have similar physical and geological settings. However, while the main carbohydrate source of the control population are yam and/or bread-fruit, the Akoko population derives her carbohydrates mainly from cassava which could lead to increased serum thiocyanate, a goitrogen. The serum level of tetraiodothyronine (T4) was significantly (P < 0.05) higher in Ifewara (11.0) and Erinmo (11.8) compared to Akungba (7.1) and Oke-Agbe (8.8[symbol: see text]micrograms/dL). The triiodothyronine (T3) was significantly (P < 0.05) higher in Ifewara (193) than Erinmo (133) and also significantly (P < 0.05) higher in Oke-Agbe (127) compared to Akungba (107 mg/dL). Conversely, thyroid stimulating hormone (TSH) (microU/mL) level was significantly (P < 0.05) higher than values obtained from Ifewara (4.5) and Erinmo (3.3). T3/T4 ratio above 25, indicative of hypothyroidism and endemic goiter, was 14, 7, 4 and 0% from Akungba, Oke-Agbe, Ifewara and Erinmo, respectively. The results of the present study clearly explain the Akoko goiter endemia in the light of modification (s) of thyroid metablism.

Non-puerperal induced lactation in a Nigerian community: case reports.

Six Nigerian women aged from 22 to 56 years who had not recently been pregnant were successfully relactated by breast suckling alone. All of them produced enough milk to exclusively breastfeed 'motherless' infants. All except one child have continued to breastfeed up to the time of this report and show adequate growth.

PIP: In developing countries such as Nigeria, breast feeding is essential to child health and survival. Since almost 8 of every 1000 pregnant women in Nigeria die in childbirth or from its complications, breast feeding by surrogate mothers is an important child health intervention. This article presents six case studies from the Irepodun Local Government Area of Osun State of successful induction of lactation by breast suckling alone in women who had not recently been pregnant. Surrogate mothers ranged in age from 22 to 56 years. The 6 infants of mothers who had died or abandoned their baby were 1 week to 2 months of age when surrogate breast feeding was commenced. Surrogate mothers were instructed to initiate lactation by suckling the infants repeatedly at least 10 times a day for at least 10 minutes on each breast. Afterward, the infants were fed with artificial milk given by cup or spoon. Successful relactation was considered to have been achieved when the infants could be sustained on breast milk alone. Milk secretion following suckling appeared on the fourth through seventh day, while complete lactation was achieved after 21-25 days. All surrogate mothers were able to produce adequate amounts of breast milk without any nutritional supplementation, even though they were of low socioeconomic status. 4 of the infants were malnourished before relactation was commenced and 3 had episodes of severe diarrhea. With establishment of full breast feeding, all 6 infants gained weight and achieved satisfactory weight for age. The one death in this series involved an infant who developed severe gastroenteritis after the surrogate mother introduced supplementary feeds at 4.5 months of age.

A possible genetic factor influencing protection from infection with Ascaris lumbricoides in Nigerian children.

An epidemiological study of Ascaris lumbricoides infections was carried out in primary school children aged 5-16 yr from Ile-Ife, Nigeria. Intensity of infection was assessed directly by means of counting worms passed during a 48-hr period after chemotherapy. Reinfection patterns of A. lumbricoides were assessed at 2 6-mo intervals and statistical evidence of predisposition to infection status was obtained. An investigation of 3 groups of children who were judged to be predisposed not to be infected, to be lightly infected, and to be heavily infected was undertaken. Assignment to the groups was based upon the mean worm burden plus 1 SD above the mean, measured at 2 6-mo intervals. The distribution of class I human leucocyte antigens among the 3 groups of children was described. None of the children who were predisposed to remain uninfected was found to possess the A30/31 antigens in contrast to those children who remained infected.

The characterisation of clinical isolates of Staphylococcus aureus in Ile-Ife, Nigeria.

Of 166 strains of Staphylococcus aureus isolated from hospital patients and staff in Ile-Ife, Nigeria, 32% were non-typable (NT). The strains were isolated from skin lesions, eye infections, wounds and nasal flora. Isolates from skin lesions or eye and wound infections were more likely to produce protease (95% and 78% respectively) than nasal isolates (11%). Nearly all (99%) of the strains isolated were resistant to penicillin and 78% were resistant to tetracycline. Streptomycin resistance occurred in 25% of isolates; 19% were resistant to chloramphenicol and 9% to methicillin.

A survey of nasal carriage of Staphylococcus aureus in a neonatal ward in Ile-Ife, Nigeria.

The nasal carriage rate of Staphylococcus aureus among maternal-infant pairs was 18% compared with 39% among hospital staff in Ile-Ife, Nigeria during a 12-week survey. Of the newborns, 46% tested positive compared with 26% of their mothers. The S. aureus phage types recovered were predominantly of the group III type (38%); however, 28% of the strains isolated were non-typable. All the S. aureus strains were resistant to penicillin, 84% to tetracycline, and 35 and 24% were resistant to streptomycin and chloramphenicol, respectively. Altogether 19% of the strains tested were resistant to methicillin.

Class-specific antibodies to Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis in human breast-milk and maternal-infant sera.

Children under 2 years of age are most susceptible to acute respiratory infections caused by Bordetella pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis. We analysed milk samples and sera from mother-infant pairs for specific antibodies that may enhance protection against the bacterial pathogens. The results show that the breast-milk samples contained significant titres of specific IgG and IgA antibodies to the four organisms, although the mean IgG antibody levels were higher in maternal sera than in breast-milk. On the other hand, the mean IgA antibody levels to the four organisms were higher in breast-milk than in both maternal and infant sera. IgM antibodies to these organisms were relatively low or absent in many milk and serum samples. Nevertheless, the significant concentrations of specific IgG and IgA antibodies in milk samples may indicate a protective role for breast-milk against the four infections in early childhood.

The epidemiology of Ascaris lumbricoides and other soil-transmitted helminths in primary school children from Ile-Ife, Nigeria.

An epidemiological survey of intestinal helminthiases was conducted on 766 primary school children aged 5-16 years from Ile-Ife, Nigeria. On the basis of stool examinations, the prevalence of Ascaris lumbricoides, Trichuris trichiura, hookworm and Strongyloides stercoralis was 88.5, 84.5, 33.1 and 3% respectively. Intensity of infection was measured indirectly by egg counts for each species of helminth and also by counting worms passed after chemotherapy in the case of A. lumbricoides. The influence of host age and sex on infection levels was assessed. Relationships between the intensities of A. lumbricoides, T. trichiura and hookworm in individual children were identified. After anthelmintic treatment with levamisole, the frequency distribution of A. lumbricoides per host and the relationship between parasite fecundity and worm burden were investigated. Reinfection patterns of A. lumbricoides were assessed at two 6-monthly intervals and even within the narrow age range described, differences were found. In addition, evidence was obtained for predisposition of individuals to heavy or light infection with A. lumbricoides.

Excretion of chloroquine and desethylchloroquine in human milk.

The excretion of chloroquine and the major metabolite, desethylchloroquine, in breast milk was investigated in eleven lactating mothers following a single oral dose of chloroquine (600 mg base). The average milk to plasma concentration ratio at the 24th hour was 6.6 +/- 2.4 for chloroquine and 1.5 +/- 0.6 for desethylchloroquine in five of the volunteers. In five other volunteers the elimination half-life of chloroquine in milk was 8.8 +/- 4.7 days which was longer than that in saliva (3.9 +/- 1.0 days) from the same volunteers. The maximum daily dose of the drug that the infant can receive from breastfeeding was about 0.7% of the maternal start dose of the drug in malaria chemotherapy. It is, therefore, suggested that it is safe for mothers to breastfeed their infants when undergoing treatment for malaria with chloroquine.

Immunoprotective factors in breast milk and sera of mother-infant pairs.

We analysed breast milk and serum samples from 33 healthy Nigerian mother-infant pairs for concentrations of IgG, IgM, IgA, C3, C4 and lysozyme. We found that the mean IgG and IgM concentrations in maternal sera were three to four times higher than the levels in infant sera, and five to ten times higher than in breast milk. The IgA and lysozyme concentrations in breast milk were, however, slightly higher than the levels in infant sera, suggesting an active localized synthesis of these factors in the mammary gland. While 54.5% of the milk samples lacked measurable concentrations of IgM by radial immunodiffusion, IgA was consistently present in all the milk samples. The mean C3 concentration in maternal sera was 164 mg/100 ml, compared to 145 mg/100 ml and 11.5 mg/100 ml in infant sera and breast milk respectively. The C4 concentration was also considerably lower in breast milk than in maternal and infant sera.

A preliminary survey of aerobic bacteria in breast milk of mothers from the low-income group in Nigeria.

The aerobic bacteria colonizing breast milk of the low-income group in Nigeria were quantified to assess its suitability for use in milk banks. In parallel, the nutritional and health status of donating mothers and their infants were assessed by physicians. The aerobic bacteria contained in the specimens included Streptococcus salivarius, Bacillus cereus, Klebsiella pneumoniae, Enterobacter aerogenes, Streptococcus pneumoniae, Streptococcus pyogenes, Pseudomonas aeruginosa and Staphylococcus epidermides. In general, the microbial load found in these milk samples is lower than levels considered dangerous. An analysis of the results showed that 50% of the mother's milk is contaminated, 17% of which was infected with primary pathogens. There was no correlation between demographic data, nutritional or health status of either mother or infant and microbial load in mother's milk. Milk obtained from this socio-economic group, is therefore, considered safe for use in milk banks.