Beliefs and perceptions about HIV infection and AIDS among mothers of infants in Ibadan, Nigeria.

In view of the growing importance of the human immunodeficiency virus (HIV) infection and the Acquired Immunodeficiency Syndrome (AIDS) in Nigeria, 221 mothers were interviewed by means of semi-structured questionnaires in an infant welfare clinic in Ibadan, Nigeria, about their perceptions and beliefs about HIV/AIDS infection with particular emphasis on how the infection could be acquired, how the risk of its acquisition can be reduced and whether how children could be infected. The findings revealed that 81% of the respondents believe that HIV infection does exist in Nigeria but only 17.6% think they have seen an AIDS patient. About two-thirds (68.8%) believe that children can be infected with HIV, 70.6% believe that a mother can transmit the infection to her child and 58% believe that HIV can be transmitted through breast milk. Eighty percent believe that people can protect themselves from having the infection by various means, including avoiding sharing needles or reusing hypodermic needles (83.3%), receiving unscreened blood (79.2%), mutual fidelity with a single sexual partner (73.8%), use of condoms (67.9%), avoiding the use of public toilets (56.1%) and avoiding mosquito bites (35.3%). Those with higher education showed better knowledge than those with lower education. In spite of the strong correlation with formal education, some misconceptions existed in all groups. For example, those without any formal education compared with those with some formal education believed that use of public toilet can cause HIV to be transmitted, the difference was not statistically significant (chi2 = 8.87; p = 0.064). Interestingly more of the highly literate women believed that HIV infection can be acquired by mosquito bites (chi2 = 16.82; p = 0.002). It was concluded that awareness of HIV infection and AIDS is high among mothers of infants attending the infant welfare clinic of the Institute of child Health, Ibadan. Whatever educational interventions is planned for this facility should take these findings into account and specially target those with none or little formal education.

Treatment of childhood diarrhoea in Nigeria: need for adaptation of health policy and programmes to cultural norms.

A community survey of treatment regimens for acute diarrhoea in children was carried out in 10 villages in the Ona Ara Local Government Area of Oyo State, Nigeria, using a combination of qualitative (focus-group discussions) and quantitative (weekly surveillance of diarrhoea) methods. Focus-group discussions were conducted with parents of children aged less than 5 years, while a surveillance of diarrhoea among 550 children of same age was carried out during a 6-month period. The findings of the study showed that not all types of diarrhoea were recognized as illnesses, and only those considered to be illnesses were treated. Treatment often involved an adhoc group which comprised adults who were present at the time the illness occurred (including parents, neighbours, relatives, and elders). Certain beliefs and practices, such as associating types of diarrhoea with occupation or ethnic groups, categorizing the severity on perceived causes, and withholding certain foods during episodes of diarrhoea, were common factors in decision-making for seeking treatment. Antimicrobial agents were used in the case of 46.8% of 205 diarrhoeal episodes, and 28.5% were not at all treated. The usual practice of focusing on a target group, such as mothers, during educational interventions may need to be modified in communities where nearly every adult has a role in decision-making in relation to health. The need to adapt health policy and programmes to cultural norms should be addressed to improve the impact of programmes.

Blood pressure patterns in Nigerian adolescents.

The study was designed to define the mean blood pressure level of adolescents in the city of Ibadan and to establish the relationship between blood pressure and age, sex, weight, height, skinfold thickness, pulse and parental socio-economic class or educational level in an urban adolescent population. All pupils attending two schools located in 2 different socio-economic areas of Ibadan, a city in Western Nigeria, were recruited into the study. Mean Systolic Blood Pressures (SBP) were 111.3 +/- 12.4 mm for males and 112.5 +/- 12.2 mm for females (P < 0.04). The Mean Diastolic Blood Pressures (DBP) were 60.2 +/- 9.7 in males and 70.7 +/- 10.0 in females (P < 0.003). Mean SBP and DBP increased with age in the 2 groups and in both sexes. Adolescents aged 16-19 years had higher blood pressures than those aged 12-15 years (P < 0.001). There were positive significant correlations between body mass index (BMI), pulse and blood pressure. Mean Systolic and Diastolic Pressures were higher in children from the lower socio-economic group and the differences were significant in females (P < 0.001). Similarly higher percentage prevalences of SBP and DBP above 95th percentile were found in adolescents from the lower socio-economic group and the differences were statistically significant (P < 0.05 and P < 0.001 respectively). The findings confirm that age, sex, body mass and socio-economic background all have an influence on the blood pressure levels of Nigerian adolescents.

Gene frequencies of ABO and Rh (D) blood group alleles in a healthy infant population in Ibadan, Nigeria.

The ABO and Rhesus blood group systems remain the most important blood group systems clinically. In order to provide gene frequency values for the ABO and Rh (D) alleles in a healthy infant population in south west Nigeria, 4748 healthy infants were typed for ABO and Rh (D) blood groups over a five year period (1988-1992). Overall, 2575 (54.2%) were blood group O, 1023 (21.6%) were blood group A, 1017 (21.4%) were blood group B and 133 (2.8%) were blood group AB. The distribution of the ABO blood groups did not differ significantly from those expected under the Hardy Weinberg equilibrium (Goodness-of-fit X2 = 6.09, df = 3, p = 0.1075). The proportions of the infants belonging to the various ABO blood groups did not vary significantly over the period of the study (X2 = 14.53, df = 12, p = 0.268). Overall gene frequencies for the O, A and B genes were 0.7398, 0.1305 and 0.1298 respectively. For the Rh (D) gene, 4520 (95.2%) were Rh-positive while 228 (4.8%) were Rh-negative. However, the proportions of Rh (D) negative infants varied significantly over the period of the study, with a particular year (1991) having nearly twice the usual frequency of Rh-negative individuals (X2 = 31.17, df =, p < 0.001). The frequency of the Rh (D) gene was 0.7809. These figures are reported in the hope that they may find some use as reference for studies of ABO blood groups in health and disease, especially since they were obtained in an infant population in which it is expected that selection pressures should not have started to act to any significant extent.

Routine screening for sickle cell haemoglobinopathy by electrophoresis in an infant welfare clinic.

The experience of a Nigerian infant welfare clinic in offering sickle cell haemoglo-binopathy (SCH) screening by electrophoresis to its clinic population over a 12-year period is reported. Overall 10,115 children were screened. Homozygous haemoglobin S was detected in 3.1% and haemoglobin S + C in 1.1%. Carriers of the sickle cell gene (haemoglobin A + S) comprised 23.7% of the children screened. Gene frequencies for the A, S and C genes were 0.814, 0.155 and 0.031 respectively. The gene frequencies of the S and C genes were higher than those reported in infants and under-five children from other parts of Nigeria. Screening for sickle cell haemoglobinopathy in the first year of life through infant welfare clinics and 'well-baby' clinics as described in this report is suggested as a viable approach to the problems of detection (and genetic counselling) of SCH in developing countries with their scant resources. The advantages and limitations of this approach are discussed.

Observations on handwashing practices of mothers and environmental conditions in Ona-Ara Local Government Area of Oyo State, Nigeria.

During baseline survey before developing an educational intervention programme for modifying behaviours toward improved home management of diarrhoea, handwashing practices and environmental conditions of 549 mothers and health care-providers of 638 children aged less than 5 years in Ona-Ara Local Government Area (LGA) were observed. The aims of the study were to describe the patterns of maternal handwashing behaviour in relation to disposal of faeces and feeding of children, and to describe environmental conditions of the households. Handwashing behaviours after cleaning a child who has just defecated and after disposal of faeces were observed in 29.3% episodes, while handwashing before feeding the child occurred in 12.4% of observations. Handwashing in relation to these events occurred more frequently in periurban than in rural villages (p < 0.001). These differences may be due to higher education of the periurban women compared to their rural counterparts. Handwashing was apparently not associated with distance from the water source or with the age groups of the children. Environmental observation revealed the presence of uncovered food (13%), human faeces (17%), animal dung (71%), animals (82%), and unprotected pit latrines (11%) in and around the house. There were significant rural-periurban differences in environmental conditions of the rural and periurban areas. It is recommended that the characteristics of areas selected for intervention be considered and important sub-group differences be identified before planning and implementing of such interventions.

Anterior fontanelle size in Nigerian children.

Anterior fontanelle (AF) dimensions were studied in 337 normal and apparently healthy Nigerian infants aged from 1 week to 12 months in Ibadan, Nigeria. Mean anterior fontanelle size fell from 3.4 cm in neonates to 2.5 cm at 4-6 months and to 0.8 cm at 10-12 months. The anterior fontanelle was closed in 11% of 4-6-month-olds and 53% of 10-12-month-olds. The mean AF size in neonates was larger than published figures from Caucasian and Chinese populations, but at 12 months mean AF size in Nigerian infants was smaller than published Caucasian and Chinese figures. The quartiles of the distribution of the AF size are also presented. It is concluded that there may be important racial differences in AF sizes and closure and closure frequencies in the 1st year of life and that appropriate local references should be used when attempting to classify a given AF size as normal or abnormal.