Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey.

BACKGROUND: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold. OBJECTIVE: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. METHODS: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. RESULTS: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991. From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. CONCLUSION: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

A public-private partnership for malaria control: lessons from the Malarone Donation Programme.

In 1996, Glaxo Wellcome offered to donate up to a million treatment courses annually of Malarone, a new antimalarial, with a view to reducing the global burden of malaria. The Malarone Donation Programme (MDP) was established the following year. Eight pilot sites were selected in Kenya and Uganda to develop and evaluate an effective, locally sustainable donation strategy that ensured controlled and appropriate use of Malarone. The pilot programme targeted individuals who had acute uncomplicated Plasmodium falciparum malaria that had not responded to first-line treatments with chloroquine or sulfadoxine-pyrimethamine. Of the 161 079 patients clinically diagnosed at the pilot sites as having malaria, 1101 (0.68%) met all the conditions for participation and received directly observed treatment with Malarone. MDP had a positive effect at the pilot sites by improving the diagnosis and management of malaria. However, the provision of Malarone as a second-line drug at the district hospital level was not an efficient and effective use of resources. The number of deaths among children and adults ineligible for MDP at the pilot sites suggested that high priority should be given to meeting the challenges of malaria treatment at the community level.

Data management in a longitudinal cross-cultural study.

The Indianapolis-Ibadan Dementia Project compares the rates of dementia at two sites, one in the U.S.A. and one in Nigeria. This paper concentrates on the data management issues in this longitudinal cross-cultural study. Approximately 2500 elderly people were recruited at each site, and continue to be re-assessed every two years. All the data are collected on paper and then entered into a FoxPro relational database. Most of the data management, including data cleaning, is done in Indianapolis. The design of the data collection forms is particularly important in a cross-cultural study, with the questions and the coding of responses clear and simple. Since Nigeria and the U.S.A. have different levels of technological development, the computer hardware and software were chosen to be suitable for use at either site. Exchange visits have been needed to address data management issues and resolve unexpected problems. The data management on cross-cultural studies can be handled successfully, given careful planning.

Severe morbidity among children in a trial malaria chemoprophylaxis with pyrimethamine or chloroquine in Ibarapa, Nigeria.

In a controlled trial of weekly malaria chemoprophylaxis with chloroquine and pyrimethamine there were no significant differences in type and frequency of severe morbidity during chemoprophylaxis. Administration of chemoprophylaxis during the current and immediately preceding month was associated with significantly fewer episodes of severe morbidity in the chloroquine and pyrimethamine groups when each was compared with the control multivite group. After chemoprophylaxis had been stopped, significantly more episodes of severe morbidity occurred in the chloroquine group than the control group, but a similar trend in the pyrimethamine group was not statistically significant. In the control group most of the episodes of severe morbidity, including those episodes which were associated with heavy parasitaemia, occurred below the age of 4 years. In contrast, the children who received chemoprophylaxis continued to experience such illness at older ages. The difference between the chloroquine group and the control group in respect of age at time of severe morbidity was statistically significant.

A prospective study on some factors which influence the delivery of low birth weight babies in a developing country.

The study was prospective in design and carried out in Ibadan, Nigeria. It was undertaken in order to provide more information on the low birth weight deliveries seen here and to evaluate some factors associated with their births. 600 randomly selected gravid women who presented to the antenatal booking clinics for the first time in this pregnancy were followed up till delivery of their babies. Data on 492 women who produced normal, singleton babies were analysed. The mean birth weight was 3167g +/- 451g (males; 3205g +/- 469g and significantly higher than of females of 2991g +/- 468g). The incidence of low birth weight (LBW) weight of 2500g and less was 8.3% and comprised of 18 males, 22 females and 1 unknown sex. 80% of these LBW babies were term (37-41 wks gestation) at delivery, while 20% were pre-term (< 37 wks). There was seasonal variation in the incidence of LBW, the risk being highest during the peak of dry season and lowest during the rainy season. The mothers age, parity, height, ponderal index at delivery, and total maternal weight gain as well as birth interval were each significantly related to the incidence of LBW in these mothers (P < 0.01). Maternal education as well as socio-economic class were not significant (P > 0.5).

PIP: The study was prospective in design and carried out in Ibadan, Nigeria. It was undertaken in order to provide more information on the low birth weight (LBW) deliveries seen here and to evaluate some factors associated with these births. 600 randomly selected gravid women who presented to the antenatal booking clinics for the first time in their pregnancy were followed up till delivery of their babies. Data on 492 women who produced normal, singleton births were analyzed. The mean birth weight was 3167 g +or- 451 g (males: 3205 g +or- 469 g; females: 2991 g +or- 468 g). The incidence of low birth weight of 2500 g and less was 8.3% and consisted of 18 males, 22 females, and 1 unknown sex. 80% of these LBW babies were term (37-41 weeks gestation) at delivery, while 20% were preterm (37 weeks). There was seasonal variation in the incidence of LBW, the risk being highest during the peak of the dry season and lowest during the rainy season. Mother's age, parity, height, ponderal index at delivery, and total maternal weight gain, as well as birth interval, were each significantly related to the incidence of LBW in these mothers (p 0.01). Maternal education, as well as socioeconomic class, were not significant (p 0.5).

Cross-cultural studies in Alzheimer's disease.

The search for risk factors for Alzheimer's disease would be greatly enhanced by identification of populations with significantly different prevalence rates, particularly if these populations consisted of ethnic groups now living in different environments and cultures. Evidence is presented that two such groups are worthy of further study: subjects of African origin living in Africa and in the West and Native Americans living on and off reserves.

Epidemiology of age-related dementias in the Third World and aetiological clues of Alzheimer's disease.

The prevalence of age-associated dementia which already constitutes enormous public health problems in many developed industrialised countries, is currently low in many developing countries. Community-based studies and autopsy survey in Nigerian Africans showed absence of Alzheimer's disease (AD). The ageing revolution with enormous increase in the population of the elderly is already occurring in developing countries which are also undergoing epidemiological transition. Geographical epidemiological studies of the age associated dementias, in developing and developed countries, and especially in ethnic groups who live in different environments have great potential in identifying putative risk factors, probably currently present in developed industrialised countries and absent in developing less industrialised countries where the disease is as of now relatively uncommon.

Contact tracing in the control of STD in Ibadan, Nigeria.

Contact tracing carried out at this clinic was analysed as part of measures for control of sexually transmitted disease (STD). Results showed that 50% of 156 contacts could not be traced at all for various reasons, and that 47% of the contacts were brought in through persuasion by index patients who had been counselled at the clinic. Only four contacts were traced, and two of these attended the clinic. Index patient cooperation is thus identified as the most important factor in the success of contact tracing, because of the high level of illiteracy and poor communications facilities in Nigeria, compared with industrialised countries.

Serum creatinine and prediction formulae for creatinine clearance.

Three formulae which could predict creatinine clearance from serum creatinine values were derived from the data which were obtained from the study of 169 patients and healthy control subjects. Values for creatinine clearance which were obtained by using these three formulae and four other previous formulae were compared with the observed values. Most of the predicted and observed values differed by more than 20% of the observed values. When a formula which was derived by using the data from forty-five healthy control subjects was used to predict the creatinine clearance values of this group and the patients, there was a close agreement between the observed and the predicted values for only the healthy control subjects but not the patients. Because of the various factors which affect creatinine excretion in health and disease, a predictive formula which includes serum creatinine alone and not urinary creatinine might give unreliable values.

Clinical experience with praziquantel in the treatment of Nigerian patients infected with S. haematobium.

A double-blind controlled trial of 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin-4-one (praziquantel, EMBAY 8440, Biltricide) in the treatment of vesical schistosomiasis has been carried out in 90 Nigerian schoolchildren of both sexes aged 9--16 years. Oral doses of 1 x 30, 1 x 40, and 2 x 20 mg/kg b.w. were assessed against placebo at 1 x 40 mg/kg, and the subjects followed up for up to twelve months after treatment. The results showed that the drug is very effective against S. haematobium infections and well tolerated. There were not significant differences between the three dosage groups, and the drug had no adverse haematological or biochemical effects. It is concluded that praziquantel widely meets the requirements necessary for use in large scale control of vesical schistosomiasis.

Renal disease due to schistosomiasis of the lower urinary tract.

The literature concerning renal impairment and damage due to vesical schistosomiasis has been reviewed, with emphasis on radiologic, biochemical, and renographic studies of renal function in affected persons. Presently available evidence suggests that infections due to S. haematobium constitute an important public health problem because they are widely prevalent. A high proportion of affected persons suffer renal impairment and damage due to obstructive uropathic lesions in the lower urinary tract and, probably, through direct immunologic involvement of the kidney. It is therefore important that efforts should be intensified to better define the size and scope of the problem, and to control the disease.

Incidence of stroke in an African City: results from the Stroke Registry at Ibadan, Nigeria, 1973-1975.

Studies based on hospital populations reported from negro communities in several countries in Africa suggest that cerebrovascular disease (CBVD) shows increasing mortality and morbidity in Africans although 2 decades ago CBVD was believed to be uncommon. We report the first study in the African to determine the incidence of stroke in an urban area, Ibadan, Nigeria.

The effect of seasonal changes and socio-economic status on urinary pH and specific gravity.

Specific gravity and pH of urine in the dry and the wet season in three socio-economic Nigerian groups have been studied. Samples were collected at 7 a.m., 11 a.m. and 3 p.m. High-income subjects had a significantly lower urinary pH than low-income. During the wet season pH values were lower than in the dry, but not significantly so. During the day S.G. values did not differ, neither did they in different seasons. But there were significant differences between high and low income groups. S.G. and pH samples of high and low income groups were similar in children and in their parents. In medical students S.G. and pH in 24-hour urines were similar to the morning value of high and middle income groups and were not affected by season, but the volume was. The relevance of these findings is discussed relative to the rarity of urinary calculi in Nigerians.

Effects of haemoglobin electrophoretic pattern and seasonal changes on urine concentration in young adult Nigerian males.

Renal concentrating capacity has been measured in healthy young adult Nigerian males with normal (AA) and abnormal (AS) haemoglobin types in both the dry and the wet seasons after 13 to 15 hours hydropenia respectively. The results show that, in the dry season, urine osmolality values in AA subjects are similar to those observed in Caucasians. They further confirm that renal concentrating capacity is impaired in persons with the S gene, and emphasize the limitations of the specific gravity test as a measure of renal concentrating capacity. In healthy AA subjects, the urine osmolality during the wet season is significantly less than in the dry season, even after longer periods of hydropenia. AS subjects, on the other hand, exhibit no seasonal variation in renal concentrating capacity.

The importance of the urine flow rate in semi-quantitative assessment of the standard renogram.

Renograms were recorded at different rate of urine flow in 30 healthy Nigerian children to establish semi-quantitative criteria to assess the standard renogram. The results indicate that knowledge of the urine flow rate during renography is necessary for meaningful interpretation of the study. They further showed that for semi-quantitative assessment of the renogram the time to peak and time to peak half values are easily identified indexes that can be measured accurately with negligible observer variation. Regression equations for the relationship between urine flow rate on the one hand, and time to peak and time to peak half values on the other have been obtained and used to compute nomograms, which should be useful for future work in this area.

Guinea worm inguinal adenopathy.

Genital involvement of Dracunculus medinensis is uncommon, and when it does occur, it usually involves the scrotum. A case has been described in which the inguinal gland was involved producing a bubo simulating that caused by other commoner conditions. It is suggested that the microscopical examination of a wet preparation of bubo aspirates should routinely be practised, especially in tropical countries.

Infection of the mastoid bone with a Paragonimus-like trematode.

Three unusual cases of mastoid abscess are described. Case histories and the clinical, laboratory, radiological, surgical, and histopathological findings in the patients are reported. Operculated eggs measuring about 60 mu times 40 mu were seen in pus obtained from two cases, but no adult worm was recovered. The findings suggest that the infections could have been caused by either Paragonimus species or Poikilorchis (Achillurbania) species.