Impact of intestinal helminthiases on the nutritional status of primary-school children in Osun state, south-western Nigeria.

In January-March 2000, the impact of intestinal helminthiases on the nutritional status of 749 pupils (353 boys and 396 girls) attending public primary schools in the Ife Central local government area of Osun state, in south-western Nigeria, was investigated. Demographic, socio-economic and other relevant information was collected on the pupils, on the same day that a single stool sample was collected from each subject and examined, using Stoll's dilution egg-count technique. The weights, heights and ages of the subjects were recorded and converted to percentages of the reference medians for weight-for-height, weight-for-age and height-for-age. The overall prevalences of helminth infection detected among the 465 malnourished pupils (i.e. those with any form of under-nutrition) and the 284 well-nourished pupils were 32.9% and 25.4%, respectively (P=0.029). The nutritional indices of the pupils who were found helminth-infected were generally lower than those of the pupils who appeared free of intestinal helminths. The mean values for weight-for-height, for example, were higher in the apparently uninfected pupils than in those found infected with any intestinal helminth (P=0.02) or only with Ascaris lumbricoides (P=0.05). Similarly, the mean height-for-age of the pupils who were apparently uninfected was higher than the corresponding value for the pupils found hookworm-positive (P=0.003). The pupils who were each found infected with two or more species of intestinal infection had significantly lower weights-for-heights, weights-for-ages and heights-for-ages than the pupils who appeared to be helminth-free. The results of a multivariate logistic-regression analysis indicated that hookworm infection was a significant risk factor for underweight (P=0.015), wasting (P=0.033) and stunting (P=0.015) whereas Trichuris was only a significant risk factor for stunting (P=0.025). It appears that intestinal helminthiasis may play a causal or contributory role in the occurrence of childhood malnutrition, at least in the present study area. Steps should be taken to control both of these important health problems, through functional school-health programmes that provide regular deworming, supervised school meals and health education.

Prevalence and problems of foetal malnutrition in term babies at Wesley Guild Hospital, South Western Nigeria.

BACKGROUND: Up to two-thirds of low birth weight babies delivered in the developing countries are also small for gestational age (SGA). Since SGA is common in West Africa, FM is expected to be common in the region. OBJECTIVE: To determine the pattern, prevalence, and problems of FM among term babies delivered at a General Hospital. METHODS: Subjects were consecutive, live, singleton; full term neonates delivered at the hospital over eight months and were assessed within 24 hours of birth. Each baby was examined for evidence of FM using the Clinical Assessment of Nutritional Status Score (CANSCORE) described by Metcoff. The babies were classified into those with and without FM and the two groups compared. RESULTS: Four hundred and seventy three term singleton live born neonates consisting of 246 males and 227 (48%) females were assessed. Eighty-nine (52%). 18.8% of the 473 babies had FM. FM was commoner in SGA babies than AGAbabies (p < 0.001). A total of 47 (82.5%) of the 57 babies who were SGA had FM while 42 (10.6%) of 396 babies who were AGA had FM (p < 0.001) and none of the 20 LGA babies suffered from FM. Severe birth asphyxia, respiratory distress, meconium aspiration, hypoglycaemia, high haematocrit and hypoalbuminaemia were significantly commoner in babies with FM. Infants with FM had significantly higher mortality and neurological sequelae in the first month of life. CONCLUSION: FM is a major health problem in Nigeria with considerable morbidity and mortality. Using CANSCORE, the clinician can diagnose cases of FM which may be missed by using intrauterine growth chart.

Latrogenic burns injury complicating neonatal resuscitation.

A case ofiatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice.

Perinatal morbidity and mortality in offspring of diabetic mothers in Qatif, Saudi Arabia.

Diabetic mothers and their offspring were prospectively studied. Perinatal and neonatal morbidity and mortality data were analysed. Out of 11,677 deliveries in the hospital, 133 (1.14%) were delivered by diabetic mothers. They were made up of six (4.5%) stillbirths and 127 (95.5%) live births. Seventy-seven (57.9%), 55 (41.3%) and 1 (0.8%) were large, appropriate and small for gestational age, respectively. Hypoglycemia occurred in 49 (38.6%) of the 127 infants. Other associated problems were bacterial infections, congenital anomalies, birth trauma, preterm delivery, respiratory distress, polycythaemia and anaemia. Only 52 (39.1%) of the mothers received appropriate treatment for their diabetes during pregnancy. Poor maternal diabetic control resulted in high perinatal morbidity and mortality in the offspring. In order to improve the outcome in offspring of diabetic mothers in Qatif and probably Saudi Arabia as a whole, health education and improved care of the diabetic mothers during pregnancy urgently needed. This may be true of other developing countries where data on diabetes in pregnancy are scarce.

PIP: In Saudi Arabia, pediatricians compared data on infants of 52 mothers who received insulin therapy during pregnancy (group A) with data on infants of 81 mothers who either did not receive insulin therapy during pregnancy or prenatal care (group B) to evaluate the outcome in infants of diabetic mothers (IDMs) managed at Qatif Central Hospital. These 133 IDMs comprised 1.14% of the 11,677 deliveries at this hospital during 1988-92. 19.7% of all mothers had gestational diabetes mellitus. Mothers in group A were younger than those in group B (31.5 vs. 35.1 years; p 0.01). They were less likely than those in group B to suffer fetal loss (23.1% vs. 53.1%; p 0.001 and [mean fetal loss] 0.62 vs. 1.33; p 0.05). All six stillbirths (2 in group A and 4 in group B) were large for gestational age (LGA) (4.543 vs. 3.753 kg for overall birth weight; p 0.001). One stillbirth was macerated and had multiple congenital anomalies including Down's syndrome. Two liveborn IDMs also had Down's syndrome. There were no early neonatal deaths. The perinatal mortality rate (PMR) was not significantly different between the groups, but the PMR for both groups was higher than it was for the same period for the hospital overall (45.1 vs. 16.6/1000; p 0.02). 57.9% of IDMs from both groups were LGA. 38.6% of all IDMs had a blood glucose level less than 30 mg/dl. Other problems identified in IDMs included bacterial infections, birth trauma, preterm delivery, respiratory distress, polycythemia, and anemia. These findings suggest that poor maternal diabetic control contributed to the high perinatal morbidity and mortality in IDMs. Health education and improved care of diabetic pregnant women are seriously needed.

Maternal tetanus toxoid coverage during pregnancy in Ile-Ife, Nigeria.

A cluster survey on maternal tetanus toxoid (TT) coverage was carried out in the Ile-Ife Central Local Government Area. Out of the 896 mothers of babies 0-12 months old who were interviewed, 668 (74.6%) claimed they received TT during pregnancy, this was confirmed in 37 (4.1%) and in only 25 (2.8%) of these cases could the babies be said to have been protected from neonatal tetanus (NNT) at birth. About 35% of the babies were delivered at home/churches where most babies with NNT are usually born.

A comparative study of elemental composition of human breast milk and infant milk substitutes.

Instrumental neutron activation analysis (INAA) and proton-induced X-ray emission (PIXE) analysis have been employed to determine the concentration of 13 elements in human breast milk, various infant formulas, and locally produced cereals from Nigeria, as well as from various infant formulas and natural cow and goat milk available in the UK. The study shows that if the locally produced cereal is to be used on a regular basis for babies in Nigeria, then their diet must be supplemented with essential trace elements. Furthermore, parents should be discouraged from giving their infants cow and goat milk because of the high concentration of major elements compared to human breast milk.

Septicaemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria.

OBJECTIVES: To determine the incidence, predisposing factors, clinical features, bacteriological pattern and antibiotic sensitivity in septicaemia in high-risk newborns. DESIGN: A prospective study. SETTING: Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. SUBJECTS: All newborns admitted with clinical features and/or risk factors suggestive of neonatal septicaemia from February 1994 to March 1995. MAIN OUTCOME MEASURES: Culture results and mortality rates. RESULTS: The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths. The predisposing perinatal factors were low socio-economic status, lack of antenatal care, maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria were found to be the most prevalent causative organisms (59.4%). Staphylococcus aureus (36.2%), Pseudomonas aeruginosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were the commonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7% and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a high degree of in-vitro antimicrobial resistance. However, all the isolates were sensitive to ofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance. The overall mortality rate was 33.3%. CONCLUSION: Improvement in the socio-economic status of the populace and availability of affordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria. Continuous surveillance in every unit, as well as close attention to preventive strategies would be necessary to reduce morbidity and mortality from neonatal septicaemia. We recommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatal unit of OAUTHC, Ile-Ife, Nigeria.

Peri-umbilical cellulitis in Nigerian neonates.

A retrospective analysis was made of 32 neonates with peri-umbilical cellulitis seen at Wesley Guild Hospital, Ilesa, Nigeria from 1979 through 1989. All were full term and delivered after a normal pregnancy. The male:female ratio was 1.3:1. On admission, the mean (Standard Deviation) post-natal age, weight and duration of symptoms were 7.3 (2.7) days, 3.21 (0.5) kg, and 1.9 (1.3) days respectively. Major features were abdominal distension, extensive peri-umbilical induration and inflammation, and foul-smelling discharge. Most mother had antenatal care, but 60 pc were delivered at home or in the mission house. There were no recognisable maternal risk factors. Hot fomentation and unsterile materials applied to the cord were the apparent causative factors. The case fatality rate was very high (71.9 pc). Recommended treatment was antibiotics and surgical debridement. If hospital delivery were accessible to the less privileged poor, this highly lethal condition could be prevented by facilitating instruction in simple sterile cord care.

Neonatal morbidity and mortality in Nigeria.

A retrospective analysis of neonatal morbidity and mortality was conducted over a ten-year period (1981-1990) at a tertiary hospital in Ilesa, Nigeria, to determine the trends in neonatal morbidity and mortality in relation to places of delivery. 7,225 babies were admitted into the neonatal unit during the period wherein 3,232 (44.7%) were inborns and 3,993 (55.3%) outborns. Places of delivery of outborn babies were government hospitals/maternity centres (44.1%), home (28.5%), private hospitals/clinics (18.8%), and mission houses (8.7%). Major indications for admission among inborns were neonatal jaundice (45.6%), low birthweight (18.6%), birth asphyxia (14.2%), and neonatal infections (9.3%), while those for outborns were neonatal jaundice (39.5%), low birthweight (23.2%), neonatal infections (18.0%), neonatal tetanus (5.7%), birth asphyxia (4.8%). Overall mortality rate was 13.0%. It was higher in outborns than inborns (p < 0.001). Mortality was lowest in 1983 and peaked in 1987 and 1988. It was higher in outborns than inborns during the period (p < 0.001). Major causes of death were low birth weight (42.8%), neonatal jaundice (14.1%), neonatal tetanus (12.8%), infections (12.4%), and birth asphyxia (11.6%). In almost all cases, case fatality rates were higher among the outborns (p < 0.001). Similarly, mortality was higher in outborns than inborns in almost all the weight range. Among the outborns, mortality was highest in babies delivered at home and private hospitals. Improved access to neonatal medical and antenatal care will significantly reduce neonatal morbidity and mortality in Nigeria.

Acute chest syndrome in children with sickle cell disease.

Acute chest syndrome (ACS) is an acute pulmonic process in patients with sickle cell disease. We prospectively studied 50 patients with ACS admitted to the Pediatric Medical Ward during one year period (Jan. 1993 through Dec. 1993). Twenty eight of them were males and twenty two were females giving a male: female ratio of 1.2:1. The age ranged between one and 12 years. Twelve (24%) of the patients had chest pain on presentation. Twenty seven (54%) patients had significant temperature (> 38 degrees C). The x-ray findings showed that the right lung was involved in 30 patients, the left in 10 patients and both lungs in 10 patients. Three patients had pleural effusion that required chest tube insertion. Laboratory profiles showed that the erythrocyte sedimentation rate ranged between 15 and 90 mm/h, and their hemoglobin ranged between 4.2 gm and 12 gm/dl. Seven (14%) patients had significantly positive mycoplasma pneumoniae titer. None of the blood cultures was positive. All of our patient received antibiotic, usually either Cefuroxime or Ceftriaxone with Erythromycin in addition to other supportive measures such as blood transfusion, oxygen therapy and hydration therapy.

Neonatal tetanus in babies of women immunized with tetanus toxoid during pregnancy.

In a study of 52 cases of neonatal tetanus admitted to Wesley Guild Hospital, Ilesha, it was found that 17 (33%) of the babies were delivered to mothers who had received adequate tetanus toxoid immunization during pregnancy. The 17 babies were compared with the remaining 35 babies whose mothers had not received tetanus prophylaxis. The case fatality rates in these two groups were 12.5% and 60% respectively (P less than 0.01). This report shows that neonatal tetanus can occur in babies of mothers who were immunized with tetanus toxoid during pregnancy. Maternal immunity may, however, improve the prognosis in such infants.

Determinants of severity of neonatal hyperbilirubinaemia in ABO incompatibility in Nigeria.

The study was designed to determine factors responsible for the severe neonatal hyperbilirubinaemia sometimes found in ABO incompatibility in Nigeria. In 50 jaundiced babies who were ABO-incompatible it was found that the mean serum bilirubin level was significantly higher in outpatients than inpatients; this difference was probably due to the delay in recognizing jaundice among the outpatients and, possibly also to the slightly higher number of G-6-PD deficient babies in the same group, and their greater exposure to icterogenic agents. The results of serological studies suggest that ABO-incompatibility was responsible for neonatal jaundice in only 36% of these babies. Among the inpatients the need for exchange blood transfusion was more common in babies of mothers with immune anti-A or anti-B titres of 1:64 or more (P less than 0.001). Neonates at risk of ABO-haemolytic disease can be identified at birth by direct positive Coombs test and detection of immune anti-A or anti-B antibodies in the mother's serum.

Neonatal jaundice among Nigerian preterm infants.

Jaundice among Nigerian preterm infants under special care was studied to determine the incidence of clinical jaundice, the predisposing factors and outcome among those with significant hyperbilirubinaemia (SBR greater than or equal to 10mg/dl). The incidence of jaundice among 292 preterm infants over an 18-month period was 71.2%. The male: female ratio was 1:1.04. Of the 74 infants with serum bilirubin 10mg/dl or more, prematurity alone was the identified cause in 44 (59.5%), Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and septicaemia were the only additional factors in 13 (17.6%) and 7 (9.5%) respectively, while multiple aetiological factors (prematurity, septicaemia and G-6-PD deficiency) were identified in six (8.1%) of the babies. Septicaemia was associated with higher mean bilirubin levels and the highest mortality. The two kernicteric infants in the study had septicaemia. Thus, the single most important cause of jaundice was prematurity. G-6-PD deficiency alone did not appear to increase the incidence and severity of hyperbilirubinaemia in this study. Septicaemia should be suspected and promptly treated in order to reduce mortality and risk of kernicterus among preterm infants with hyperbilirubinaemia.

Screening for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency by a simple method.

The methaemoglobin reduction test (MHRT) was used at room temperature (27-32 degrees C) to screen for G-6-PD deficiency. Blood (0.5 ml) was incubated for 4 h. The results obtained were in good agreement with those obtained using the fluorescent screening method (FSM) (P less than 0.01). In the males, there was agreement in 95% of the cases. Most of the differences occurred in the females. It is concluded that since MHRT can be used at room temperature, and since the materials needed are cheap and easy to get and electricity is not essential, most hospitals should be able to use the MHRT method to screen for G-6-PD deficiency.

Prognostic factors in childhood intra-abdominal sepsis.

Over a 36-month period, prognostic factors in childhood intra-abdominal abscesses were evaluated in fifty-five Nigerian children (38 boys [69.1%] and 17 girls [30.9%] aged 2 months-15 years (mean 8.9, SD 4.3 years). The mortality rate was 20%. The adverse prognostic factors were: a high fever, a positive blood culture, subphrenic location of abscesses, abscesses associated with a typhoid perforation, post-operative abscesses, presence of organ impairment, and multiple abscesses occurring together in the same patient. The age of the patient, duration of illness before hospitalization as well as the number and type of microorganisms cultured from the abscess did not have any influence on the prognosis in the children in this study.

Quantitative analysis of 1-naphthol in urine of neonates exposed to mothballs: the value in infants with unexplained anaemia.

In Nigeria, severe NNJ is common in babies exposed to mothballs and other icterogenic agents. High-performance liquid chromatographic (HPLC) method was employed for quantitative analysis of 1 and 2-naphtol in the urine of 50 neonates aged one to 19 days. Five of the 25 babies who had a history of exposure to mothballs, and none of the babies without a history of exposure had 1-naphtol in their urine. The value of 1-naphtol ranged between 0.75 and 11.69 micrograms/ml with mean of 5 +/- 5 micrograms/ml. The overall correlation coefficient (r) between bilirubin values and 1-naphtol was 0.1 while it was 1 in the three G-6-PD deficient infants. The procedure will be very useful in the evaluation of infants with unexplained NNJ, anaemia, acute haemolytic jaundice and haemoglobinuria if naphthalene poisoning is suspected.

Cause-specific infant mortality rate in Qatif area, eastern province, Saudi Arabia.

Cause-specific infant mortality rate data are useful in the planning and evaluation of strategies designed to address high infant mortality rate (IMR). Cause-specific infant mortality rate was determined for the Qatif area using information obtained from the birth and death registers and birth and death certificates. The IMR for the Qatif area for 1992 was 21.06/1000 live births. Forty-five (70.3%) of the deaths occurred in the neonatal period and about 75% of the deaths were preventable. Major causes of IMR were premature delivery in 25 (39.1%), infections in 16 (25%), birth defects in 12 (18.8%), sudden infant death syndrome (SIDS) in four (6.3%) and difficult delivery in three (4.7%) cases. Prevention of premature delivery through improved prenatal care coverage and improvements in neonatal intensive care facilities will reduce deaths due to prematurity and difficult delivery. The impact of birth defects can be lessened with improvement in epidemiological data that may result in prevention of some of the birth defects. Better facilities for managing infants with cardiovascular anomalies will decrease infant death due to CVS defects.