The first six month growth and illness of exclusively and non-exclusively breast-fed infants in Nigeria.

OBJECTIVE: To compare the growth and illness pattern of infants who were exclusively breast fed for six months with those of infants commenced on complementary feeding before the age of six months and ascertain reasons for the early introduction of complementary feeding. DESIGN: A comparative prospective study. SETTING: Urban Comprehensive Health Centre (UCHC), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. SUBJECTS: Three hundred and fifty-two mothers and their normal birth weight babies, weighing 2.500kg or more, and aged less than 14 days were serially recruited into the study. MAIN OUTCOME MEASURES: Mean/median monthly weights in the first six months of life, history/outpatient presentation for illnesses. RESULTS: Of the 352 mother-infant pairs recruited into the study, 345 (98%) were successfully followed up for the first six months of life. At six months, 264 (76.5%) were exclusively breast-fed, 45 (13.1%) were started on complementary feeding, between the ages of four and six months while 36 (10.4%) commenced complementary feeding before the age of four months. Infants who were exclusively breast-fed for six months had median weights above the 50th percentiles of the WHO/NCHS reference that is currently used in the national "road to health" (growth monitoring) cards. Furthermore, the mean weight of these babies at age six months was above those of babies who started complementary foods before six months. They also reported fewer symptoms and had fewer illness episodes (0.1 episodes per child) compared to those who started complementary feeding before six months. Infants who commenced complementary feeding before four months reported more symptoms and had more illness episodes (1.4 episodes per child) compared to those that commenced complementary feeding between four and six months (1.2 episodes per child). Common symptoms/illnesses seen or reported during the study among the groups were fever, diarrhoea and cough. Reasons given for early introduction of complementary foods include insufficient breast milk, thirst and convenience. CONCLUSION: It is concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the infants studied. Early introduction of complementary foods did not provide any advantages in terms of weight gain in our environment, it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breastfeed exclusively for the first six months of life.

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife, Osun State, Nigeria.

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.

Urinary schistosomiasis: options for control within endemic rural communities: a case study in south-west Nigeria.

A preliminary investigation was conducted into factors that may bring about control of morbidity due to endemic urinary schistosomiasis in rural communities. A Knowledge, Attitudes, Practices and Beliefs (KAPB) study was conducted among primary schoolchildren (those with more than four years elementary education) in Ogbagba village, Osun State, Nigeria, from October 1990 to December 1993, to ascertain their understanding of urinary schistosomiasis. The study further assessed the potential of subjective haematuria, i.e. asking children with haematuria in the recent past to so indicate, in detecting urinary schistosomiasis. It was established that subjective haematuria is both sensitive and specific for detecting urinary schistosomiasis in endemic communities. The study also established that subjective haematuria offers a valid, easy to recognize target for morbidity control in endemic situation. It is proposed that with appropriate health education; availability of safe, effective, easy-to-administer drugs, such as praziquantel, morbidity control of urinary schistosomiasis is feasible within the primary health care system with the lower cadre health worker or even a volunteer village health worker (VVHW) at the centre of the control effort.

PIP: During October 1990 to December 1993, in Ife-Central Local Government Area of Osun State, Nigeria, interviews with and physical and laboratory examinations of 106 grade 4-6 pupils aged 8-16 were conducted in Ogbagba village so the researchers could determine their knowledge, attitudes, practices, and beliefs about urinary schistosomiasis as well as the factors that offer opportunities for morbidity control of urinary schistosomiasis in an endemic area. There was no health facility in Ogbagba. 89.5% of the children had urinary schistosomiasis. 75.5% of all pupils knew the local name for urinary schistosomiasis. 66% had previously passed blood in their urine. 85.7% of these pupils believed hematuria was serious. 70.8% gave a positive history of current episode of hematuria. 62.7% of these pupils did not seek any treatment. Symptoms associated with past hematuria included abdominal pain, weakness, weight loss, and fever. 65.7% of all pupils did not know what causes urinary schistosomiasis. 67.1% believed that urinary schistosomiasis was acquired via some form of contact with water, especially swimming (57.1%). The leading types of water contact included washing clothes (95.3%), fetching water (94.3%), bathing (87.7%), and swimming (74.5%). 74.5% of all pupils urinated deliberately in the river. The sensitivity, specificity, predictive values, and efficiency of alternative methods of detecting urinary schistosomiasis revealed that subjective hematuria was comparable to gross/microscopic hematuria. These findings will be used to design information, education, and communication materials for a health education program on urinary schistosomiasis using the primary health control approach. The researchers propose that both subjective and gross hematuria be used as the basis for treating children aged 4-19 living in areas endemic for urinary schistosomiasis. Praziquantel should be used as the only drug for treating urinary schistosomiasis. Health education in the schools' curriculum and information, education, and communication developed by health authorities should promote better water contact practices. Teachers need to regularly ask their pupils about hematuria and encourage them to seek medical treatment.

Third molar eruption among rural Nigerians.

Times of eruption of third molars were studied in rural Nigerian adolescents--125 males and 133 females. Results of this study showed that the average age for the initial eruption of third molars was 15 years in male subjects and 13 years for female subjects. The incidence of eruption showed a steep rise after the age of 16 years for male subjects and 14 years for female subjects. By the age of 19 years, all third molars had erupted into the oral cavity. The eruption of lower third molars was generally ahead of the upper third molars for all age groups. The results of this study suggest that (1) the timing of third molar eruption is strongly influenced by the availability of mandibular trigone space, (2) the attrition and shrinkage of the dental arch, probably as the result of nonrefined highly fibrous diets, produce larger mandibular trigone spaces, and (3) the early eruption of third molars observed in the present study may be due to the nature of the diet used and the vigorous employment of the masticatory apparatus (from infancy) by the subjects examined.

Renographic studies in vesical schistosomiasis in children.

Renal function in children infected with Schistosoma haematobium and in uninfected controls has been studied with the I131 hippuran renogram. The results suggest that renographic abnormalities which persist after a water-load are more common in infected children who have heavy egg-output in their urine, and abnormal pyelograms. Specific chemotherapy restored the renogram to normal within 3 weeks in several cases. It is suggested that the renogram is useful for the assessment and followup of patients with vesical schistosomiasis, and further work should be done to more clearly define the renal function of such patients.