Infant Care Practices at Home in the First Weeks of Life in Ibadan, South-West Nigeria.

BACKGROUND: The World Health Organization recommends essential newborn care, which includes components that should be provided at home and in the community, to improve newborn outcomes. This study was carried out to assess infant care practices at home in the first week of life and how they conform to the provisions of essential newborn care. METHODS: A total of 678 mothers who delivered their babies at Adeoyo Maternity Hospital, Ibadan were visited at home between the 8th and 10th days of delivery. Information on infant care practices with respect to hygiene, feeding, provision of warmth, eye care, cord care, immunization and health seeking behaviour was obtained. RESULTS: Only 9.3% of the mothers washed their hands always before handling their babies, 83.3% did sometimes and 94.0% did so after diaper change. Breastfeeding was the first feed given by 93.8% of mothers, but only 21.6% of them started within one-hour of life. At the end of the first week, 71.2% were still breastfeeding exclusively. Only 16.6% of mothers bathed their newborns on the first day of life. To keep newborns warm, 82.0% shut their windows all day, and 9% lit kerosine-wick lanterns indoors. Mothers used alcohol (97.2%) and breastmilk drops (18.2%) for umbilical cord and eye care, respectively. Only 58.6% and 14.5% of babies had received any vaccination or had postnatal visit, respectively. CONCLUSION: Infant care practices at home for newborns in Ibadan did not substantially conform to the provisions of essential newborn care and many practices were harmful. The need for supportive supervision in addition to health education for essential newborn care is indicated.

CONTEXTE: L'Organisation mondiale de la santé recommande des soins essentiels pour les nouveau-nés, qui comprennent des éléments qui devraient être fournis à domicile et dans la communauté, afin d'améliorer les résultats des nouveau-nés. Cette étude a été menée pour évaluer les pratiques de soins aux nourrissons à domicile au cours de la première semaine de vie et leur conformité aux dispositions des soins essentiels aux nouveau-nés. MÉTHODES: 678 mères ayant accouché à la maternité d'Adeoyo, Ibadan, ont été visitées à leur domicile entre le 8e et le 10e jour de l'accouchement. Des informations sur les pratiques de soins du nourrisson en matière d'hygiène, d'alimentation, d'apport de chaleur, de soins oculaires, de soins du cordon, de vaccination et de comportement de recherche de santé ont été obtenues. RÉSULTATS: Seulement 9,3% des mères se lavaient toujours les mains avant de manipuler leur bébé, 83,3% le faisaient parfois et 94,0% le faisaient après le changement de couche. L'allaitement maternel était le premier aliment donné par 93,8% des mères, mais seulement 21,6% d'entre elles ont commencé dans l'heure qui suit la naissance. A la fin de la première semaine, 71,2% étaient encore en train d'allaiter exclusivement. Seuls 16,6 % des mères ont donné un bain à leur nouveau-né le premier jour de sa vie. Pour garder les nouveau-nés au chaud, 82,0% fermaient leurs fenêtres toute la journée et 9% allumaient des lanternes à mèche de kérosène à l'intérieur. Les mères utilisaient de l'alcool (97,2%) et des gouttes de lait maternel (18,2%) pour les soins du cordon ombilical et des yeux, respectivement. Seuls 58,6% et 14,5% des bébés avaient reçu une vaccination ou une visite postnatale, respectivement. CONCLUSION: Les pratiques de soins à domicile pour les nouveaunés à Ibadan n'étaient pas essentiellement conformes aux dispositions des soins essentiels pour les nouveau-nés et de nombreuses pratiques étaient néfastes. La nécessité d'une supervision de soutien en plus de l'éducation sanitaire pour les soins essentiels aux nouveau-nés est indiquée. Mots clés: Soins aux nourrissons ; Domicile; Nouveau-nés; Première semaine; Communauté.

Challenges of caregivers and needs of children with parents in a Nigerian prison.

Background: Separation of a parent from the family as a result of incarceration has both short-term and long-term effects on the family, even after release from prison. This study is a report of factors and challenges of the family left to adapt to the changed circumstances of separation from parent(s) who are incarcerated. Methods: This was a cross sectional study carried out on 89 caregivers of children whose parents are incarcerated at the Agodi prison, Ibadan who gave informed and written consent to interview their families. Results: Most caregivers had little or no formal education (69.7%) and 67.4% are into petty trading or subsistence farming. A majority of the caregivers reported the need of schooling (85.4%), provision of food (84.3%) and medical care (71.9%) as major challenges, only 25% received any form of support to meet these needs. Twenty-nine (32.6%) respondents reported receiving financial support to provide for the child's feeding. Some caregivers 21 (23.6%), obtained loans to cope with the financial needs of the children while only 3 (3.4%) received support from family or other non-governmental organisations. Conclusion: The caregivers of children of prison inmates face significant challenges in meeting the needs of feeding, health and schooling. Support structures and policies to address these gaps are required.

Co-existing sickle cell anaemia and inflammatory bowel disease: case report and review of the literature.

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

Ultrasonographic Hepatosplenic Parenchymal and Blood Flow Changes in Children with Acute Falciparum Malaria.

BACKGROUND: Malaria, a major cause of morbidity and mortality in Nigerian children, is associated with biochemical, haematological, blood flow and clinical multiorgan changes, including changes in the spleen and the liver. OBJECTIVES: To investigate hepatosplenic pathologies in a Nigerian children cohort with acute P. falciparum malaria. METHODS: A prospective case-control study of 260 children (65 uncomplicated malaria (UCM),65 complicated malaria (CM) cases and 130 controls) aged six months to six years. All subjects had laboratory tests and hepatosplenic parenchymal and blood-flow ultrasonographic evaluation. RESULTS: Mean splenic length was 8.13cm (95% CI: 7.84cm, 8.41cm) and 7.42cm (95% CI: 7.13cm, 7.71cm) in CM and UCM (p=0.001) respectively, liver span was significantly different in controls and CM (p<0.001); controls and UCM (p=0.014). Portal vein flow velocity was 32.5cm/s, 25.4cm/s and 26.5cm/s in controls, UCM and CM (p=<0.001 and 0.004 respectively) while splenic flow velocity was 30.7cm/s and 25.8cm/s in controls and CM (p=0.022). Splenic artery peak systolic velocity (PSV) =73.78cm/s, 66.52cm/s and 59.35cm/s (p = 0.008) among controls, UCM and CM respectively. There was significant correlation between malaria parasite (MP) density and splenic length (r =0.239, p = 0.007), splenic artery pulsatility index (PI) (r = 0.300, p = 0.001), splenic artery resistivity index (RI) (r = 0.260, p = 0.003) and liver span. CONCLUSION: In children with acute malaria, the splenic vessels and portal vein blood flow velocities were reduced. High malaria parasite density evokes direct relationship with spleen and liver span, splenic artery RI and PI and portalvein diameter.

CONTEXTE: Le paludisme, une cause majeure de morbidité et de mortalité chez les enfants nigérians, est associé à des modifications biochimiques, hématologiques, de la circulation sanguine et de plusieurs organes cliniques, y compris des modifications de la rate et du foie. OBJECTIFS: Étudier les pathologies hépatospléniques dans une cohorte d'enfants nigérians atteints de paludisme aigu à P. falciparum. MÉTHODES: Une étude prospective cas-témoins de 260 enfants, 65 cas de paludisme simple (UCM), 65 cas de paludisme compliqué (CM) et 130 témoins) âgés de six mois à six ans. Tous les sujets ont subi des tests de laboratoire et une évaluation parenchymateuse hépatosplénique et échographique du flux sanguin. RÉSULTATS: La longueur splénique moyenne était de 8,13 cm (IC à95%: 7,84 cm, 8,41 cm) et 7,42 cm (IC à 95%: 7,13 cm, 7,71 cm) en CM et UCM (p = 0,001) respectivement, la contrôles et CM (p<0,001); contrôles et UCM (p = 0,014). La vitesse d'écoulement de la veine porte était de 32,5 cm / s, 25,4 cm / s et 26,5 cm / s chez les témoins, UCM et CM (p = <0,001 et 0,004 respectivement) tandis que la vitesse d'écoulement splénique était de 30,7 cm / s et 25,8 cm/ s chez les témoins et CM (p = 0,022). Vitesse systolique maximale de l'artère splénique (PSV) = 73,78 cm / s, 66,52 cm / s et 59,35 cm /s (p = 0,008) parmi les témoins, UCM et CM respectivement. Il y avait une corrélation significative entre la densité du parasite du paludisme (MP) et la longueur splénique (r = 0,239, p = 0,007), l'indice de pulsatilité de l'artère splénique (IP) (r = 0,300, p = 0,001), l'indice de résistivité de l'artère splénique (RI) (r = 0,260, p = 0,003) et la durée hépatique. CONCLUSION: Chez les enfants atteints de paludisme aigu, les vaisseaux spléniques et la vitesse du flux sanguin de la veine porte ont été réduits. Une densité parasitaire élevée du paludisme évoque une relation directe avec la rate et le foie, l'artère splénique RI et PI et le diamètre de la veine porte. MOTS CLÉS: Paludisme aigu à falciparum, foie, rate, circulation sanguine, échographie.

Long-term effects of Maternal HIV Infection and Anti-Retroviral Medications on the Hearing of HIV-Exposed Infants.

BACKGROUND: The long-term effect of maternal HIV and antiretroviral medication on the hearing of HIV-exposed infants has not been well studied. We determined and compared the hearing thresholds of HIV-exposed infants with that of HIV-unexposed infants within the first month of life and at three, six and nine months of life. MATERIALS AND METHODS: This was a Case control study of 126 HIV-exposed newborns and 121 HIV-unexposed newborns. Data collected included Socio-demographic, clinical characteristics and risk factors for hearing loss. Hearing was evaluated at newborn, 3, 6, and 9 months of life. Within and between groups analyses were done with appropriate statistics. Level of significance was P<0.05. RESULTS: In both ears, the mean hearing thresholds of HIV-exposed infants were greater than those of the HIV-unexposed infants at baseline, 3, 6 and 9 months (P>0.05). In both groups, there was a decline in the mean hearing thresholds from baseline (new born) till 6 months of age. The highest mean threshold was recorded at 9 months. The mean hearing thresholds of infants at 3, 6, and 9 months were lower for HIV-exposed infants and higher for HIV-unexposed infants than the corresponding mean hearing thresholds measured at baseline. There was a significant strong correlation among hearing thresholds at 3, 6 and 9 months but weakly correlated with hearing thresholds at baseline. CONCLUSION: There was a tendency towards higher hearing thresholds in HIV-exposed infants than the HIV-unexposed infants throughout the infancy period. This appears to have association with in-utero exposure to HIV.

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults. METHODS: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records. RESULTS: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p

Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days.

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availability in Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency (25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5-50 nmol/L)) has been described in various population groups, ranging from 5% to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs. Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D. Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentre for many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to be taken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised.

Backpack-related musculoskeletal symptoms among Nigerian secondary school students.

Musculoskeletal discomfort in schoolchildren is significantly related to the weight and mode of carrying backpack to school. Prevalence and patterns of musculoskeletal discomfort among Nigerian secondary school students carrying backpack was investigated. Systematic sampling technique was used in the selection of the participating junior secondary schools for this study. Participants comprised 1,785 students aged 10-15 years. Standardised Nordic musculoskeletal questionnaire was used to collect information on musculoskeletal pain. Backpack weight and participants' body weight were measured using a weighing scale. The visual analogue scale was used to assess pain intensity. Gender differences in backpack weight, backpack percentage and musculoskeletal discomfort were studied using Mann-Whitney U test; Kruskal-Wallis test was used to study the influence of backpack carrying style on musculoskeletal discomfort; and Spearman rho correlation to determine the relationships between backpack weight, backpack to body weight ratio, age and pain intensity. There were 882 boys and 903 girls recruited into the study. Shoulder pain was the most prevalent discomfort (63.5 %), and pain was significantly higher in girls (p = 0.013). There were weak relationships between pain intensity, body weight and backpack to body weight ratio (r range 0.433-0.442; p < 0.001), and a weak negative relationship between pain intensity and age [r = -0.135; p < 0.001; 95 % confidence interval (CI) -0.168, -0.075]. There was a strong relationship between backpack weight and age (r = 0.892; p < 0.001; 95 % CI -0.129, -0.013); however, there was a weak relationship between backpack weight and body weight (r = 0.136; p < 0.001). Prevalence of shoulder pain was high, particularly among the girls, in this sample. We suggest that factors other than the weight of backpack may predispose to musculoskeletal pain. Parents, teachers and clinicians can influence the mode of carrying backpack by secondary school students.

Burden of health-care of carers of children with sickle cell disease in Nigeria.

Sickle cell anaemia in children is characterised by recurrent crises that frequently involve intensive medical care which may impact on the health and well-being of their carers. The psychosocial impact of sickle cell disease on 67 carers of children with sickle cell disease attending the Paediatric Haematology/Oncology clinic of the University College Hospital, Ibadan, Nigeria, was determined between February and May 2007 using a structured questionnaire adapted from an instrument earlier validated for the study of carer burden in sickle cell disease and relevant to the Nigerian culture. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 15.0. Demographic factors as well as frequency of hospitalisations and blood transfusions were each categorised into groups and the Mann-Whitney U-test was used to test for differences in stress scores between any two groups while the Kruskal-Wallis test was used to test for differences in more than two groups. Level of statistical significance was set at P < 0.05. Family finances were adversely affected in 39 (58.2%) families. Financial stress was frequently associated with a history of two or more hospitalisations in the previous year and more so in families with more than three children. Majority (80.6%) of the carers said they had minimal or no difficulty coping with their children. There was also a significant correlation between financial stress and difficulty in parental coping. Caring for the illnesses in the children often caused disruptions in family interactions; worst in the first year after diagnosis and improved over the years. Regular assessment of psychosocial areas of need is necessary to guide provision of necessary support.

The economic burden of preterm/very low birth weight care in Nigeria.

The care of very low birth weight (VLBW) neonates may impose an enormous burden on professional resources and finances of caregivers. This study seeks to evaluate the immediate cost of care of VLBW babies in a developing economy. Twenty-four hospital case records VLBW babies who survived till discharge over a 1 year period at the University College Hospital, Ibadan, Nigeria were reviewed. Estimates of the out of pocket costs of managing these babies were calculated. The overall cost of hospital care ranged from US$211.1 to US$1573.9. The direct (median) and indirect (median) cost of care ranged from US$80 to US$1055 (US$247.3) and US$101.0 to US$1128.1 (US$257.2), respectively. These constituted 22.8% and 3966.3% (median 133.4%) of the combined family income. In conclusion, the cost of care of the VLBW deliveries in Nigeria is very high for the level of the economy and constitutes a major financial burden on the family.

Choledochal cysts in African infants: a report of 3 cases and a review of the literature.

Choledochal cysts are relatively rare and are an uncommon cause of cholestasis. Early diagnosis and prompt treatment can prevent complications such as cholangitis, cirrhosis and portal hypertension. This article reviews a rarely reported disease in Africans in whom only 3 cases were documented over the 18 year period in Nigeria. The 3 cases were all females with ages between less than a month and 13 months at presentation. All presented with abdominal swelling with or without jaundice or acholic stools. The use of real-time ultrasonography antenatally and postnatally aided the diagnosis in our patients. Two of the patients presented and were operated and both made full recovery confirming the importance of early surgical intervention. The third patient died, and exemplified the consequences of delayed diagnosis and treatment which occur not uncommonly in developing countries mostly because of sparse and or expensive tertiary health care facilities.

An unusual presentation of congenital bronchoesophageal fistula.

We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features suggestive of congenital diaphragmatic hernia. Emergency limited barium swallow done was initially reported as a case of diaphragmatic hernia. Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed.

Hepatocellular carcinoma in Nigerian children.

Childhood primary hepatocellular carcinoma is rare and accounts for less than 1% of all abdominal malignancies in children < or = 14 years of age. A review of the records of the Cancer Registry, Ibadan, Nigeria covering the period 1960-1995 was scrutinised and 19 cases of hepatocellular carcinoma (HCC) were registered, accounting for 0.49% of all abdominal malignancies over the period of review. The mean (SD) age at presentation was 10.4 (3.0) years and the duration of illness before presentation was short. All the children presented late with abdominal distension and hepatomegaly as the major clinical features. Weight loss was evident in 80% of cases, splenomegaly occurred in 50% and jaundice was present in a third of them. The prognosis was poor; all the cases died within 2 weeks of presentation in hospital. There was evidence to suggest an association between hepatitis B virus infection and HCC in all the liver tissue stained by Shikata-Orcein. This review shows that HCC, though uncommon, is important enough to be considered a possible cause of unexplained hepatomegaly in Nigerian children and that hepatitis B virus is an important aetiological factor. Though the number of cases under review is small, universal early vaccination against hepatitis B virus is necessary in Nigerian children in order to reduce the burden of chronic hepatitis B disease and hepatocellular carcinoma.

Tympanic thermometry in Nigerian children.

Rectal and aural temperatures were recorded at the same time in 378 children aged < or = 60 months and were found to be similar across the various age groups, correlation coefficients (r) ranging from 0.61 to 0.91. The mean differences between rectal and aural temperatures varied between -0.06 and 0.25 degree C. Concordance between the two methods ranged from 88.9% to 98% across the temperature range. Tympanic thermometry is simpler, safer and quicker than rectal thermometry and these findings justify the use of aural thermometry in any busy clinical facility for children.

Vitamin A status of pre-school children in Ibadan (South West Nigeria), risk factors and comparison of methods of diagnosis.

Vitamin A deficiency (VAD) and protein energy malnutrition (PEM), sharing common aetiological factors, are important public health problems in many developing, countries. A cross-sectional survey of the vitamin A status of 128 well nourished and 230 malnourished pre-school children was carried out in order to define factors associated with increased risks of VAD and also to determine the predictive values of CIC-T in identifying serum retinol of < 10 microg/dl in these children. The proportional morbidity rates of VAD defined by serum retinol concentrations (7.3%) and CIC-T (6.2%) was similar (p>0.05), and children aged < 3 years accounted for 70% of VAD cases. VAD occurred in 6.3% and 7.8% of well-nourished and malnourished children respectively. The risk of VAD was increased following measles, history of persistent diarrhoea and wasting. The predictive value of CIC-T is highly dependent on CIC-T such that abnormal and normal smears classification appears to be very robust and predictive of serum retinol of < 10 microg/dl, with sensitivity of 83.3% (95%CI: 61.8-94.5), and specificity of 73.3% (95%CI: 68.3-78.5). Judging by the proportional morbidity rate in this study, VAD appears to be a significant public health problem in both malnourished and well-nourished Nigerian children, especially in children < 3 years of age. The history of measles and persistent diarrhoea appear to increase the risk of VAD. The simplicity, sensitivity and specificity of CIC-T suggest that this procedure is a good screening tool for epidemiological survey of vitamin A status.

Urinary recovery of caffeine and its metabolites in healthy African children.

Consumption of caffeine containing products is very popular in African children, particularly during ill health in the belief that caffeine promotes good health. This study aims to define the metabolism of caffeine, which takes place in the liver in a group of healthy Nigerian children. About 100 mg of caffeine was ingested after an overnight fast. Urine was collected before caffeine ingestion and over 12-hour periods for 36 hours in 13 healthy Nigerian children. The percentage of caffeine and metabolites recovered in urine was determined by high performance liquid chromatography. The total urinary caffeine and metabolites recovered over the 36-hour sampling period was 63.6%, with only 0.4% of the caffeine dose ingested recovered as unchanged caffeine during the same period. Insignificant amounts of 3,7-dimethyluric acid (0.2%), 3-methyluric acid (0.3%) and 1,3,7-dimethyluric acid (0.4) were recovered in the 36hour urine sample. This study also found that the N3-demethylation pathway was the principal pathway of caffeine metabolism accounting for 83.3% of the total metabolites recovered while C8-hydroxylation accounted for only 0.6% of metabolites recovered. The pattern of urinary metabolites recovered suggested that N3-demethylation is the principal pathway of caffeine metabolism in healthy African children and that small amounts of unchanged caffeine, as well as 3,7-dimethyluric acid, 3-methyluric acid and 1,3,7-dimethyluric acid were recovered during the sampling period.

Comparative efficacy of chloroquine plus chlorpheniramine alone and in a sequential combination with sulfadoxine-pyrimethamine, for the treatment of acute, uncomplicated, falciparum malaria in children.

One hundred and eight children with acute, symptomatic, uncomplicated, falciparum malaria were randomized to receive chloroquine (for 3 days) plus chlorpheniramine alone (for seven days) (CQ-CP group; N = 55) or, in a sequential treatment, chloroquine plus chlorpheniramine for 3 days followed, on the fourth day, by a single oral dose of sulfadoxine-pyrimethamine (25 mg sulfadoxine/kg) (CQ-CP-SP group; N = 53). The mean (S.D.) parasite-clearance time in the CQ-CP group [2.1 (0.7) days; range = 1-5 days] was similar to that in the CQ-CP-SP [2.1 (0.8) days; range = 1-5 days]. The fever-clearance times were also similar: 1.2 (0.1) days (range = 1-3 days) v. 1.1 (0.4) days (range = 1-3 days). The cure rates on days 14, 21 and 28 were 98.2%, 96.3% and 92.7%, respectively in the CQ-CP group, and 100%, 100% and 96.2%, respectively, in the CQ-CP-SP group. The rates of gametocyte carriage were low and similar (5.4% in the CQ-CP group and 3.8% in the CQ-CP-SP group) throughout the duration of the study. Both treatment regimens were relatively well tolerated, the main adverse reactions being similar: sleepiness (on day 1) and pruritus (on days 1-3). No adverse effect was attributable to SP. The results indicate that sequential treatment, for 3 days with CQ and CP, followed by a single dose of SP, is effective and well tolerated in children with acute, uncomplicated, falciparum malaria and may be an alternative treatment for CQ- and/or SP-resistant falciparum malaria. Treatment with a CQ-CP combination (CQ and CP for 3 days and then CP alone for another 4 days) is also effective but requires continuing administration after the signs and symptoms of acute malaria have disappeared.

The pharmacokinetics of caffeine in Nigerian children suffering from malaria and kwashiorkor.

OBJECTIVES: Caffeine-containing beverages are generally consumed by Nigerians suffering from malaria and kwashiorkor in the belief that caffeine aids early recovery from these illnesses, which are common in the tropics. However, there are no studies on the influence of these diseases on the absorption and pharmacokinetics of caffeine in Africans. MATERIALS AND METHODS: A single oral dose of caffeine was given to five healthy children and to five and seven children suffering from malaria and kwashiorkor, respectively. Caffeine and its dimethylxanthine metabolites were measured in plasma using high-performance liquid chromatography. RESULTS: The maximum plasma concentration (Cmax) of caffeine and the time of Cmax were similar (P > 0.05) in the three groups. However, the elimination half-life of caffeine was significantly longer in children with malaria (9.2 +/- 3.5 h) (P < 0.01) and kwashiorkor (13.1 +/- 7.9 h) (P < 0.05) than in the healthy controls (3.7 +/- 1.8 h). The total plasma oral clearance of caffeine of 4.4 +/- 1.9 ml/min/kg in healthy children was significantly higher (P < 0.01) than in those with kwashiorkor (2.0 +/- 0.9 ml/min/kg) and malaria (1.6 +/- 1.0 ml/min/ kg) (P < 0.05). Paraxanthine was the principal metabolite in all the three groups with Cmax significantly higher in healthy children (1.3 +/- 0.3 microg/ml) than in children with malaria (0.8 +/- 0.4 microg/ml) (P < 0.05) and kwashiorkor (0.3 +/- 0.1 microg/ml) (P < 0.0001). CYP1A2 activity, measured by the plasma ratios of paraxanthine: caffeine, was significantly lower in kwashiorkor and malaria. CONCLUSIONS: This study showed that the plasma kinetics of caffeine are significantly altered in malaria and kwashiorkor, and CYP1A2 activity was lower in these two disease groups.