Iron Status of Pregnant Women in Rural and Urban Communities of Cross River State, South-South Nigeria.

Anaemia in pregnancy is a major public health problem in Nigeria. Iron deficiency is one of the major causes of anaemia in pregnancy.  Inadequate iron intake during pregnancy can be dangerous to both baby and mother. Iron status of pregnant women was assessed in two rural and one urban communities in Cross River State Nigeria. Packed cell volume, haemoglobin, mean cell haemoglobin, mean cell haemoglobin concentration, red cell count, serum iron, total iron binding capacity, transferrin saturation, serum ferritin, soluble transferrin receptor and soluble transferrin receptor/ferritin ratio were measured in plasma/serum of 170 pregnant women within the age range of 15-45 years. Seventy participants were from antenatal clinic of University of Calabar Teaching Hospital Calabar (urban community), 50 from St Joseph Hospital Ikot Ene (rural community) in Akpabuyo Local Government Area and the remaining 50 from University of Calabar Teaching Hospital   extension clinic in Okoyong (rural community), Odukpani Local Government Area of Cross River state. The prevalence of   anaemia, iron deficiency, iron depletion and iron deficiency anaemia were found to be significantly higher among pregnant women from the two rural communities when compared to the urban community. it was also observed that  the prevalence of  anaemia, iron deficiency, iron depletion and iron deficiency anaemia   were significantly higher (p<0.05) among pregnant women from Akpabuyo   38(76.00%),   20(40.00%),   23(46.0%)   ,   16(32.00%)   respectively followed   by  Okoyong 24(48.0%),  20(40.0%),  16(32.0%),  6(12.0)     and  then  those  from     Calabar  14(20%), 12(17.90%) , 14(20.0%).  The mean haemoglobin and haematocrit were significantly reduced in pregnant women from the two rural communities. Serum iron, serum ferritin and transferrin saturation showed no significant difference while total iron binding capacity and soluble transferrin receptor significantly increased among pregnant women from Okoyong when compared to those from Calabar. It was also shown that pregnant women in their third trimesters and multigravidae had the highest prevalence of iron depletion and iron deficiency anaemia while prevalence of iron deficiency and anaemia were higher in primigravidae and the pregnant women in their second trimester. In conclusion, this study has shown that the prevalence of anaemia and iron deficiency anaemia are higher among pregnant women in the rural communities when compared to those in the urban areas.

Glucose-6-phosphate dehydrogenase deficiency in Kuwait, Syria, Egypt, Iran, Jordan and Lebanon.

A total of 3,501 male subjects from six Arab countries living in Kuwait were investigated for quantitative and phenotypic distribution of red cell glucose-6-phosphate dehydrogenase (G6PD). The ethnic origins of those investigated were Kuwait, Egypt, Iran, Syria, Lebanon and Jordan. The distribution of G6PD deficiency among the different ethnic groups varied widely, ranging from 1.00% for Egyptians to 11.55% for Iranians. The activity of the normal enzyme was remarkably similar, with values ranging from 6.1 +/- 0.8 to 6.5 +/- 1.1 IU/g Hb. A low frequency of the Gd(A) allele was found in two ethnic groups, Egyptians (0.019) and Iranians (0.014). Gd(A-) was present at the very low frequency of 0.006 in another two ethnic groups, Kuwaitis and Jordanians.

Increased platelet factor 3 activity in Plasmodium falciparum malaria.

Platelet count and platelet factor 3 (pf 3) availability were determined in twenty five febrile subjects with no parasitologic Plasmodium falciparum malaria and in thirty eight febrile subjects with parasitologic malaria. Eighteen age and sex matched afebrile subjects without parasitologic malaria served as controls. Platelet counts were significantly lower in the malaria patients (p < 0.01) and in the non-parasitologic but febrile subjects (p < 0.01) than the control group. Platelet factor 3 activity was significantly higher in the febrile group (p < 0.01) than in the control subjects. Parasite density did not correlate either with platelet count or with platelet factor 3 clotting time.

Frequency of MNSs blood groups in south eastern Nigeria.

A total of 614 inhabitants of Calabar, south eastern Nigeria were tested with anti-M, anti-N and anti-S sera to determine the frequency of MNSs blood groups in that population. The results showed that neither ABO blood group nor sex has influence on the occurrence of MNSs blood groups in the population. It was also observed that whereas S antigen was more frequently associated with M antigen, s associated more frequently with N antigen. One half of the Su antigen occurred with MN phenotype. Significantly, the Su antigen occurred in 94% of the male subjects.

Haemoglobin C gene in south eastern Nigeria.

Haemoglobin C (Hb C) is very rare in eastern Nigeria (east of River Niger). Isolated cases have been reported. The incidence is however as high as 6% in western Nigeria. This study was undertaken to locate the isolated cases with a view to determining their origin. Hb electrophoresis was performed on 4,263 subjects in Akwa Ibom State in south eastern region of Nigeria. The subjects were selected from all the local government areas of the state and were aged 15 years and above. They comprised secondary school children, civil servants, farmers and fishermen. The results revealed complete absence of Hb C from the upland population whereas this was present in the fishing settlement population (6 or 0.4% Hb AC and one or 0.07% Hb SC subjects). The possible entry points of Hb C gene into south eastern Nigeria is discussed.

Blood donation and patterns of use in southeastern Nigeria.

A retrospective study of donor blood availability and patterns of use from 1984 through 1988 was conducted in a 400-bed university teaching hospital in Nigeria by extraction of data from the master registers for blood donors and recipients. Blood transfusion requests, number of persons who underwent phlebotomy, number of crossmatches performed, and blood use increased each year during the period of study. Average wastage rate and crossmatch-to-transfusion ratio were 3.5 percent and 1.61, respectively. Replacement blood donation constituted 98 percent of available donor blood. Obstetrics and gynecology and surgery patients used 70.4 percent of the donor blood. The donor blood units were used as whole blood (81%) because of a lack of infrastructure such as a refrigerated centrifuge. Less than 5 percent of the donors were females. It is concluded that the levels of voluntary blood donation and general blood supply are unacceptably low. The need for a functional National Blood Transfusion Service is highlighted.

Correlation between in vivo and in vitro response of chloroquine-resistant Plasmodium falciparum in Calabar, south-eastern Nigeria.

Since chloroquine-resistant Plasmodium falciparum (CRPF) has emerged in Nigeria, we monitored the susceptibility of the parasite strain to a standard chloroquine (C25) dose in our Children's Emergency Unit. Chloroquine (CQ) is the drug of choice for malaria chemotherapy in Nigeria. The WHO 7-day in vivo evaluation and Rieckmann's microtitre technique (in vitro test) were used. 33 children of mean age 4.9 years were enrolled in the study. 27 (81.8%) of the in vitro cultures were successful. 16 (59.3%) of the successful isolates still showed schizogony at CQ concentration of 5.7 pmol/well and above. 28 (84.8%) of the children completed the in vivo study. 15 (53.6%) were parasitaemic on day 7 and/or day 14 and were regarded as parasitologic failures. The isolates from 14 of these children showed corresponding in vitro resistance of CQ concentrations equal to or above 5.7 pmol/well. The proportion of RIII (= 13.3%) appears to have increased as compared to 5.9% recorded in 1987. We conclude that there appears to be a good correlation between in vivo evaluation of parasitologic failures (53.6%) and in vitro resistance (59.3%). It thus appears that CRPF is definitely increasing in South-Eastern Nigeria. This can be expected not only to complicate malaria chemotherapy in the Children's Emergency Unit of the University of Calabar Teaching Hospital, but will contribute immensely to the deterioration of malaria therapy and control in Nigeria.

Depressed erythropoietic activity of Nigerian pregnant women.

Reticulocytes production index was determined in 63 pregnant women and in 96 patients. The results show that 86% of the pregnant women, who were registering their pregnancy for the first time, were anaemic. There was significant reticulocytopenia in all the anaemic pregnant women and in the patients. Erythropoiesis was found to be depressed in all subjects patients by two to seven times those expected in normal responsive bone marrows. There was no correlation of the bone marrow impairment with parity of the pregnancy. The bone marrow impairment was more pronounced during the 16th week of gestation and less so in older pregnancies. Malnutrition and infection (especially malaria) are suggested as the aetiological factors of the bone marrow depression of erythropoiesis.

New trends in chloroquine efficacy in the treatment of malaria: chloroquine-resistant Plasmodium falciparum in Anambra and Benue States of Nigeria.

Increasing malaria treatment failures with chloroquine (C25) and reports of chloroquine resistant Plasmodium falciparum (CRPF) led to the field survey of two sites (Agbani and Jato-Aka) both in Primary Health Zone A, using WHO--in vivo seven-day test, modified to 14-day follow-up period. Of the 922 children studied, high transmission rates of 40 pc and 59.2 pc were found in Agbani and Jato-Aka respectively. Varying degrees of parasitologic failures (CRPF), 52 pc in Agbani and 60 pc in Jato-Aka were confirmed. However, chemotherapy with C25 significantly reduced the clinical symptoms of malaria infection, even in the CRPF-cases. The clinical success in the two study sites were 69 pc ad 94 pc respectively.

Depressed erythropoietic activity in Nigerian pregnant women.

Reticulocytes production index was determined in 63 pregnant women and in 96 patients. The results show that 86% of the pregnant women, who were registering their pregnancy for the first time, were anaemic. There was significant reticulocytopenia in all the anaemic pregnant women and in the patients. Erythropoiesis was found to be depressed in all subjects and patients by two to seven times those expected in normal responsive bone marrows. There was no correlation of the bone marrow impairment with parity of the pregnancy. The bone marrow impairment was more pronounced during the 16th week of gestation and less so in older pregnancies. Malnutrition and infection (especially malaria) are suggested as the aetiological factors of the bone marrow depression of erythropoiesis.

Malaria and its treatment in rural villages of Aboh Mbaise, Imo State, Nigeria.

We examined the malaria situation among 489 children under 5 years of age in the rural villages of Aboh Mbaise, Nigeria, using a combination of a standard questionnaire technique and laboratory diagnosis to confirm clinical observations. The results show a high prevalence rate of 52.8% for Plasmodium falciparum in this area. The geometric mean parasite density (GMPD) was 19,361.4/mm3. The proportion of children with fever and/or parasitaemia was not related to age, although the numbers in the febrile group appeared to increase with age. Using 37.5 degrees C as the threshold for fever, 48.7% of the heavily infected group (more than 1000/mm3) were afebrile while 51.3% were febrile. High grade temperatures above 38 degrees C were associated with high parasitaemia above 10,000 parasites/mm3. Of the 911 children who died in the area within the last five years, 22.4% died of fever of unknown origin, 39.7% from malaria, 22.5% from convulsion, 10.5% from diarrhoea and 4.6% from cough. Chloroquine is the drug of choice for the treatment of malaria and there were many cases of drug abuse, and use of sub-curative doses prescribed by non-medically qualified staff.

Iron stores of Nigerian blood donors as assessed by serum ferritin concentration.

Haematological indices and parameters of iron status were obtained from 29 normal male subjects and from 32 male blood donors. Percentage saturation of transferrin with iron and the usual erythrocyte parameters of iron status were similar in both group of subjects. The mean ferritin concentration was 64.75 ng/ml +/- 4.6 (SEM) in normal males and 49.19 ng/ml +/- 5.1 (SEM) in the male donors. This difference was statistically significant (p less than .05). Serum ferritin concentration thus appears to be a sensitive index of iron stores. The results also indicate that some blood donors may be pre-latent or latent iron deficient at the time of donation and may manifest as iron deficient after blood donation. Based on these findings, it is suggested that blood donors be given iron supplementation and those who do not meet the minimum screening haemoglobin concentration be further investigated and treated.

Prevalence and titre of ABO haemolysin antibodies in pregnant Nigerian women.

The prevalence and titre of anti-A and anti-B haemolysin antibodies was determined in pregnant and non-pregnant women in a Nigerian community. The results show that alpha haemolysin occurs less frequently than beta-haemolysin in both pregnant and non-pregnant subjects. However, the prevalence of alpha haemolysin was significantly higher in pregnant subjects than in the non-pregnant ones. Surprisingly, the prevalence of haemolysin was significantly lower among the pregnant group than the non-pregnant group. These findings seem to suggest that the foetus probably plays a dual role in alpha and beta-haemolysin production--it enhances the production of alpha-haemolysin while suppressing that of beta-haemolysin. These findings offer explanations for the usually observed low frequency of occurrence of haemolytic disease of the newborn due to ABO incompatibility.

Efficacies of chloroquine and pyrimethamine-sulphadoxine in a Nigerian population with chloroquine resistant P. falciparum malaria.

A modification of the standard World Health Organisation 7--day in vivo test was used to assess the parasitologic and, to limited extent, the clinical response of children less than 5 years of age to defined oral dosages of chloroquine and pyrimethamine-sulphadoxine during the 14 days following the initiation of treatment. The study took place in Jato-Aka, a rural community in Benue State of Nigeria. 471 children were screened and 271 (59%) of these had plasmodium parasites thus showing a high transmission rate at a time of the year with scarce rainfall. Of the 42 children on chloroquine and who were followed up to day 2, 4 or 9.5% of them were parasitologic failures while none of the 45 children on pyrimethamine-sulphadoxine (P-S) failed parasitologically. By day 7, 21 (50%) of the children on chloroquine and 4 or 8.9% of those on P-S. had become parasitologic failures. The total number of parasitologic failures on day 14 were 21 (50%) and 4(8.9%) for chloroquine and P-S groups respectively. Chloroquine improved the clinical state of the patients better than P-S. However, P-S appears superior in clearing the parasites. These results confirm the existence of both chloroquine and pyrimethamine-sulphadoxine resistant strains of P. falciparum in some regions of Nigeria. The routine chloroquine chemoprophylaxis of children under 5 years of age should be discontinued so as not to hasten the intensification of chloroquine resistance and because of its probable marginal efficacy at chemoprophylaxis dosages. There is also need for a national policy on pyrimethamine-sulphadoxine usage in order not to hasten its resistance to P. falciparum.

Mitotic inhibitors arrest the growth of Plasmodium falciparum.

We report that the mitotic inhibitor, vinblastine (VLB), is highly toxic to the malarial parasite, Plasmodium falciparum. In cultures in vitro growth is inhibited by 50% at a VLB level of about 28 nM, and totally abolished at a level of 100 nM. By tests on synchronized cultures we have found that the effect of VLB takes place at the trophozoite stage. Colcemid also inhibits schizogony with somewhat different kinetics. By mutagenesis with nitrosoguanidine followed by VLB selection we have isolated a VLB-resistant mutant which exhibits cross-resistance to vincristine. These data suggest a critical role of microtubules in the asexual schizogonic cycle of P. falciparum.

Adaptation of Plasmodium falciparum to glucose 6-phosphate dehydrogenase-deficient host red cells by production of parasite-encoded enzyme.

There is impressive evidence from geographical data, studies in the field and in vitro culture work that genetically determined deficiency of glucose 6-phosphate dehydrogenase (G6PD) confers relative protection against the human malaria parasite, Plasmodium falciparum. G6PD is encoded by an X-chromosome-linked gene, and protection phenomenon is manifested in heterozygous females who are genetic mosaics but, surprisingly, not in hemizygous males with complete deficiency. We have shown previously that the parasite, when passaged serially through G6PD-deficient red cells, undergoes adaptive changes that gradually improve its ability to multiply in these deficient cells. To explain the above paradox, we now show that this adaptive process is associated with, and may consist in, the induction of synthesis of a novel G6PD coded by Plasmodium falciparum.

Evaluation of serum ferritin levels and other hematological parameters in a Nigerian population.

Hematological parameters, including serum ferritin, were estimated in a healthy Nigerian population and in patients with other clinical conditions. The hematological values fell within the reported range for healthy populations in other parts of the world. The mean serum ferritin value in the male population was 72.4 ng/mL compared with the female value of 34.3 ng/mL. There was a strong correlation between the percentage of transferrin saturation and the serum ferritin level in males only (r = .40, P < .002).In patients with sickle cell disease, SC-group patients had a significantly higher hemoglobin concentration (P < .001) than the SS group. However, the SS group had higher values for mean corpuscular hemoglobin, mean corpuscular volume, and transferrin saturation than the SC group. Also, the mean ferritin level in the SS group (296.3 ± 61.9 ng/mL) was significantly higher (P < .01) than in the SC group (mean 180.8 ± 97.2 ng/mL).When sickle cell anemia was complicated by chronic osteomyelitis, the ferritin level was much higher (mean, 1,470 ng/mL) than at the steady state. Finally, in patients with leukemia, serum ferritin levels were much higher than in the healthy population.

Imbalance in X-chromosome expression: evidence for a human X-linked gene affecting growth of hemopoietic cells.

In each of six family members who were heterozygous at the X-linked locus for glucose-6-phosphate dehydrogenase, only one or the other of the two alleles at that locus was almost exclusively expressed. The data are consistent with evidence that X-chromosome inactivation is a random process that may be followed by selection for one of the two resulting cell types on the basis of an unknown gene, which is located on the X chromosome and which can affect the rate of proliferation of hemopoietic cells in humans.

Genetic variants of human erythrocyte glucose 6-phosphate dehydrogenase: new variants in West Africa characterized by column chromatography.

Five electrophoretically slow-moving genetic variants of glucose 6-phosphate dehydrogenase are described: four are from Nigeria and one is from Togo. All variants have normal or moderately reduced activity, and they are not associated with adverse clinical or haematological manifestations. Three variants have been fully characterized and are different from all previously described ones. Two variants have been partially characterized and at least one of them is also probably new. The overall population incidence of sporadic variants of G6PD in the Nigerian population is 0-3%. In the course of this study a previously described ion-exchange chromatographic technique for the characterization of G6PD variants has been extensively evaluated. Data are given on ten different variants to demonstrate the high resolving power of this technique.