Mothers' attitudes towards donated breastmilk in Jos, Nigeria.

In many developing countries, the use of pooled human milk is not widely accepted. Six hundred eighty breastfeeding mothers were interviewed to ascertain their acceptance of donated breastmilk. Their attitudes toward stored breastmilk, human milk banking, and breastfeeding in the event of human immunodeficiency virus (HIV) positivity were solicited. About 71 percent would not accept donated breastmilk for their baby while the rest would consent only if the donor were a close family relative, owing to fear of transfer of diseases (28 percent), fear of transfer of genetic traits (22 percent), and religious and cultural taboos (14 percent). However, 60 percent were willing to donate breastmilk. Only 38 percent would accept milk from a breastmilk bank. None would breastfeed if she were HIV positive.

PIP: In the Jos community of Plateau state, Nigeria, a survey was conducted among mothers who were specifically questioned in relation to transmissible diseases such as HIV. Their attitudes regarding pooled breast milk, breast milk banks, and offering stored breast milk to their babies were also ascertained. 680 breast-feeding mothers attending the Jos University Teaching Hospital (JUTH) were interviewed at the Pediatric Outpatient Department, Postnatal and Immunization clinics using a structured pretested questionnaire. The ethnic distribution reflected the major tribes in Nigeria (Ibo, Yoruba, and Hausa). Most of the women had at least a primary school education, were Christians, were employed, and had nursed babies previously. 70% were unwilling to accept donated breast milk. The remaining mothers would accept it only if the donor was a close family relation. Among the 92 health workers (90 nurses and 2 doctors) included in the study, only 11 (12%) would consent to using donated breast milk. Mothers who were employed were less willing to accept donated breast milk when compared with unemployed mothers (p .001). Similarly, mothers with secondary or postsecondary education as a group were significantly less willing to accept donated breast milk in comparison to those with primary or no formal education (p .02). The majority of employed or well- educated mothers opted for manufactured baby milk feeds. Under HIV-positive status, none would breast feed regardless of their educational or employment status. 410 (60%) of the women were willing to donate breast milk, but they preferred to do so for a relative's baby; 25% feared producing insufficient breast milk to sustain their own infants if they had to donate milk. On the whole, 63% believed that stored breast milk was unsafe after 6 hours in a home refrigerator. Breast milk from a well- established human milk bank was acceptable to 38% of the respondents. Negative responses were due to religious injunction (27%), fear of transfer of genetic traits (17%), possible transfer of disease (11%), cultural inhibition (4%), and personal dislike (2%).

Performance of children on weaning foods in Jos, Nigeria.

A Nutritional survey on weaning foods used in Jos, Nigeria, was conducted on representative samples of 572 mothers of children between the ages of one and 18 months. The nutritional status of the children was determined by using weight for age. Four weaning foods were assessed, namely, commercial weaning food (CWF), family menu, Ogi (a sour maize beverage), ogi plus legumes and/or animal products. Only 147 (25.7%) of the mothers still depended on CWF with the rest,209 (36.5%) using fortified ogi; ogi alone by 112 (19.6%) and family menu by 104 (18.2%). No differences in weight were noticed in children, aged 6 months or under. Thereafter, the children on ogi or ogi based diet had significantly lower mean weights (p < 0.01) when compared with those on CWF. This could be attributed to lack of sufficient knowledge and exposure in preparing well balanced diet from locally available food stuff by mothers. While discouraging the use of CWF because of cost, efforts should be made to educate the mothers on how to prepare traditional multimix of good nutriture. Emphasis should be placed on how to increase the energy density by adding edible oil or using sprout grains.

Respiratory syncytial virus infections in malnourished children.

The prevalence of respiratory syncytial virus (RSV) infection among severely malnourished children was studied at the University of Benin Teaching Hospital, Benin City, Nigeria at a time when the infection was known to be prevalent in the community. Nasopharyngeal washings were obtained from subjects on admission and thereafter every 4 days until discharge. RSV was detected by ELISA technique. Of 20 well nourished children who served as controls, 11 were ELISA-positive for RSV (55%). Eight (16%) of the 51 patients who were malnourished were ELISA-positive, four of whom (8%) had nosocomial infection. Fever and rhinitis were the most common presenting features in the RSV-infected malnourished children. None of the children showed any clinical or radiological signs of lower respiratory tract infection. Malnourished children appear not to be at increased risk of RSV infection, and those who contract the infection usually do not manifest severe disease.

Cholelithiasis in children with homozygous sickle cell anaemia in northern Nigeria.

The prevalence of gall stones was studied prospectively by abdominal ultrasound examination in 65 consecutive children with sickle cell anaemia (SCA) aged 5-13 years, 35 males and 30 females, in Jos, northern Nigeria. The prevalence of cholelithiasis was 4.6%. This rate was similar to previous studies from southern Nigeria and higher than that reported in American children with SCA. The different dietary habits of children in southern and northern Nigeria appear not to play any role in the prevalence rate. None of the children followed up for more than 12 months had upper quadrant abdominal pain that warranted surgery.

Pattern of bacteraemia in febrile children with sickle cell anaemia.

A total of 166 episodes of fever in 162 children with sickle cell anaemia (SCA) aged between 6 months and 16 years who presented with rectal temperatures > or = 38.3 degrees C were studied for bacteraemia. Non-sicklers of similar ages and with similar temperatures were also studied as controls. Bacteraemia occurred in 32.5% (54) of children with SCA and in 26% (39) of controls. Gram-negative bacteria were the predominant organisms (70.4%) in SCA. The commonest organisms isolated were Salmonella (25.9%), Klebsiella (25.9%) and Staphylococcus aureus (22.2%). Gram-positive bacteria were the predominant organisms (51.3%) in controls, with Staphylococcus aureus accounting for 41% of all organisms isolated. In both groups, the incidence of bacteraemia decreased in children after the age of 10 years. Use of antibiotics prior to presentation in hospital was commoner among children with SCA (47.6%) than controls (14.7%). Antimicrobial agents were detected in the urine of 12 children with SCA and four controls whose parents denied prior antibiotic usage. The predominant organisms isolated were sensitive to gentamicin and 3rd-generation cephalosporins.

Neonatal tetanus: incidence and improved outcome with diazepam.

During a four-year prospective study at a referral hospital, 61 patients with neonatal tetanus were encountered and the contribution of continuous intravenous diazepam was noted. The over-all incidence during the study was 21.8/1000, with a mortality rate of 8.2 per cent. Signs associated with fatal outcome were hypothermia, generalized rigidity and opisthotonus. The mean dose of diazepam used was 25.8 mg/kg/day, in combination with sodium phenobarbitone (mean dose 10.7 mg/kg/day). The results suggest that high-dose intravenous (continuous) diazepam is effective, economical and feasible for reducing mortality in neonatal tetanus. Side-effects were minimal.

Malarial parasitaemia in febrile children with sickle cell anaemia.

One-hundred-and-sixty-six episodes of fever in 162 children with sickle cell anaemia (SCA) aged 6 months to 16 years, presenting to the children emergency room of the University of Benin Teaching Hospital, Nigeria with rectal temperature greater than or equal to 38.3 degrees C were studied for malarial parasitaemia. Non-sicklers of similar ages and with similar temperatures were also studied as controls. Malarial parasitaemia was documented in 9 per cent of children with sickle cell anaemia, and 29 per cent of controls (P less than 0.0001). Bacteraemia occurred in 33 per cent of children with SCA and 26 per cent of controls (P greater than 0.10). Bacteraemia was, therefore, the commonest cause of pyrexia in febrile children with sickle cell anaemia on antimalarial prophylaxis. It is suggested that children with SCA on regular anti-malarial prophylaxis who present with significant pyrexia should be carefully screened for bacterial infection and appropriate anti-microbial therapy instituted.

Diethylene glycol poisoning in Nigerian children.

Between June and September 1990, 47 children died at Jos University Teaching Hospital, Nigeria from ingestion of paracetamol syrup adulterated with diethylene glycol. Most of the children presented with anuria, fever, vomiting, diarrhoea and convulsions. Signs on admission were tachycardia, acidotic breathing, pallor, oedema and hepatomegaly. Laboratory findings included hyperkalaemia, acidosis, elevated creatinine level and hypoglycaemia. Management consisted of correction of dehydration and acidosis plus administration of antibiotics when indicated. None of the children had dialysis. All died within 2 weeks of admission. Proper government supervision of pharmaceutical companies and their agencies is urgently needed in order to prevent any future occurrence of such tragic deaths.

Nosocomial respiratory syncytial virus infection in a newborn nursery.

The nosocomial spread of respiratory syncytial virus (RSV) was studied in a newborn nursery in Benin City, Nigeria at a time the virus was known to be highly prevalent in the community. Nasopharyngeal washings were obtained from babies on admission and, thereafter, every 4 days until discharged. Questionnaires were administered to medical personnel with upper respiratory tract infection (URTI). RSV was detected by an ELISA technique. A total of 56 babies were studied, made up of 33 preterm and 23 full term babies. Fourteen of the 56 babies (25%) developed RSV infection. Eleven babies (20.8%) acquired the infection nosocomially. The infected babies were all symptomatic and some had significant morbidity. One preterm baby died following acquisition of RSV. The study demonstrated that medical personnel working in our newborn nursery were a major contributor to the spread of nosocomial RSV infection. Babies hospitalized for more than 4 weeks were more likely to acquire RSV infection. Control measures are outlined for the reduction of nosocomial spread of RSV infection in our newborn nursery.

Unilateral aplasia of the lung - a case report

The case of a 2 month old Nigerian girl with right-sided pulmonary aplasia and extra-pulmonary anomalies is presented. The early demise of the patient is attributable to the apprarent dextrocardia; repeated bronchopneumonia of the sole lung and failure to institute continuous antibiotic therapy. The difficulty in differentiating between pulmonary aplasia; agenesis and hypoplasia is highlighted