Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood.

OBJECTIVE: To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6-7 years. SUBJECTS AND METHODS: A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6-7 years in 31 primary schools randomly selected among 272 in Ibadan. RESULTS: Data was collected from 1,704 children (797 boys and 907 girls; M:F ratio 1:1.14), giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls (rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%), except for wheezing, which was higher in boys (9.0%) than girls (5.6%), p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. CONCLUSION: The study demonstrates a high prevalence of atopic conditions among children 6-7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age.

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.

Factors associated with exclusive breastfeeding in Ibadan, Nigeria.

Although nationwide efforts to promote exclusive breastfeeding began in Nigeria in 1992, data on this type of infant feeding are still generally scarce. Current status breastfeeding data were obtained from 2794 mothers, enrolled from randomly selected infant welfare clinics in Ibadan, Nigeria, to evaluate factors that are associated with exclusive breastfeeding. The exclusive breastfeeding rate dropped from 57.4% at 1 month to 23.4% at 6 months. Using multiple regression analysis, younger age of infant (P < .0001), higher maternal occupation (P < .05), and delivery in tertiary (P < .0001) or secondary (P < .0001) health facility were predictive of exclusive breastfeeding. Mothers 24 years or younger and primiparous mothers were less likely to breastfeed their babies exclusively (P < .01 and P < .05, respectively). Additional programs are needed to meet the needs of at-risk mothers, who should be identified and counseled.

A rapid assessment of breastfeeding status using current status data.

Probit analysis of current status epidemiological data was used to estimate breastfeeding rates using 3428 mother-baby pairs from randomly selected facilities in the city of Ibadan, Nigeria. The children whose ages range from 1 to 548 days were distributed over 13 age groups. The observed proportions of breastfeeding children (exclusive and ever-breastfed) in each group were transformed into probits, and a weighted linear regression of probits (y) on ages (x) was calculated using the maximum likelihood Iterative procedure. Prevalence rate for exclusive breastfeeding for Ibadan was 39.6 percent and over 99 percent of the children were ever-breastfed. Median duration of exclusive breastfeeding was 61 days, when half of the exclusively breast fed in the study population would have discontinued exclusive breastfeeding. Mean duration was 64.8 +/- 44.4 days. Nationwide efforts to promote exclusive breastfeeding started in 1992, but there remains a lot more that can be done to promote, support and protect the practice of exclusive breastfeeding in this community. Using this simple procedure, current status data, easily obtained from mothers can be used to rapidly assess breastfeeding practices in the community. This will go along way towards improving documentation of rates, thereby making planning easier.

Fertility regulatory methods and development of complications after evacuation of complete hydatidiform mole.

In a prospective, simple randomised study, we evaluated the relative efficacy of hormonal (oral contraceptive pill) and non-hormonal (intrauterine contraceptive device) methods of contraception as fertility regulatory agents in patients with complete hydatidiform moles and assessed the development of complications and sequelae if any, following their use. Fifty-six patients each on oral contraceptive pills (OCP) and intrauterine contraceptive device (IUCD) were recruited into the study. Ten patients, six on OCP and four on IUCD discontinued for varying reasons. Five patients (two on OCP, and three on IUCD) developed a gestational trophoblastic tumour and were admitted for chemotherapy. There was no complication attributable to any of the methods.

Environmental and personal hygiene practices: risk factors for diarrhoea among children of Nigerian market women.

A Cross-sectional survey was carried out to determine the environmental and personal hygiene practices of mothers of children aged less than five years in two markets in Ibadan--one with poor sanitary conditions (Bodija) and the other one with better sanitation facilities (Gbagi). The study sought to identify the risk factors for diarrhoea among these children. Two hundred and sixty-six mothers in Bodija and 260 in Gbagi were interviewed. A questionnaire was used for collecting information on social and demographic characteristics, personal and environmental hygiene practices, including sources of food and water for their children, waste-disposal practices and occurrence of diarrhoea among their children aged less than five years. The educational status of the women in Bodija was lower than that of the women in Gbagi (p < 0.001). Sixty (23%) women of the Bodija market mentioned that tap water was the source of drinking water for their children, while 91 (34%) brought water from their homes, and 45 (17%) bought it from vendors in the market. The corresponding figures for women of the Gbagi market were 41 (16%), 98 (38%) and 19 (7%). Two hundred and thirty-four (90%) women in Gbagi prepared breakfast at home for their children compared to 216 (81%) women in Bodija. This difference was statistically significant (p < 0.05). Waste disposal and personal hygiene practices were poorer among the women in Bodija. Yet the occurrence of diarrhoea was not significantly different in both the markets. Risk factors for diarrhoea identified in this study were water and food bought from vendors, child defaecation practices, mothers' cleaning up practices after child's defaecation, and refuse-disposal practices. The inherent risk of sale of unwholesome food and water by vendors is a great concern for public health authorities in Nigeria. Efforts to control diarrhoea must not only be focused on improving mothers' knowledge about food hygiene but also on environmental hygiene practices within the community.

Diarrhoea in children of Nigerian market women: prevalence, knowledge of causes, and management.

A cross-sectional survey was carried out among mothers of children aged less than five years in two markets in Ibadan, one with poor environmental sanitation and the other clean and well maintained. The study took place between September 1996 and March 1997. The questionnaire used for this survey sought information about the occurrence of diarrhoea among children aged less than five years, their mothers' knowledge about the management of diarrhoea and their practices, including care-seeking practices, and the use of oral rehydration solutions. Two hundred and sixty-six mothers were interviewed in the first market (Bodija) and 260 in the other (Gbagi). Thirty-seven percent of the children in the cleaner market (Gbagi) were said to have had diarrhoea within the last 3 months compared to 33% of the children in the unhygienic Bodija market (p > 0.05). These results suggest that environmental sanitation may not be a major determinant of diarrhoea among children of the two groups of market women. When their children had diarrhoea, 44% (Bodija) and 40% (Gbagi) of the mothers attended health centres, 33% (Bodija) and 32% (Gbagi) gave ORT at home, and 12% (Bodija) and 19% (Gbagi) purchased drugs at a chemist. The study further showed that, while only one-third of all respondents resorted to home-treatment of diarrhoea with ORS, more than 80% of them knew the components and composition of ORS solution. There is a need to continue to encourage mothers to use ORS and, thus, bridge the knowledge-practice gap in mothers' management of diarrhoea at home.

PIP: A large proportion of lower socioeconomic status women in Nigeria are petty traders, with many selling their products in markets with poor environmental conditions. Therefore, the children who often accompany their mothers to the market are constantly exposed to health hazards, especially contaminated food and water. Child diarrhea is an important cause of morbidity and mortality in this environment. Findings are presented from a cross-sectional survey conducted among mothers of children under 5 years old in Bodija and Gbagi markets, Ibadan, the former market with poor environmental sanitation and the latter with a clean and well maintained market. The study took place between September 1996 and March 1997. The survey investigated the occurrence of diarrhea among children under age 5 years, their mothers' knowledge about the management of diarrhea, and their practices, including care-seeking practices and the use of oral rehydration solutions (ORS). 266 mothers were interviewed in Bodija and 260 in Gbagi. 33% and 37% of the children in Bodija and Gbagi markets, respectively, were reported to have had diarrhea within the previous 3 months. These results suggest that environmental sanitation may not be a major determinant of diarrhea among the children of these 2 groups of market women. When their children had diarrhea, 44% of mothers in Bodija and 40% in Gbagi attended health centers, 33% and 32% gave ORS at home, and 12% and 19%, respectively, bought drugs at a chemist. Although only approximately 33% of the women treated diarrhea at home with ORS, more than 80% knew the components of ORS solution. Mothers need to be encouraged to use ORS when their children have diarrhea.