Management of diarrhoea at the household level: a population-based survey in Suleja, Nigeria.

Home management of diarrhoea was studied in 1,638 children under 5 years of age whose 1,160 mothers we randomly selected in Suleja local government area (LGA) in November 1991. The sampling method used was a cluster scheme based on "probability proportionate to size", with 40 clusters randomly selected. Prevalence of diarrhoea during the two preceding weeks was 20.8%; 73.8% of the cases were in children under two years of age; 32% of the children had received no treatment, and 56% of the mothers had used health facilities (Government and private). The estimated annual incidence rate of diarrhoea disease was 4.6 episodes per child. During episodes of diarrhoea, almost all mothers continued breast-feeding and giving other available home fluids, but 42.2% stopped solid food. Forty-four percent of mothers gave sugar-salt-solution (SSS) at home for diarrhoea; nearly half (45.3%) of them could not prepare the solution correctly. Mothers treated at home with SSS, herbs and fluids significantly more often when the diarrhoea was perceived as severe. Mothers sought help outside the home (at a health facility or traditional healer) significantly more often for severe cases. The survey provides important information about what happens at home - the place where diarrhoeal disease control programmes succeed or fail. The findings highlight the communication messages that need to be devised for mothers. Since government health facilities remains the commonest (87%) source of information on diarrhoea, health workers need to be equipped with the skills for advising mothers on management of diarrhoea in the home.

Detection of circulating parasite antigen and specific antibody in Toxocara canis infections.

Serological surveys, measuring humoral antibody responses, have indicated significant levels of human infection with the zoonotic nematode Toxocara canis, and raised concern about the resultant risk of ocular and neurological damage. Such measurements do not distinguish with certainty current infection from past exposure. Thus, we have developed a test for circulating Toxocara antigen released by parasites in the host. This monoclonal antibody-based two-site 'sandwich' assay discriminates between T. canis and the related feline ascarid T. cati, and has been used, in tandem with the standard ELISA, to examine experimental and human infections. In experimental animals, antigen is transiently detectable, disappearing when immunocomplexed with host antibody. Antigen was also found in sera from UK patients diagnosed with visceral or ocular toxocariasis, and in four asymptomatic Papua New Guinean children. In the latter population, individuals positive for parasite antigens were not necessarily positive for antibody, implying that some infected cases may be negative in the current diagnostic ELISA. The antibody test was also adapted to measure host antibody directed to single monoclonal antibody-defined epitopes, revealing evidence of differential temporal regulation of distinct antibody specificities.