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Background. Pneumonia is a major cause of morbidity and mortality in under-5 children. Caring for children with pneumonia, especially in the case of prolonged hospitalisation, is a daunting task in resource-poor countries where caregivers are required to pay for treatment ‘out of pocket’ at the point of care. These children are often discharged against medical advice with incomplete treatment, with a consequent high rate of re-admission and complications. Objective. To determine factors that predict prolonged hospitalisation among under-5 children with severe pneumonia admitted to a compre h ensive health centre in rural Gambia. Methods. We prospectively assessed 420 consecutive under-5 admissions with severe pneumonia, diagnosed using World Health Organization criteria, for factors in patient history, examination or investigations that could predict a hospital stay longer than 5 full days. Results. Over the 6-month study period, pneumonia accounted for 27.6% of the total number of under-5 admissions. The mean age of children with pneumonia was 18.0 months (standard deviation (SD) ±13.7), there was a male to female ratio of 1.2:1, and 40.0% of the children were infants. Their mean hospital stay was 4.5 (SD ±3.0) days and 105 (25.0%) of the children had a prolonged hospital stay. Head nodding (odds ratio (OR) 1.929; 95% confidence interval (CI) 1.124 - 3.414; p=0.018), the presence of oedematous protein-energy malnutrition (OR 5.813; CI 1.060 - 3.616; p=0.006), severe wasting (OR 2.071; CI 1.047 - 3.241; p=0.034) and hypoxaemia at presentation (OR 2.220; CI 1.097 - 3.405; p=0.023) were independent predictors of prolonged hospital stay. Conclusion. Caregivers of children hospitalised with pneumonia and severe wasting, head nodding, oedema or hypoxaemia should be counselled at admission about the possibility of prolonged hospitalisation.

Background: School environment connotes the physical, biological and social milieu within which members of the school community operate. Its status has great impact on the health of the school children and other members of the community. Objective: To assess the healthfulness of the primary school environment in Ilesa East Local Government Area, Osun State, Southwest Nigeria. Methods: A cross sectional descriptive study of all primary schools in the area was done using a validated healthful school environment checklist. Data was analyzed using SPSS and compared between the two ownership groups of the schools. Results: There were 64 schools in all, of which 34 were public schools and 30 were private schools. All (100%) practiced open dumping and burning of refuse. Sundry health hazards were found in 81% of studied schools. The recommended toilet-pupils ratio existed in only 5.8% of the schools. Water sources were located far away in 24% of the schools with water supply. Dilapidated Classrooms were found in 42.2% of the schools. There was no difference between the scores of the two groups of schools. P=0.923 (Mann-Whitney U Test). Conclusion: The school environment was not healthy in most schools. There is a need to monitor and enforce the implementation of national guidelines on school environment in the study area.

Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

In an open, non-comparative study carried out between August and December 2002 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, 5 patients with scabies were successfully treated with crude gel of Aloe vera; thereafter the efficacy of the extract was compared with that of benzoate lotion among 30 patients. Sixteen patients were treated with Aloe vera and 14 patients had benzyl benzoate lotion. Itching was still present in 3 patients in the benzyl benzoate group and in 2 patients in the Aloe vera group after 2 courses of treatment. The scabietic lesions virtually disappeared in all of them. None of these patients had any noticeable side effects. It is concluded that Aloe vera gel is as effective as benzyl benzoate in the treatment of scabies.

The tropical fruit Carica papaya and its seeds have proven antihelminthic and anti-amoebic activities. To determine the effectiveness of air-dried C. papaya seeds on human intestinal parasitosis, 60 asymptomatic Nigerian children with stool microscopic evidence of intestinal parasites received immediate doses (20 mL) of either an elixir composed with air-dried C. papaya seeds and honey (CPH) or honey alone (placebo) in two randomized treatment groups. Repeat stool microscopic examinations were conducted 7 days postintervention for intestinal parasites. Significantly more subjects given CPH elixir than those given honey had their stools cleared of parasites [23 of 30 (76.7%) vs. five of 30 (16.7%); z = 4.40, P = .0000109]. There were no harmful effects. The stool clearance rate for the various types of parasites encountered was between 71.4% and 100% following CPH elixir treatment compared with 0-15.4% with honey. Thus, air-dried C. papaya seeds are efficacious in treating human intestinal parasites and without significant side effects. Their consumption offers a cheap, natural, harmless, readily available monotherapy and preventive strategy against intestinal parasitosis, especially in tropical communities. Further and large-scale intervention studies to compare C. papaya with standard antiparasitic preparation are desirous.

To clinically compare the healing of abscess wounds dressed with either crude undiluted honey or Edinburgh University solution of lime (EUSOL).A prospective clinical randomized study.The Isolation Children's Ward of the Wesley Guild Hospital, Ilesa, an affiliate of the Obafemi Awolowo University, Ile-Ife, Nigeria.Thirty-two (32) Nigerian children with 43 pyomyositis abcesses.All subjects had fresh surgical incision and drainage of the abcesses and a 21-day course of ampicillin plus cloxacillin (Ampiclox) and gentamicin; the wounds were left to close spontaneously with twice-daily wound dressing with packing of the abscess cavity with either honey- or EUSOL-soaked gauze in two randomized treatment groups.The clinical conditions of the wound sites were documented on days 1, 3, 7, and 21 as either clean or dirty, dry or wet, granulation tissue present or absent, and epithelialization present or absent; the length of hospital stay was also measured.Honey-treated wounds demonstrated quicker healing and the length of hospital stay was significantly shorter in patients with honey-treated wounds than those treated with EUSOL (t = 2.45, p = 0.019).Honey is a superior wound dressing agent to EUSOL. Honey is recommended for the dressing of infected wounds, more so in tropical countries, where it is most readily available.

Physical abuse and other forms of child maltreatment occur worldwide. However, in developing countries such as Nigeria they are not often considered in the differential diagnosis. A 3-year-old girl is presented who sustained injuries including traumatic teeth extraction, multiple bruises, femoral shaft fracture and haemorrhage resulting in severe anaemia as a result of physical assault by her father. This case underscores the need for the implementation of appropriate legislation to combat child maltreatment in Nigeria.

MR has become a reliable and noninvasive method of hepatic iron quantification. Currently, most of the hepatic iron quantification is performed on 1.5 T MR, and the biopsy measurements have been paired withR2andR2*values for 1.5 T MR. As the use of 3 T MR scanners is steadily increasing in clinical practice, it has become important to evaluate the practicality of calculating iron burden at 3 T MR. Hepatic iron quantification on 3 T MR requires a better understanding of the process and more stringent technical considerations. The purpose of this work is to focus on the technical challenges in establishing a relationship betweenT2*values at 1.5 T MR and 3 T MR for hepatic iron concentration (HIC) and to develop an appropriately optimized MR protocol for the evaluation ofT2*values in the liver at 3 T magnetic field strength. We studied 22 sickle cell patients using multiecho fast gradient-echo sequence (MFGRE) 3 T MR and compared the results with serum ferritin and liver biopsy results. Our study showed that the quantification of hepatic iron on 3 T MRI in sickle cell disease patients correlates well with clinical blood test results and biopsy results. 3 T MR liver iron quantification based on MFGRE can be used for hepatic iron quantification in transfused patients.

Childhood pneumonia is a leading cause of morbidity and mortality among underfives particularly in the resource-constraint part of the world. A high proportion of these deaths are due to lack of oxygen, thereby making oxygen administration a life-saving adjunctive when indicated. However, many primary health centres that manage most of the cases often lack the adequate manpower and facilities to decide which patient should be on oxygen therapy. Therefore, this study aimed to determine factors that predict hypoxaemia at presentation in children with severe pneumonia. Four hundred and twenty children aged from 2 to 59 months (40% infants) with severe pneumonia admitted to a health centre in rural Gambia were assessed at presentation. Eighty-one of them (19.30%) had hypoxaemia (oxygen saturation < 90%). Children aged 2–11 months, with grunting respiration, cyanosis, and head nodding, and those with cardiomegaly on chest radiograph were at higher risk of hypoxaemia (P<0.05). Grunting respiration (OR=5.210, 95% CI 2.287–7.482) and cyanosis (OR=83.200, 95% CI 5.248–355.111) were independent predictors of hypoxaemia in childhood pneumonia. We conclude that children that grunt and are centrally cyanosed should be preferentially commenced on oxygen therapy even when there is no facility to confirm hypoxaemia.

BACKGROUND : Prompt and accurate diagnosis is needed to prevent the untoward effects of anaemia on children. Although haematology analyzers are the gold standard for accurate measurement of haemoglobin or haematocrit for anaemia diagnosis, they are often out of the reach of most health facilities in resource-poor settings thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyzer in determining the haematocrit levels in children and to determine its usefulness in diagnosing anaemia in resource-poor settings. METHODS : EDTA blood samples collected from participants were processed to estimate their haematocrits using the two devices (Mindray BC-3600 haematology analyzer and Portable Mission Hb/Haemotocrit testing system). A pairwise t-test was used to compare the haematocrit (PCV) results from the automated haematology analyzer and the portable haematocrit meter. The agreement between the two sets of measurements was assessed using the Bland and Altman method where the mean, standard deviation and limit of agreement of paired results were calculated. RESULTS : The intraclass and concordance correlation coefficients were 0.966 and 0.936. Sensitivity and specificity were 97.85% and 94.51% respectively while the positive predictive and negative predictive values were 94.79% and 97.73%. The Bland and Altman`s limit of agreement was -5.5 5.1 with the mean difference being -0.20 and a non-ignificant variability between the two measurements (p = 0.506). CONCLUSION : Haematocrit determined by the portable testing system is comparable to that determined by the haematology analyzer. We therefore recommend its use as a point-of-care device for determining haematocrit in resource-poor settings where haematology analyzers are not available. KEYWORDS : Child health, Anaemia, Point-of-Care devices, Early diagnosis and treatment, Nigeria

In an open non-comparative study to evaluate the efficacy and safety of Acalypha wilkesiana ointment in superficial fungal skin diseases, 32 Nigerian patients with clinical and mycological evidence of superficial mycoses were recruited. Twelve patients defaulted and were lost to follow up, while one patient withdrew because of intolerable excoriation at the site of the lesion. Of the 19 patients that completed the trial, clinical cure was achieved in 73.3% of the patients. The ointment was very efficacious in the treatment of Tinea pedis, Pityriasis versicolor and Candida intetrigo where the cure rate was 100% in each condition. It is recommended that Acalypha ointment can be used for the treatment of these superficial mycoses.

Hydroxyurea (HU) is highly effective treatment for sickle cell disease (SCD). While pediatric use of HU is accepted clinical practice, barriers to use may impede its potential benefit.A survey of parents of children ages 5-17 years with SCD was performed across five institutions to assess factors associated with HU use.Of the 173 parent responses, 65 (38%) had children currently taking HU. Among parents of children not taking HU, the most commonly cited reasons were that their hematology provider had not offered it, their child was not sufficiently symptomatic and concerns about potential side effects. Even parents of HU users reported widespread concern about effectiveness, long-term safety, and off-label use. In bivariate analyses, children's ages, parental demographics such as education level, or travel time to their hematology provider were not correlated with HU use. Bivariate analysis and multivariate logistic regression revealed three significant factors associated with current HU use: better parental knowledge about its major therapeutic effects (P0.001), sickle genotype (P = 0.005), and institution of clinical care (P = 0.04).Pervasive concerns about HU safety exist, even among parents of current users. Varying knowledge among parents appears to be independent of their demographics, and is associated with HU use. Inter-institutional variability in parental knowledge and drug uptake highlights potentially potent site-specific influences on likelihood of HU use. Overall, these survey data underscore the need for strategies to bolster parental understanding about benefits of HU and address concerns about its safety.

Introduction: The development and spread of Plasmodium falciparum resistance to most commonly used antimalarials remain a major challenge in the control of malaria. Constant monitoring of drug efficacy is an important tool in establishing rational antimalarial drug policies. Methodology: A randomized comparative study was conducted at the Wesley Guild Hospital, Ilesa, Nigeria between February 2010 and September 2011 comparing the efficacy and safety of artemether-lumefantrine (Coartem) and fixed dose of artesunate plus amodiaquine (Larimal) in the treatment of uncomplicated P. falciparum malaria in children betweem 6 and 144 months of age. P. falciparum malaria parasitemia was assessed by microscopy and rapid diagnostic test. Drugs were administered according to age for three days under supervision. The primary efficacy endpoint was a day 28 PCR-corrected parasitological cure. Results: A total of 182 patients were enrolled in the two treatment groups, Coartem (n = 101) and Larimal (n = 81), and tested after 28 days. In the intention-to-treat population, Coartem (n= 101) and Larimal (n= 81) had a PCR-corrected cure rate of 98% and 100% respectively, while in the per-protocol population, Coartem (n = 89) and Larimal (n = 71) both had a PCR-corrected cure rate of 100% at day 28. Although parasite and fever clearance time was faster in the Larimal group, no significant difference was observed between the two drugs. No serious adverse effects were reported. Conclusion: Five years after being introduced in Nigeria, both Coartem and Larimal have been shown to be safe and highly effective in the treatment of uncomplicated P. falciparum malaria in children.

Vaso-occlusive crises (VOC) contribute to frequent hospitalizations among children with sickle cell disease (SCD). The objective of this study was to determine whether length of stay (LOS) has decreased for VOC hospitalizations between 1997 and 2009.We analyzed pediatric discharges (aged 0-18) with a primary or secondary diagnosis of SCD with crisis from the Kid's Inpatient Database (years 1997, 2003, and 2009), a nationally representative sample of pediatric hospital discharges. We conducted bivariate and multivariate, sample-weighted linear regression analyses to determine associations between independent variables (patient demographics, hospital characteristics, co-diagnoses, and procedures) and LOS.Both the number (22,661-21,741) and proportion of VOC hospitalizations (0.34-0.29%) among all pediatric hospitalizations marginally decreased between 1997 and 2009 (P0.01). Mean LOS decreased from 4.59 to 4.21 days (P0.01). For all study years, older age was the only socio-demographic variable associated with longer LOS, controlling for other factors. Between 1997 and 2009, LOS decreased for all age categories, with the largest statistically significant reduction occurring among adolescents (5.69-4.76 days).Nationally representative hospital data indicate modest but meaningful reductions in LOS for children with VOC over a 12-year period. Adolescents who typically have the greatest disease severity showed the largest reduction in LOS. However, adolescents continue to account for a large proportion of inpatient stays for VOC. These findings illustrate that the adolescent period is a critical time in the lifespan for targeted intervention.

anemia. Blood 2010;115:5300–5311. 10. Thornburg CD, Calatroni A, Telen M, Kemper AR. Adherence to hydroxyurea therapy in children with sickle cell anemia. J Pediatr 2010;156:415–419. 11. Sichle Cell Disease Guidelines-Hydroxyurea Chapter. http://rover.nhlbi.nih. gov/guidelines/scd/about.htm. Accessed November 21, 2011. 12. de Montalembert M, Brousse V, Elie C, et al. Long-term hydroxyurea treatment in children with sickle cell disease: Tolerance and clinical outcomes. Haematologica 2006;91:125–128. 13. Zimmerman SA, Schultz WH, Davis JS, et al. Sustained long-term hematologic efficacy of hydroxyurea at maximum tolerated dose in children with sickle cell disease. Blood 2004;103:2039–2045. 14. Burgess SW SP, Morawska A, Devadason SG. Assessing adherence and factors associated with adherence in young children with asthma. Respirology 2008;13:559–563. 15. Jentzsch NS, Camargos PA, Colosimo EA, Bousquet J. Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods. Allergy 2009;64:1458–1462. 16. Thornburg CD, Calatroni A, Telen M, Kemper AR. Adherence to hydroxyurea therapy in children with sickle cell anemia. J Pediatr 2010;156:415– 419. 17. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353: 487–497. 18. Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Diabet Med 2006;23:1332–1338. 19. Lee SJ, Joffe S, Kim HT, et al. Physicians’ attitudes about quality-of-life issues in hematopoietic stem cell transplantation. Blood 2004;104:2194– 2200. 20. Wong EC, Perez-Albuerne E, Moscow JA, Luban NL. Transfusion management strategies: A survey of practicing pediatric hematology/oncology specialists. Pediatr Blood Cancer 2005;44:119–127. 21. Streiff MB, Smith B, Spivak JL. The diagnosis and management of polycythemia vera in the era since the Polycythemia Vera Study Group: A survey of American Society of Hematology members’ practice patterns. Blood 2002;99: 1144–1149.

The aim of the study was to create awareness on the effect of dumpsite on groundwater in developing countries, especially Nigeria. In order to achieve this, water samples were obtained from 20 randomly selected hand dug wells and boreholes in the area, in February and August, 2006. 10 leachates samples were also obtained from the dumpsite. From these samples, pH and conductivity were determined using a pH/conductivity meter (Jenway model), while the concentrations of the heavy metals (Co, Fe, Pb and Cu) were determined using atomic absorption spectrophotometer (AAS). The trend of dispersion of each variable was demonstrated on Landsat ETM+ (2006) imagery using Erdas Imagine and ArcView GIS software. The study showed that the groundwater in the study area were generally alkaline (8.3 ±2.77) and contained Cu (0.02 ± 0.04 mg/l), Fe (4.23 ± 6.4 mg/l), Pb (2.4 ± 3.3 mg/l) and Co (1.03 ± 1.1 mg/l) concentrations that are higher than the permissible limits recommended by the World Health Organization (0.5, 0.1, 0.01 and 0.0002 mg/l, respectively; p > 0.05). The study concluded that the groundwater sources within 2 km radius of a major landfill will be vulnerable to the effect of landfill, if they are not adequately protected.

The study was carried out to investigate the economic viability of setting up a small scale palm wine bottling factory with a view to providing investment data to guide entrepreneurs in making investment decisions. The economic evaluation was based on a factory capacity of 750,000 bottles (60cl) per annum with production commencing in year one at 75% capacity utilization. Production cost estimate varies between N37.85/bottle (60cl) in the first year and N35.37/bottle (60cl) in the fifth year. The annual netprofits are N8, 460,430.00 and N12, 025,710.00 in years one and five respectively. Projected cash flow is positive in year one i.e. N5,329,960.00 while the projected balance sheet shows that the net worth of theproject is N19,904,010.00 in year one and N41,887,370.00 in year five. Payback period, discounted payback period and profitability index are 1.4 years, 3.3 years and 1.5 respectively. The breakeven point in year one is 48.1% or a breakeven sales volume of N16, 236,312.35.00. The Return on Investment (ROI) and Return on Equity (ROE) in year one are 57.5% and 86.1% respectively. Capital Turnover Ratio (CTR) varies between 2.3 and 2.9 within the first five years. Internal Rate of Return (IRR) is above 45%. The Net Present Value (NPV) at 25% is estimated at N3, 143,100.00. The Debt Service Coverage Ratio (DSCR) increases gradually from 1.33 to 2.75 between the first and the fifth year.

Large administrative healthcare data sets are an important source of data for health services research on sickle cell disease (SCD) and thalassemia. This paper identifies and describes major U.S. healthcare administrative databases and their use in published health services research on hemoglobinopathies.Publications that used U.S. administrative healthcare data sets to assess healthcare use or expenditures were identified through PubMed searches using key words for SCD and either costs, expenditures, or hospital discharges; no additional articles were identified by using thalassemia as a key word. Additional articles were identified through manual searches of related articles or reference lists.A total of 26 original health services research articles were identified. The types of administrative data used for health services research on hemoglobinopathies included federal- and state-specific hospital discharge data sets and public and private health insurance claims databases. Gaps in recent health services research on hemoglobin disorders included a paucity of research related to thalassemia, few studies of adults with hemoglobinopathies, and few studies focusing on emergency department or outpatient clinic use.Administrative data sets provide a unique means to study healthcare use among people with SCD or thalassemia because of the ability to examine large sample sizes at fairly low cost, resulting in greater generalizability than is the case with clinic-based data. Limitations of administrative data in general include potential misclassification, under-reporting, and lack of sociodemographic information.

Background: Little information is available about the aetiology and epidemiology of serious bacterial infections in Nigeria. This study determined bacterial isolates from blood and cerebrospinal fluid (CSF) of children presenting in the emergency room of a teaching hospital in Nigeria. Method: From October 2005 to December 2006, children aged two to 60 months presenting with signs of acute systemic infections were recruited. Blood culture and CSF specimens were collected and processed using standard microbiological protocols. Data were analysed using SPSS version 11 software. Results: Two hundred and two blood and 69 CSF samples were cultured. Fifty-five (27%) of the blood cultures yielded Gram-negative bacilli and Gram-positive cocci in almost equal proportions. The most common isolates from the blood cultures were Staphylococcus aureus, 26 (12.9%) and atypical coliforms, 13 (6.5%). Others are Klebsiella spp, 3 (1.5%); Klebsiella pneumonia, 2 (1.0%); Escherichia coli, 3 (1.5%); Enterobacter agglomerans, 2 (1.1%); Proteus mirabilis, 2(1%); Pseudomonas spp, 2 (1.0%); Haemophilus influenza, 1 (1.0%); and Coagulase-negative Staphylococcus, 1 (1.0%). Fourteen out of 67 (20.9%) of the CSF samples yielded bacterial isolates: Streptococcus pneumonia, 3 (4.5%); Haemophilus influenza, 8 (11.9%); Hemophilus spp, 1 (1.5%); E. Coli, 1 (1.5%); and atypical coliform, 1 (1.5%). Gram-negative coliform isolates were predominantly resistant to penicillin based antibiotics and co-trimoxazole but sensitive to third-generation cephalosporins and quinolones. A high percentage of S. aureus isolates were multi-drug resistant. Conclusions: Bacterial infections contribute to the significant morbidity among children in our environment. S. aureus was more frequently isolated in sepsis while H. influenzae appears to play a major role in meningitis. Appropriate use of antibiotics is needed to manage affected children effectively. We also recommend improved vaccine coverage of children under the age of five years.

The main objective of the study was to determine the role of maternal factors in the etiology of fetal malnutrition (FM) in Nigeria. Neonatal and Maternity Units of the Wesley Guild Hospital Ilesa Nigeria a unit of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was the setting for the study. This was a prospective study of consecutive singleton term live babies delivered between January and August 2001. Fetal malnutrition was diagnosed using Clinical Assessment of Fetal Nutritional Status (CANS) and the score (CANSCORE) adapted by Metcoff. The maternal prenatal record was checked and additional history was obtained from the mother. This included history of maternal illness and drugs taken during pregnancy. The socioeconomic class of the parents was also documented. Nutritional status of the mother was determined using mid arm circumference (MAC) and the body mass index (BMI). Babies were stratified into babies with FM and babies without FM. The two groups of babies were compared. Of the 473 studied 89 [18.8%] had FM. Maternal factors found associated with FM were: lack of antenatal care young mother (< 18 years) primiparity maternal undernutrition (BMI < 18.5 kg/m 2 and MAC < 23.5 cm) low socioeconomic status pregnancy-induced hypertension antepatum hemorrhage and maternal infections especially malaria urinary tract infections and HIV (P < 0.05). Improvement in the socioeconomic status of women and good antenatal care will reduce most of the maternal factors associated with FM in Nigeria. Therefore antenatal should be made cheap and accessible to all pregnant mothers. (authors)

The objective was to determine the prevalence of parasitic agents among under-five children with diarrhea in Ilesa, Nigeria and the clinical correlates of diarrhea associated with parasitic infestation. All under-five children presenting with diarrhea in the hospital had stool microscopic examination. Children with parasites in diarrheic stools (cases) were compared with those without (controls) for clinical features. Out of 300 under-five children with diarrhea, 70 (23.3%) had parasites. There were 18 (6%) helminthes and 52 (17.3%) protozoas. These included the' ova of Ascaris lumbricoides (13; 18.6%), cysts and trophozoites of Entamoeba. histolytica (46; 65.7%), cysts of Entamoeba coli (1; 1.4%), Giardia Lamblia (5; 7.1%), Necator american us (1; 1.4%) and Trichuris trichiuria (4; 5.7%). As against the controls, the cases were older (t = 4.88; p = 0:0000017), more undernourished (OR = 2.04; 95% CI = 1.14 to 3.63; p = 0.009) and belonged to the lower socio-economic classes (OR = 7.15; 95% CI = 3.83 to 13.43; p=0.0000). It is concluded that parasitic infestations are commonly associated with childhood diarrhoea in Nigeria. Malnutrition and low socio-economic status are risk factors.

A case of a three-and-a-half month old infant from a rural area, who presented with an encephalocoele, is reported. The case was complicated by acute rupture of the encephalocoele. Due to financial difficulties, there was late presentation at an appropriate health facility, and this delayed adequate management. The problem was further compounded by an industrial unrest in the public health sector at the time. There is a need to site investigational and surgical services for minor neurosurgical problems in the rural areas of the country. Nigerian Journal of Paediatrics Vol. 31(3) 2004: 93-96

No Abstract. Nigerian Journal of Paediatrics Vol. 32(1) 2005: 7-11

Thirty years ago, the first major federal legislation concerning sickle cell disease treatment was passed, resulting in the development of comprehensive sickle cell centers. We are now at another watershed moment in the treatment of this illness with the passage in October 2004 of the Sickle Cell Treatment Act, designed to substantially expand specialized sickle cell treatment programs. This legislation offers a remarkable opportunity to significantly improve health outcomes for individuals with sickle cell disease if it is implemented with a specific focus on the distinct but related issues of equity and quality. Despite major advances in sickle cell disease treatment that have occurred over the past 3 decades, important gaps exist both in the equity of government and private philanthropic support for research and in the uniform provision of high quality clinical care. This article assesses the current gaps in funding support and in the implementation of improvements in clinical care in order to suggest strategies for making optimal use of the opportunity that the new legislation presents to improve the health of all individuals affected by this disease.

Background: In sickle cell disease (SCD) abnormally shaped RBCs interact with white blood cells and the endothelium, leading to a vasculopathy and thrombotic/ prothrombotic complications such as stroke and pulmonary hypertension. About 10 % of patients with a thrombotic event in the general population will have the presence of an antiphospholipid (aPL) antibody (Andreoli et al. 2013). One proposed mechanism for the thrombophilic nature of aPL antibodies is the disruption of annexin A5. Annexin A5 is a potent anticoagulant protein that has an affinity to phospholipids. In the presence of aPL antibodies, annexin A5 is unable to form its crystallized anticoagulant shield (annexin A5 resistance). There is a paucity of data which assesses the association of aPL antibodies with vasculopathic complications of SCD, and there have been no studies investigating the annexin A5 resistance assay (A5R). We designed a pilot study assessing aPL antibody levels and A5R in a pediatric sickle cell population. Methods: Patients with a history of stroke, abnormal transcranial doppler (TCD) and elevated TR gradient by echocardiography (>25mm of Hg) were eligible. A5R, lupus anticoagulant- DRRVT, anti β2GP1, anti phosphatidylserine and anti cardiolipin antibody (IgG, IgA, IgM) assays were performed on samples obtained prospectively when patients were at a steady state (at least 4 weeks after an acute event). A5R measures coagulation times in the presence and absence of annexin A5. Resistance to the anticoagulant effects of annexin is expressed as a reduction in this ratio (Rand et al. 2004). Statistical analysis assessed multiple variables including age, gender, hemoglobin, reticulocyte count, LDH, hydroxyurea therapy, transfusion therapy, elevated TR gradient, stroke and silent stroke. Univariate analysis and multivariate logistic regression was performed with abnormal annexin A5 as the outcome variable. Results:There were a total of 39 patients: 12 patients with a history of stroke, 6 with an elevated TCD velocity and 15 patients with an elevated TR gradient. Of the 27 patients that did not have a stroke, 25 had a screening MRI in the prior year, and 9 of these patients had silent infarcts. Only 1 of 39 patients had elevated anticardiolipin IgG antibodies and 1 had an abnormal lupus coagulant (DRVVT). In contrast, 5/39 patients (12.8%) had low or abnormal annexin A5 resistance, 7/39 (18%) were in the borderline range and 27/39 (69%) were normal. This frequency of abnormality was unexpected in the antiphospolipid antibody and lupus anticoagulant negative population. None of the patients, except the one with the positive lupus anticoagulant, developed any thrombotic events in 3.5 years of follow up. None of the patients with overt stroke or abnormal TCDs had an abnormal A5R. Multivariate logistic regression analyses showed statistically significant association of hemoglobin (p= 0.037, OR 0.25, CI 0.07-0.92)), age (p =0.047, OR 1.43, CI 1.01-2.04) and silent infarct (p =0.015, OR 28.5, CI 1.9-420.5) with abnormal annexin A5 resistance. A multivariate analysis using linear regression with annexin A5 resistance as a continuous outcome variable (Table 1), showed persistence of the significant association of silent infarcts (p =0.037). Conclusion: We report an association between annexin A5 resistance and low hemoglobin, older age and presence of silent infarct in a subgroup of SCD patients. Prevalence of abnormal aPL antibody assays and lupus anticoagulant was strikingly low in this cohort. A potential role for perturbed annexin A5 resistance in the pathophysiology of silent infarction in SCD will need to be evaluated further in carefully designed prospective studies and may be a novel therapeutic target. Table 1. Hemoglobin, Age and Silent Stroke are Associated with Abnormal Annexin A5 Resistance Characteristic Odds Ratio Odds Ratio Confidence Interval p-value Hemoglobin* 0.25 0.07-0.92 0.037 Reticulocyte count 0.77 0.54-1.08 0.13 LDH 1.00 0.99-1.00 0.51 Age* 1.43 1.01-2.04 0.047 Monocyte count 1.00 1.00-1.00 0.34 Silent infarct* 28.5 1.9-420.5 0.015 Stroke 0.47 0.05-4.88 0.53 Elevated TR gradient 0.34 0.03-3.49 0.36 Gender 0.47 0.05-4.88 0.53 Allosensitization 0.56 0.05-5.86 0.63 HU vs no treatment 0.46 0.03-6.93 0.58 Transfusion vs no treatment 0.18 0.01-4.26 0.29 Disclosures No relevant conflicts of interest to declare.

Three middle-aged males and one female were diagnosed as having urinary tract infections (UTIs) between 2001 and 2003 in the Wesley Guild Hospital, Ilesa, a unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria. Of the 4 patients, only the female was asymptomatic. The 3 males had Pseudomonas aeruginosa, Klebsiella species, and Staphylococcus aureus, respectively, in their urine samples, while the female had Escherichia coli. All 4 patients were treated with grapefruit seeds (Citrus paradisi) orally for 2 weeks and they all responded satisfactorily to the treatment except the man with P. aeruginosa isolate. However, the initial profuse growth of Pseudomonas isolate in the patient that was resistant to gentamicin, tarivid, and augmentin later subsided to mild growth with reversal of the antibiotic resistance pattern after 2 weeks' treatment with grapefruit seeds. These preliminary data thus suggest an antibacterial characteristic of dried or fresh grapefruit seeds (C. paradisi) when taken at a dosage of 5 to 6 seeds every 8 hours, that is comparable to that of proven antibacterial drugs.

Accidental poisoning is common in children. Potassium bromate is a commonly used additive and raising agent in many edibles particularly bread, a staple food worldwide, yet its accidental poisoning has hitherto, not been documented in Nigeria. We report an unusual case of acute renal failure following accidental ingestion of potassium bromate tablets. Key Words: Acute renal failure, Poisoning, Potassium bromate Nigerian Journal of Paediatrics Vol.30(4) 2003: 150-153

OBJECTIVE: This study determined rates of breastfeeding advice given to African American and white women by medical providers and WIC nutrition counselors, and sought to determine whether racial differences in advice contributed to racial differences in rates of breastfeeding. METHODS: The study used data from the 1988 National Maternal and Infant Health Survey, a cross-sectional survey of a nationally representative sample of mothers with a live birth, infant death, or fetal death in 1988. The authors compared white women (n=3,966) and African American women (n=4,791) with a live birth in 1988 on self-reported rates of medical provider and WIC advice to breastfeed, WIC advice to bottlefeed, and breastfeeding. RESULTS: Self-reported racial identification did not predict medical provider advice. However, being African American was associated with less likelihood of breastfeeding advice and greater likelihood of bottlefeeding advice from WIC nutrition counselors. In multivariate analyses controlling for differences in advice, being African American was independently associated with lower breastfeeding rates (odds ratio [OR] = 0.41, 95% CI 0.32, 0.52). CONCLUSIONS: African American women were less likely than white women to report having received breastfeeding advice from WIC counselors and more likely to report having received bottlefeeding advice from WIC counselors. However, African American and white women were equally likely to report having received breastfeeding advice from medical providers. Lower rates of breastfeeding advice from medical or nutritional professionals do not account for lower rates of breastfeeding among African American women.