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Background Malnutrition is appreciated as a global leading paediatric burden that indirectly or directly contributes to child mortality. In children, malnutrition has profound effects on health and development; and has been associated with poor outcomes in paediatric diseases. However, it is not clear if malnourished children are at an increased risk of having malaria. This study was conducted to evaluate the risk of malaria infection in children with malnutrition. Methods The study design was pre-post. A protective clothing against mosquitoes (pCAM) was given to 102 under-five children in two coastal communities, after screening for malaria parasitaemia. The children’s weight, height and body temperature were measured at recruitment. Blood was also taken at recruitment and monthly for malaria parasitaemia, haemoglobin concentration and random blood sugar. The parents/care-givers were visited daily for 1 month only, after recruitment, to ensure that the children wore the pCAM daily from 5 pm and the children were followed up monthly for 2 months. Results Of the 102 study participants, 60 (24 males and 36 females) were rapid diagnostic test (RDT)-positive at recruitment, indicating 58.8% prevalence of malaria parasitaemia. The prevalence of malnutrition and of stunting were 32.3% (33/102) and 54.9% (56/102), respectively, while 7.8% (8/108) children were wasted. Twenty (60.6%) of the malnourished children and 30 (53.6%) of those stunted were RDT-positive at recruitment. At the first post-intervention screening, only 7 (31.8%) of the malnourished and 13 (28.9%) of those stunted were RDT-positive. Malnourished and stunted children were 2.57 times and 2.31 times more likely to be malaria infected (OR = 2.57, 95% CI 0.97, 6.79; OR = 2.31, 95% CI 1.01, 5.26 respectively). Malnourished females were 2.72 times more likely to be RDT-positive compared to malnourished males (OR = 2.72, 95% CI 0.54, 11.61) and stunted females were 1.73 times more likely to the positive for malaria parasites than stunted males (OR 1.73, 95% CI 0.59, 5.03). The prevalence of anaemia at recruitment decreased from 82.4 to 69.6% after intervention. The mean haemoglobin concentration (g/dl) at recruitment was significantly lower (P Conclusion Results from this study suggest a higher risk of malaria infection among malnourished and lower risks among stunted and wasted children. Females were at a higher risk of malnutrition, stunting and wasting than males. Protective clothing against malaria seemed to reduce malaria infection and improve anaemia status.

Introduction: Painful vaso-occlusive crises are frequent complications of sickle cell disease (SCD), which affects about 3% of the Nigerian population with a high mortality in children. Relevance of hematological and biochemical parameters to clinical symptoms of SCD are not often documented. Aims and Objective: This study aimed at determining the prevalence of fatigue, acute bone pains (ABP) and acute chest syndrome (ACS) and to assess the associating hematological and biochemical parameters before and after administration of ImmunozinTM. Materials and Method: This study was a double-blind, two-arm, randomized control pilot study with 30 SCD patients presenting with fatigue, acute bone pains (ABP) and ACS, each of whom was given the study agent. At the first visit, after thorough assessment of each patient had been undertaken and hematological parameters were measured, the study drug was administered to each patient accordingly. This process was repeated monthly for five more monthly visits when the study concluded. At each visit, venous blood sample was collected for hematological parameters, electrolytes, urea and creatinine analyses within 2 hours of collection. Results: Means (±sd) of age and BMI (Kg/m2 ) of the study subjects were 13.0 (5.6) and 16.1 (1.9) respectively with 26 (86.7%) of the patients underweight. At enrollment into the study, 25 (83.3%), 18 (60.0%) and 10 (33.3%) of the patients presented with ABP, fatigue and ACS respectively but at the end of study, post administration of study drug, 11 (36.7%), 8 (26.7%) and 7 (23.3%) presented with ABP, fatigue and ACS. At enrollment, females were less likely to present with moderate fatigue (χ²=2.03, P-value=0.15, OR=0.23, 95% CI: 0.05, 1.18), moderate ABP (χ²=0.09, P-value=0.77, OR=0.80, 95% CI: 0.18, 3.46) and moderate ACS (χ²=0.01, P-value=0.90, OR=0.40, 95% CI: 0.03, 4.96) compared to males. Only one patient each presented with fatigue and ABP at the end of study. The values of many hematological parameters, electrolytes, urea and creatinine significantly varied at the end of the study compared with enrollment values. A significant positive correlation (Pearson’s r=0.40, P-value=0.031) was observed between serum urea and ACS at enrollment, and astonishingly between fatigue and ABP (r=0.52, P-value=0.003) but no notable correlation between any of the clinical symptoms and other variables at the end of study. Conclusion: The significant reduction in proportion of patients with fatigue, ABP and ACS at the end of study, after administration of test drug may suggest the therapeutic consequence of the test drug among SCD patients. There is urgent need to conduct multi-center and multi-disciplinary studies to corroborate these findings.

One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus.Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into35 years and35 years and by BMI into18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data.The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease.Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.Un mal gynécologique qui est souvent un mystère pour les femmes préménopausées qui sont touchées est l'endométriose, une affection bénigne caractérisée par un endomètre ectopique poussant à l'extérieur de l'utérus mais se comportant comme s'il était toujours dans l'utérus.Les dossiers hospitaliers de 226 femmes ayant consulté pour la gestion de la fertilité au Nordica Fertility Center ont été étudiés rétrospectivement. Ces femmes ont été stratifiées par âge en35 ans et35 ans et par IMC en18,5 (poids insuffisant), 18,5 à 24,9 (normal), 25,0 à 29,9 (surpoids) et30 (obèse). Il y avait 113 qui avaient un diagnostic laparoscopique d'endométriose et 113 sans endométriose, mais juste l'infertilité. Le logiciel statistique STATA 13 a été utilisé pour l'analyse des données.L'âge moyen (± sd) des femmes de l'étude était de 34,3 (4,9) sans différence significative entre celles avec (33,9 (4,3)) et sans (34,6 (5,4)) endométriose. Il y avait une différence significative (t = -3,36, valeur p = 0,0005) dans l'IMC moyen (Kg / m2) des femmes atteintes d'endométriose (25,8 ± 4,9) par rapport à celle des femmes sans endométriose (27,9 ± 4,5). La probabilité d'endométriose chez les femmes de poids normal était plus élevée à l'âge35 ans (OR = 2,76, intervalle de confiance à 95% 1,33,5,73) qu'à l'âge35 ans (OR = 1,59, intervalle de confiance à 95% 0,62, 4,10). La parité moyenne (± ET) parmi les personnes atteintes d'endométriose (0,13 ± 0,34) était significativement plus faible (test t = 2,31; valeur p = 0,01) que chez les femmes sans endométriose (0,28 ± 0,60). L'infertilité primaire était plus fréquente (62,0%) que l'infertilité secondaire (38,0%) chez les personnes atteintes d'endométriose, tandis que l'infertilité secondaire était plus fréquente (55,8%) que infertilité primaire (44,3%) chez les personnes sans endométriose. L'âge moyen (années) à la ménarche des femmes sans endométriose (13,3 ± 1,6) était significativement plus élevé (test t = 1,88, valeur p = 0,03) que celui des femmes atteintes d'endométriose (12,9 ± 1). Les personnes atteintes d'endométriose étaient plus susceptibles de souffrir de dysménorrhée seule, de ménorragie seule et à la fois de dysménorrhée et de ménorragie en même temps que celles sans maladie.Le profil anthropométrique et menstruel anormal des patientes présentant des douleurs pelviennes, une comorbidité de dysménorrhée et de ménorragie, l'infertilité et une faible parité peuvent guider les cliniciens et le gynécologue pour faire un diagnostic précoce et approprié de l'endométriose pour de meilleurs résultats de traitement.femmes noires africaines, dysménorrhée, endométriose, infertilité, ménorragie, parité, profil menstruel, sub-saharienne.

Implementation of safe motherhood programs in sub-Saharan African nations requires recognition of signs of potential emergency obstetric cases to facilitate immediate care seeking and urgent medical intervention. This questionnaire-based survey aimed to describe the perception of obstetric danger signs among women of reproductive age, living on the Atlantic coastline of rural Lagos. This cross-sectional, descriptive study took place in two non-congruent communities of Lagos State, Nigeria, between October 2012 and March 2013. Epi Info 7 was used to calculate sample size for the projected population in each community. Statistical analysis was carried out using STATA 13 software. A total of 829 females (20% single, 80% married) participated in the study. Among these, about 76 and 79% disagreed that bleeding and high blood pressure were obstetric danger signs, respectively. Multivariate analysis showed a positive and significant association between awareness of bleeding as obstetric danger sign as the dependent variable and both knowledge of antenatal care (t=6.53, p=0.000) and knowing a woman who died in pregnancy (t=3.34, p=0.001) as independent variables. Rural women on Atlantic Ocean coastline of Lagos had low perception of obstetric danger signs indicating promotion of acceptable maternal health in this environment. Key words: Perception, danger signs, obstetrics, reproductive age, Atlantic ocean coastline, rural.

Background: The health and well-being of women have not been studied extensively and had not been the major focus of policy fabricators and decision makers in Nigeria. It is imperative to explore the factors influencing health and the well-being of women in child-bearing age (WCBA). Methods: This study was cross-sectional and descriptive in nature. It used semi-structured questionnaires in 9 domains of age-group, marital status, parity, educational status, religion, occupation, income of respondent, income of husband and pregnancy state, to collect data on perceived health and wellbeing from 829 WCBA living on the Atlantic Ocean coastline in Lagos, Southwest Nigeria. Results: Majority of the surveyed women were aged 25- 34 years (406, 49.0%), ever married (660, 79.6%), have had 1-2 children (347, 41.9%), had attained secondary level of education (548, 66.0%) and were traders (472, 57.6%). In all, 252(30.4%) had no monthly income and only 15(1.2%) had the highest monthly income of over US$166.8. In comparison, 331(39.9%) and 67(7.6%) of respondents’ husbands had no income or had income of over US$166.8 respectively. Only 19(2.3%) perceived their well-being to be very poor while 70(8.4%) and 165(19.9%) respectively perceived it to be neither poor nor good or to be good. In all, 50(6.5%) respondents were very dissatisfied with their health compared to 254(30.6%) who were very satisfied with their health. Of those with no income, 31.6% and 48.0% respectively perceived their well-being to be very poor and their health status to be very unsatisfactory. In this group also 24.2% and 27.6% respectively perceived their well-being to be very good and their health status to be very satisfactory. Of those with income ≥US$166.8, 5.3% and 2.8% respectively perceived their well-being to be very good and health status to be very satisfactory. Significant relationships were observed between level of satisfaction with one’s health, age, woman’s income as well as pregnancy state. Discussion: The findings indicate that the experiences of well-being and health status of women in child-bearing age, living on the Atlantic Ocean coastline varied by age, marital status and educational status. A more robust study is needed to appropriately measure these variances among women, accommodate them in policies for better empowerment of women.

Aims: This study attempted to describe the prevalence and perception of hypertension (HPT) among consenting female adults in two rural communities on the Atlantic coastline of Lagos, Southwest Nigeria. Study Design: This was a community-based descriptive survey design. Place and Duration of Study: The study was conducted at Iyafin and Ketu-Ejirin in Lagos State, Original Research Article Afolabi et al.; BJESBS, 5(3): 354-367, 2015; Article no.BJESBS.2015.029 355 Nigeria, between March and June 2014. Methodology: To accomplish this aim, a structured questionnaire was served to all parents/caregivers who brought their children to an on-going malaria program so as to evaluate their perception of hypertension. Socio-demographic and other relevant data were obtained and resting blood pressure (BP) of each participant was measured. Hypertension, defined as systolic BP ≥140 and/or diastolic BP ≥90 mmHg, was categorized into mild, moderate and severe. Data were analyzed using STATA 13. Results: A total of 77 adult females (mean age 33.4 years) participated in the study. The prevalence of hypertension in our study participants was 18.2% while 19.5% of the participants presented with elevated systolic blood pressure only and 26.0% with elevated diastolic blood pressure only. Approximately 24%, 7% and 2% of married participants presented with mild, moderate and severe diastolic hypertension respectively and 20.8% of hypertensive participants measured their BP more than 2 years prior to survey. A proportion (33, 43%) of the participants did not know what hypertension is while 14 (18%) and 11(14%) respectively related it to excessive thinking and fear. Married participants were about 6 times more likely to have had their BP measured (χ2=9.2, P = 0.002, OR=5.9, CI =1.8, 20.1) compared to single participants. The commonest reason for measuring BP was general check-up (13%) among single and illness-related (23%) among married participants. Majority of single (73%) and married (53%) participants wanted their BP measured to know about personal health problems. Linear regression analysis showed a positive significant relationship between both systolic blood pressure and length of time of last BP measurement (Coef. = 0.20, P=0.01). Conclusion: Findings in our study suggest a relatively high prevalence of hypertension among women in rural coastline communities in Nigeria coupled with limited knowledge and misconception of the disease. This gap in knowledge and misconception could impact negatively on their healthseeking attitude and family life, calling for an aggressive approach to health promotion/education on and regular screening of hypertension in these coastal rural communities.

Background\ud \ud Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria.\ud \ud \ud Methods\ud \ud A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants.\ud \ud \ud Results\ud \ud Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed.\ud \ud \ud Conclusion\ud Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings.

The health of women is not only linked to reproductive issues but also to efforts in health promotion, improved nutritional status and general well being of girls and adolescents from infancy to adulthood. The aim was to evaluate the use and non-use of long lasting insecticidal nets (LLIN) among women in child-bearing age in Nigeria. This survey employed cross-sectional survey to collect data from households on coverage and use of LLINs. The study took place in 2007, five months after the distribution of LLINs, coinciding with the second raining period of the year and a time of high malaria transmission during the wet season. In the 1,756 households sampled, the ratio of women in child-bearing age to currently pregnant women was 8.2 to 1. The probability of having a woman in reproductive age in the household is 50 times more than having a pregnant woman. Overall, there was a significant difference in the proportion of pregnant women who slept under any net (χ² = 23.2; p = 0.000003; odds ratio (OR) = 1.89; confidence interval (CI) = 1.46, 2.46) or under an LLIN (χ² = 15.17; p = 0.0001; OR = 1.73; CI = 1.31, 2.28) night before survey compared to women in child-bearing age. A significant proportion of currently pregnant women took IPT1 only compared to WCBA in their last pregnancy (χ² = 524.04; p = 0.000000; OR = 35.2; CI = 22.6, 54). Use of LLINs among women in child-bearing age (WCBA) in Nigeria is low. Aggressive approach is needed to increase the utilization of LLIN among WCBA to improve use among pregnant women. Key words: Women in child-bearing age, currently pregnant women, long lasting insecticidal nets, intermittent preventive treatment, malaria, school children.

The study reported in this paper was carried out in the Northwestern and Southwestern regions of Nigeria, between October 1996 and April 1998. The study examined the possible contributory role of living conditions in the development of acute necrotizing gingivitis (ANG) or noma from oral lesions. Questionnaire data obtained from 42 fresh noma cases seen in the Northwest and four fresh cases seen in the Southwest were examined. In addition 46 cases of advanced ANG from the Southwest were included. The main focus was to compare some of the environmental living conditions of cases with advanced ANG and those with noma in these regions. All the noma and ANG cases were seen in children aged 2-12 years. The level of good oral hygiene practices and general environmental living conditions were significantly higher in the Southwest than in the Northwest. Data also showed that living in close proximity with livestock was significantly higher in the Northwest than in the Southwest (P < 0.05). The environmental living conditions of children in the Northwest were further compounded by poor sanitary faecal disposal practices as well as minimal access to potable water. The overall data indicated that living in substandard accommodations, exposure to debilitating childhood diseases, living in close proximity to livestock, poor oral hygiene, limited access to potable water and poor sanitary disposal of human and animal faecal waste could have put the children in the Northwest at higher risk for noma than the children in the Southwest. These could have been responsible for the higher prevalence of noma in the Northwest than in the Southwest.

Among the strategies being tested to improve prompt and appropriate treatment of febrile illness, especially malaria, in young children is the prepackaging of antimalarial drugs in easy to use daily dosages. A TDR-sponsored study in three rural communities in southern Nigeria tested a delivery system for prepackaged chloroquine and cotrimoxazole for children aged 6 months to 6 years. A variety of distributors were trained including village health workers (VHWs), patent medicine vendors (PMVs), and health clinic staff. These distributors also performed community health education. During a 12-month study period, 3954 units of project medicines were sold. While VHWs accounted for the majority of distributors and as a group sold the largest proportion of drugs overall, health staff sold the highest number on average. A follow-up survey found a 25 percent increase in the use of antimalarials over baseline, almost all of which could be attributed to sales of the project chloroquine. While there was also an increased use of cotrimoxazole over baseline, the contribution of project drugs was less. PMVs remained the most common source of treatment both before and after intervention, and there was a small but significant rise in the proportion who sought care from VHWs. While 93 percent of respondents sought care for their sick child within 24 hours, there was significantly more delay among those whose first choice was a government or private clinic. Factors that were positively associated with use of project drugs included reports that the child had a high temperature and seeking care from a VHW or PMV. The results indicate that it is possible to gain a significant market share for prepackaged drugs using locally available distribution channels. The value lies in using a variety of channels, both ones that are centrally located and others that are accessible to scattered, outlying communities that are poorly served by orthodox medicine.

Objectives: To examine age- and gender-specific presentations and assess clinicians’ subjective prognosis and outcome of illnesses of critically ill neonates in the emergency room. Design: A hospital-based retrospective appraisal of medical records of neonates in emergency room. Participants: Neonates admitted into the emergency room of a second-tier pediatric hospital in Lagos, Nigeria, between March 2005 and February 2007. Intervention: Appraisal of the medical records of newly-born ill infants. Results: There was no statistically significant difference in the mean weight of the neonates in each age group (df=4, p=0.5). Failure-to-cry (23.3%) and fever (37%, 52%, 54.2%, and 70%) were the main presentations in the first day of life and in all other age groups respectively. The most frequent diagnosis among the day old was birth asphyxia (21/30; 70%); among those 2-7 days old was neonatal jaundice (66/135; 48.9%); among those 8-14 days old (17/25, 68.0%) and those 15-21 days old (23/24, 92.0%) was neonatal septicemia and among those 22-28 days old was bronchopneumonia (5/10, 50.0%) respectively. Full blood count was the most repeated laboratory investigation requested for and antibiotics the most frequently-prescribed medication. Overall, there was a positive correlation (r=0.28, p=0.00) between clinicians’ subjective prognosis and outcome of illness although this was not reflected among the day-old neonates. The highest mortality rate (30.0%) was among the day-old neonates. Conclusion: Birth asphyxia was the dominant illness that brought 24-hour old neonates to the Intensive Care Unit in the health facility of study. Mortality was also highest in this age group. Jaundice, septicemia and bronchopneumonia were other leading causes of neonatal morbidity and mortality according to the age group. Clinicians’ prognosis directly correlated with disease outcome.

Introduction: Neonatal period in developing countries is characterized by various infectious diseases that make up leading causes and significant contributors to dismal morbidity and mortality statistics in this period of life. The diagnosis of neonatal sepsis in sub-Saharan Africa represents a challenge due to unavailability or scarcity of laboratory aids. The clinical diagnosis of sepsis may be difficult without laboratory aids irrespective of where the infant is born due to the fact that other non-infectious conditions can present with sepsis-like picture. Objectives : The main objectives of this study were to document frequently diagnosed illnesses, record the management of the ill neonates and present the leading causes of death during the neonatal period for the purpose of future planning. Methodology : This was a retrospective review of the medical records of children admitted into the Intensive Care Unit (ICU) of a public health facility between March 2005 and February 2007. Descriptive analysis was used to illustrate findings. The study was conducted between March 31, 2009 and June 30, 2009. Results: Majority (135, 60.3%) of the study neonates (135 males, 89 females) were aged between 2-7 days. In all, 46 (20.5%) neonates weighed less than 2.5 kg. There was a considerable difference (t=-2.45; p=0.015; CI -0.60, -0.06) in the mean (± SEM) body temperature of 24-hour old neonates (36.7 ± 0.11) compared with those 2-7 days old (37.1 ± 0.06). Fever (56, 44%) was the most frequent presentation among neonates diagnosed with septicaemia (126, 56.3%), yellowness of the eyes (47, 65.3%) among those diagnosed with jaundice (72, 32.1%) and failure to cry (9, 25.7%) among those diagnosed with birth asphyxia (35, 15.6%). Full blood count was the most frequent (207, 92.4%) investigation requested for while antibiotics was the commonest (461, 205.8%) medication prescribed. Medications were administered to the neonates mainly through the intravenous route (538, 240.2%). In all, mortality among the studied neonates was 76 (33.9%). Conclusion: More effective measures to improve neonatal mortality could be 1) improving access to antenatal care provided by trained medical professionals 2) giving general instructions to mothers who just gave birth regarding when to seek medical attention for her newborn infant 3) assessing local professional competencies 4) reviewing obstetrical procedures and interventions around the time of labour for women who deliver in hospital/private clinic settings, etc. For example appropriate chemoprophylaxis of pregnant mothers colonized with Group B Strep (GBS) proved to be a very effective prophylactic measure for early-onset neonatal GBS sepsis.

Introduction Current evidence on the root-causes of deaths among children younger than 5years is critical to direct international efforts to improve child survival, focus on health promotion and achieve Millennium Development Goal 4. We report a hospital-based estimate for 2005-2007 of the major causes of death in children in this age-group in south-west Nigeria. Methods We used retrospective data from the intensive care unit of a second-tier health facility to extract the presenting complaints, clinical diagnosis, treatment courses, prognosis and outcome among children aged 6—59months. SPSS-19 was used for data analysis. Results Of the 301 children (58% males, 42% females) admitted into the ICU within the period of study, 173 (26%) presented with complaints related to the gastrointestinal system, 138 (21%) with respiratory symptoms and 196 (29%) with complaints of fever. Overall, 708 investigations were requested for among which were full blood count (215, 30%) and blood slides for malaria parasite (166, 23%). Infection ranked highest (181, 31%) in clinicians’ diagnosis, followed by haematological health problems (109, 19%) and respiratory illnesses (101, 17%). There were negative correlations between outcome of the illness and patient’s weight (r=-0.195, p=0.001) and a strong positive correlation between prognosis and outcome of admission (r=0.196, p=0.001). Of the 59 (20%) children that died, presentation of respiratory tract illnesses were significantly higher in females (75%) than in males (39%) (χ²=7.06; p=0.008) and diagnoses related to gastrointestinal pathology were significantly higher in males (18%) than in females (0%) (χ²=4.07; p=0.05). Majority of the deaths (21%) occurred among children aged 1.0 to 1.9years old and among weight group of 5.1-15.0kg. Conclusion The major causes of deaths among under-five years old originate from respiratory, gastrointestinal and infectious diseases – diseases that were recognized as major causes of childhood mortality about half a century earlier. Realization of MDG4 - to reduce child mortality by two-thirds – is only possible if the government and donor agencies look beyond the health sector to find hidden causative factors such as education and housing and within the health sector such as vibrant maternal, new-born, and child health interventions.

Background The exacerbation of malaria in sub-Saharan Africa towards the end of the 20th century accrued from amplified resistance to chloroquine and sulfadoxine-pyrimethamine (SP) the most affordable antimalaria medicines [1]. Contact with substandard antimalarial medicines probably aggravated this development [2-4]. Pressure from malaria scientists triggered extensive acceptance and implementation of artemisinin-based combination therapies (ACTs) by endemic country governments and donors [5]. All medicines carry some risk of harm and it is important to monitor their intended and unwanted effects for good evidence upon which to base an assessment of risk versus effectiveness or risk

The clinical and case management application of erythrocyte osmotic fragility and peripheral blood platelets were investigated in 40 healthy children (N=40; M/F = 20/ 20 mean age 6.2 + 3.7 years) and103 falciparum malaria children with severe anaemia (N = 41; M/F=22/19; mean age = 5.3 + 1.5) cerebal malaria (N = 16; M/F = 10/6; mean age = 3.8 + 0.7 ) and uncomplicated malaria (N =46; M/F = 21/25; mean age = 7.4 + 1.3). At presentation, thrombocytopenia (platelet count < 150 x 109/L) was found in all the children with cerebral malaria, 14 children with severe anemia and 8 of the 46 children with uncomplicated malaria. Three out of the forty healthy controls also had thrombocytopenia aside parasitaemia. Thrombocytopenia in severe malaria was significantly higher than that in uncomplicated malaria (X2 = 6.4 – 13.7; P < 0.05). At day 3 to 4 of treatment with quinine, parasitaemia became zero in all the malaria subjects but resolution of thrombocytopenia and osmotic fragility (except in uncomplicated malaria) to normalcy was incomplete. However, at day 10 after schizonticidal intervention, osmotic MCFs of all the malarial children fell within the normal range and were not significantly different (P>0.05) from that of healthy children. Thrombocytopenia also reduced substantially from 100% to 14.30% in cerebral malaria, 34.1% to 7.30% in severe anaemia and 17.4% to 4.30% in uncomplicated malaria. It was concluded that effective management of acute P. Falciparum malaria in Nigerian children is a combination of good therapeutic response and substantial recovery from acute illness, which can be adequately assessed by monitoring parasite clearance; osmotic fragility and platelet count patterns.

No Abstract. NQJHM Vol. 6 (3) 1996: pp. 196-200

No Abstract. Journal of Malaria in Africa and the Tropics Vol. 1 (2) 2002: pp. 12-15

No Abstract. Journal of Malaria in Africa and the Tropics Vol. 1 (3) 2005: pp. 15-27

No Abstract. Journal of Malaria in Africa and the Tropics Vol. 1 (3) 2005: pp. 35-39

No Abstract. Journal of Malaria in Africa and the Tropics Vol. 1 (2) 2002: pp. 29-32

Background Contraceptives are advocated to be used against unwanted pregnancy and sexually transmitted diseases as unsafe abortion contributes to high maternal mortality in Nigeria while unwanted pregnancies have terminated the educational development of many females. Objective This questionnaire-based survey aimed to describe the knowledge, nonuse, and use of various contraceptive methods among women in different child-bearing age groups in rural Lagos, Nigeria. Materials and methods Between 2012 and 2013, 816 females in rural communities within Lagos State were surveyed for their knowledge, source of information, and use of contraceptives. They were grouped into early, mid, and late reproductive age. Statistical analysis of data harvested from respondents was carried out using STATA 13 software. Results In all, 816 females in different stages of reproductive age were involved in the study, among whom 19% were single, 78% married, 3% divorced, and 0.5% widowed. About 6% had no formal education, while the majority (81%) were of the Yoruba ethnic group. Married respondents were approximately thrice more likely to know of contraceptives than single respondents (χ2=29.9, P=0.000, odds ratio =2.9, 95% confidence interval =1.9, 4.2). Condom use was the most widely known and used method of contraceptive regardless of marital status and reproductive age status. Information about contraceptives was mainly from health facilities among married and divorced women and from school or educational institution among singles. Overall prevalence of contraceptive use was 51.9%. Nonuse of contraceptives was 43% among married women and 67% among singles. Knowledge of contraceptive method was negatively associated with marital status (t=−2.24, P=0.025) but positively associated with source of information on contraceptives (t=20.00, P=0.000). Use of contraceptives was positively associated with stage of reproductive age (t=1.94, P=0.05) and source of information on contraceptives (t=11.22, P=0.000), but negatively associated with marital status (t=−2.79, P=0.005) and religious belief (t=−1.89, P=0.05). Conclusion Knowledge and use or nonuse of contraceptives could be pivotal in designing adequate prenatal care to prevent unwanted pregnancy and consequently illegal abortion or possible adverse pregnancy outcomes such as low birth weight, preterm birth, and conditions such as small for gestational age. Data from this study can also be used to design penetrating health education on making pregnancy safer or living a healthy female reproductive life., Video abstract

The sensitivity of Plasmodium falciparum to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) combination was assessed in vivo in children under five years of age in Barkin Ladi, in the cool Plateau of North Central Nigeria using the standard 14-day protocol. This was the first study of its kind, in this part of the country, under the new roll-back-malaria (RBM) initiative of the World Health Organization (WHO) Plasmodium infection was detected in 42% of the children screened: pure P. falciparum , 97% pure P. malariae , 2 mixed P. falciparum and P. malariae , 1%. The computed parasite density index (PDI) was 7.42. Children who qualified for enrolment into the study (54 for CQ and 55 for SP) were on average 31.1+14.7 and 26.5 + 14.9 months old, weighing 12.1+2.9 and 10.8+3.6 kg, respectively. Average drug consumptions were 304.0+72.3 mg for CQ and 0.6+0.2 tablet for SP. Cure rates were only 43% and 85%, while mean parasite clearance times (MPCTs) were 5.07 and 3.37 days, respectively confirming a significant decline in sensitivity of P.falciparum to the drugs. The need for an effective first-line drug as well as for combining SP with an effective anti-malaria drug is strongly emphasized. Nigerian Journal of Parasitology Vol. 25, 2004: 57-63

Background : Malaria remains one of the most common threats to child survival in Nigeria. Chloroquine (CQ) is the first line drug of choice against uncomplicated malaria. In view of reports indicating an increasing resistance of P. falciparum to CQ, a regular surveillance of malaria therapy requires constant evaluation of its efficacy and that of suitable alternatives. Objective : To compare the current efficacy of CQ with that of sulphadoxine/pyrimethamine (SP) in the treatment of P falciparum infection in Plateau State. Patients and Methods : Using a 14-day protocol, an open randomized study of the efficacy of CQ and SP in the treatment of uncomplicated P. falciparum infection was conducted in 109 febrile children under five years of age in the Barkin Ladi Local Government Area of Plateau State. Adequate clinical response (ACR), adequate clinical and parasitological response (ACPR) and clinical efficacy (CE) were assessed in the two treatment groups. Results : Out of the 708 children screened for P. falciparum parasitaemia, 378 (53.4 percent) tested positive. One hundred and nine of the 115 children who qualified for enrollment, completed the study. Fifty-four and 55 children received CQ and SP, respectively. The mean (SD) duration of illness before presentation at the hospital was 1.5 (0.71) days. The means of age, temperature, packed cell volume and parasite counts on admission to the study were similar in the two treatment groups. Thirty-nine (75 percent) of the 52 children who received CQ, and in respect of whom the data was complete, attained clinical cure compared to 52 (94.5 percent) of 55 children on SP (p= 0.013). Twenty-seven (51.9 percent) of 52 children treated with CQ versus 48 (87.3 percent) of 55 children on SP achieved adequate clinical and parasitological cure (p=0.00010). Thirty (57.7 percent) of 52 children on CQ versus 48 (87.3 percent) of 55 children who received SP were clinically cured (p = 0.0012). Failure to achieve fever clearance by day 14 was noted in eight (16.7 percent) of 48 children on CQ against four (7.3 percent) of 55 children on SP. Conclusion : Although both drugs fell short of a hundred percent cure rate, CQ performed less creditably than SP in the treatment of uncomplicated malaria. There appears to be an urgent need to seek other effective alternative first-line anti-malarial drugs in the country. Nigerian Journal of Paediatrics Vol. 31(3) 2004: 87-92

A study was undertaken among 395 intra-city commercial bus drivers, conductors and motor park attendants in a sub-urban community in Lagos, Nigeria. It was aimed at ascertaining the level of knowledge of the participants on sexually transmitted diseases including AIDS, their sexual practices and perceived vulnerability to these diseases and, in particular, their attitude to and use of condoms. A semi-structured interview schedule was used for data collection. The men were found to have a strongly woven network of sexual relationships. Their sexual network included, apart from their wives and regular partners, commercial sex workers, young female hawkers, schoolgirls, and market women within and outside the motor parks. More than two thirds (74.3%) of the men had multiple sex partners and many of them had had sexually transmitted diseases at one time or another. Condom ever-use rate was 65.6% but consistent and regular use rate with casual partners was 11.6%. Almost all the respondents (96.4%) knew themselves to be at high risk of contracting STDs, while 87.6% felt that it was impossible for them to “catch” AIDS. Poor knowledge of risk factors for STDs was exhibited, as many of them attributed their previous STDs to excessive exposure to the sun, having sex in the sun, and their partners remaining in the bath for too long. Intra-city commercial bus operators and men at motor parks are a high risk group for acquiring HIV infection. Their sexual networking with a variety of women within and outside the parks also seems to suggest that they play a major role in transmitting HIV infection in urban communities in Nigeria. There is a need for intervention programmes with a focus on men at motor parks and similar high risk groups. RESUME Une etude a ete menee au sein de 395 chauffeurs d'autobus, des receveurs et les assistants des gares d'autobus dans une communaute sous-urbaine a Lagos, Nigeria. Elle avait pour but de verifier le niveau de connaissance des participants par rapport aux maladies sexuellent transmissibles y compris le SIDA, leurs pratiques sexuelles et la vulnerabilite percue a ces maladies, surtout leur attitude envers leur utilisation des preservatifs. Les donnees ont ete collectes a l'aide d'un programme d'une interview structuree. On a decouvert que les hommes avaient un reseau de rapport sexuel bien tisse. A part leurs femmes et des partenaires sexuels regulieres, leur reseau sexuel comprenait des prosittuees, des jeunes colporteuses, des ecolieres, des marchandes a l'interieur et a l'exterieur de la gare d'autobus. Plus de deux tiers (74,3%) des hommes avaient de multiples partenaires sexuelles et beaucoup d'entre eux ont eu, a un moment ou un autre, des maladies sexuellement transmissibles. Le taux d'avoir jamais utilise les preservatifs etait de 65,6% alors que le taux par rapport a l'utilisation constamment et regulierement avec les partenaires occassionnelles etait de 11,6%. Presque tous les repondants (96,4%) savaient qu'ils couraient de haut risque de contracter les ISTs alors que 87,6% ont estime qu'il leur etait impossible d'“attraper” le SIDA. Ils ont fait preuve d'une faible connaissance des facteurs de risque face aux ISTs puisque beaucoup d'entre eux ont attribue leurs ISTs ulterieures au fait d'etre en contact excessif avec le soleil, d'avoir fait l'amour sous le soleil et que leurs partenaires sont restees longtemps dans le bain. Les chauffeurs d'atuobus qui disservent la ville et les hommes qui se trouvent dans les gares d'autobus constituent un groupe en grand danger d'attraper l'infection du VIH. Leur moullage de reseau sexuel avec une variete de femmes a l'interieur et a l'exterieur de la gare d'autobus semble suggerer qu'ils jouent un role important dans la propagation du VIH dans les communautes urbaines au Nigeria. Il faut des programmes d'intervention qui se concentrent sur les hommes dans les gares d'autobus et sur les autres groupes en grand danger pareil. Afr J Reprod Health Vol.9 (1) 2005: 78–87

A study was undertaken among 395 intra-city commercial bus drivers, conductors and motor park attendants in a sub-urban community in Lagos, Nigeria. It was aimed at ascertaining the level of knowledge of the participants on sexually transmitted diseases including AIDS, their sexual practices and perceived vulnerability to these diseases and, in particular, their attitude to and use of condoms. A semi-structured interview schedule was used for data collection. The men were found to have a strongly woven network of sexual relationships. Their sexual network included, apart from their wives and regular partners, commercial sex workers, young female hawkers, schoolgirls, and market women within and outside the motor parks. More than two thirds (74.3%) of the men had multiple sex partners and many of them had had sexually transmitted diseases at one time or another. Condom ever-use rate was 65.6% but consistent and regular use rate with casual partners was 11.6%. Almost all the respondents (96.4%) knew themselves to be at high risk of contracting STDs, while 87.6% felt that it was impossible for them to "catch" AIDS. Poor knowledge of risk factors for STDs was exhibited, as many of them attributed their previous STDs to excessive exposure to the sun, having sex in the sun, and their partners remaining in the bath for too long. Intra-city commercial bus operators and men at motor parks are a high risk group for acquiring HIV infection. Their sexual networking with a variety of women within and outside the parks also seems to suggest that they play a major role in transmitting HIV infection in urban communities in Nigeria. There is a need for intervention programmes with a focus on men at motor parks and similar high risk groups.

Objectives: To determine the hourly density of vector mosquitoes in coastal Nigeria, compare seasonal human-biting and sporozoite rates in the vector density, locate breeding sites of mosquitoes, and determine larval population at breeding sites. Materials and Methods: Indoor and outdoor mosquitoes of a coastal Nigerian community were caught during early and late wet seasons and in the harmattan period, a time of dusty wind from the Sahara on the western coast of Africa. Larvae were collected from various locations during the study period. The mosquitoes were physically characterized and their salivary glands dissected for sporozoite rate. Larvae density was calculated. Human-biting rate was calculated for Anopheles gambiae complex. Results: Of the 4,317 female A. gambiae complex collected during the night bait catches, 3,543 (82.1%) were from outdoors and 774 (17.9%) from indoors during the three seasons. The maximum human-biting rate approached 25/h and the sporozoite rate was almost 3.0%. These vector mosquitoes were mainly outdoor biting and midnight feeding. Of the 1,269 Anopheles mosquitoes collected with pyrethrum spray catches, 1,245 (98.1%) were A. gambiae complex. There was no significant difference in the entomological inoculation or sporozoite rates during the three seasons of study. There was a preponderance of A. gambiae complex larvae from larval collection. Conclusion: Findings from this study should be useful in the implementation of Integrated Vector Management for the control of malaria in coastal and noncoastal areas of Nigeria.

Parents and caregivers often try various treatment modalities for their sick children before bringing them to clinic. Many community-based studies have documented home and self-treatment practices, often with the aid of patent medicine vendors, but less is known about prior treatment behaviour of caregivers who actually reach a government clinic. This study, therefore, aimed at documenting the treatment provided by caregivers prior to their attendance at a public hospital. Beginning in April 1996, a year-long study was conducted among 1,943 sick children and their caregivers who attended the largest government-owned paediatric hospital in Lagos, Nigeria. The major complaints mentioned by the caregivers included fever, cough, and diarrhoea. Most (89%) caregivers had administered some form of medicine to the child prior to the clinic visit, and on average, 2.5 medications had been given. Associations were found between major complaint and type of medicine given: fevers were associated with antimalarial drugs and analgesics (antipyretics), cough was associated with cough syrup and analgesics, while diarrhoea was associated with antidiarrhoeal drugs. Although one-fifth of the children had received an antibiotic, provision of antibiotics was not associated with a particular complaint/illness. Since caregivers appeared to use perceived complaints/illnesses as a treatment guide, this can form the basis of safer and more appropriate recognition of illness and home management. In addition, the information obtained in this study can be used for training clinicians to inquire about home management and, thus, for making more informed decisions about their own treatment and prescribing practices.

The efficacy of amodiaquine against Plasmodium falciparum malaria was assessed in an area of confirmed chloroquine resistance in the cool, north-central plateau of Nigeria, using a 14-day protocol. The patients were all children aged5 years of age. The drug proved highly efficacious, giving a cure 'rate' of 100% on day 14 and mean fever- and parasite-clearance times of 1.11 and 3.11 days, respectively. It was also well tolerated. Following treatment, packed-cell volumes (PCV) generally increased (65% of patients) but remained constant (12%) or even decreased (23%) in some patients; the overall improvement in PCV was not statistically significant (P0.05). The results justify the use of amodiaquine to treat P. falciparum malaria in those who have failed treatment with chloroquine and the second-line drugs (e.g. sulfadoxine-pyrimethamine) currently used in Nigeria. As the amodiaquine would be better employed as one part of a combination than on its own, there is a need to identify suitable partner compounds.

A total of 446 infants in the first 6 months of life who presented at an urban children's hospital with complaints of any illness whatsoever were recruited into a study with the aim of determining the contribution of malaria to infant morbidity in a malaria-endemic urban area in Nigeria. Sixty-eight of the infants were in their first month of life and 79, 77, 61, 97, and 64 were in their second, third, fourth, fifth and sixth month of life, respectively. Overall, 107 (24.0%) infants were clinically diagnosed as having malaria. This included 3 who were in the first month of life, 12 in the second, 15 in the third, 17 in the fourth, 33 in the fifth, and 27 in the sixth months of life (4.4, 15.2, 19.5, 27.9, 34.0, and 42.1%, respectively). Laboratory investigations confirmed 35 (32.7%) of those clinically diagnosed and 86 (25.4%) of those not clinically diagnosed (n = 339) as having malaria parasitemia, giving an overall malaria parasite rate of 27.1% among the infants. Acute respiratory infection was the major diagnosis (41.3%) among those that were not initially diagnosed as malaria but turned out to have malaria parasitemia followed by gastroenteritis (11.8%) and failure to growth (1.5%). Overall geometric mean parasite density was 202.5 parasites/microL of blood (range, 12-65,317 parasites/microL of blood). The mean hematocrit of infants with parasites (33.0%) was significantly lower (P < 0.005) than that of infants without parasites (35.1%). The mean hematocrit of infants with malaria parasites in each age group was lower than that of infants without malaria parasites in the corresponding age group. Among the infants with malaria parasites, those aged 2 to 2.9 months recorded the lowest mean hematocrit (30.1%), and those aged < 1 month recorded the highest mean hematocrit (42.7%). Axillary temperature increased and hematocrit decreased with increase in parasite density. The percentage of infants with anemia likewise increased as the parasite density increased. Plasmodium falciparum was present in all infected infants, but mixed infection with P. malariae was present in only 2.5% of infections. Analysis of our data suggests an urgent need for health education of caretakers and for training of clinicians for increased awareness of malaria as an important cause of illness and anemia in infants aged < 6 months so as to reduce children's wasting due to an easily preventable and treatable disease.

The seeking of healthcare for childhood illnesses was studied in three rural Nigerian communities of approximately 10,000 population each. The aim was to provide a baseline understanding of illness behaviour on which to build a programme for the promotion of prepackaged chloroquine and cotrimoxazole for early and appropriate treatment of childhood fevers at the community level. A total of 3117 parents of children who had been ill during the 2 weeks prior to interview responded to questions about the nature of the illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illness and the actions taken. Local illness terms were elicited, and the most prevalent recent illnesses were 'hot body' (43.9 per cent), malaria, known as iba (17.7 per cent), and cough (7.4 per cent). The most common form of first-line treatment was drugs from a patent medicine vendor or drug hawker (49.6 per cent). Only 3.6 per cent did nothing. Most who sought care (77.5 per cent) were satisfied with their first line of action, and did not seek further treatment. The average cost of an illness episode was less than US$2.00 with a median of US$1.00. Specifically, chloroquine tablets cost an average of US 29 cents per course. Analysis found a configuration of signs and symptoms associated with chloroquine use, to include perception of the child having malaria, high temperature and loss of appetite. The configuration positively associated with antibiotic use consisted of cough and difficult breathing. The ability of the child's care-givers, both parental and professional, to make these distinctions in medication use will provide the foundation for health education in the promotion of appropriate early treatment of childhood fevers in the three study sites.

Severe falciparum malaria, with its associated hyperpyrexia, distorts plasma levels of large neutral amino acids (NAA) and consequently, brain uptake of individual NAA. Since brain levels of NAA determine cerebral synthesis of monoamines (serotonin, histamine, catecholamines), we measured plasma concentrations of NAA, and also plasma histamine (Hm) in children with falciparum malaria and in uninfected controls. Malaria elicited a marked (P < 0.025) increase in plasma histidine (His) with a 5-fold significant (P < 0.001) elevation in histamine, as well as a 2.5-fold increase (P < 0.005) in plasma phenylalanine (Phe), with no changes in the other NAA. Using kinetic parameters of NAA transport at human blood-brain barrier (BBB), we showed that malaria significantly altered calculated brain uptake of His (+30%), Phe (+96%), Trp (-30%) and Ile (-27%), with no change in the other NAA, compared with controls. Our data suggested enhanced cerebral synthesis of Hm with impaired production of serotonin and the catecholamines in the patients, and therefore, the need to evaluate the encephalopathy in severe malaria within the context of abnormalities in metabolism of Hm and other monoamines resulting from imbalance in plasma levels of the large neutral amino acids. Of clinical relevance also is the impaired inactivation of increased brain Hm by antimalarials such as the widely used aminoisoquinolines leading to elevated brain levels of imidazole-4-acetic acid (IAA), a potent inducer of a sleep-like state often accompanied by seizures, analgesia, decreased blood pressure and other effects.

Background and aims: Neonatal period in sub- Saharan Africa is characterized by various infectious diseases that make up leading causes of morbidity and mortality in this part of the world. The main objective of this study is to document frequently diagnosed illnesses in early, mid and late neonatal periods, record management of the ill neonate and scrutinize clinicians' prescription patterns. Methodology: This was a health facility-based retrospective case review of records of children admitted into the intensive care unit (ICU). Records of all neonates admitted from March 2005 to February 2007 were extracted for analysis. Results: Two hundred and twenty four neonates (135 males; 89 females), disaggregated into different age groups, were admitted into the ICU during the period of study. The main diagnoses in early, mid and late neonatal periods were birth asphyxia (63%) and neonatal septicaemia (50%), neonatal septicaemia (46%) and neonatal jaundice (15%), bronchopneumonia (50%) and neonatal meningitis (30%) respectively. Common investigations requested for across different age groups were full blood count, electrolyte, urea and creatinine, and serum bilirubin. Most prognoses were poor or very poor. The commonest prescriptions were antibiotics and fluids; common route of drug administration was intravenous and mortality ranged from 20-30%. Malaria parasite examination was very low. Conclusion: Accurate diagnosis of neonatal infectious diseases poses a dilemma to clinicians in ICU. Modern instrumentation for quick diagnosis and life-support system will support improved neonatal health care delivery system and reduce high mortality rate in this period of life.

Described here is a computer predicted and computer measured pulmonary function in a randomly selected population sample of 111 men. These consisted of 36 primary school teachers (control), 35 Tetra-ethyl Lead handlers (TEL) and 40 Tanker Loaders (TL) at a petrochemical industry in Warri, Delta State, Nigeria. Productive cough and headache were commoner among the TL (45%, 38%) and the TEL handlers (43%, 31%). TEL handlers were 5 times likely to develop insomnia and other sleep disturbances than the control group. TL were more than 3 1/2 times more likely to develop nervousness than the control group. Measured FEF25-75% was significantly lower than its predicted value among the TEL handlers (56%) and TL (55%) when compared with the control group (36%) (P0.05 respectively). Although there were distinct reductions in the measured values of FEF75-85% among the TEL handlers (41%) and the TL (40%) compared to the control group (28%), this difference did not reach a level of significance when the TEL or the TL were compared individually to the control group. Predicted and measured forced mid expiratory flow time (FMFT) was not significantly varied among the cases and the control. There was statistically significant disparities (P0.005) in the values of predicted and measured maximum voluntary ventilation (litres) of the TEL handlers (47%) and of the TL (46%) compared with that of the control group (29%). The data suggest obstruction of the big and small airways of those occupationally exposed at a petrochemical factory in Nigeria especially the tetra-ethyl lead handlers and the tanker loaders. This data also suggests that pulmonary impairment may lead to an increased respiratory absorption of lead in its organic form. Efforts should be made to ascertain the degree of impairment and to treat the affected workers.

Brain monoamine levels may underlie aspects of the cerebral component of falciparum malaria. Since circulating amino acids are the precursors for brain monoamine synthesis, we measured them in malaria patients and controls. Malaria elicited significantly elevated plasma levels of phenylalanine, particularly in comatose patients, with the Tyr/Phe (%) ratio reduced from 83.3 in controls to 39.5 in infected children, suggesting an impaired phenylalanine hydroxylase enzyme system in malaria infection. Malaria significantly increased the apparent K(m) for Trp, Tyr and His, with no effect on K(m)(app) for Phe. Using the kinetic parameters of NAA transport at the human blood-brain barrier, malaria significantly altered brain uptake of Phe (+96%), Trp (-28%) and His (+31%), with no effect on Tyr (-8%), compared with control findings. Our data suggest impaired cerebral synthesis of serotonin, dopamine and norepinephrine, and enhanced production of histamine, in children with severe falciparum malaria.

Chlorpheniramine (CP), a histamine H1-receptor antagonist, enhances the efficacy of chloroquine (CQ) in acute uncomplicated falciparum malaria. The effects of this combination therapy on the pharmacokinetic disposition of CQ is, however, unpredictable. A standard treatment with 25 mg CQ base per kg bodyweight was orally administered over 3 days, alone or in combination with CP, to 17 semi-immune Nigerian children with Plasmodium falciparum parasitaemia attending hospital in Lagos, Nigeria, and observed for 28 days. Whole-blood CQ concentrations were monitored 14 times during the follow-up by high-performance liquid chromatography analysis of blood dried on filter paper. Parasitaemia was determined on thick blood films stained with Giemsa, and treatment failures were established following the WHO classification for CQ resistance. Our pharmacokinetic data showed that the peak whole-blood CQ concentration was significantly increased (P0.05) by CP administration, and the time to achieve the peak was reduced in the presence of CP. The area under the first-moment drug-concentration-time curve was also significantly increased (P0.05) by CP administration. Treatment with CQ-CP combination resulted in a shorter parasite clearance time (2.0 +/- 0.5 days) and a higher cure rate (87.5%) compared to treatment with CQ alone (3.5 +/- 0.5 days; 66.7%). Our data suggest that CP enhanced the efficacy of CQ against resistant P. falciparum in acute uncomplicated malaria by increasing the uptake/concentration of CQ in resistant parasites.

The profile of some risk factors for coronary heart disease was studied in 557 male and 325 female Nigerians aged 20 years and above from the low and medium income groups, respectively. Except for the weight of subjects in the low income level, values of all physical characteristics were significantly higher in females than males (P0.01). In the 20-39 years age group, the systolic blood pressure was higher in males than females, and among the medium income group than the low income group (P0.01); but this difference disappeared in the higher age groups. The mean diastolic blood pressure was higher (but not statistically significant) at medium income levels than low income levels (P0.05). In each age group, the mean plasma total cholesterol was significantly higher in the medium income group than in the low income group (P0.01). The percentage of smokers and alcohol consumers were higher in the high income group than the low income group (P0.01). A high percentage of the smokers and alcohol consumers were male subjects. Blood pressure was correlated with age, smoking and body fat, (P0.01). Waist to trochanter ratio, and percentage body fat were significantly related to plasma total cholesterol level (P0.01).

We have investigated the effects of leaf and bark decoctions of Ocimum gratissimum, Azadirachta indica, Morinda lucida and Enantia chlorantha on (a) the course of Plasmodium yoelii nigeriensis malaria (b) reticulocyte and haematocrit values and (c) nucleated cell numbers in the spleen, bone marrow, peritoneum, liver and peripheral blood of Swiss albino mice. Results obtained showed that normal mice infected with the parasite (10(4)/mouse) suffered fulminant parasitaemia which resulted in death, 7-10 days later. All infected mice treated with chloroquine survived. On the other hand all infected mice treated with the medicinal plants exhibited varying percentages of chemosuppression of early parasitaemia which did not lead to their survival. The total number of nucleated cells in the liver, spleen and peripheral blood of malaria-infected mice increased enormously before the animals died. Such increases were maintained in other groups of mice treated with the medicinal plants. In the non-infected mice, O.gratissimum and E. chlorantha administration increased the number of nucleated cells in the spleen, liver and peripheral blood. Chloroquine on the other hand decreased the number of nucleated cells in both the malaria-infected and un-infected mice. There was also a decrease in reticulocyte numbers in the blood of normal mice injected with chloroquine. Conversely reticulocyte numbers increased in normal mice administered with some medicinal plants. Acute and chronic toxicity tests revealed that some of the medicinal plants were much more toxic than others.(ABSTRACT TRUNCATED AT 250 WORDS)

IntroductionEach year in sub-Saharan Africa, where 80 to 90% of the world's malaria cases occur, approximately 19 to 24 million women are at risk for malaria and its adverse consequences during pregnancy. The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent, predominantly low-grade, sometimes sub-patent, parasitaemia. In Nigeria, malaria has severe negative effects on maternal health and birth outcomes, resulting in maternal anaemia, a high incidence of miscarriages and low birth weight. Primigravidae and secundigravidae are most at risk.Resistance to first-line antimalarials has increased in sub-Saharan Africa, and the available arsenal of alternative tools for malaria control in pregnancy is very limited. One of the most promising of these tools is insecticide-treated bed nets (ITNs), which have been shown to reduce the number of infective mosquito bites by 70 to 90% in a variety of ecologic settings. In Nigeria, the current use of ITNs by the at-ris...

Background Current use of treated mosquito nets for the prevention of malaria falls short of what is expected in sub-Saharan Africa (SSA), though research within the continent has indicated that the use of these commodities can reduce malaria morbidity by 50% and malaria mortality by 20%. Governments in sub-Sahara Africa are investing substantially in scaling-up treated mosquito net coverage for impact. However, certain significant factors still prevent the use of the treated mosquito nets, even among those who possess them. This survey examines household ownership as well as use and non-use of treated mosquito nets in Sahel Savannah and Niger Delta regions of Nigeria. Methodology This survey employed cross-sectional survey to collect data from households on coverage and use of mosquito nets, whether treated or not. Fever episodes in previous two weeks among children under the age of five were also recorded. The study took place in August 1 – 14 2007, just five months after the March distribution of treated mosquito nets, coinciding with the second raining period of the year and a time of high malaria transmission during the wet season. EPI INFO version 2003 was used in data analysis. Results The survey covered 439 households with 2,521 persons including 739 under-fives, 585 women in reproductive age and 78 pregnant women in Niger Delta Region and Sahel Savannah Region. Of the 439 HHs, 232 had any mosquito nets. Significantly higher proportion of households in the Niger Delta Region had any treated or untreated mosquito nets than those in the Sahel Savannah Region. In the Niger Delta Region, the proportion of under-fives that had slept under treated nets the night before the survey exceeded those that slept under treated nets in the Sahel Savannah Region. Children under the age of five years in the Niger Delta Region were four times more likely to sleep under treated nets than those in the Sahel Savannah Region. Conclusion This study found that despite the fact that treated nets were distributed widely across Nigeria, the use of this commodity was still very low in the Sahel Savannah region. Future campaigns should include more purposeful social and health education on the importance and advantages of the use of treated nets to save lives in the Sahel Savannah region of Nigeria.