Relationship between Serum Uric Acid and Hypertension among Secondary School Adolescents in Ekiti State, Nigeria

BACKGROUND

With the seemingly increasing trend of childhood hypertension, high serum uric acid (SUA) levels might be an indicator of essential hypertension among adolescents.

OBJECTIVE

To determine the SUA levels of hypertensive students and randomly selected controls and find the association, if any, between SUA level and blood pressure (BP) among secondary school students in Ido-Osi Local Government Area (LGA).

METHODOLOGY

The study was a nested case-control study conducted among selected secondary school students in IdoOsi LGA from June 2017 to March 2018. Of the 573 students screened for hypertension, SUA was assayed from 31 hypertensive students and an equal number of age- and sexmatched controls. Serum uric acid greater than 5.5 mg/ dL was taken as high. Statistical analysis included chi-square and Pearson correlation.

RESULTS

There was a positive correlation between SUA level and both systolic BP (p < 0.013) and diastolic BP (p < 0.017). The mean (SD) serum uric acid level of the hypertensive students [5.39 (2.08) mg/ dL] was higher than that of the controls [4.24 (1.81) mg/ dL] (p = 0.023). Hypertensive students with hyperuricaemia had a higher mean (SD) systolic BP than those with low uric acid: 138.67 (14.81) versus 128.68 (10.04); p =0.037.

CONCLUSION

The mean serum uric acid level of students with hypertension was higher than that of the non-hypertensive students and high SUA levels appear to more prominently affect systolic than diastolic blood pressures among the cohort of hypertensive students.

Sickle cell disease clinical phenotypes in children from South-Western, Nigeria

BACKGROUND

The clinical phenotypes of children with sickle cell disease (SCD) are poorly described in many sub-Saharan countries including Nigeria.

OBJECTIVES

The objective was to highlight various clinical phenotypes of SCD in children and investigate the influence of sociodemographic indices on the development of SCD complications.

METHODS

We carried out a cross-sectional study of 240 pediatric patients attending the sickle cell clinic and the emergency room in a teaching hospital in South-Western Nigeria over a 12-month period. The clinical phenotypes and severity of the disease were documented, and the influence of sociodemographic variables was investigated.

RESULTS

The five leading clinical phenotypes in our patients were significant pain episodes, that is, vaso-occlusive crisis in 159 (66.3%); anemic crisis in 62 (25.8%); severe bacterial infections, 57 (23.8%); acute chest syndrome (ACS), 27 (11.3%) and stroke, 7 (2.9%). Forty-two (33.1%) had a previous history of dactylitis (hand-foot syndrome). Other clinical phenotypes such as avascular necrosis of the femur, 4 (1.7%); nephropathy, 2 (0.8%); priapism, gallstone and chronic leg ulcer, one (0.4%) each, were not commonly seen. More children with a history of asthma had ACS. Furthermore, high steady-state white blood cell count was associated with severe disease.

CONCLUSION

The clinical phenotypes of SCD in children from South-Western Nigeria are highly variable with the disease manifesting very early and about 10% having significant complications. Sociodemographic characteristics appear to have little influence on the development of SCD complications among our patients, but age and low-socioeconomic class are associated with anemic crisis.

Prevalence of overweight and obesity among children in Ile-ife, south-western Nigeria

BACKGROUND

Childhood obesity is a potential health problem in Nigeria because of our changing patterns of lifestyle. It is associated with significant health, medical and psychological consequences for children and adolescents.

OBJECTIVE

To determine the nutritional status of Nigerian children aged six to eighteen years using anthropometry.

METHODS

The study which was a school-based cross-sectional survey employed a multi-staged random sampling method. Four secondary and four primary schools (two private and two public) were selected to ensure adequate representation of the focus age group of six to 18 years and social classes. Ninety students were selected from each school. Overall, 360 subjects were selected from primary and secondary schools respectively giving a total of 720 school children. Each subject had a questionnaire complete followed by the measurement of height and weight. Nutritional status was determined using the International Obesity Task Force criteria.

RESULTS

Two (0.3%) of the 720 students studied were obese both being females. Twenty (2.8%) subjects were overweight of which 17 (85.0%) were females and three (15.0%) males. Females had a higher prevalence of overweight when compared with males. There was a higher proportion of overweight students in the higher social classes when compared with the lower social classes (p=0.03). Five hundred and sixty (77.8%) were underweight with a BMI less than 18.50.

CONCLUSION

Obesity and overweight are rather uncommom problems among children in Ile-Ife a semi urban south-western Nigeria town. However, overweight is more common in children from high social classes and among adolescents, the girls tend to have higher BMI than the boys. Underweight is prevalent among these children.

Low prevalence of malnutrition in a rural Nigerian community

This study was carried out to determine the prevalence of malnutrition in a rural Nigerian community. Using the modified Wellcome Classification, the prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of underweight, wasting and stunting were 23.1%t, 9% and 26.7%, respectively. The low prevalence of PEM in this rural Nigerian community may be due to the services and intervention provided by a non-governmental organization in the community. This method of intervention is similarly achievable in any other community.

Ocular manifestations of Burkitt's lymphoma: experience in Ile-Ife south western Nigeria

BACKGROUND

Burkitt's lymphoma is the most common childhood tumour in subSaharan Africa that typically affects the jaws and abdomen. Ocular involvement with blindness has been documented in some studies.

OBJECTIVE

This was to evaluate the role of Burkitt's lymphoma (BL) as a cause of blindness in Nigerian children.

METHODS

Cases of BL seen in the hospital between 1986 and 2003 were studied retrospectively. Some of the patients with orbital disease at presentation underwent ultrasonographic examination of the eyes.

RESULTS

Forty-three (16.5%) of the 260 patients seen presented with orbital tumours; 29 (67.4 %) of the 43 patients had full ophthalmic examination. The patients studied comprised 22 males and 7 females with a M: F ratio of 3:1, and median(age range) of 7(3-15) years. Orbital tumours occurred concurrently with jaw masses on the same side in 19(65.5 %) of 29 patients; the eye diseases were unilateral in 23 (79.3%) and bilateral in six (20.7%) of the cases. Proptosis was the ocular presentation in 27(93%) of patients and it was associated with conjunctival injection in nine, chemosis in 11 and exposure keratopathy in five. Fourteen (48.3%) patients had associated blindness; 12 (85.7%) remained blind in the affected eye(s) and one regained vision to 6/36 after chemotherapy. The patients underwent Cyclophosphamide-Oncovin-Methotrexate (COM) regimen with intrathecal therapy. Eight (27.6%) patients had concomitant CNS disease; these included cases of 6th and 7th nerve palsies, one case of intra-cerebral extension of tumour and another case of total ophthalmoplegia.

CONCLUSION

Burkitt's lymphoma is an important cause of childhood blindness in Nigeria and the orbital disease ismainly extra ocular.

The use of antimalaria drugs and insecticide treated nets in Ile-Ife, Nigeria

BACKGROUND

The Roll Back Malaria Initiative (RBMI) is aimed at halving the malaria mortality in the year 2010 using prompt diagnosis and treatment of malaria and the use of Insecticide Treated Nets (ITNs).

METHODS

This is a cross sectional study of children aged 1 month to 14 years with confirmed malaria to assess the burden of malaria and to evaluate the home use of anti-malarial drugs and ITNs among children with malaria in Ile Ife, Nigeria.

RESULTS

Of the total of 1047 children seen, 190 (18.1%) had malaria and were surveyed. Complications were present among 74 (38.9%) children and a significantly higher of the under-fives had complications (p by Fisher's exact test = 0.0018). Chloroquine was administered to 63 (67.0%) children within the first 24 hours of the illness although only 25 (26.6%) children had the correct dosage. One hundred and fifty three (80.5%) were aware of the use of untreated bed nets in preventing malaria while 38 (20.0%) and 4 (2.1%) were aware of ITNs and used ITNs respectively. The awareness of ITNs increased with increasing maternal education.

CONCLUSION

Awareness of the parents about ITNs and their use are poor. Health education on appropriate antimalarial drug use and ITN use should be intensified. ITNs should be made more widely available.

Hypoglycaemia in a Nigerian paediatric emergency ward

Hypoglycaemia is a common problem in paediatric emergency admissions. It has not received enough attention in Nigeria. It has been shown to complicate many childhood illnesses. This study aimed to determine the prevalence of hypoglycaemia in paediatric emergency admissions, describe clinical factors that commonly predispose to it and investigate its effect on outcome of management. Three-hundred and ninety-two consecutively admitted patients were studied. Two milliliters of blood was obtained from each patient for plasma glucose determination. Hypoglycaemia was defined as plasma glucose <2.5 mmol/l (<45 mg/dl). Out of these 392, twenty-five (25) of them were hypoglycaemic giving a prevalence of hypoglycaemia to be 6.4 per cent in our emergency ward. Hypoglycaemia was found to be associated commonly with severe malaria, septicaemia, pneumonia, and protein energy malnutrition. Interval of last meal and unconsciousness were the only two significant associated factors to hypoglycaemia. However, the likelihood of hypoglycaemia is increased with night admissions and prolonged duration of illness before admissions. Presence of hypoglycaemia at admission was also found to be significantly associated with death and dying within 24 hours of admission. The prevalence of hypoglycaemia was found to be 6.4 per cent. It was found to complicate many childhood illnesses and it is associated with a higher mortality. It should be suspected in all very ill children, particularly when they are unconscious and have not eaten for over 12 hours.

Prevalence of congenital malaria in Ile-ife, Nigeria

The study was designed to determine the prevalence of congenital malaria, cord blood and placental malaria parasitaemia and the prevalence of clinical manifestations of congenital malaria. Ile-Ife is a holoendemic area for malaria. Placental, cord and peripheral blood smears of 120 newborn babies were examined for malaria parasites. They consisted of 104 (86.7 per cent) full term babies and 16 (13.3 per cent) preterm babies. Positive parasitaemia was found in 56 (46.7 per cent) of peripheral blood smears, 68 (56.7 per cent) and 65 (54.2 per cent) of the placental and cord blood smears respectively. There were strong associations between placental malaria and cord malaria parasitaemia and congenital malaria (p < 0.001). Congenital malaria has a high prevalence in Ile-Ife. There is a paucity of its clinical manifestations in the newborn. Only two babies had fever within 48 hours of birth.

Determinants of survival in Nigerians with Burkitt's lymphoma

There is paucity of information on the factors influencing survival of patients with Burkitt's lymphoma (BL) in Nigeria. This work was undertaken to examine the roles of presenting clinical and laboratory features in the survival of a number of Nigerian patients with BL. Confirmed cases of BL diagnosed in the hospital between January 1986 and December 1999 were studied. Diagnosis of the tumour was based on fine needle aspiration cytology of easily accessible mass in a large majority of patients. Median survival was calculated for all the dead patients using Kaplan-Meier technique. SPSS 10 statistical software and EPI 6.04b were used for all statistical calculations. A total of 213 patients were recruited over the 13-year period; with ages ranging from 3-45 years (median = 9) at diagnosis. The male-female ratio was 1.8:1. At the time of analysis in December 2001, 166 (77.9%) of patients had defaulted, 44 were known to have died and 3 were still alive. Only 81 (38%) of the patients had adequate chemotherapy (4-6 cycles). Fifty one (23.9%) patients had an initial complete remission. The mean survival of the 44 patients that died was 10.5 weeks (95% Cl = 3.9-17.1). It is concluded that survival in Burkitt's lymphoma was significantly better in patients who had adequate therapy, mean 40.8 +/- 12.2 (SE) weeks compared to those who had less than adequate cycles of chemotherapy, mean 3.7 +/- 1.0 (SE) weeks (p = 0.0000). Inadequate therapy and high default rate were partly responsible for the poor survival results obtained in this study.

Blood transfusion related paediatric HIV/AIDS in Ile-Ife, Nigeria

This prospective study was aimed at determining the contribution of blood transfusion to paediatric HIV infection in Ile-lfe, Nigeria. It involved HIV screening of consecutive children presenting at the Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, between March 1996 and March 2001, with any of the signs in the WHO clinical case definition for paediatric AIDS. The HIV serostatus of blood donors at the OAUTH was also extracted from the blood bank records. Of the 263 children who met the criteria for HIV screening, 35 (13.3%) were HIV-positive. Eighteen of the 263 children screened had a history of blood transfusion and 12 (66.7%) of the 18 were HIV-positive. Eleven (91.7%) of the 12 HIV-positive patients were transfused in private hospitals with blood collected from private laboratories. The blood with which the HIV-positive children were transfused was unscreened in three, screened in two and the HIV status unknown in the others. The sole voluntary donor was an HIV-positive father whose child received his unscreened blood. Only two (16. 7%) of the mothers of the previously transfused HIV-positive children were also HIV-positive. 'Paid'donors accounted for 94.3% of total donors in OAUTH blood bank records and cumulative HIV-positivity was statistically significantly higher in 'paid' donors than in voluntary donors (p = 0.005). Wl conclude that transfusion with unsafe blood is an important route for HIV infection in symptomatic children and that HIV-positivity is higher among paid donors. recommend the establishment of a national blood transfusion service, which is presently non-existent in Nigeria, and the enforcement of laws guiding blood transfusion. Voluntary blood donation should been encouraged and health workers in the private sectors educated on the link between blood transfusion and HIV infection.

Trace element status and early physical growth of exclusively breastfed normal and asphyxiated Nigerian babies

Serial anthropometry and assay of plasma iron (Fe), zinc (Zn) and copper (Cu) were done on 72 babies with birth asphyxia during the first six months of life to assess the pattern of their physical growth and trace element status, respectively. Eighty-seven non-asphyxiated babies served as controls. The mothers of babies in both groups also had their plasma assayed for Fe, Zn and Cu immediately following delivery. Asphyxiated babies were lighter than non-asphyxiated controls during the first two months of life and they also had smaller mean occipito-frontal circumference at birth. While Fe, Zn and Cu status was generally comparable in both groups, the newborn Cu concentrations were very low compared with earlier reports. No baby showed any overt signs of trace element deficiency.

Glomerular filtration rate in Nigerian children with homozygous sickle cell disease

The study proposed to assess glomerular filtration rate as determined by endogenous creatinine clearance in steady state Nigeria children with homozygous sickle cell disease and normal controls. Twenty-four hours urinary creatinine clearance was estimated over a 6-month period in 54 steady-state homozygous sickle cell disease and 57 normal control children aged 5 to 13 years. Each child was admitted and a 24-hour urine sample (8.00 am to 8.00 am) was collected both for volume measurement and creatinine concentration determination. Blood was also collected from each child 30 minutes to end of urine collection for plasma creatinine concentration determination, haematocrit and reticulocyte counts. The results were compared between the two groups of children using student's t-test and the chi (X2) square test where necessary. The mean glomerular filtration rates +/- SD (ml/min/1.73 M2) for homozygous sickle cell disease children and normal controls were not significantly different (p > 0.05). Glomerular filtration rate did not differ significantly between the age groups in both patients and normal controls; haematocrits correlated weakly with glomerular filtration rates in the patients (r = +0.213; p < 0.001). Nigerian children with homozygous sickle cell disease who are in steady states have normal glomerular filtration rate that is hardly influenced by increasing age and low haematocrit level.

Septicaemia in high risk neonates at a teaching hospital in Ile-Ife, Nigeria

OBJECTIVES

To determine the incidence, predisposing factors, clinical features, bacteriological pattern and antibiotic sensitivity in septicaemia in high-risk newborns.

DESIGN

A prospective study.

SETTING

Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.

SUBJECTS

All newborns admitted with clinical features and/or risk factors suggestive of neonatal septicaemia from February 1994 to March 1995.

MAIN OUTCOME MEASURES

Culture results and mortality rates.

RESULTS

The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths. The predisposing perinatal factors were low socio-economic status, lack of antenatal care, maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria were found to be the most prevalent causative organisms (59.4%). Staphylococcus aureus (36.2%), Pseudomonas aeruginosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were the commonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7% and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a high degree of in-vitro antimicrobial resistance. However, all the isolates were sensitive to ofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance. The overall mortality rate was 33.3%.

CONCLUSION

Improvement in the socio-economic status of the populace and availability of affordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria. Continuous surveillance in every unit, as well as close attention to preventive strategies would be necessary to reduce morbidity and mortality from neonatal septicaemia. We recommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatal unit of OAUTHC, Ile-Ife, Nigeria.

Chronic hepatomegaly in steady state haemoglobin S children: some clinical and abdominal duplex ultrasonographic observations

Chronic hepatomegaly (CH) is an index of severe disease in children with sickle cell anaemia (HbS). We studied 14HbS children with CH and two groups of controls made up of age and sex-matched HbA and HbS children without CH. The objective was to determine and compare hepatic perfusions in the children and also determine which clinical and ultrasonographic features are associated with CH. Hepatic perfusion was assessed using abdominal duplex ultrasonography which made possible the measurement of portal vein diameter (PVD) and the velocity of portal blood flow. The mean weights, blood pressure profiles and ultrasonographic splenic span and common bile duct diameters (BDD) did not differ significantly among the three groups. Similarly, the man PVDs of the three groups were not significantly different despite the large livers of the CH group. The CH group however showed linear growth faltering, a significantly lower mean haematocrit, faster pulse rate but paradoxically reduced hepatic portal blood flow velocity than HbA controls. Because of the disproportion of PVD relative to liver size in HbS patients with CH and the reduced portal blood flow velocity, hepatic perfusion is probably poorer in these patients. HbS children with CH therefore need careful management of hepatic and anaemic crises to prevent severe hypoxic liver damage.

Primary hepatocellular carcinoma in Ile-Ife, Nigeria: a prospective study of 154 cases

Primary hepatocellular carcinoma is a tumour with a dismal prognosis. In recent times, however, great advances have been made in its management. This 13-year prospective study done at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, was an attempt to appraise the outlook of the disease in Nigeria at the turn of the 21st century. Primary hepatocellular carcinoma affected mainly middle-aged Nigerians (peak age-group = 40-59 years), predominantly males (M:F = 2:1) and, in a sizeable proportion (78%), it co-existed with cirrhosis. Significant risk factors found were scarification marks (87%), anicteric hepatitis (71.3%), abuse of medicinal herbs and analgesics (68.6%) and injection from quack doctors (51%). Blood test for HBsAg was positive in 61% of patients. The mean duration of symptoms. before diagnosis was 12.64 weeks (SD 13.77) while, on the average, patients died within 14.0 weeks (SD 13.0) of illness, usually of liver failure (67.7%). Only symptomatic treatment could be offered in 148 patients (96.1%) while chemotherapy was merely attempted in 5 (3.25%). Majority of the patients (59.8%) were either discharged against medical advice or lost to follow-up. This study shows that Nigerian patients presenting with primary hepatocellular carcinoma already have advanced disease and this makes treatment and survival hopeless. Universal immunisation with HB vaccine should be implemented in Nigeria without further delay and health education should be directed against socio-cultural practices which are aetiological risk factors for primary hepatocellular carcinoma.

P53 codon 249 mutation in hepatocellular carcinomas from Nigeria

Mutations of p53 tumour suppressor gene often occur in hepatocellular carcinoma and, in particular, codon 249 hot-spot mutation is displayed by hepatocellular carcinomas occurring in hepatitis B virus-endemic areas with high dietary aflatoxin intake. This study was done to determine the frequency of p53 codon 249 mutation in hepato-cellular carcinoma in Nigerian patients with this tumour. Tumour samples were obtained from 18 Nigerian patients (all from the Southwest of the country) with histologically confirmed hepatocellular carcinoma by autopsy (n = 14), surgical resection (n = 3) and ante-mortem liver biopsy (n = 1). Fourteen of them had co-existing cirrhosis. Amplification of exon 7 of p53 gene from DNA samples of hepatocellular carcinoma tissue was undertaken by nested polymerase chain reaction followed by restriction enzyme analysis. One out of the 18 tumour samples tested (5.5%) demonstrated codon 249 mutation. This study suggests that, in Nigeria, especially the south-western region, aflatoxins appear to play a limited role in hepatocarcinogenesis.

A comparative study of perception of sickle cell anaemia by married Nigeria rural and urban women

Environmental factors may influence perception of or attitude to chronic disorders. The perception of sickle cell anaemia (SCA by 165 married Nigerian rural and 507 urban women was studied to determine how living in an urban or rural environment may influence perception. None of the subjects had children with SCA. The instrument used for data collection was a structured questionnaire designed to enquire into their knowledge about the cause, precipitating factors for crises, clinical features of SCA and their opinions regarding traditional and modern treatment options for the disorder. As a group, urban women had better knowledge about SCA than rural women probably because their social environment afforded a wider scope for interaction with and information exchange among people. For most respondents, the educational institutions attended the health institutions in the locality and the electronic media were poor sources of information on SCA. The study showed a serious lack of information about important aspects of SCA among rural women. We think the training of primary health care providers as counsellors on SCA, the inclusion of instruction about SCA in the curriculum of schools and sustained outreach programmes on SCA on the electronic media would ensure early education of people in both rural and urban communities and help to improve perception of the disorder.

Anaemia in Nigerian mothers and their children: relative importance of infections and iron deficiency

The study assessed the relative contribution of infections and iron deficiency to anaemia in Nigerian mothers and their children. Sixty-one mother-child pairs were recruited. The mean ages of mothers and children were 31.05 +/- 9.35 years and 30.85 +/- 16.70 months, respectively. Dietary iron intake was used as proxy for iron status while anaemia was diagnosed by whole blood haemoglobin concentration < 120 g/L in mothers and < 110 g/l in the children. A structured questionnaire was used to collect information on the exposure of the mothers and their children to infections. Approximately 53% of mothers and 56% of children had abnormal haemoglobin concentrations indicative of anaemia. Also, 41% of the mothers and 37% of the children had dietary iron intakes below the recommended dietary allowance. In the preceding 6 months of the study, about 50% of the mothers, and 65% of the children in the preceding month, were ill. Febrile illness accounted for 70% and 30% of the illness in mothers and children, respectively. There was significant correlation between mothers' and children's dietary iron intake and blood haemoglobin concentration. In conclusion, iron deficiency and infections were equally important aetiological factors in the anaemia recorded in the subjects of this study.

Hepatitis D virus antigen in HBsAg positive chronic liver disease in Nigeria

Hepatitis B virus (HBV) is strongly associated with an aggressive type of chronic active liver disease (CALD) and hepatocellular carcinoma, which tend to present in the relatively young, in sub-Saharan Africa. It is known that co-existent infection with HDV tends to aggravate the course of HBV-associated liver disease. This study was carried out to determine the sero-prevalence of hepatitis D virus (HDV) among thirty one consecutive southwestern Nigerians with HBsAg-positive, HCV antibody-negative chronic liver disease. Alongside, we tested for HBsAg and the HDV antigen in fifty randomly selected sera each from blood donors and university freshmen undergoing pre-admission medical tests and who had no clinical evidence of liver disease. The HDV antigen (HDVAg) was found in the sera of two of 31 (6.5%) patients. Among the blood donors and university freshmen, HBsAg prevalence was twelve and eight per cent respectively, while HDVAg was present in none. In addition, liver biopsies of 28 other patients were stained for HDVAg. None of these was positive. These findings show that HDV prevalence is low in our community, and suggest that the virus might play only a minor role in the pathogenesis of HBsAg-associated chronic liver disease among our patients. A review of reports on the epidemiology of HDV in sub-Saharan Africa shows a rather complicated pattern that makes its impact on HBsAg-associated CALD difficult to assess. More studies designed to elucidate this pattern of HDV epidemiology are called for.

Familial Burkitt's lymphoma in Nigerians

Three Nigerian sib-pairs with familial Burkitt's lymphoma (BL) seen between 1986 and 1996 are described. Their ages ranged from 4 to 20 years (median 9.5), and there were five males and one female. The mean age interval between each pair at presentation was 4 years (3-6) and the mean time interval 22 months (0.3-41). Two of the sib-pairs were sex-concordant, including a set of monozygotic twins. Five of the patients presented in stage C and one in stage A. Parental consanguinity was not found in any group. Space-clustering was confirmed in all three but time-clustering in only one. The occurrence of BL in multiple members of the same family, the presence of sex concordance and the relatively wide variation in the time of onset of disease between each pair suggest genetic predisposition as a possible additional aetiological factor for BL in the families affected.

Comparative effects of malaria and malnutrition on plasma concentrations of antioxidant micronutrients in children

The comparative effects of malaria and malnutrition on plasma antioxidant vitamins were studied in 65 children aged 8-96 months. Forty-six (71%) of them had malaria; nineteen (29%) served as controls. Patients and controls were further subdivided into two groups depending on whether they were malnourished or well nourished, as defined by weight-for-age Z score (WAZ) +/- -2. Plasma levels of alpha-tocopherol, beta-carotene and retinol were measured. Results indicate that malaria was associated with levels of antioxidants lower than in the controls. Two-way analysis of variance shows that for all three plasma micronutrients concentrations were lower in those children infected with malaria but were not influenced by malnutrition. There were an equal number of malnourished children in both malaria and non-malaria groups; nevertheless, WAZ tended to be lower in those with malaria (p = 0.056), although this did not quite reach significance. It is concluded that in areas where malaria and malnutrition co-exist, malaria alone exerts a greater influence on plasma antioxidants than does malnutrition.

Interrelationship in nutrient intake of Nigerian mothers and their children: nutritional and health implications

This study examined the interrelationships in the nutrient intake of mothers and their children. One hundred and eight mother-child pairs participated in the study. The children were aged 36-59 months (mean age 44 months) while the mean age of the mother was 31.0 years. The subjects were drawn from rural locations, were largely illiterate, and farming and petty trading were main occupations. Intakes of energy, protein, total fat, and iron were assessed from 3 consecutive 24 hour recalls given by the mothers. There were significant positive correlations between energy, total fat, and iron intakes of mothers and their children. There was no significant correlation in protein intakes of mothers and children. The results also indicate that total fat and protein make little contribution to the total energy intake of the subjects. Mother's age was significantly correlated with child's protein intake (r = 0.21, P < 0.01) but not with child's energy, total fat, or iron intakes. Although mother's energy intake was significantly correlated with child's energy intake (r = 0.39, P < 0.001) this was not the case with the intakes of the other three nutrients. The results indicate aggregation of nutrient intakes in mothers and their children which has important nutritional and health implications.

Lymphadenopathy in Nigerian children

The histopathologic findings on 121 excised enlarged lymph nodes from 48 female and 73 male Nigerian children resident in Ife-Ijesa zone of Western Nigeria over a period of ten years (1982-1991) form the basis of this study. Patients' ages ranged from 2 months to 15 years. Most of the patients (81%) were aged 6 years and above. The cervical region was the commonest site of lymphadenopathy (48%) and localized lymphadenopathy was the rule. Chronic specific inflammation (tuberculosis, toxoplasmosis, and histoplasmosis) predominated as a cause of lymphadenopathy (44%) compared with non specific lymphadenitis (31%) and malignant tumours (24%). Tuberculosis was the commonest cause of chronic specific lymphadenitis and was commoner in girls. The cervical region was the commonest site for chronic specific lymphadenitis, as well as Hodgkin's and non-Hodgkin's lymphoma. The lymphomas were more common in males. The peak incidence for Hodgkin's disease was between the ages of 12 and 15 years.

Hepatitis B virus markers, hepatitis D virus antigen and hepatitis C virus antibodies in Nigerian patients with chronic liver disease

Although carrier rates for the HBsAg as well as the prevalence of HBV-associated chronic liver disease (CALD) are known to be high in Nigeria, not much is known about the role of the hepatitis C (HCV) and D (HDV) viruses. We undertook a prospective serological study of a cohort of 50 new patients and attending a Nigerian teaching hospital for various forms of histologically characterised chronic liver disease. Forty-five patients (90%) had antibodies to HBcAg (anti-HBcAb). Thirty one patients (62%) were HBsAg-positive, out of whom 15 were HbeAg-positive. Two (4%) of the HbsAg-positive patients, both suffering from liver cancer, were also hepatitis D antigen positive. Similarly, two (4%) patients were positive for anti-HCV antibodies. There were no cases of co-infection by the HBV and HCV. This study suggests that while the HBV is the major aetiological agent of chronic liver disease in Nigeria, the HDV is not an important aggravating factor save in a small number of patients. The HCV is probably not yet an important cause of chronic liver disease but this situation might change when HBV infection is controlled.

Spleen in sickle cell anemia: comparative studies of Nigerian and U.S. patients

Anecdotal reports have attributed persistent splenomegaly in African sickle cell anemia (SS) patients to the effects of malaria. However, no comparative studies of patients in malarial and nonmalarial regions have been conducted, and few studies of malaria antibody titers have been reported. In the present study, age- and sex-matched Nigerian patients (n = 310), while it was found only in 8% of U.S. patients (n = 100) from Georgia. There was significant linear correlation between spleen size and Hb levels and with serum immunoglobulins in the Nigerian group. However, serum complement levels (C3 and C4) were not affected by spleen size. In both groups, patients with splenomegaly had fewer circulating pitted red cells than their counterparts without splenomegaly. The mean +/- SE of IgG-specific malaria antibody titer among the Nigerian patients without palpable spleens was 9,386 +/- 2,036; 9,334 +/- 2,980 in those with spleens between 1 and 5 cm, 16,201 +/- 4,502 in those with spleens between 6 and 10 cm, and 22,445 +/- 8,456 in those with spleens above 10 cm. Coexistent alpha-thalassemia did not influence the prevalence of splenomegaly among the Nigerian SS patients. This study provides additional evidence that malaria plays a significant role in the persistence of splenomegaly in African patients.

Haplotypes in SS patients from Nigeria; characterization of one atypical beta S haplotype no. 19 (Benin) associated with elevated HB F and high G gamma levels

We have determined the haplotypes of 669 beta S and 109 beta A chromosomes from numerous members of 297 Nigerian families of various ethnic backgrounds. Among the beta S chromosomes, haplotype 19 was detected in 93.2%, haplotype 17 in 3.4%, and haplotype 20 in 0.1%, while 2.4% represented atypical haplotypes. As many as 60.6% of the beta A chromosomes exhibited haplotype 19 mutations, 8.2% had haplotype 3, and 1.8% had haplotype 20. Two siblings with elevated Hb F and G gamma levels were heterozygous for a beta S chromosome with haplotype 19 and a second chromosome with a hybrid haplotype (termed 19 B). In this hybrid chromosome, haplotype 3-like locus control region (LCR) [hypersensitive site-2 (HS-2)] sequences are in juxtaposition to those of the 5' flanking region of the G gamma promoter of a beta S chromosome with haplotype 19. The presence of this hybrid chromosome is associated with high G gamma values in individuals with both sickle cell anemia (SS) and sickle cell trait (AS); it closely resembles another hybrid beta S chromosome, termed 19 A, observed in a previously reported Turkish SS patient who was homozygous for this chromosome and had high Hb F and high G gamma values. In both instances, it is hypothesized that the haplotype 3-like sequences of the LCR HS-2 contain genetic determinants that can combine with factors produced during hematopoietic stress, resulting in increased gamma-globin gene expression.

Plasma ferritin concentration in relation to vitamin A and E status of children with severe oedematous malnutrition

The association between plasma ferritin concentration and vitamin A and E status was studied in 17 children aged 15-72 months with severe oedematous malnutrition. The controls were 10 children of similar age who were apparently well and with no obvious signs of clinical malnutrition. Plasma ferritin concentration in the patients was significantly higher than that in the control children. Conversely, the plasma concentrations of beta-carotene, alpha-tocopherol and retinol in patients were significantly lower than those in plasma of control children. The median (interquartile range) plasma alpha-tocopherol concentration of patients, 6.03 (5.29-9.50) mumol/l, is below the threshold of vitamin E deficiency (11.6 mumol/l). Fifteen of 17 (88%) malnourished patients were found to have plasma tocopherol concentrations below the normal threshold. However, all the patients had a tocopherol: cholesterol ratio greater than 2.22, indicating adequate vitamin E status for the level of cholesterol present in plasma. Twelve of 17 patients (70.5%) had plasma retinol concentration less than 0.70 mumol/l, indicative of marginal vitamin A status, while 3 patients had plasma retinol concentrations less than 0.35 mumol/l, indicating vitamin A deficiency. The median (interquartile range) plasma retinol concentration of patients, 0.51 (0.41-0.93) mumol/l, is significantly less than that of control children, 0.96 (0.74-1.09) mumol/l; p less than 0.01 Mann Whitney U test. Furthermore, anaemia (Hb less than 110 g/l) was widespread in the patients. The results also indicate no significant correlation between elevated ferritin concentration and the concentrations of beta-carotene, retinol and alpha-tocopherol in the patients' plasma.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of parental socioeconomic status on casual blood pressures of Nigerian school children

The purpose of this study was to determine the effect of parental socioeconomic status on blood pressures of Nigerian school children. The weight, height, blood pressure and heart rate of 807 school children in Ile-Ife, Nigeria were measured. The subjects' ages ranged between 8 and 20 years. The subjects were classified into three (lower, middle and upper) groups based on the socioeconomic status of their parents. The findings revealed that parental socioeconomic status has no effect on the systolic and diastolic pressure, heart rate, rate pressure product and pulse pressure of Nigerian children. We found the 95th centile blood pressure to be 133/92 mm Hg. If the 95th centile is considered the diagnostic criteria for hypertension, then Nigerian children with sustained blood pressure in excess of 133/92 mm Hg should be investigated.

Clinical and laboratory features associated with persistent gross splenomegaly in Nigerian children with sickle cell anaemia

Tow age-matched groups of patients with sickle cell anaemia (SS), one with persistent gross splenomegaly (PGS) and the other without palpable spleens, were studied to determine the clinical and laboratory features associated with PGS. The group with PGS had significantly larger mean liver size, higher serum indirect bilirubin levels, but lower mean haematocrit, blood cell counts and serum albumin: globulin ratio when compared to the control group without splenomegaly. Large palpable livers (greater than 6 cm below the coastal margin) among the PGS group tended to be associated with digital clubbing. A retrospective analysis of their case files showed that patients with PGS had had predominantly anaemic crises while those without splenomegaly had had predominantly vaso-occlusive crises over a 2-year period. No difference was found between the 2 groups, in respect of anthropometric data, prevalence of hepatomegaly or frequency of hospital admissions and blood transfusions.

Anthropometric determinants of resting blood pressure and heart rate of Nigerian school children

Blood pressure, heart rate and anthropometric parameters were measured in 807 Nigerian school-age children. There was no significant difference between the blood pressure and heart rate of boys and girls after adjusting for differences in age and anthropometric parameters. The stepwise regression analysis revealed that the strong determinants of blood pressure levels were weight, Quetelet index and triceps skinfold thickness. Based on our findings, we recommend that body weight norms rather than age should be used in evaluating abnormal blood pressure levels in Nigerian children.

Serum immunoglobulins A and M in sickle cell patients in Ile-Ife, Nigeria

Serum immunoglobulins A (IgA) and M (IgM) titres were determined in 25 patients with sickle sickle cell anaemia (HbSS) in steady state and in 25 age and sex-matched normal controls. The mean serum immunoglobulins A and M titres (221 +/- 65.2 and 177.4 +/- 62.7 mg/dl respectively) were significantly higher (p less than 0.01) in the patient group than in the controls (148.3 +/- 55.6 and 132.6 +/- 45.9 mg/dl respectively). Above the age of 10 years however, no statistically significant difference exists between the mean serum IgM titres of the patient and control groups. Chronic haemolysis and state of splenic function seem to play some role in the determination of serum immunoglobulin titres in sickle cell patients. The study shows that the proneness of SS patients to infections cannot be explained on the premise of low titres of serum immunoglobulins alone.

Persistent gross splenomegaly in Nigerian patients with sickle cell anaemia: relationship to malaria

Serum IgM levels, hepatic histopathology, and response to prolonged proguanil treatment were investigated in 15 patients with sickle cell anaemia (SS), aged 8-15 years, with persistent gross splenomegaly (PGS). They were compared with age- and sex-matched SS patients without splenomegaly and with AA controls. The mean +/- SD serum IgM levels were 249.7 (75) mg/100 ml in the SS patients with PGS, 157.6(57.3) mg/100 ml in the SS patients without splenomegaly, and 146.2(48.9) mg/100 ml in the AA controls. The differences between these mean values were statistically significant (P less than 0.05). Hepatic histopathology in 11 of these patients showed moderate to severe sinusoidal dilatation and portal lymphocytic infiltration. Of the 13 patients that were followed on daily proguanil therapy, 10 showed remarkable reduction in splenic size within 6 months. The mean splenic size diminished by 13.8(3.2) cm to 5.6(5.3) cm over the period. The difference was statistically significant (P less than 0.01). This study has confirmed the previous belief that malaria plays a role in the aetiopathogenesis of persistent splenomegaly in sickle cell patients in a fashion similar to, but not quite the same as in, tropical splenomegaly syndrome (TSS). It also underscores the need for malaria chemoprophylaxis in these patients.