J.A. Omene

A point prevalence of otitis media in a Nigerian village

One hundred seventy children and 103 adults from a rural Nigerian village were examined for the presence of middle and external ear pathology. Ear, nose and throat examination included: (1) pneumatic otoscopic exam, (2) tympanometry and (3) contralateral acoustic reflex. A diagnostic algorithm was applied to these 3 findings for each subject and each ear. Our data showed a point prevalence of otitis media in children (less than or equal to 15 years) to be 21.2% compared to 4% in adults (greater than 15 years). Of the 36 children with otitis media, only 3 had perforation and otorrhea; a diagnosis of otitis media with effusion behind an intact tympanic membrane was made in the other 33 children. The prevalence of otitis media varied significantly with age and evidence of upper respiratory tract infection. There was no significant difference between sexes. External ear pathology was found as an independent variable in 24% of the 170 children; three-fourths of these children had concurrent middle ear pathology. The results are discussed in relation to the current understanding of the differences that exist in the epidemiology and pathogenesis of otitis media in different racial groups.

Neonatal Meningitis in Nigerian Infants

53 Nigerian infants with neonatal meningitis were prospectively studied. The striking features were: (a) the higher predisposition (26.7‐fold) of LBW infants to developing meningitis than has been previously reported in the literature; (b) the predominant role of E. coli and Staphylococcus aureus; and (c) the rarity of salmonella organisms and the conspicuous absence of group B streptococcus as aetiological pathogens. The outcome was related to the age of onset and type of micro‐organism. The presence of neurological signs, particularly nuchal rigidity and bulging anterior fontanelle, carried a poor prognosis. The overall mortality was 37.7%

Trends in neonatal mortality in Benin City, Nigeria

A total of 18,334 live births and 376 neonatal deaths at the University of Benin Teaching Hospital were analyzed. The neonatal mortality rate has declined significantly from 49.5/1000 in 1974 to 16.4/1000 live births in 1981. The decrease mainly resulted from the reduction of mortality of fullsize infants (>2500 g) and deaths resulting from perinatal asphyxia. Further reduction may be anticipated if careful attention is paid to the management of breech delivery and if a more intensive care for low birth weight infants is provided.

Changing pattern of neonatal septicaemia in an African city

The pattern of neonatal septicaemia in a large cosmopolitan African city is presented. Comparison of microorganisms isolated in the present study when compared with the results of previous reports from the same institution, show an increase in the incidence of klebsiella and pseudomonas septicaemia. In contrast, Escherichia coli infection has decreased appreciably from an incidence of 56.8% to 14.3%. Staphylococcus aureus has remained the dominant Gram-positive pathogen over the last decade while group B streptococcal (GBS) disease was rarely encountered. A significant finding was the emergence of gentamicin-resistant strains of E. coli and proteus species during the past 5 years. The overall incidence of neonatal septicaemia was 5.6/1000 livebirths and the mortality rate was 30.6%.

Bacterial growth in expressed breast-milk

We determined the degree of bacterial contamination and the rate of bacterial growth in expressed breast-milk stored in a tropical environment with high ambient temperatures and humidity. Colostrum or mature milk obtained from mothers who were delivered preterm or at term was stored at room temperature (27-32 degrees C) and in a refrigerator (4 degrees C) over a 24-h period. Bacterial isolates represented normal skin flora. Our study showed that colostrum was more inhibitory than mature milk, and term colostrum more so than preterm colostrum. At room temperature, mature milk from term mothers could be stored for 6 h without a significant increase in bacterial counts. Term colostrum could be stored for 12 h without significant bacterial growth. Preterm milk could be stored for 4 hr. Our findings should be of practical value to lactating mothers without access to refrigerators.

Normal hematological values of the african neonate

SummaryA longitudinal study of normal hematological values of the newborn infant was undertaken in an effort to provide baseline data for assessing the African Neonate with hematological problems. There were 402 neonates, consisting of 304 full-term, 51 preterm and 47 post-term infants. The Hematocrit (Hct), Hemoglobin (Hb), Red Blood Cell Count (RBC), Reticulocyte count (Retic) and Nucleated Red Blood Cell Count (NRBC) were serially determined. The red cell indices, Mean corpuscular Hemoglobin (MCH), Mean Corpuscular volume (MCV) and Mean corpuscular Hemoglobin Concentration (MCHC) were calculated for each neonate. Our results showed that African neonates have lower hematological values than their North American and European counterparts. This was neither a reflection of an intrauterine anemia nor was it due to variables resulting from the timing of cord blood sampling. On the first day of life, the mean Hct was 45.4%; mean Hb was 15.46 gm/dl; and the RBC was 4.02×106 cells/mm2. The Retics, NRBC and other red blood cell indices do not differ from those of neonates reported from other parts of the world. We suggest therefore that the low hematological values of the African neonate may be intrinsic.

Pepsin and its multiple forms in early life.

Pepsin and its multiple molecular forms have been studied in pre-term and post-term Nigerian infants. The levels of total enzyme activity and acidity were lower in the pre-term infants when compared to term and post-term infants. Resolutions of the various species by ion-exchange chromatography and electrophoresis revealed that the development of specific isoenzymes in term infants occurred towards the end of the neonatal period. Differential development of the enzyme and the isoenzyme in the neonatal period may have important clinical bearing on the subsequent pancreatic protease hydrolysis which may provide a basis for evaluating gastric capacity for nutritional management of these infants.

Changes in serum lysosomal hydrolases in marasmus

The activities of several lysosomal hydrolases including beta-glucuronidase, acid phosphatase and hexosaminidase were compared in serum from 19 well-nourished subjects and 13 children (age 5--24 months) who were suffering from marasmus. The marasmic children exhibited growth retardation and muscle wastage but had normal serum protein values and absence of psychomotor retardation or oedema. Significant changes were observed in serum beta-glucuronidase and acid phosphatase activities. Compared to the control group, serum beta-glucuronidase (determined at pH 4.5 using the fluorogenic substrate, 4-methylumbelliferyl-beta-D-glucuronide) was 2.3-fold higher (p less than 0.001) in the marasmic children. In contrast, serum acid phosphatase values were approximately 50% lower (p less than 0.01) in the marasmic population. Serum hexosaminidase values in the two groups under study were not significantly different. Determination of the beta-glucuronidase to acid phosphatase ratio permitted effective discrimination (p less than 0.001) of serum from normal and protein-calorie malnourished children. The finding that the elevated value of the beta-glucuronidase : acid phosphatase ratio (0.64--1.37) decreased to within the normal range of values (0.10--0.43) after nutritional rehabilitation of several marasmic cases indicates that the determination of serum lysosomal hydrolases using fluorogenic substrates might provide a rapid and sensitive quantitative method for objectively evaluating the status of protein-calorie malnourished children and their responsiveness to nutritional therapy.

Breast milk composition and bile salt-stimulated lipase in well-nourished and under-nourished Nigerian mothers.

Breast milk was analysed in 9 under-nourished Nigerian mothers and 23 well-nourished mothers who served as controls. Milk from the under-nourished mothers contained adequate amounts of lactose and total triglycerides, but had significantly lower bile salt-stimulated lipase activity (BSSL); their mean BSSL activity was only about 50% of the activity in milk from the control group. Total milk protein was also significantly lower than for the controls (1.45 vs. 1.09 g/dl, respectively;P<0.01). Our findings may have nutritional implications for breast-fed infants of under-nourished nursing mothers.

Pattern of Leukocytes in the Blood of Healthy African Neonates

Serial leukocyte counts were performed on 107 full-term, 40 preterm and 35 postterm African neonates during the first 4 weeks of life. In addition, WBC differential counts were done on 85 of these neonates, selected randomly. Both the absolute and relative amounts of each cell type were determined. The main features of leukocyte counts during the neonatal period were: a mean leukocyte count of 12,580 cells/mm3 (range 3,500-20,500) on day 1, with no statistical difference observed between any two of the three groups studied; a decline in mean leukocyte count by day 7 which remained stable throughout the neonatal period, and a neutrophil count of 5,670 cells/mm3 (range 980-12,900) on day 1. This figure is much lower, both in relative and absolute numbers, than that reported for babies in Europe and North America. Lastly, the lymphocyte count was consistently higher than in comparable reports from Europe and North America. The constant leukocyte count, particularly that of neutrophils, may be of importance in detecting infected African neonates.