Oyeku A. Oyelami

Maternal factors in the etiology of fetal malnutrition in Nigeria.

Background: The main objective of the study was to determine the role of maternal factors in the etiology of fetal malnutrition (FM) in Nigeria. Neonatal and Maternity Units of the Wesley Guild Hospital Ilesa, Nigeria, a unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile‐Ife was the setting for the study.

Preliminary Trial of Aloe Vera Gruel on HIV Infection

BACKGROUND Ten (10) young women diagnosed with human immunodeficiency virus (HIV) infection in the Wesley Guild Hospital Ilesa, a unit of Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun State, Nigeria who did not meet the national criteria for the use of antiretroviral drugs were managed with 30-40 mL of aloe vera (Aloe barbadensis miller) gruel daily. METHODS Their CD4 counts, general improvement, and physical well-being (including weight gain) were monitored over a 1-year period. The findings were compared with those of 20 age- matched controls who were on antiretroviral drugs. One (1) patient who reacted badly to antiretroviral drug switched over to aloe vera. RESULTS The average weight gain among those on aloe vera was 4.7 kg compared to 4.8 kg by those on antiretroviral drug (p=0.916). The average rise in CD4 count among them was 153.7 cells/μL compared to 238.85 cells/μL among the controls (p=0.087). There was no significant side effect(s) in either group except in the 1 patient who switched over from antiretroviral drugs to aloe vera gruel. CONCLUSIONS These preliminary data suggest that consumption of aloe vera may be of help to HIV-infected individuals in the tropics, given its availability and inexpensiveness.

Influence of Lime Juice on the Severity of Sickle Cell Anemia

BACKGROUND AND OBJECTIVES The pain in sickle cell anemia (SCA) is often triggered by dehydration, acidosis, and fever that are usually due to malaria. Intake of lime juice was recently demonstrated to facilitate clearance of the malaria parasite. It was therefore sought to determine whether regular intake of lime juice will ameliorate crisis, especially recurrent bone pain. DESIGN In this preliminary, open-labeled, randomized study, the effects of lime juice on the clinical and some laboratory characteristics of children with SCA were tested. RESULTS Among the 113 children with SCA studied in two hospitals, the 58 receiving lime treatment had lower rates of significant painful episodes than the 55 without lime (37 versus 83 crises in 6 months, and 0.64±0.11 versus 1.51±0.34 average rates per child, p<0.001). Also, fewer subjects than the controls had significant painful episodes (50.0% versus 92.7%); febrile illness (46.6% versus 87.3%) and admission rate (3.4% versus 34.5%) (p<0.001). The mean hematocrit of the subjects (26.23±2.03%) at the end of the study was also higher, p<0.001. However, transfusion rate, presence of hepatomegaly, splenomegaly, and jaundice was similar. Treatment with lime did not cause any significant side-effect. CONCLUSIONS Regular intake of lime juice may be of great therapeutic and nutritional relevance in children with SCA.

Risk factors for mortality in childhood pneumonia in a rural West African region

Pneumonia is a major killer of children worldwide. It is responsible for 19% of under-five-year-old mortality, of which 70% occurs in sub-Saharan Africa and South East Asia. A substantial proportion of deaths attributed to pneumonia is caused by failure to recognise factors at presentation that affect prognosis. The present study was aimed to assess for factors at presentation that determine mortality among children with WHO ARI defined severe pneumonia. This was a prospective observational study of consecutive children aged 2 to 59 months admitted with severe pneumonia at a major health centre in rural Gambia to de- termine the risk factors for mortality using logistic regression analysis. Four hundred and twenty (27.6%) out of the 1517 under- five admissions during the study period fulfilled the criteria of severe pneumonia using the WHO ARI criteria. Fifteen of the 420 cases died giving case fatality of 36 per 1000 admissions, with pneumonia accounting for 21.4% of all 70 deaths during the period. Although age ranges 12-23 months and 36-47 months, overcrowding, hypothermia at presentation, oedematous PEM, severe wasting, grunting respiration, convulsion, somnolence and hypoxaemia were significantly associated with mortality (p < 0.05); only convulsions ( OR = 16.64, 95% CI 1.028-1.033) and severe wasting (OR = 5.05, 95% CI 1.459-20.484,) were independent determinants of mortality. We conclude that children with severe pneumonia who in addition have severe wasting and convulsion are at increased risks of dying and should be managed in better equipped secondary or tertiary health facilities.

Multiple injuries in a 3-year-old Nigerian girl: an extreme form of physical abuse

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

A Study of the Primary School Environment in a Local Government Area, South West Nigeria

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

Vitamin A deficiency among under-five Nigerian children with diarrhoea

Background Vitamin A deficiency (VAD) and diarrhoea are still important contributors to childhood deaths in Africa, and vitamin A deficient children are at increased risk as well as severity of diarrhoea. Objectives To determine the prevalence of VAD and identify the associated factors among children with diarrhoea. Methods The study was a hospital-based cross-sectional descriptive study. Consecutive children with diarrhoea were recruited, provided they met the inclusion criteria. Serum retinol levels were determined by high performance liquid chromatography (HPLC) in one hundred and seventy under-five children who presented with diarrhoea at the Wesley Guild Hospital, Ilesa, Nigeria. Results The serum retinol levels of the children ranged from 0.29 — 2.35 µmol/L with a mean ± SD of 1.07 ± 0.42 µmol/L. Twenty seven (15.9%) were vitamin A deficient with three (1.8%) of these having severe VAD. Wasting was significantly associated with a higher prevalence of VAD [p = 0.023, OR (95% CI) = 3.08 (1.21 – 7.79)]. A significantly greater proportion of the subjects who had VAD were hospitalized, compared with the non-deficient ones [p = 0.001, OR (95% CI) = 4.40 (1.82 – 10.66)]. The only subject who died was vitamin A deficient. Conclusion Wasting and hospitalization are factors that may indicate the presence of VAD in a child with diarrhoea. Vitamin A supplements should therefore be given, as part of the treatment for diarrhoea, to children who have wasting, especially when they require hospitalization.

Health instruction in Nigerian schools: what are the missing links?

Introduction School health instruction (SHI) is the instructional aspects of school health programme. It provides information on key health issues to school children who are in their formative years. Methods A cross sectional descriptive study of all the primary schools in a focal Local Government Area in Nigeria was carried out to ascertain the implementation of SHI with regards to the contents, methods of delivery and teachers preparation for health teaching using an evaluation checklist for SHI. Results There were more female pupils enrolled in the study area compared to their male counterparts with a male to female ratio of 0.9:1.0 and only 3.0% of the teachers had In-service training on health related issues in the previous five years preceding the study. 79.4% of the teachers had the recommended qualification to work in the schools. Teachings on emotional health, communicable diseases and safety education were sparingly given by 1.6%, 4.7% and 56% schools respectively. Only three (4.7%) schools (all private) had health instruction given by designated health education staff. No school gave health instruction at least thrice a week as recommended. Conclusion Compliance with the implementation of SHI was very poor in the study area.