Seline N. Okolo

Current breastfeeding knowledge, attitude, and practices of mothers in five rural communities in the Savannah region of Nigeria

The knowledge, attitude, and practices regarding breastfeeding of 310 mothers in five rural communities in Toto Local Government in Nassarawa State, Nigeria were investigated using a questionnaire. One hundred and sixty-two (52.3 per cent) mothers were illiterate while 148 (47.7 per cent) had either primary or secondary school education. Apart from giving babies colostrum, which was seen more amongst mothers with higher levels of education (p < 0.001), other practices investigated such as exclusive breastfeeding, demand feeding, rooming-in, and time of first breastfeed were not influenced by the mothers level of education. Fifty-four per cent of mothers did not give their babies colostrum. All mothers attended the antenatal clinic but only 103 (33.3 per cent) received instructions from the health worker on breastfeeding and 46.8 per cent delivered at home. Only 28.6 per cent of babies were breastfed within 24 hours of birth. The mean time after birth for the first breastfeed was 47.7 hours. Although breastfeeding is widely practiced, none of the babies was exclusively breastfed, and prelacteal feeds ranging from water, formula, or herbal tea were given by all the mothers. The practice of discarding colostrum and replacing it with a wide range of prelacteal feeds and late initiation of breastfeeding has implications for health education programmes and neonatal feeding strategies.

Antioxidant content of the milk of Nigerian women and the sera of their exclusively breast-fed infants

The content of many nutrients in breast milk are dependent on the nutritional status of the lactating woman. This is particularly true for fat and water-soluble vitamins, some of which have antioxidant properties. We have previously reported that the total antioxidant content of the milk of women residing in different regions of the developing world varies significantly. In this report we describe the relationship between the antioxidant status of lactating women and their exclusively breast-fed infants from different ethnic groups in Nigeria and the antioxidant content of breast milk. The total antioxidant content of milk from 47 Nigerian women (32 Fulani, 8 Ibo, 3 Yoruba and 4 other ethnic groups) was determined using the Randox® assay. Maternal and infant serum total antioxidant activity were also measured using the same assay. The milk of the Fulani women contained significantly lower antioxidant capacity than the milk from the other ethnic groups (1.1 mmol/L vs. 3.1 mmol/L, p = <0.001). The antioxidant content in the serum of the Fulani women and their exclusively breast-fed infants was also significantly lower that the other non-Fulani subjects. For the combined subjects there was a significant correlation between the maternal antioxidant status and the antioxidant content of breast milk (p < 0.001, r = 0.62) and between the infant antioxidant status and milk (p < 0.001, r = 0.77). The maternal and infant serum antioxidant levels were also significantly correlated (p < 0.001, r = 0.74). These data suggest that the antioxidant status of exclusively breast-fed infants is dependent on the antioxidant status of their mothers.

Hypocholesterolemia in Nigerian children with sickle cell disease

Reports of circulating lipids of children with sickle cell disease (SCD) in Nigeria disagree on the question of whether these children are at increased risk of cardiovascular disease (CVD). We therefore analyzed the serum of 40 females and 37 males with SCD, age 5-19 years, and equal numbers of age-matched controls for total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and homocysteine. Using bioelectrical impedance analysis, we documented a significant reduction in the per cent fat-free mass in the SCD males and increases in the per cent body fat in both the male and female children with SCD. Marked hypocholesterolemia was present in both genders (means, 100-102 mg/dl) and the LDL-cholesterol levels of the male and female subjects with SCD (54 mg/dl) were below the lower limit of the reference range (59-137 mg/dl). Serum triglycerides in the SCD subjects were in the middle of the reference range for children. Although the mean HDL-cholesterol levels of the SCD males (23.1 mg/dl) and females (24.5 mg/dl) were well below the lower limit of the reference range (35-84 mg/dl), respectively, the LDL-cholesterol/HDL-cholesterol ratios of the SCD subjects were not abnormal. The mean serum homocysteine concentrations of the male and female SCD subjects (9.4-9.6 micromol/l) were at the high end of the normal range. Collectively, these results indicate that children with SCD in northern Nigeria are not at increased risk of CVD. However, their marked hypocholesterolemia should be a cause of concern about the overall mortality and general well-being.

Content of Lipid Nutrients in the Milk of Fulani Women

Little is known about the nutrition of the infants of the Fulani, migratory nomads of the western Sahel of Africa. Milk was collected from 18 Fulani women 10 to 30 days postpartum and the fatty acid compositions of the triacylglycerol and phospholipid fractions were determined by capillary gas-liquid chromatography. De novo fatty acids (10:0-14:0) comprised 36.3 12.7% of fatty acids of the triacylglycerols. Compared to the milk of various populations worldwide, the milk of the Fulani women contained adequate proportions of oxlinolenic acid (0.50 ± 0.16%) and arachidonic acid (0.42 ± 0.22%), but relatively low amounts of linoleic acid (9.95 ± 2.13%) and docosahexaenoic acid (DHA) (0.15± 0.08%). In addition, the milk of the Fulani women contained adequate concentrations of P-carotene (1.58 ± 0.69 Rtgfdl) and vitamin A (42.7 ± 40.3,ug/dl), but very low levels of vitamin E (0.1 1 ± 0.10 mg/dl). These data indicate that exclusively breastfed infants of Fulani women were receiving relatively low amounts of critical fatty acids and vitamin E.

Bioelectrical impedance analysis of the body composition of Nigerian children with sickle cell disease

We used bioelectrical impedance (BIA) to investigate the body composition of children with sickle cell disease (SCD) in northern Nigeria. A total of 48 children with SCD and 51 controls between 3 and 20 years of age were studied. A significant difference was found in the weights of male subjects over the age of 10 years compared to controls (p = 0.01), but not in height. Significant differences were also observed for SCD males in the 10-18-year-old age range in body mass index (p = 0.001), fat free mass (p = 0.001), per cent fat free mass, (p = 0.02), body fat (p = 0.02), and per cent body fat (p = 0.02). No significant differences in any of these parameters between SCD subjects and controls were obtained for males under the age of 10 years. There were no significant differences in the height, weight, body mass index, or fat free mass for female SCD subjects compared to controls over the age range we studied. However, there were significant differences in the per cent fat free mass (p = 0.006), body fat (p = 0.025), and per cent body fat (p = 0.01) for female SCD subjects over the age of 10 years compared to controls. In addition to documenting differences in the body composition of adolescent boys with sickle cell disease in Nigeria, this study also demonstrated the feasibility of using bioelectrical impedance to analyse the body composition of individuals under the hot, arid conditions which prevail in sub-Saharan Africa.

Fatty acid composition of the milk lipids of Fulani women and the serum phospholipids of their exclusively breast-fed infants

We previously reported that, relative to milk of women elsewhere in the world, the lipid fraction of milk of Fulani women in northern Nigeria contained relatively low proportions of alpha-linolenic acid and docosahexaenoic acid (DHA). This led us to question the essential fatty acid status of Fulani infants and the relation between the proportion of critical n-3 and n-6 fatty acids in the serum phospholipids of the mothers, their milk, and the serum phospholipids of their exclusively breast-fed infants. We were also interested in the effect de novo intermediate chain length-fatty acids (C10-C14) had on the proportions of critical and non-essential fatty acids in milk. Capillary gas-liquid chromatography was used to analyze the fatty acid content of the total milk lipids of 34 Fulani women, as well as the fatty acid content of serum phospholipids of the women and their breast-fed infants during the first 6 months of life. The proportions of critical n-3 and n-6 fatty acids in the milk of the Fulani women were adequate, but the proportions of these same fatty acids were low in their exclusively breast-fed infants. The serum phospholipids of the infants contained 18.8% linoleic acid, 0.13% alpha-linolenic acid, 12.8% arachidonic acid, and 3.40% DHA, whereas, the mean percentages of linoleic, alpha-linolenic, arachidonic and DHA in the serum phospholipids of the Fulani mothers were 21.4, 0.20, 9.79, and 1.97, respectively. There was a strong positive correlation between fatty acid content of serum phospholipids of Fulani women and the fatty acid content of their milk lipids. As the proportion of C10-C14 fatty acids in the milk lipids increased, the proportions of critical n-3 and n-6 fatty acids in milk remained relatively constant; however, proportions of three non-essential fatty acids decreased dramatically. C10-C14 fatty acids do not appear to displace critical n-3 and n-6 fatty acids in milk.

The effects of birth weight and gender on neonatal mortality in north central Nigeria

BackgroundWorldwide 15.5% of neonates are born with low birth weight, 95.6% of them in the developing countries. Prematurity accounts for 10% of neonatal mortality globally. The purpose of this study was to evaluate the effects of birth weight and gender on neonatal outcome.FindingsThe data of 278 neonates managed in the Special Care Baby Unit (SCBU) of Jos University Teaching Hospital (JUTH) over a 2 year period from July 2006 to June 2008 were analyzed.One hundred and fifty nine (57.2%) were males and 119(42.8%) females. There were 87(31.3%) preterm and 191 (68.7%) term babies. Twelve of the babies died. Seven (2.52%) and 5 (1.80%) being males and females respectively. The neonatal mortality rate by gender was not significant (p > 0.05). The neonatal mortality was 25.2 deaths per 1000 live births for boys and 18.0 for girls. The mean birth weights of the preterm and term babies were 1.88 ± 0.47 kg and 3.02 ± 0.50 kg respectively, with a mean gestational age of 30.62 ± 3.65 weeks and 38.29 ± 0.99 weeks respectively.Eighty seven (31.3%) of the babies were of low birth weight, 188(67.6%) were of normal birth weight and 3(1.1%) high birth weight. Of the low birth weight babies, 6(2.2%) were term small for gestational age. Six (2.2%) of the preterm infants had normal birth weight.Eleven of the babies that died were preterm low birth weight. The overall mortality rate was 4.32%. The birth weight specific mortality rate was 126 per 1000 for the preterm low birth weight and 5 per 1000 for the term babies. Birth weight unlike gender is a significant predictor of mortality, mortality being higher in neonates of <2.5 kg (OR = 0.04; 95% Cl 0.005-0.310, p = 0.002) (p = 0.453). Seven (58.3%) and 4(33.3%) of the pre-terms that died were appropriate and large for gestational age respectively. Gestational age is not a significant predictor of neonatal mortality (p = 0.595). Babies delivered at less than 37 weeks of gestation recorded a higher rate of mortality than those of 37 weeks and above (p = 0.000).The subjects showed one or more major clinical indications for admission. The major clinical indications for the preterm and term babies were respectively as follows: neonatal sepsis 63(22.7%) and 124(44.6%); neonatal jaundice 32(11.1%) and 71(24.7%); malaria 9(3.1%) and 13(4.5%); birth asphyxia 3(1.0%) and 7(2.4%). Neonatal sepsis was a common denominator among the babies that died.ConclusionBirth weight unlike gender is a significant predictor of neonatal outcome

Concentration of eight trace minerals in milk and sera of mother-infant pairs in Northern Nigeria

Breastmilk from 15 healthy lactating women (21-31 years of age) from the hot, semi-arid sahel of Africa were analysed for copper, iron, zinc, magnesium, manganese, sodium, potassium, and phosphorus. Relative to published data from other populations worldwide, the milk of the Jos women appeared to contain adequate levels of magnesium, manganese, sodium, potassium, phosphorus and iron, but relatively low concentrations of zinc (1.07 micrograms/ml) and copper (170 micrograms/l). The sera of the exclusively breastfed infants nursed by these mothers contained levels of all these minerals that are within the international reference range of values. No statistically significant correlation was observed between the level of a particular mineral in the mothers milk and the sera of their nursing infants.

The Fatty Acid Composition of Human Milk in Northern Nigeria

The authors previously reported that the milk of Yoruba women in southwestern Nigeria was deficient in •-linolenic acid and contained a high percentage (42%) of medium chain–length fatty acids (MCFA, C10-C14). In the present study, the authors used capillary gas-liquid chromatography to analyze the milk of Hausawomen in the northern region of Nigeria. The milk of the Hausa women contained 27% MCFA, 10.6% linoleic acid, 0.41% •-linolenic acid, 0.52% arachidonic acid, and 0.32% docosahexaenoic acid. The proportion of •-linolenic acid in the serum phospholipids of a subset of exclusively breastfed infants (n=15; mean age, 6.2 ± 0.3 months) was below the limit of detection (<0.03%). While the milk of women in northern Nigeria is adequate with regard to n-3 and n-6 fatty acids, to satisfy the requirements for •-linolenic acid, it may be necessary to supplement the infants of these women after the first 6 months of life.

Temporal artery thermometry in children younger than 5 years: a comparison with rectal thermometry.

Background Temporal artery (TA) thermometry has come as one of the new methods for temperature measurement, especially in children in whom accurate temperature monitoring can save lives. The device which is convenient and simple to use is yet to gain popularity in several parts of the world, as there are conflicting reports of its accuracy. This study compares the accuracy of the TA thermometry in children younger than 5 years using the rectal thermometry as the gold standard. Methods Temperature was measured simultaneously in eligible children younger than 5 years from the forehead and rectum using the TA thermometer (TAT-2000C Exergen, USA) and standard mercury in glass rectal thermometer, respectively. The difference between the mean temperatures obtained by the 2 thermometry methods was tested using the paired t test. Pearson correlation coefficient, linear regression, and Bland-Altman plot were also used to test the relationship and agreement between the 2 instruments. The sensitivity, specificity, and positive and negative predictive values were also calculated. Results Overall, the mean TA temperature (37.80°C ± 1.07°C) was significantly lower than the mean rectal temperature (38.07°C ± 0.95°C), P < 0.001. In neonates, however, the mean difference was not significant, 0.02 ± 0.59 (P = 0.810). There was a significant positive correlation between the rectal and the temporal temperatures (r = 0.80, P < 0.01). The Bland-Altman plot showed wide variation in the limit of agreement between the rectal and the TA temperatures which ranged from −1.02°C to +1.56°C. The sensitivity of the TA thermometer was 64.6% and 83.5%, respectively, at a TA fever cutoff of 38.0°C and 37.7°C. Conclusions Temporal artery thermometer is not accurate enough for the measurement of core body temperature in children younger than 5 years. However, it may be used as a tool for screening for fever in very busy clinics and emergency room at a fever cutoff of 37.7°C.