Hepatitis-B virus infection in children and adults in Northern Nigeria: a preliminary survey

Hepatitis-B surface antigen (HBsAg) and its corresponding antibody (anti-HBs) have been detected by radio-immunoassay in children and adults and in adult expatriates in Zaria, Northern Nigeria. The exposure rate to hepatitis-B virus (frequency of HBsAg and anti-Hbs) was found to vary from 59% in children under five years to 72·5% in adults over 30 years of age, while the frequency of HBsAg alone was 40% and 10% respectively. The anti-HBs prevalence rates rose progressively with age and reached a peak at 62·5% in adults. Five of 32 adult expatriates (15·6%) were positive for anti-HBs. The factors contributing to the high exposure rate in the indigenous population in this region require further study to enable judicious use to be made of preventive measures.     

Endotoxaemia in Vibrio El Tor cholera

Endotoxaemia and endotoxin-induced changes were sought in Nigerian patients presenting with cholera/diarrhoea. The organism was Vibrio cholerae, bio-type El Tor, serotype Hikojima. The limulus amoebocyte lysate gelation test was used qualitatively by the clot method, whilst a spectrophotometric method was used quantitatively to measure endotoxin levels. 25 acutely ill patients tested had detectable endotoxaemia by the Escherichia coli endotoxin standard. The highest endotoxin level was found in a patient with sub-conjunctival haemorrhage. Changes in platelet counts, the detection of complement breakdown product C3d in plasma, the elevation of fibrin degradation products, the finding of elevated, normal or depressed C3 levels and the absence of circulating immune complexes, suggest a pathogenic role for endotoxin in Vibrio cholerae El Tor diarrhoea.     

Orchidectomy in a rural African population

From 1971 to 1977 in Zaria, Nigeria, orchidectomy was performed on 341 men, mostly in the third to sixth decades of life. The testis itself was diseased only in 21% of cases. Torsion of the spermatic cord with testicular infarction occurred in 11% and cancer was present in less than 2%. Orchidectomy was performed therapeutically in 5% of the patients. The major causes for testicular resection were complicated and large inguinal herniae and hydroceles. These two conditions are a source of socio-economic hardship and considerable morbidity in a farming population. It would thus be worth while to include facilities for surgery of small herniae and hydroceles in plans for rural health care.     

Use of low-dosage oral cyproterone acetate as a male contraceptive

To ascertain the effects of low-dosage cyproterone acetate (CPA) on the reproductive and endocrine functions of normal men, 25 volunteers were given CPA 0, 5 or 10 mg daily over 16 weeks, preceded by 12 weeks pretreatment observation and followed by 24 weeks posttreatment follow-up. CPA caused a decrease in sperm concentration, percentage motility, proportion of normal sperm and ability of the sperm to penetrate a column of cervical mucus in most patients. In addition, circulating testosterone, estradiol, LH and FSH levels were significantly reduced during treatment. All these changes reverted to the pretreatment level upon drug withdrawal. These findings suggest that firstly, although low dosage CPA was able to induce changes in seminal analyses, azoospermia was present in only one out of 15 subjects exposed to the drug. Secondly, the marked decrease in androgen levels associated with CPA treatment renders CPA unsuitable as a single entity agent for long-term male contraception.     

Standardization of the indirect fluorescent antibody test for malaria.

Methods are described whereby results of malarial immunofluorescence tests can be evaluated objectively. The IFA test was quantitated by standardizing the physical system against a fluorescent standard and preparation of biological standards of malarial antisera and fluorescein labelled conjugates. Using these known standards the reactivity of antigens was characterized. It was found that antigen preparations are best when they include mature schizonts, and keep best when they are stored in a dry condition at or below -20 degree C. However, even under carefully controlled conditions of storage, antigens showed considerable variation of reactivity between individual batches.     

First report of septicaemic melioidosis in Hong Kong

Septicaemia due to Pseudomonas pseudomallei was found in five patients; it complicated pneumonia in three. Four patients were old and had diabetes mellitus; the fifth patient, though young, was immunocompromised by steroid therapy. The clinical features were indistinguishable from those of other Gram-negative septicaemia. Four of the patients died. This was the first report of septicaemic melioidosis in Hong Kong where the disease might be endemic. Soil sampling and serological survey gave further supporting evidence. Early treatment using a bactericidal anti-Pseudomonal cephalosporin, such as ceftazidime, was suggested for this life-threatening infection.     

Closed digital commissurotomy for mitral stenosis in Northern Nigeria

Despite the absence of sophisticated thoracic surgical facilities, valuable relief was provided to young patients with progressive symptoms of rheumatic mitral stenosis in Zaria (Nigeria) whose response to the medical regime had been unsatisfactory. Using digital trans-atrial commissurotomy, which is technically straightforward and involves little blood loss and no elaborate surgical equipment 18 patients with a lone mitral stenosis were symptomatically improved but three with mixed mitral stenosis and regurgitation died. There is urgent need to reduce the prevalence of rheumatic fever in this and other parts of the tropics.     

Antibiogram of Pseudomonas aeruginosa strainsisolated from Zaria, Nigeria

Antimicrobial sensitivities of 100 strains of Pseudomonas aeruginosa, isolated from various clinical specimens and the environment, were done for gentamicin, carbenicillin, amikacin, polymyxin B sulphate and tetracycline, using standard techniques.Amikacin followed by carbenicillin and polymyxin B sulphate were found to be currently the drugs of choice for the treatment of P. aeruginosa infections in Zaria.The usefulness of monitoring antibiogram and the judicious use of effective antimicrobialagents in the therapy of Pseudomonas infections is stressed.     

Characteristics of family planning acceptors at aprimary health care project in Lagos, Nigeria

Analysis of data collected from the family planning section of a Primary Health Care Project in Lagos, shows that the majority of the 275 acceptors in 1979 were aged 25-39 years. 96% of the clients were married. 1 explanation is that unmarried women may be wary of coming forth for family planning, as this might indicate that they have an active sexual life in a culture which is probably still conservative. Clients with 2ndary and post 2ndary education are over represented. This underscores the importance of education in stimulating demand for family planning in the population. A comparison of the data with those from the Lagos University Hospital in 1972 shows that women with 2 or fewer children continue to be under presented in relation to their proportion in the population. The number of children and the age of the acceptors suggests that people in this environment tend to adopt modern family planning after completion of their family, rather than to space children. Catholics seem to be over represented in the data. Lower socioeconomic groups patronize the clinic more than the higher socioeconomic groups or professionals. The majority of the clients were referred by nurse-midwives and friends. The most common method of family planning was the IUD, followed by the pill. It was felt that part of the reason for the much lower clinic continuation rate for the pill was due to the fact that patients may continue on the pill without the knowledge of the clinic. It was also found that even though the project was catering to a geographically demarcated target population, most clients came from outside of the area, and some from very far away. This suggests that other strategies for delivery of family planning services may be called for.     

Blood transfusion induced malaria in Iran

Blood transfusion plays the main rôle in induced malaria in Iran. Over 111 cases of transfusion malaria were recorded during the 10 years from 1963 to 1972. Seventy-three% of the species of plasmodia have been P. malariae and 27% P. vivax. 9 cases of transfusion induced quartan malaria in blood recipients have been studied. In 2 blood donors who were proved to be carriers of P. malariae by the fluorescent antibody test, scanty malaria parasites were detected in thick films made from blood concentrate obtained by centrifugation.     

Detection and measurement of species-specific malarial antibodies by immunofluorescence tests.

Species-specific serodiagnosis of malaria could be made by means of the standardized indirect fluorescent antibody test, either by determination of the usual end-point titres or by fluorescent intensity measurements on antigens. The malarial antibody levels could also be measured by the fluorescent intensity measurements at a single serum dilution. Thus the fluorescent intensity measurements could effectively replace the end point titre determination, with the advantages of standardization and saving in technician time.     

Traditional medicine and lead-containing preparations in Nigeria

Traditional medicine, its preparations and practices, plays a major role in the health care of the community of Nigeria. In many cases the native doctor (“Babalawo”) and the local herbalist (“Eleweomo”) are the only practitioners available for the treatment of illness. Even in the towns where allopathic medicine is available the limited facilities it offers make many patients rely on traditional methods. Little is known of the pharmacological action of these traditional remedies which the native doctor prescribes. Our own studies have concentrated on the metal content of such materials. Here we report on the material known as “tiro” which is used for the treatment of eye infections and disease as well as an “eye cleaner” and cosmetic. On analysis we found that all samples of tiro measured contained lead ranging from 12·8 to 81·1% (w/w), with a mean concentration over all samples determined of 50·1% (w/w). In addition, it was also found that tiro is used by some members of the Nigerian community in Britain and is brought in in decorative containers as a gift. The extent of use in this country still remains to be determined, however. The use of lead-containing preparations^* in traditional practices presents a significant health hazard to a substantial section of the world's population. We suggest urgent steps are required to encourage governments to establish education programmes to eliminate this avoidable source of morbidity among their populations.     

Chloroquine sensitivity of Plasmodium falciparum in Ibadan,Nigeria: II. Correlation of in vitrowith in vivo sensitivity

Plasmodium falciparum malaria was treated in 82 children with 25 mg/kg chloroquine orally over three days. They were observed for 28 days during which blood films were examined periodically for malaria parasites. Asexual forms of P. falciparum, present in the blood films of all the patients before commencing treatment, disappeared rapidly and by the third day no parasites were seen in blood films from any of them. Among the patients observed for more than three days, blood films remained negative throughout the observation period. In vitro tests of sensitivity of blood samples from 10 patients showed chloroquine concentrations of 0·5 to 0·8 nmol/ml to inhibit completely maturation from ring forms to schizonts.This suggests that P. falciparum in the Ibadan area is probably still fully sensitive to chloroquine.     

Field epidemiology: Methodological constraints and limitations in the developing world

Effective planning for health services and facilities requires knowledge of not only theillnesses prevalent in a community but also of the quantity, distribution and the factors affecting their occurrence. In many developing countries, such information is not readily available because of gross inadequacies in the demographic, vital and health statistics collection system. In the absence of a reliable data source, well designed epidemiological surveys may provide clues on the health status of the community. However, the conduct of epidemiological surveys in this part of the world is subject to setbacks, limitations and constraints. Some of the limitations and constraints confronting epidemiologists are discussed. Their implications in the possible malpractice of epidemiology in developing countries should be of much concern.     

The use of cervical caps at the University of California, Berkeley: a survey

A survey of cap use and efficacy of women who initially purchased a cervical cap at the University of California at Berkeley Student Health Service is described. It reports the follow-up of 65 U.C. women students who purchased either Vimule or Cavity-rim cervical caps from May, 1978 through June, 1981 and raises questions about cervical cap use and efficacy. Participants were divided into two groups: regular and irregular users. Of the 33 regular users, 16 experienced unplanned pregnancy during the study. Survival probabilities were 80% at 6 months, 73% at one year and 52% after 2 years. Life table analysis of the 33 regular users indicated a 20% probability of pregnancy in the first 6 months of use, 27% by 1 year and 48% by the end of 2 years.     

Placental malaria and foetoplacental function: low plasma oestradiols associated with malarial pigmentation of the placenta

Placental biopsies were taken immediately post partum from 65 Gambian mothers who had not received anti-malaria chemoprophylaxis during pregnancy whilst living in an area hyperendemic for Plasmodium falciparum malaria. The biopsies were examined without knowledge of the mothers' health or the outcome of pregnancies. Histologically, they were divided into two groups: those with macrophages containing malarial pigment in the inter-villous spaces, and those without such pathology. Babies with pigmented placentae had a mean (SD) weight for gestational age of 83.3 (10.6)%, which was significantly lower (p less than 0.01) than that of 91.2 (7.7)% in the non-pigmented group. The plasma oestradiol concentrations in the mothers who later delivered pigmented placentae were significantly lower from 32 weeks of gestation onwards, and did not continue to rise in the last trimester as they did in the non-pigmented group. The last trimester appears to be the critical time for protection of the foeto-placental unit against malaria. Anti-malaria chemoprophylaxis should be given to all pregnant women.     

The chemotherapeutic value of sulphadiazine in treatment of Acanthamoeba meningoencephalitis in mice

The chemotherapeutic value of three sulphonamides, sulphamethizole,sulphamethoxazole and sulphadiazine, was examined in experimental Acanthamoeba meningoencephalitis in mice. Only sulphadiazine was capable of protecting mice challenged with A. culbertsoni A-1 strain. However, protection to mice was only afforded if the drug was given early after infection. Once the amoebae reached, and became established in, the central nervous system, sulphadiazine displayed no chemotherapeutic value.