Coping strategies and nutritional health in rural Niger: recommendations for consumption of wild plant foods in the Sahel

People who live in food and water deficit regions of Sahelien West Africa employ various coping strategies as they attempt to meet their food and water needs. In this paper we discuss various coping strategies employed by rural Nigeriens living in the Tanout and Mirriya administrative regions of central Niger. In rural Niger people often harvest or buy wild plant foods to eat. Laboratory studies of the nutritional content of these plants indicate that there are benefits to eating wild plant foods. In this study we summarize the results of field research conducted during the summer of 2002 on the use of wild plant foods in three regions of rural central Niger. Comparing local use of various wild plant foods with major nutrition-related health problems including protein deficiency, essential fatty acid deficiency, iron deficiency and iron deficiency anemia, calcium deficiency rickets, and zinc deficiency, suggests potential recommendations for consumption of these plants. However, further research on the bioavailability of these nutrients is needed to confirm the potential benefits of these plants.     

Can Long-lasting Insecticide-treated Bednets with Holes Protect Children from Malaria?

Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.     

Traumatisme crânien et dysfonctionnements antéhypophysaires. À propos de 33 cas : profil évolutif sur 6 mois

ObjectivesTo measure anterior pituitary dysfunction in traumatic brain injury (TBI) and assess the correlations between this disorder, clinical signs and brain lesions.MethodThis was a prospective, longitudinal and analytic study conducted in the department of neurosurgery at the National Hospital of Niamey and the institute of radioisotopes of Niamey University between November 2009 and November 2010. All patients admitted for head trauma were included in the study. They were followed-up for 6 months and underwent clinical, hormonal and CT scan analysis. The hormonal studies targeted gonadotroph hormone, growth hormone (GH), corticotroph, lactotroph, and thyreotroph axes.ResultsThirty-three patients were included in the study. The sex ratio was 15.4:1. The mean age was 28.21 years. Glasgow coma scale score was between 7 and 12 in 52% of cases, with brain contusions in 54.5% of cases. In the acute phase, hypogonadism was reported in 64% of cases, and growth hormone deficiency in 58% of cases. Hormonal follow-up at three months showed GH deficiency in 48% of cases with an elevated luteinizing hormone (LH) in 42% of cases. At sixth months, a rise in LH was observed in 55% with GH deficiency in 52% of cases. Surgical procedures were performed in 21% of cases. At 6 months a post-concussion syndrome was observed in 48.48% of cases.ConclusionThese pituitary dysfunctions are common and should be investigated into the management of TBI.     

Schistosomiasis in infants and preschool-aged children: Infection in a single Schistosoma haematobium and a mixed S. haematobium-S. mansoni foci of Niger

The burden of schistosomiasis in infants and preschool-aged children and their mothers is poorly known. We carried out a cross-sectional epidemiological survey in two villages in Niger: Falmado is endemic for Schistosoma haematobium only, whereas a mixed S. haematobium-S. mansoni focus has been reported from Diambala. The survey examined 282 children (149 girls, 133 boys, average age: 2.6 years) and 224 mothers (average age: 30.1 years). For S. haematobium diagnosis, two urine samples obtained on consecutive days were subjected to the standard urine filtration method. Additionally, macro- and microhaematuria were determined. The diagnosis of S. mansoni was based on a single stool sample with duplicate Kato-Katz thick smears. In Diambala, a standardised, pre-tested questionnaire was administered to mothers, which recorded demographic data, treatment history with anthelminthic drugs, household sanitation and water supply, and bathing practices for their children. Prevalence of egg-patent S. haematobium infections among young children and their mothers was respectively 50.5% and 55.6%, in Falmado, and 60.5% and 72.2% in Diambala. The prevalence of S. mansoni infection in Diambala was 43.8% among children and 52.1% in mothers. Mixed egg-patent infections of S. haematobium and S. mansoni were revealed in 28.6% of the children and 37.3% of the mothers. Questionnaire data showed that 69.8% of the children were accompanied by their mothers to schistosomiasis transmission sites before they were 1 year of age, and that three-quarter of the mothers used water directly drawn from the irrigation canals to wash their children. To conclude, a substantive proportion of children below the age of 5 years had egg-patent schistosomiasis, inclusive of co-infection with S. haematobium and S. mansoni. In the context of schistosomiasis control, more attention should be paid on preschool-aged children and women of childbearing age, so that they can benefit from preventive chemotherapy, which in turn might increase effective coverage of those infected.     

Distribution of Subsidized Insecticide-treated Bed Nets through a Community Health Committee in Boboye Health District,Niger

In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system.     

Congenital heart disease in the Niger Delta region of Nigeria: a four-year prospective echocardiographic analysis

Congenital heart disease (CHD) affects approximately eight per 1 000 live births in the general population, making it one of the most common classes of birth defect.1 CHD is defined as an abnormality in the cardio-circulatory structure or function, which is present at birth, even if it is discovered later.2More children die from CHD each year than are diagnosed with cancer.3 A large number of these children are in the developing countries. They are often repeatedly admitted and treated for recurrent chest infections and failure to thrive due to ignorance of the attending health caregiver, poor diagnostic tools, poor referral systems, and lack of skilled personnel. These lead to late diagnosis and increased mortality rates.CHD can be life threatening in early childhood, and children born with severe forms are at approximately 12 times higher risk of mortality in the first year of life, especially if they are missed in the neonatal period.4 About two to three in 1 000 newborns with heart disease will be symptomatic in the first year of life, diagnosis is established by one week in 40–50%, and by one month of age in 50–60% of patients.5The incidence of CHD in Nigeria 30 years ago was 3.5 per 1 000 population.6 This has increased in recent studies to 4.6/1 000 in the southern,7 and 9.3/1 000 in the northern8 parts of Nigeria, apparently due to increased diagnostic facilities and more trained paediatric cardiologists in the country.Echocardiographic evaluation remains the gold standard for the diagnosis of structural cardiac disease.7 Paediatric echocardiography has not been widely available in Nigeria as there are few paediatric cardiologists and most of the available echocardiography machines have no paediatric probes. Prior to the procurement of an echocardiography machine with paediatric probes in the reporting echocardiographic centre, history, clinical diagnosis and chest radiography were used as tools for provisional diagnosis of CHD.9There has been no previous report on the incidence of CHD in the Niger Delta region of Nigeria. Previous studies on CHD from Nigeria have been retrospective studies and none from the Niger Delta region of Nigeria, where there have been claims of increasing risks to maternal and child health due to environmental degradation and industrial pollution secondary to petroleum mining and gas flaring in this region. This study was done to determine the frequency and pattern of CHD, using echocardiography as a diagnostic tool.     

Malaria transmission dynamics in Niono, Mali: the effect of the irrigation systems

The type of water management and drainage system could be a potential reason for variation in malaria transmission in rice cultivation areas. To investigate this we have compared the population dynamics of Anopheles mosquitoes (Diptera, Culicidae) in rice plots with controlled and uncontrolled water depth, i.e. casiers and hors-casiers, respectively in the Office du Niger, Mali. We also compared malaria transmission in areas with mixed and casiers plots. Larval collection was performed fortnightly with the standard WHO dipping technique. Adult Anopheles were collected both by pyrethrum spray and landing catches. During the dry season rice cultivation cycle, the larval density in the hors-casier was significantly higher than in the casier plots. The larval peak in the casier plots was considerably smaller than the one in the hors-casier. During the rainy season, no significant difference was observed between the two plot types. However, larval densities begin to rise approximately one month earlier in the casier then in the hors-casier plots, and continued to increase trough the rice development phases until the grain filling/maturation phase, declining thereafter. In contrast, in the hors-casier rice plots larval density increased throughout the rice development. This difference was not significantly reflected in the adult vector density and man biting rate. However, high relative frequencies of Anopheles funestus, survival and entomological inoculation rates of An. gambiae s.l. were observed in the mixed plot sector.     

Epidemiologic profile of women presenting to the National Hospital of Niamey,Niger for vaginal fistula repair

Objective

To describe the epidemiologic profile of women with vaginal fistulas presenting to the surgical mission trips of the International Organization for Women and Development (IOWD) at the National Hospital of Niamey, Niger.

Methods

In a cross-sectional retrospective study, data were assessed from a database of women who attended the IOWD at the National Hospital of Niamey, Niger, from October 2003 to April 2009. The database was compiled from the history and physical examination forms for each patient visit.

Results

During the study period, there were 1323 data entries and 896 initial patient visits. Overall, 580 women presented with obstetric fistulas. The median age was 29 years; the mean age at marriage was 16 years; 73.7% were married. The median age at first delivery was 18 years; the mean number of past full-term pregnancies was 3; the mean parity was 4. Vaginal (66.3%) or cesarean (27.7%) delivery was a common predisposing factor for developing an obstetric fistula. Overall, 97.4% of women labored for 24 hours or more; 75.4% delivered in hospital; 82.9% had a stillbirth.

Conclusion

Women presenting to the IOWD for fistula repair have specific epidemiologic characteristics. Better understanding of these characteristics might help to formulate future public health programs for fistula prevention.     

Emergence of Schistosoma mansoni in the Niger River valley, Niger

Urinary and intestinal schistosomiasis are both endemic in Niger with a dominance of Schistosoma haematobium. This study pointed out the appearance of the infection to S. mansoni in the Niger River valley, where it was until then unknown in Niger. In one year the prevalence increased from 5.9 to 19.5%.