Nutritional Status of Under-five Children living in Orphanages compared with their Counterparts living with their Families in Host Communities in Lagos State

Background: The prevalence of malnutrition in Nigerian orphanages is not clearly defined despite the high burden. This study was conducted to determine and compare the nutritional status of children living in orphanages and children living in the host communities.Methods: It was a comparative cross-sectional study. A multistage sampling technique was used to select 180 under-five children each from orphanages and host communities. A pre-tested questionnaire was used to obtain data on socio-demographic characteristics and nutrient intake. Weight, height, mid-upper-arm circumference and nutrient intake were assessed following standard procedures. SPSS (version 20.0) was used for data entry and analysis. Association between variables was determined using Chi-square, t-test or Fisher’s exact tests and level of significance was set at p < 0.05.Result: The mean age of the children in orphanages was 38.5 months while that of the children in the host communities was 38.3 months. Wasting and over-nutrition were significantly lower among children living in orphanages compared with those living in the host communities, (5.6% versus 14.4%, p=0.006) and (5.6% versus 13.9%, p=0.008), respectively. The proportion of children living in orphanages who met the Recommended Dietary Allowance for proteins (95%) was significantly higher than those in the host communities (88.9%), (p=0.033).Conclusion: The nutritional status of children living in the orphanages was better than that of the children living in their host communities. More interventions on feeding infant and young children are needed in communities in Lagos State to ensure better nutritional status

Home management of childhood diarrhea including zinc supplementation among mothers attending primary health centers in an urban community in Lagos

No Abstrac

Gastrointestinal parasites of fish as bio-indicators of the ecology of Chanchaga River, Minna, Niger State

Fish parasites are of particular interest in relation not only to fish health but also in the understanding of ecological problems. A study of the gastrointestinal parasites of fish as bio-indicators of heavy metal pollution in Chanchaga River was carried out from May-August, 2014. A total of 100 specimens were sampled which comprises of 4 species; Tilapia zilli, Auchenoglanis occidentalis, Clarias gariepinus and Mormyrus rume (25 samples each). The intestinal contents of the samples were analyzed, parasites found were the Nematodes, 52.00% and mean intensity of 57.03, Cestodes, 28.00%with 4.14 mean intensity and some unidentified species of insects and Copepods were 12.00% and a mean intensity of 7.85. The concentration of the metals (Fe, Zn, Cu, Cr&Mn) were determined using Atomic Absorption Spectrophotometer (AAS). Result showed no significant (P>0.05) difference in the heavy metal accumulation in the muscle of both the infected fishes and the uninfected ones, but there was a significant (P<0.05) difference in the metal concentration in the intestines amongst the fish species for Cu in T. zilli (0.83±0.01mg/g) and in A. occidentalis(0.02±0.01 mg/g). Among the species sampled for heavy metal in fish muscle M. rume had the lowest mean concentration (0.27±0.01 mg/g) while C. gariepinus had the highest (0.45±0.03 mg/g). This study has established the presence of gastrointestinal parasites in fish from Chanchaga River and also presence of heavy metal though in low quantity in the fish from the River thereby indicating that the river is slightly polluted.Keywords: Fish parasites, Heavy metals, Gastrointestinal and Chanchaga Rive

Trypanosoma cruzi: modification of alkaline phosphatase activity induced by trypomastigotes in cultured human placental villi Trypanosoma cruzi: alteração da atividade de fosfatase alcalina induzida por tripomastigotas em culturas de vilos placentários humanos

Human term placental villi cultured ''in vitro" were maintained with bloodstream forms of Trypanosoma cruzi during various periods of time. Two different concentrations of the parasite were employed. Controls contained no T. cruzi. The alkaline phosphatase activity was determined in placental villi by electron microscopy and its specific activity in the culture medium by biochemical methods. Results showed that the hemoflagellate produces a significant decrease in enzyme activity as shown by both ultracytochemical and specific activity studies and this activity was lower in cultures with high doses of parasites. The above results indicate that the reduction in enzyme activity coincides with the time of penetration and proliferation of T. cruzi in mammalian cells. These changes may represent an interaction between human trophoblast and T. cruzi.<br>Vilos placentários humanos a termo foram mantidos "in vitro" em interação com formas tripomastigotas sangüíneas de Trypanosoma cruzi, durante diversos períodos de tempo. Foram utilizadas concentrações diferentes de parasitas. Os controles não continham T. cruzi. Determinou-se a atividade de fosfatase alcalina em vilos placentários mediante microscopia eletrônica e sua atividade específica no meio de cultura, mediante métodos bioquímicos. Os resultados mostraram que o hemoflagelado produz uma diminuição significante da atividade enzimática tanto pelos estudos ultracitoquímicos como de atividade específica e esta atividade de fosfatase alcalina foi menor em culturas com altas doses de parasitas. Estes resultados são indicadores de que a redução de atividade enzimática coincide com o tempo de penetração e proliferação do T. cruzi nas células. Estas mudanças podem representar uma interação entre o trofoblasto humano e o T. cruzi

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda