Factors affecting haemoglobin dynamics in African children with acute uncomplicated Plasmodium falciparum malaria treated with single low dose primaquine or placebo

Background: Single low-dose primaquine (SLDPQ) effectively blocks the transmission of Plasmodium falciparum malaria, but anxiety remains regarding its haemolytic potential in patients with glucose-6-phopshate dehydrogenase (G6PD) deficiency. We, therefore, examined the independent effects of several factors on haemoglobin (Hb) dynamics in falciparum-infected children with a particular interest in SLDPQ and G6PD status. Methods: This randomised, double-blind, placebo-controlled, safety trial was conducted in Congolese and Ugandan children aged 6 months–11 years with acute uncomplicated P. falciparum and day (D) 0 Hbs ≥ 6 g/dL who were treated with age-dosed SLDPQ/placebo and weight-dosed artemether lumefantrine (AL) or dihydroartemisinin piperaquine (DHAPP). Genotyping defined G6PD (G6PD c.202T allele), haemoglobin S (HbS), and α-thalassaemia status. Multivariable linear and logistic regression assessed factor independence for continuous Hb parameters and Hb recovery (D42 Hb > D0 Hb), respectively. Results: One thousand one hundred thirty-seven children, whose median age was 5 years, were randomised to receive: AL + SLDPQ (n = 286), AL + placebo (286), DHAPP + SLDPQ (283), and DHAPP + placebo (282). By G6PD status, 284 were G6PD deficient (239 hemizygous males, 45 homozygous females), 119 were heterozygous females, 418 and 299 were normal males and females, respectively, and 17 were of unknown status. The mean D0 Hb was 10.6 (SD 1.6) g/dL and was lower in younger children with longer illnesses, lower mid-upper arm circumferences, splenomegaly, and α-thalassaemia trait, who were either G6PDd or heterozygous females. The initial fractional fall in Hb was greater in younger children with higher D0 Hbs and D0 parasitaemias and longer illnesses but less in sickle cell trait. Older G6PDd children with lower starting Hbs and greater factional falls were more likely to achieve Hb recovery, whilst lower D42 Hb concentrations were associated with younger G6PD normal children with lower fractional falls, sickle cell disease, α-thalassaemia silent carrier and trait, and late treatment failures. Ten blood transfusions were given in the first week (5 SLDPQ, 5 placebo). Conclusions: In these falciparum-infected African children, posttreatment Hb changes were unaffected by SLDPQ, and G6PDd patients had favourable posttreatment Hb changes and a higher probability of Hb recovery. These reassuring findings support SLDPQ deployment without G6PD screening in Africa

Breast-feeding among female employees at a major health institution in Lagos, Nigeria

The importance of breast-feeding to the health of infant and mother is discussed. However the working conditions of employed women in developing countries prevent exclusive breast-feeding once the mother has returned to work after delivery and also present obstacles to partial breast-feeding. The breast-feeding practices of women employed at a major health institution in Lagos, Nigeria are examined. Duration of breast-feeding was in inverse relation to salary level. Women on the lowest salaries had a mean duration of breast-feeding their last child of 8 months, whereas women in senior professional positions had a mean breast-feeding duration of 3.3 months. Conflicts with work responsibilities were the most commonly cited reason for terminating breast-feeding earlier than the mother desired. If a creche was available at place of work, half the women surveyed said they would breast-feed for longer. Anticipated durations, if a creche was available, would lengthen breast-feeding to 12 months for lowest paid women and to nearly 9 months for women at the higher salary levels. Present options available to the employed women who wishes to breast-feed as long as possible, namely the use of wet-nurses and expression of breast-milk, are discussed. It is concluded that the most satisfactory means of promoting breast-feeding among employed women is the provision of paid leave post delivery for at least three months and the provision of a creche at place of work. The costs should be borne by the employer, assisted by government in the form of grants and tax-relief. In this way the importance of the contribution of the employed woman to national development is recognised. Moreover since employed women are role-models for other women in the society, promoting breast-feeding among this group has an important

Pan African Nappe system: evidence of thrust structures from Okemesi, southwestern Nigeria

The Okemesi area, southwestern Nigeria, is part of the Ilesha schist belt and play host to the Okemesi fold belt and the Ifewara Shear Zone. Nappe structures had been proposed for some parts of Southwestern Nigeria without very clear meso or micro structural evidence. This study provides a lot of new structural evidences to substantiate the inferred Nappe structures within the Okemesi fold belt. Mapping of the Okemesi fold has been hampered by thick vegetation in the past. However, a major deformation zone was exposed by the recent landslide activities in the area, structures and lithologies exposed by the landslide were studied and structural features that are typical of transtensional and transpressional settings were observed. This paper presents the result of the systematic filed mapping which revealed the complete, fold transposition, elements of internal strain such as cleavages and mineral lineation, intrafolial folds, flexure slip, sheath, recumbent and conjugate kink folds, winged porphyroblast, faults (low angle reverse faults, dextral faults, normal faults), ramp and flat structures, etc. The characteristics and the geometry of the observed thrust structures make it an important piece of evidence, not only to infer the tectonic events in the area, but also to constrain the timing and nature of movement associated with thrusting in the area