Determination of Anti-nutrients and Toxic Substances of Selected Fresh Leafy Vegetables Obtained from Minna Town, Nigeria

Determination of antinutrients and toxic substances in leafy vegetables is an imperative facet in nutritional studies as it establishes the baseline concentrations index for phytotoxins in the vegetables. Concentrations of cyanide, nitrate, soluble and total oxalates were quantitatively determined in the common leafy vegetables (Amaranthus cruentus, Hibiscus sabdariffa, Corchorus olitorius, Telfairia occidentalis and Vernonia amygdalina) consumed in Minna, Niger State, Nigeria, using colourimetric and titrimetric methods. The results show  that the concentration of cyanide in the leafy vegetables is within the permissible level of 200 mg/kg fresh weight while the concentration of nitrate in V. amygdalina and H. sabdariffa is within the acceptable daily intake of 219.00 mg/day, those of A. cruentus, C. olitorius and T. occidentalis is enough to induce toxicity in man. The soluble and total oxalates content in the vegetables are higher than the permissible level except that the concentration of soluble oxalate in H. sabdariffa is within the acceptable level of 250 mg/100 g. The results suggest that while the concentrations of cyanide in the analysed vegetables and nitrate in V. amygdalina and H. sabdariffa are safe for consumption, the concentrations of soluble and total oxalates in the vegetables and nitrate in A. cruentus, C. olitorius and T. occidentalis may contribute to nutritional problems if ingested without proper processing.Keywords: Leafy vegetables, toxic substances, cyanide, nitrate, oxalates                      

Reasons and outcome of paediatric referrals from first-level health facilities in Sabongari, Zaria, Northwestern Nigeria

Background: Referral is a crucial component of primary care and when appropriately carried out is believed to result in favourable outcome of illnesses. This study sought to determine the reasons and outcomes of Paediatric (under-five) referrals from first-level health facilities, and the factors influencing the outcomes. Methods: A cross-sectional descriptive study was carried out in six sampled public first-level health facilities in Sabon Gari Local Government Area of Kaduna State in the Northwest zone of Nigeria. A total of 106 under-five children referred during the sixteen-week study period from the six sampled health facilities were studied. Structured questionnaires and a two-way referral form were designed and used for data collection and the children followed up to determine the type of care received and its outcome. Results: Diarrhoea was the most common reason for referral (34%) followed by convulsion (10.4%), difficulty in breathing (8.5%) and surgery (8.5%). The most important reason for the decision to refer was for better diagnosis and treatment (70.8%). The referral compliance rate was 37.8%. Of those that complied, 31 (83.8%) of them recovered, 6 (16.2%) died and none had a disability (P > 0.05). Of the 61 (62.2%) of the referrals that did not comply, the majority (65.6%) of them were treated by traditional healers while 34.4% were managed at home using home-based remedies. The compliant referrals were found to significantly have more favourable outcomes than the non-compliant cases. Factors that influenced the referral outcomes included compliance, transport difficulty, financial constraints and husband\'s consent. Conclusion: Referral to a higher level of care where there are better facilities for diagnosis and treatment generally improve the chances of a favourable outcome.There is a need for adequate investment in resources at first-level health facilities to make referrals worthwhile and more effective. Key Words: Child illness; Referral; First-level health facilities; Reasons; Outcome Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 10-1

Effect of fruiting on micronutrients, antinutrients and toxic substances in Telfairia occidentalis grown in Minna, Niger State, Nigeria

A pot experiment was conducted to determine the effect of fruiting on antinutrients (soluble and total oxalates), toxic substances (cyanide and nitrate) and some micronutrients namely: vitamin C, β-carotene (provitamin A) and mineral elements [(sodium (Na), iron (Fe), magnesium (Mg), copper (Cu), Zinc (Zn), calcium (Ca) potassium (K)] in Telfairia occidentalis grown in nitrogen and non-nitrogen treated soil. Vegetable leaves were harvested at both market maturity (vegetative phase) and fruiting (reproductive phase), and were subjected to chemical analysis. Results showed that the cyanide and total oxalate concentrations were significantly higher at fruiting stage of vegetables grown on both control and nitrogen applied soil, while the nitrate and β-carotene concentration in T. occidentalis were significantly reduced irrespective of the soil nitrogen levels. Fruiting however, had no significant effect on soluble oxalate and vitamin C concentration in T. occidentalis grown under control and nitrogen treatment conditiond. The results also revealed that while Fe and Mg contents were increased, K and Cu content decreased significantly with fruiting in both control and nitrogen fertilization treatment. Similarly, the Na content in the vegetable was decreased significantly only when nitrogen fertilizer was used. The levels of Zn and Ca were not affected by fruiting. We conclude that consumption of the leaves of T. occidentalis at vegetative phase (market maturity) reduces the levels of most of the plant toxins and still retain most of the micronutrients in an amount to meet nutritional requirements.Key words: Telfairia occidentalis, anti-nutrients, toxic substances, micronutrients, market maturity and fruiting, soil nitrogen levels

Selenium as adjunct to HAART in the management of HIV/Hepatitis B Virus coinfection: A Randomized open label study

Objective: Management of viral hepatitis in patients with HIV disease is quite challenging and  complex. With effective HIV treatment, people with HIV/HBV co-infection are living longer. HBV  epidemiologic surveys showed an inverse association between selenium (Se) level and regional cancer incidence, as well as viral infection. This study assessed effect of selenium as adjunct to HAART in management of HIV/HBV co-infection.Methods: A randomized open label study with participants allocated into three treatment groups: – HAART-only, Se-only and HAART-plus-Se. HIV viral load, HBV viral load, CD4 cell count, and alanine aminotransaminase (ALT), were analyzed at baseline and 18th month, analyzed using SPSS 5 v11. Ethical approval was obtained from Institute’s Ethical Review Board.Results: Sample size was 149 HIV/HBV patients. Rate of HBV clearance was higher among those on HAART-plus-Se at 18th month when compared with rate of clearance among those on HAART-only (p=0.046). CD4 count increment among HAARTplus- Se group compared with HAART-only group was higher (p=0.133), though not statistically significant. On comparison of baseline and 18th month ALT, there was significant decline for HAART-plus-Se (p=0.002) compared with HAART-only group.Conclusion: Selenium seems to have protective effect on liver cells; may be beneficial as adjunct to HAART in HIV/HBV management.Key words: HIV/HBV co-infection, Selenium adjunct, HAAR

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Five insights from the Global Burden of Disease Study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3.5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.Peer reviewe

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence