SUMMARY A review of 63 Nigerian children with salmonella osteomyelitis showed that in all but 2 ofthem the disease occurred in association with HbS either in the homozygous state (57 patients) or in heterozygous combination with other haemoglobins (4 patients). Osteomyelitis was most prevalent during the first 2 years of life, and boys were more often affected than girls. In the majority, multiple sites were involved and lesions were usually bilateral and often symmetrical. Salmonella sp. was isolated from blood or pus, or both, in all patients. In some patients additional pathogens were also isolated from blood or pus. Clinical presentation was variable. In many patients the illness was slight and they were treated entirely as outpatients, but serious toxaemia, severe bone lesions with pathological fractures, and chronic suppuration occurred in others. Most patients responded well to chloramphenicol and conservative management. There were 4 deaths. 17 patients recovered with sequelae.

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Sixty-five of 3261 (2%) Saudi neonates were found to be severely G6PD-deficient during a cord blood screening programme conducted from April to December, 1992. However, at the time of molecular studies, the blood samples were available from only 20 randomly selected children, aged from 1 to 6 years. DNA analyses showed that seven (three boys, four girls) of these 20 (35%) had G6PD Aures (nt 143 T - > C), a variant associated with favism which was recently reported in an Algerian. Twelve carried the G6PD Mediterranean (563 T) mutation, and in one child the mutation remained unidentified. The medical records of these children showed that all who had G6PD Aures, including a premature baby, were jaundiced during the 1st week of life, but only six full-term infants had moderate-to-severe hyperbilirubinaemia. Two of seven babies had seizures and one of these two developed kernicterus, in spite of timely blood transfusion.

SUMMARY A prospective study of the psychosocial and cultural factors influencing the management of spina bifida cystica was carried out on Nigerian children (48 males, 28 females) seen at the University College Hospital, Ibadan, between January 1982 and December 1983. The parents of 74 of the 76 children had never heard of the disease, many had no idea of its causation and one‐third incriminated witchcraft. Of primary concern was the cyst on the back. The better‐educated parents tended to demand surgical treatment more than the illiterate parents. 22 children were treated surgically. The default rate was high because parents failed to get the expected hospital treatment. Most mothers showed relief rather than remorse on the death of their child. RÉSUMÉ Facteurs psycho‐sociaux et culturels, associés au traitement du spina bifia en Nigeria Une étude prospective concernant les facteurs psycho‐sociaux et culturels influençant la prise en charge du spina bifida a été entreprise auprès des enfants nigériens (48 garcons, 28 filles) examinés á l'University College Hospital, à Ibadan entre Janvier 1982 et décembre 1983. 74 des 76 parents n'avaient jamais entendu parler de la maladie. La plupart n'avaient aucune idée de sa cause et un tiers incriminaient une malédiction de sorcier. La tumeur du dos constituait la préoccupation principale. Les parents mieux éduqués demandaient plus souvent le traitement chirurgical que les parents illettrés. 22 enfants furent traités chirurgicalement. Le taux d'échec a étéélevé en raison de l'impossibilité de fournir le traitement hospitaller attendu. La plupart des mères montraient un soulagement plutôt que des remords à la mort de leur enfant. ZUSAMMENFASUNG Psychosoziale und kulturelle Fakloren, die für die Behandlung der Spina bifida cystica in Nigeria eine Rolle spielen Von Januar 1982 bis Dezember 1983 wurde bei nigerianischen Kindern (48 männliche und 28 weibliche), die im University College Hospital, Ibadan behandelt wurden, eine prospektive Studie durchgeführt mit der Fragestellung: welche psychosozialen und kulturellen Faktoren beeinflussen die Behandlung der Spina bifida cystica. 74 von 76 Eltern hatten nie von der Erkrankung gehört, viele wußten nichts über ihre Ursache und ein Drittel vermutete Hexerei. Die Hauptsorge gait der Cyste am Rücken. Die gebildeteren Eltern verlangten häufiger eine chirurgische Behandlung als die ungebildeten. 22 Kinder wurden operiert. Die Versäumnisrate war aufgrund nicht erfolgter Krankenhausbehandlung hoch. Die meisten Mütter zeigten eher Erleichterung als Bedauern über den Tod ihrer Kinder. RESUMEN Factores psicosociales y culturales asociados al tratamiento de la espina bífida cística en Nigeria Un estudio prospectivo relativo a los factores psicosociales y culturales que influyen en el tratamiento de la espina bifida cística fue llevado a cabo en niños de Nigeria (48 varones y 28 hembras), vistos en el University College Hospital en Ibadan, entre Enero de 1982 y Diciembre de 1983. 74 de los 76 padres no habian oido nunca hablar de la enfermedad...