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Objective: Because prelacteal feeds can adversely affect breastfeeding, UNICEF=WHO discourage their use unless medically indicated. The study was carried out to determine the proportion of healthcare workers who routinely give prelacteal feeds, and their reasons for doing so; further, to determine whether any differences exist between medically and non-medically trained healthcare workers in their administration of prelacteal feeds. Design: Survey. Setting: Primary, secondary and tertiary health facilities in Kaduna township Nigeria. Subjects: Of 1100 healthcare workers sampled, 747 (68%) responded. Of these 80% had received medical training, 20% had not. Methods: Use of a pretested validated questionnaire. Results: Large proportions of both medical and non-medically trained healthcare workers stated they routinely give prelacteal feeds (doctors, 68.2%; nurses, 70.2%; and non-medical, 73.6%). However their reasons for doing so differed significantly (P ¼ 0.00001). Nurses gave mainly for perceived breast milk insufficiency, doctors for prevention of dehydration, hypoglycaemia and neonatal jaundice and non-medical staff to prepare the gastrointestinal tract for digestion and to quench thirst. Conclusions: Most healthcare workers (medical and non-medical) routinely and unnecessarily give prelacteal feeds. Therefore training and retraining programmes in lactation management are necessary and must include non-medical staff. These programmes, while emphasizing the danger of giving prelacteal feeds, must deal with the misconceptions of each group. Deliberate efforts have to be made to incorporate clinical training in breastfeeding in curricula of Schools of Medicine and Nursing.

Roll Back Malaria Initiative encourages participation of private health providers in malaria control because mothers seek care for sick children from them. This study investigated Patent Medicine Sellers (PMS) management of presumptive malaria in children in order to identify how they can assist malaria control. A cross-sectional survey of 491 PMS in Kaduna, Nigeria, was done using interviews and observation of shop activities. Most (80%) customers bought drugs without prescriptions. Only 29.5% were given instructions about doses. Between 40–100% doses of recommended antimalarials were incorrect. Some (22%) PMS did not ask questions about illness for which they were consulted. Most children treated in shops received injections. PMS facilitate homecare but have deficiencies in knowledge and practice. Interventions must focus on training them to accurately determine doses, give advice about drug administration, use oral medication, and ask about illness. Training should be made a prerequisite for registering and reregistering shops.

In order to determine the prevalence and pattern of bacterial infections in children with sickle cell disease (SCD) admitted with acute illness, a prospective study of 304 sicklers aged 3 months to 15 years was carried out over 1 year in the emergency pediatric unit of ABU Teaching Hospital Kaduma. Initial blood and urine cultures were obtained in all cases and other cultures were performed as determined by the patients' clinical condition. Almost 60 per cent of the patients had positive bacterial cultures with gram negative organisms accounting for 55 per cent of them, but the single most predominant organism isolated was Staphylococcus aureus. Of note was the strikingly low isolation rate of Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitides. Possible reasons for this difference from the majority of reports from the western World are advanced and the implications discussed, especially as regards vaccination programmes in sickle cell disease and initial antibiotic treatment of those with acute illness.

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