No abstract

In a 9-month study of acute lower respiratory infections (ALRI), the short-term prognostic implications of socio-economic and household risk factors were examined in 103 hospitalized pre-school Nigerian children. Seventy-nine (77%) subjects were potentially exposed to the combustion products of kerosene stoves, 16 (16%) to wood smoke and five (5%) to the products of cooking gas combustion. Only 17 subjects (17%) were exposed to household cigarette smoke. A highly significant association (p < 0.005) was shown between household cooking fuel and the outcome of hospitalization: five (63%) of the eight who died were potentially exposed to wood smoke. The duration of hospitalization was only significantly associated with paternal income (p < 0.05). None of the other domestic risk factors was significantly related to outcome or duration of admission. These findings suggest an association between an adverse outcome of ALRI and domestic exposure to wood smoke. While the hospital-based source will not allow definite conclusions, the present findings underscore the need for community-based studies. The implications for future strategies of ARI control are discussed, with suggestions.

SUMMARY Clinical and laboratory studies on bronchial asthma in 200 Nigerian children who were seen during a 2k-year period in Ibadan are described. Contrary to reports that the condition is rare in African children, after pulmonary tuberculosis, asthma is the next most common chronic chest disease in Ibadan. While many features of the disease are similar to those seen elsewhere, skin tests indicate that ascaris is the most common antigen associated with asthma, followed by Dermatophagoides pteronyssinus.Bronchial asthma, a common childhood chronic respiratory problem in the West (Godfrey, 1974), is reported to be rare among African children (Wesley et al., 1969;Godfrey, 1975;Warrell et al., 1975).While studies by Mitchell (1970), Sofowora (1970), Anim and Edoo (1972), and Buchanan and Jones (1972) showed that the condition is common in African adults, Wesley et al. (1969) reported that bronchial asthma is extremely rare among Bantu children in South Africa. In Nigeria, Warrell et al. (1975) reported that asthma is rarely seen in children living in the savanna region of the country. Our experience at this hospital in Ibadan during the last few years indicates that the condition is far more common in children here than these reports suggest. This paper gives the results of studies on 200 asthmatic children seen at this hospital during a 2j-year period (June 1974 to December 1976). Materials and methodsThe patients in this study were referred to the chest clinic mainly from the general outpatient department of the hospital but some came from private clinics and hospitals in Ibadan and nearby. Diagnosis of asthma was based on a history of at least three attacks of breathlessness and wheezing (Blair, 1969), often associated with cough, and usually supported at the time of initial examination or during subsequent follow-up, by the auscultatory finding of widespread respiratory rhonchi. In some patients who presented in acute attacks, the diagnosis was further supported by the demonstration of at least Laboratory investigations carried out on the patients included packed cell volume, white blood count-total and differential-stool microscopical examination, chest x-rays, and in a few children, the radiology of the paranasal sinuses. Skin sensitivity tests were done by the prick method, using a selected range of commercially prepared allergen extracts (Bencard). The weal diameter of the reaction recorded was the difference in mm between it and the control. Weals of at least 2 mm in diameter were regarded as positive (Pearson, 1973).The children were classified into three groups according to the severity of the disease. This grading system was modified from one described by Dawson et al. (1969). The severe group consisted of patients with more than 10 acute attacks a year with or without complete clinical recovery between attacks. The moderate group had 5 to 10 attacks a year and usually showed complete or partial freedom from wheezing between attacks, while the mild group had I to 5 attacks a year with complete clini...

The relationship between certain host-related variables and the short-term outcome of hospitalization for severe acute lower respiratory infections was studied prospectively in a cohort of 103 pre-school Nigerian children. The respective mean ages of those with bronchiolitis and croup were 3.2 months and 18.9 months while the corresponding M:F ratios were 2.5:1 and 1:1. It was highly significant that all the eight children that died were malnourished (P less than 0.01). Furthermore, malnourished subjects with pleural effusion, in whom bacteraemia was common, stayed longest in hospital while subjects with bronchiolitis and croup, in whom malnutrition was distinctly uncommon, had the shortest duration of admission. Multiple microbial identifications and bacteraemia were common in malnourished subjects with ALRI. Mortality was significantly higher in older children (P less than 0.05), but sex, immunization/breast-feeding status and co-existing measles or pertussis, were individually neither related to the admission outcome nor the duration. It is concluded that malnutrition is a strong predictor of ALRI-related death in the pre-school child. The significance of bacteraemia and multiple microbial identifications in malnourished children, and the ARI-control implications of the study are discussed.

(Thorax 1995;50:739-745)