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During a five year period, 233 cases of malaria (2.4%) were diagnosed among 9259 children with fever and hepatosplenomegaly seen in Asir Central Hospital, Abha, Saudi Arabia. The majority of these were below four years of age and came from Tihama, a hot, humid valley area in the Asir region. The infection was seasonal and occurred between December and May. Apart from fever, vomiting and hepatosplenomegaly, anemia was a common clinical finding; this was partly due to iron deficiency anemia, probably nutritional. Most of the cases responded to chloroquine therapy; however, three required intravenous quinine and two received Fansidar to effect eradication of the parasitemia. During the study, two patients died, one from cerebral malaria and the other from severe hemolytic anemia and hemoglobinuria. For prevention of malaria in this endemic area, an integrated program is advocated that includes the use of bednets impregnated with permethin, adequate treatment of proven cases and intensive health education on malaria control and nutrition.

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A total of 4359 children with sickle cell anaemia were treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria in an eight year period 1979-1986. Of this number 4 children with hypersplenism associated with intractable complaints were offered splenectomy as the treatment of choice. Following splenectomy they had improved haematological indices and general wellbeing, but splenectomy did not abolish abdominal or bone pain crises. This study emphasizes that though splenectomy could be of beneficial effect on carefully chosen cases of hypersplenism, it has not become a major form of therapy for the majority of children with sickle cell anaemia in Nigeria.

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In a study on the influence of birth weight and social status on cord blood cholesterol, it was found that the serum cholesterol level at birth for full term babies from Eastern Nigeria is 2.71 +/- 0.42 mmol/l with a range of 1.90-3.58 mmol/l. This is higher than the figure obtained from Ibadan babies in Western Nigeria. There was no correlation between birthweight and serum cholesterol for term babies, coefficient of correlation being +0.138. Social status of parents did not influence cholesterol level at birth.

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Although child abuse occurs in Nigeria, it has received little attention. This is probably due to the emphasis placed on the more prevalent childhood problems of malnutrition and infection. Another possible reason is the general assumption that in every African society the extended family system always provides love, care and protection to all children. Yet there are traditional child rearing practices which adversely affect some children, such as purposeful neglect or abandonment of severely handicapped children, and twins or triplets in some rural areas. With the alteration of society by rapid socioeconomic and political changes, various forms of child abuse have been identified, particularly in the urban areas. These may be considered the outcome of abnormal interactions of the child, parents/ guardians and society. They include abandonment of normal infants by unmarried or very poor mothers in cities, increased child labour and exploitation of children from rural areas in urban elite families, and abuse of children in urban nuclear families by childminders . Preventive measures include provision of infrastructural facilities and employment opportunities in the rural areas in order to prevent drift of the young population to the cities. This would sustain the supportive role of the extended family system which is rapidly being eroded. There is need for more effective legal protection for the handicapped child, and greater awareness of the existence of child abuse in the community by health and social workers.

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Postpneumonic pleural suppuration is a common condition seen in paediatric practice in Nigeria. One hundred and twenty cases seen at the University of Nigeria Teaching Hospital, Enugu, over a 4-year period were reviewed. The patients were aged between 1 1/2 months and 16 years. History of antecedent measles was elicited in 27 of the children, and 70% of the patients presented to the hospital later than 7 days after the onset of symptoms of pleura suppuration. From the pleural aspirates of 106 cases (88.3%) Staphylococcus aureus was cultured in 31.2%, but there were no organisms cultured in 39.4%. Twenty-nine children were treated by chemotherapy only; 11 of them (37.9%) died. Sixty-eight cases had tube drainage of the pleural collections, with 6 deaths (8.8%). Twenty-three patients had thoracotomy, evacuation of the suppurative lesion and decortication of the lung, with no mortality. There was overall hospital mortality of 14.2%, the highest mortality being in children who had associated measles, gastroenteritis, anaemia or malnutrition. Early surgical drainage by tube thoracostomy or by thoracotomy and decortication in addition to appropriate and adequate antibiotic therapy is the treatment of choice.

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The growth of 38 Nigerian children who had suffered from marasmus was studied for five years after hospital treatment. In spite of health and nutritional education provided to the mothers, most of the children did not catch up in growth by the end of this period. Three children died within the first two years. Only one child attained a height above the 50th percentile, and two gained weight above the 50th percentile, using Nigerian standards. The head circumference measurements of only four children were above the 50th percentile of the Nellhaus chart after five years. Lack of sustained nutritional support due to the low socioeconomic status of the families to which the children returned after treatment and poor environmental stimulation were the major factors responsible for the stunting of growth. The early age of onset of marasmus in some of these children suggests that the syndrome is a sequel to low birth weight complicated by infections and inadequate feeding. In view of the poor long-term prognosis of marasmus, emphasis should be on prevention through health education and improvement of maternal and child health services.

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Tuberculosis is still a major paediatric problem in many parts of Africa, and the diagnosis may be missed because of the unusual and varied clinical features in some children. This is illustrated by 5 cases which have been described who presented with (a) unilateral swelling of the leg associated with inguinal lymphadenopathy; (b) subcutaneous emphysema; (c) 'cystic lung' disease; (d) respiratory stridor and (e) abnormal behaviour.

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The iron status in children with sickle cell anaemia has been studied in 45 patients. The mean haemoglobin level was 7.4 g/dl (s.d. 1.7) and the white cell count more than 11 X 10(9)/l in 35 (78%). Bone marrow examination showed depletion of iron stores of 21 (47%). The total iron binding capacity was elevated in most of the children and serum iron was below the normal mean level for age in 14 (31%) children. The possible causes of iron deficiency in some of these children include dietary deficiency, infections, malabsorption, blood loss through hookworm infestation and growth spurt. In the management of a child with sickle cell disease, iron administration is not recommended unless there is evidence of coexisting iron deficiency.

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The report concludes that there is a need for training in Oral Rehydration Therapy [ORT] and the standardization of oral rehydration salts [ORS] solutions; therefore a Regional Oral Rehydration Training Centre is needed and the project is feasible

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