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The child in Nigeria is loved and pampered but food may be scarce or inadequate in nutrients, and he/she has overcrowding and poor sanitation to deal with as well as a maze of conflicting and hybrid values and way of life. Statistics show that in black Africa 1 child out of 5 will survive up to his 5th birthday. The infant mortality rate is high primarily because of inadequate nutrition and communicable diseases. The 10 most common diseases in Africa from 4 sample countries, i.e., Ethiopia, Nigeria, Uganda, and Kenya are: malaria; gastroenteritis, measles; respiratory tract infections; malnutrition; intestinal worm, anemias; tetanus; meningitis; and tuberuclosis. All these diseases are preventable, but prevention is more difficult because there are few health workers and inadequate facilities. 80 pediatricians and a few unrecognized pediatric trained nurses look after about 40 million children in Nigeria. Nutrition plays a prominent role in both growth and development. Local food may be plentiful but some families are unable to balance their diets. There is malnutrition or undernutrition because of ignorance, poverty, and feeding habits. In Africa the effect of malnutrition is most marked during weaning. In a traditional African society a child does not lack for love and affection. There are no unwanted pregnancies, no motherless children, no unmarried women, for the extended family system absorbs many of these shocks. The circumstances of the family are related to the incidence of child abuse, which is increasing. Children are used as cheap labor by both parents and guardians. In the current 5-year development plan, the government is making a bold step in health care. Some of the major goals of this 4th 5-year development plan in health care delivery include: rapid expansion of facilities to achieve 100% primary health care coverage by the year 2000; emphasizing preventive care; decentralization so that the local government areas are implementation units; modification of the health care system to suit local conditions and resources; and crash training programs for various health personnel. Suggestions of this author include the following: the full implementation of the health plan; education; school health service; the provision of school children with 1 balanced meal per school day; the preparation of inexpensive baby foods with local foodstuff demonstrated to mothers' groups; and the development of day care centers.
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PMID:Nigeria: child health. 655 Mar 10

The case is recounted of a child who was admitted to hospitals several times over a period of 8 years on account of fictitious illnesses invented by his mother. The first occurred when he was 3.5 years old in January 1984. His mother, a nurse, gave a history of intermittent fever for 3 months, loss of appetite and weight. He had been treated with ampicillin, chloramphenicol, and procaine penicillin. No abnormality was detected and his weight at 15.5 kg was appropriate for his age. No fever was recorded throughout 2 weeks in hospital, but he was given chloroquine for possible malaria and then discharged. At follow-up 6 months later, the mother complained of his wheezing. On examination he was normal and had gained 3.8 kg since discharge. The possibility of vernal conjunctivitis plus asthma was entertained and he was then placed on ketotiphen prophylaxis. There was an uneventful follow-up for 6 months. 5 years later in March 1990, his mother related that he had been treated from 22 January 1988 to 21 November 1989 for tuberculosis with streptomycin, isoniazid, rifampicin, and ethambutol. He was also treated with digoxin and Esidrex-K for suspected rheumatic carditis, after which at the University Teaching Hospital, Enugu, he was investigated from 11 April 1989 to 10 August 1989 and found to be normal. One year later in August 1991 she went to one of the authors complaining about polydypsia, polyphagia, and polyuria. Examination had revealed nothing of note. A clinical assessment for diabetes mellitus found the urine specific gravity persistently at 1.010. He was therefore put on carbamazepine (Tegretol) 100 mg t.i.d. After review by a pediatric nephrologist, the child was declared normal. During this visit, the mother and child were interviewed separately. He believed he was ill because his mother said so. A diagnosis of Munchausen syndrome by proxy was made. The mother was referred back to her doctor to arrange for psychiatric care. In Munchausen syndrome, patients fabricate a variety of symptoms and evidence of illness that have no organic basis. Munchausen syndrome by proxy is a form of child abuse, difficult to diagnose, that could result in death. It is more prevalent in affluent countries with sophisticated medical facilities. Its rarity in developing countries may contribute to the difficulty of detection.
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PMID:Munchausen syndrome by proxy: an experience from Nigeria. 750 55

This article describes the methodology of this bibliography. A search was conducted on the following: (1) bibliographic databases (PubMed, Scopus, and other databases) using search terms that maximize the retrieval of Malaysian publications; (2) Individual journal search of Malaysian healthrelated journals; (3) A targeted search of Google and Google Scholar; (4) Searching of Malaysian institutional repositories; (5) Searching of Ministry of Health and Clinical Research Centre website. The publication years were limited to 2000- 2013. The citations were imported or manually entered into bibliographic software Refworks. After removing duplicates, and correcting data entry errors, PubMed's Medical Subject Headings (MeSH terms) were added. Clinical research is coded using the definition "patient-oriented-research or research conducted with human subjects (or on material of human origin) for which the investigator directly interacts with the human subjects at some point during the study." A bibliography of citations [n=2056] that fit the criteria of clinical research in Malaysia in selected topics within five domains was generated: Cancers [589], Cardiovascular diseases [432], Infections [795], Injuries [142], and Mental Health [582]. This is done by retrieving citations with the appropriate MESH terms, as follow: For cancers (Breast Neoplasms; Colorectal Neoplasms; Uterine Cervical Neoplasms), for cardiovascular diseases (Coronary Disease; Hypertension; Stroke), for infections (Dengue; Enterovirus Infections, HIV Infections; Malaria; Nipah Virus; Tuberculosis), for injuries (Accidents, Occupational; Accidents, Traffic; Child Abuse; Occupational Injuries), for mental health (Depression; Depressive Disorder; Depressive Disorder, Major; Drug Users; Psychotic Disorders; Suicide; Suicide, Attempted; Suicidal Ideation; Substance- Related Disorders).
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PMID:Bibliography of clinical research in malaysia: methods and brief results. 2541 46

Physical abuse of children can be of varying nature. Children can be shaken, beaten, burnt, or cut by their parents or guardians. The incidence of trauma inflicted on children is underestimated in many countries, probably because clinical signs are misjudged, as this case report shows. This three-year-old boy was seen in several health facilities of Yaounde, Cameroon. He was treated erroneously for severe malaria and then for meningitis because he presented with neurologic signs, before the diagnosis of child abuse was made. This was confirmed after an imaging work-up revealed fractures of the skull and the leg. The diagnosis was therefore delayed by at least six weeks from the date of the first consultation. This case report demonstrates that child abuse is not well known in our environment, and it is therefore crucial to train those who provide health care to children to recognize it.
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PMID:Child abuse: an underestimated health problem? A case report from Cameroon. 2741 83