For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.

A particularly severe epidemic of meningococcal meningitis (cerebrospinal meningitis, CSM) occurred in Nigeria between January and June 1996. There were 109,580 recorded cases and 11,717 deaths, giving a case fatality rate of 10.7% overall. This is the most serious epidemic of CSM ever recorded in Nigeria, and may be the largest in Africa this century. It took over 3 months and the combined efforts of a National Task Force set up by the Federal Ministry of Health, the WHO, UNICEF, UNDP, Médecins Sans Frontières, the International Red Cross and several other non-governmental organizations to bring the epidemic under control. The main control measures centred on active treatment of infected persons, mass vaccination and health education. The exact number of persons treated cannot be ascertained, but there were treatment centres in almost every Local Government Area in the affected States. A study of 1577 patients admitted at the Infectious Diseases Hospital, Kano, showed that 84% of those infected were aged < or = 20 years and that, for the first time, infants aged < or = 2 months were affected. Despite intervention, the case fatality rate of 9.1% among this group of patients was similar to the nationwide figure of 10.7%. Long-acting oily chloramphenicol proved highly effective in the treatment of patients, and its routine use in epidemic CSM is recommended. Over 13 million persons were vaccinated in the course of the epidemic. For the first time, cases of CSM were reported from States south of the 'African meningitis belt', suggesting an extension of the belt. The severity of this epidemic yet again underscores the need for a clear policy regarding control measures aimed at forestalling future epidemics. The availability of the recently developed polysaccharide-protein conjugate vaccine should facilitate a decision on mass vaccination for the prevention of epidemic CSM in Africa.

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This study was carried out in Borno and Plateau States of Nigeria to determine the baseline titre for the diagnosis of typhoid fever using a single Widal test. Of 172 patients with symptoms and signs of typhoid fever, 92.4% and 90.7% had reciprocal O and H antibody titres respectively of 160 or above. On the other hand, 95.3% and 66.3% of the 937 healthy control subjects had reciprocal O and H antibody titres respectively of 80 or less. The results of this study suggest that in Borno and Plateau States of Nigeria a reciprocal O antibody titre of 160 and above in persons with illness whose symptoms and signs are compatible with typhoid fever could be considered diagnostic using the single Widal test.

As urban expands into peripheral areas, peri-urban indigenous farmers lose their land and highly vulnerable to negative externalities of urbanization. The aim of the study is to assess the economic linkage between urban development and the livelihood of peri-urban farming communities, focus on current practice and policies. From Ethiopia, Amara regional state was selected. Through multistage sampling, five municipalities (Debra Birhan, Shewa Robit, Kombolcha, Dessie, and Woldia) were taken as the sample from Amara regional state. Interviews were conducted with 30 municipalities' officials of the selected town. Questionnaires collected from 200 respondents of peri-urban evicted farmers. As the findings of the study suggest, peri-urban farmers' evictions from their indigenous land for land redevelopment are the continuous process that negatively affects the livelihood of farming communities. The factors that contribute for urban expansion in Amara regional state are economic policy reform, the creation of enabling the environment for private investors, the unsatisfied demand of urban dwellers for residential, and expansion of public sector projects. A collaborative effect of policy limitations, potential conflicts, unplanned livelihood, and poor saving habits of peri-urban farmers, lack of municipality intervention and lack of good governance negatively affect the livelihood of peri-urban farmers and jeopardize the image of government. The forwarded solutions are municipalities should have fully implemented urban policies, should have work on mutual benefits of concerned stakeholders, farmers' background should be recorded and continuous follow up of evicted farmers livelihood should be practiced.

Children with acute Plasmodium falciparum malaria and anemia were investigated to see if immunological factors could be implicated in the pathogenesis of their anaemia. Direct Coombs tests using an anti-whole immunoglobulin antiserum were negative in all 12 children tested but two had positive tests with antisera to C3b and C3d. Low plasma levels of C3 and C4 were found but these were not significantly different from values found in a group of children with acute malaria who were not anaemic. Serum levels of immune complexes were normal at the time of their presentation at hospital with anaemia but were elevated one month later. Incubation of group O rhesus-negative red cells in a serum pool obtained from children with acute malaria and anaemia did not cause enhanced haemolysis or reduce their survival time on injection into mice. Splenic uptake of red cells was, however, significantly enhanced. We conclude that the anaemia of acute malaria is due mainly to destruction of red cells by malaria parasites and to enhanced erythrophagocytosis of normal cells.

SUMMARY Abnormal 1251-Clq-binding activity was found in the sera of 94% of 55 haemophiliacs. Sera from 66 % of these patients inhibited macrophage uptake of labelled aggregated human IgG in a competitive radiobioassay. These (Thompson et al., 1973;Potter et al., 1973), autoantibodies (Doniach et al., 1966;Thompson et al., 1973), increased Clq-binding and anticomplementary activity (Thomas et al., 1976), and increased C3 turnover . This study was undertaken to evaluate some immunological parameters in a population of haemophiliacs, many of whom, while entirely asymptomatic, have persistently abnormal liver function tests. Received for publication 26 May 1977Patients and methods Fifty-five patients attending the Royal Free Hospital Haemophilia Centre were investigated. The mean age was 30 years, 20 being under and 35 over the age of 20 years. Fifty-three were deficient in factor VIII (haemophilia A) and two were deficient in factor IX (haemophilia B). Thirty-four were severe cases (factor VIII or IX under 2 %), 11 moderately severe (2-5 %), and 10 mild (more than 5%). Seven patients had antibodies to factor VIII.Information about the type of therapeutic material given and the total number of factor VIII or IX units infused during the six months immediately before the study was available for 45 patients. Cryoprecipitate was used alone in 27 patients, factor VIII or IX concentrate alone in five patients, while 11 patients had not received any blood product during this period. All patients, however, had been previously exposed to therapeutic materials containing factor VIII or IX. Patients were tested at least 24 hours after the last dose of factor VIII or IX.

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