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A high incidence of protein energy malnutrition (PEM) was found in a community survey of preschool children in rural northern Nigeria among whom gastro-enteritis is common. Wasting (less than 80% Weight/Height) was more common (37.9%) among those with scanty, unprotected water supplies than in those with copious protected water (10.2%) whereas the incidence of stunting (less than 90% Height/Age)) was similar. Severe coliform contaminatin of all water sources was demonstrable. Even higher numbers of coliforms in foods sampled suggests that other factors related to water supply may be more important than water purity in the genesis of the PEM/gastro-enteritis complex.

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.

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