Evaluation of the Effectiveness of the Prevention of Mother-to-Child Transmission (PMTCT) Interventions in HIV-Exposed Children

Background: Mother-to-child transmission of HIV can be reduced by interventions targeted at the mother during pregnancy and at the baby after birth. Aim: To evaluate the effectiveness of the prevention of mother-to-child transmission (PMTCT) interventions in HIV-exposed infants presenting at the University of Port Harcourt Teaching Hospital; and to compare the level of interventions and outcomes at the UPTH-based programme with those elsewhere. Methods: An analytical cross-sectional study of HIV exposed infants aged 6 weeks-18 months presenting at the Paediatric HIV Clinic between November 2007 and June 2008. Information obtained included gender; age; antiretroviral drugs in pregnancy and at birth; place of antenatal care and delivery; method of delivery and feeding option. Infection status was determined by DNA PCR using dried blood spot (DBS) specimen. Results: A total of 294 children (139 males and 155 females; M:F ratio of 1:1.1) were seenwithin the study period; out of which 72 (34 males and 38 females; M:F ratio of 1:1.1) were positive giving an overall infection rate of 24.5. In 92 (31.3) mother-baby pair; there was no intervention and 53 (73.6) of the 72 babies that were infected were from this group whereas 63 (21.4) mother-baby pair received full PMTCT intervention and 1(1.4) was infected. The difference in the number of infected children in those who had no intervention and those who had at least one intervention was highly significant (?2 =41.55; p=0.00000). The transmission rates were 5.6; 7.7; 23.1and 50.4in babies delivered in UPTH; other full PMTCT implementing sites; partial PMTCT implementing sites and non-PMTCT implementing sites respectively.Conclusion: PMTCT interventions are highly effective in preventing HIV infection in exposed infants

Diarrhoea Management: an Evaluation of the Appropriateness of the Home Treatment Given by Caregivers

Background: Diarrhoea often starts at home. Early and appropriate treatment by caregivers will go a long way towards reducing the morbidity and mortality from diarrhoea. Aim: To document how acute diarrhoea is managed at home by caregivers and to determine the appropriateness of such treatment. Methods: A prospective study of children less than 5 years with diarrhoea attending the Diarrhoea Training Unit (DTU) and Children Emergency Ward (CHEW) of the University of Port Harcourt Teaching Hospital (UPTH) was conducted using a structured questionnaire administered to the caregivers. Results: A total number of 250 children were recruited for the study. Twenty-four (9.6) children had blood in stool (dysentery) while 226(90.4) had acute watery diarrhoea. Thirty-six (14.4) gave oral rehydration therapy (ORT) as the only home treatment; 60 (24.0) gave both drugs and ORT; while 151 (60.4) gave drugs alone and 3 (1.2) children received no treatment. The drugs given included antibiotics in 188 (89.1); adsorbents in 53 (25.1); antiemetic in 12 (5.7); antispasmodic in 8 (3.8); antihelminthics in 7 (3.3); and antacid in 6 (2.8). None of the cases with blood in the stool (dysentery) received the appropriate antibiotics. Parental education and social class did not seem to have an effect on the appropriateness of the care given to these children. Conclusion: Diarrhoea management at home is inadequate in terms of low utilization of oral rehydration therapy; inappropriate adminis- tration of antibiotics for cases with bloody stool; and unnecessary use of antibiotics/antidiarrhoeals for acute watery diarrhoea

Haematological Parameters and Haemoglobin Genotype in Maternal and Cord Blood Pairs in Port Harcourt; Nigeria

Background: The study was conducted to ascertain the pattern of haematological parameters and haemoglobin genotype in maternal and cord blood pairs in the Port Harcourt area of the South-South geopolitical zone of Nigeria. Methods: One hundred and three (103) postpartum women and their newborns were randomly recruited into the study. Five millilitres (5ml) of blood was taken from the mothers and their respective babies and analyzed for haematological parameters and haemoglobin genotype. Results: Haemoglobin concentration (Hb) in mothers was 10.90-14.45 g/dl (PCV; 32.42-43.92Hb in cord blood was 12.50-17.68 g/dl (PCV; 37.5-52.90). Average total white blood cell count (WBC) in mothers was 3.32-10.70 X 109/l and in cord blood; 4.10-13.10X109/l. Haemoglobin genotype revealed that AS was higher in maternal blood (17.5vs 4.8) while AA was higher in cord blood (94.2vs 82.5). Conclusion: The study adds to the data base of reference haematological values in Nigeria; especially the South-South zone and suggests that the frequency of the AS genotype may be undergoing a gradual reduction in subsequent generations as malaria is being controlled makings its relative advantage less important. Testing of prospective couples and counselling of AS individuals is still very important

Foreign Body Ingestion in a Neonate

Background: Foreign body ingestion is a very common event in the paediatric age group. There are however very few reports of foreign body ingestion in neonates. Aim: To report a case of ingestion of foreign body in a neonate. Case report: A neonate with thumb tack ingestion presented with respiratory distress. She had an emergency tracheostomy and subsequent extraction of the foreign body. She was extubated after four days and was discharged on the eighth day in good clinical condition. Conclusion: Foreign body ingestion in the neonate although very uncommon is possible. Paediatricians should therefore remember that an oesophageal foreign body may be a possible cause of respiratory distress in a neonate