Usefulness of rapid diagnostic test in the diagnosis of asymptomatic malaria in HIV infected children on cotrimoxazole prophylaxis in Benin City, Nigeria

Background: Rapid diagnostic test (mRDT) is a useful tool in demonstrating parasitologically proven malaria. Its efficacy is however hampered when parasite density is low. Prophylactic use of cotrimoxazoleas in cases of HIV infected children can cause reduction in parasite count. It is doubtful if mRDT will retain its diagnostic usefulness among such individuals.Objectives: The study sought to evaluate the diagnostic value of mRDT in HIV infected children on cotrimoxazole prophylaxis in Benin City.Methods: In the prospective, cross sectional and descriptive study, we assessed malaria parasitaemia using standard methods in microscopy and parasite density and malaria antigenaemia using Care Start Pf (monoclonal antibodies specific to histidine rich protein ­ 2 antigen) in 221 each of HIV infected subjects on cotrimoxazole managed in a specialist clinic and HIV negative controls all seen at the University of Benin Teaching Hospital between April and June 2016.Results: Malaria antigenaemia rate MAr (20.8%) was lower than malaria parasitaemia rate MPr (24.4%) in subjects. MAr (20.8) and MPr (24.4%) in subjects were higher than MAr (18.10%) and MPr (17.7%) in controls. Mean (SEM) parasite count in subjects of was low (50.88 + 2.24 per µl). Using microscopy as gold standard the sensitivity, specificity, PPV and NPV of mRDT in subjects were 77.8%, 97.6%, 91.3% and 93.1%. Corresponding values in controls were 100.0%, 99.5%, 97.5% and 100.0%. Youden indices for subjects and controls were 0.75 and 0.99. Conclusions/Recommendations: Sensitivity of mRDT in HIV infected children on cotrimoxazole prophylaxis for opportunistic infections (OI) is reduced. However, the indices of specificity, PPV and NPV are high enough to retain its value in the evaluation of HIV infected children for asymptomatic malaria and perhaps the clinical disease

Evaluation of adolescent medicine sub-specialty training in Nigeria: trainees' perspectives

Objective: To evaluate the extent of coverage of curriculum contents pertinent to Adolescent Medicine; as well as the adequacy of facilities and professionals in Nigeria using residents' viewpoint. Design: A descriptive cross-sectional study. Setting: The Intensive Course in Paediatrics of the National Post-graduate Medical College of Nigeria at the University of Benin Teaching Hospital; Benin City Nigeria. Subjects: One hundred and three paediatric residents from training institutions in all zones of the country. Results: Altogether;68.0% and 32.0% of the participants were from Southern and Northern geopolitical zones respectively. Only 14% of them stated that a rotation in an AM unit is a part of training in their centres. None specified its duration. Coverage of AM topics; physical facilities and trainers were rated as inadequate by 77.0%; 82.8% and 70.8% of the respondents respectively. Residents from north were more likely to rate interview/ confidentiality in AM as covered (either partly or well) than their colleagues from the South; (p 0.01; OR= 5.3, 95% CI = 1.5-19.5). We found no difference between federal and state residents' perceived adequacy of AM training. Conclusion: AM in paediatric residency programme in Nigeria is still an unmet challenge. There is a need for a revision of the training curriculum to specify mandatory duration of clinical rotation in AM units

The Prevalence and Antibiogram of Esherichia Coli from Clinical Specimens of Superficial Wounds; High Vagina and Antral Washouts in University of Benin Teaching Hospital; Benin City; Edo State

This study seeks to determine the prevalence of recovery of Escherichia coli from clinical specimens of superficial wounds; high vagina and antral washouts. This study which was prospective and cross-sectional involved six hundred and sixty eight (668) participants who were patients seen at the various facilities in the hospital. Males were two hundred and forty (35.9) Females were two hundred and twenty eight (34.3) while children were two hundred (29.9). Specimens of wounds; aspirates and high vagina were cultured on chocolate; blood and McConkey and Eosin methylene blue agars. Specimens on blood agar were incubated both aerobically and anaerobically for 24hrs. Isolates were identified by their colonial morphology and biochemical reactions and tested for sensitivity. Escherichia coli isolates demonstrated strong resistance to some of the antibiotics while they showed moderate sensitivity to ceftazidime; ofloxacin; clarithomycin and amoxicillin clavulanate. The increasing resistance of Escherichia coli to the commonly used antibiotics in the community is a cause of concern; and measures were suggested for effective resistance control

Predicting Urinary Tract Infection in Malaria Co-Morbidity among Under Fives

Fever presenting in children less than 5 years of age in malaria endemic areas will almost always be treated as cases of malaria. However fever is a common feature to other childhood illnesses including ARI and UTI. Besides; malaria is known to co-exist with these other morbidities including UTI. Undiagnosed and poorly treated UTI can lead to immediate and long term sequelae. Reliance on clinical features for the identification of presence of the co-morbidity could be quite tasking in the absence of discriminatory features. This work was meant to evaluate children less than 5 years of age presenting with fever (without localising signs) for discriminatory features (if any) for malaria; UTI co-morbidity. This was a prospective and cross sectional study carried out between June and August 2006. The study involved well nourished under fives with parasitologically proven malaria seen at the Children's Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH) Benin City. The presence of UTI was evaluated in this cohort using urinalyses; microscopy and culture. Of the 300 children evaluated; 27(9) had UTI-malaria co-morbidity. There was paucity of known symptoms or signs of UTI in those with the co-morbidity. The clinical features of abdominal pain; vomiting; irritability; showed very low sensitivity while the same features had high negative predictive values with respect to the presence of the co-morbidity (67.40). Tachycardia and tachypnoea also had very low sensitivity with regard to detecting the child with the co-morbidity. However; the features occurred significantly more in children without the co-morbidity. In conclusion; malaria-UTI co-morbidity occur frequently (in 1 out of every 10 children under 5 years of age with presumed sole diagnosis of malaria) to warrant the evaluation of such children; if the long term sequelae of undiagnosed and poorly treated UTI are to be minimized

Community survey of attention-deficit/hyperactivity disorder among primary school pupils in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neuro-developmental condition with early onset. ADHD affects children worldwide. However, there is a variation in the prevalence across different countries. In Nigeria, there is paucity of information on the prevalence. To provide the relevant information, a cross-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6-12 years selected systematically among pupils in Egor Local Government Area of Edo State. Materials and Methods: All the 1473 pupils were screened with the Disruptive Behavior Disorder (DBD) Rating Scale to identify children who had ADHD symptoms as contained in the DSM -IV. Such children were compared with randomly selected controls. The academic records of both the groups were also compared. Results: The prevalence of ADHD was 7.6%. The prevalence was higher in boys (9.4%) when compared to girls (5.5%) (P = 0.003). Of the three different subtypes of ADHD, the predominantly inattentive subtype (ADHD-I) was the most prevalent (47.3% of the ADHD population) followed by the combined type (ADHD-C; 31.3%), while the least prevalent was the hyperactive/impulsive subtype (ADHD-HI; 21.4%). There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. Conclusion: The prevalence of ADHD was relatively high when compared to the figures available for other countries. For this reason, there is a need to pay increased attention to this condition in Nigeria. Community screening under the umbrella of the School Health Program could be of assistance