Serum selenium status of HIV-infected children on care and treatment in Enugu, Nigeria

Objective. To compare the selenium status of HIV-infected and HIV-uninfected children. Methods. This was a hospital-based comparative study using a structured questionnaire in the quantitative research domain at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria. Seventy-four HIV-infected children were compared with 74 non-HIV-infected children (35 males and 39 females in each group). The outcome measure was the selenium status of the study participants. Results. The mean (standard deviation (SD)) weight-for-height z-score among the subjects was ­0.18 (1.53) compared with 0.05 (1.68) among the controls (p=0.457). The mean (SD) height-for-age z-score among the subjects was ­1.16 (1.44) compared with 0.06 (1.06) among the controls (p<0.001). Eighteen subjects (24.3%) compared with eight controls (11.4%) were selenium deficient (odds ratio 2.49; 95% confidence interval 1.00 - 6.18; p=0.044). Median CD4 counts of selenium-deficient and non-deficient subjects were 765.5 (range 409 - 1 489) and 694.0 (range 85 - 2 196) cells/µL, respectively (p=0.321). The proportions of selenium deficiency were 26.4% and 22.2% in the highly active antiretroviral therapy (HAART) and pre-HAART groups, respectively (p=0.565). Conclusion. There was a significant difference in the proportion of HIV-infected children who were selenium deficient compared with their uninfected counterparts

Outcomes of Paediatrics HIV care at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu after ten years of service

Background: Antiretroviral therapy is associated with improved survival among HIV-infected children. In Nigeria, HIV treatment scale up was extended to children over a decade ago. This poses new challenges of sustained quality care. Aim: To determine the outcomes for HIV infected children and factors that influenced retention in care at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu.Methods: This was a study of HIV-infected children seen between September 2004 and October 2015 and at the Paediatric HIV clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. Data collected include socio-demographics, HAART regimen and outcomes. Data analysis were done with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL).Results: Five hundred and nineteen of 555 enrolled children with complete data were included in the data analysis. Two hundred and sixty-seven (51.4%) were females. Three hundred and thirty-nine participants (65.3%) were still in care, 12345 (23.7%) had been lost to follow up, or 22 (4.2%) dead while 35 (6.87%) were transferred out to other health facilities or into the adult ART clinic. Factors associated with retention in care were both parents being HIV positive (p<0.0001), commencement of HAART (p<0.0001) and HIV disclosure status of the child (Fisher's exact Test =0.003).Conclusions: About a quarter of our HIV-infected children were lost to follow up. Prompt initiation of HAART and HIV disclosure will positively influence retention in care

Clinical and Laboratory Profile of ARV Naive HIV Infected Children in the Era of Highly Active Anti-retroviral Therapy in Enugu, South-East Nigeria.

Background: HIV/AIDS is one of the most dynamic epidemic infectious diseases. An estimated 1000 children are newly infected with HIV every day, most of them in sub-Saharan Africa. They often present with various clinical and laboratory manifestations that complicates their management. Objectives: To determine the baseline clinical and laboratory features of HIV-infected children presenting at the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla. Methods: Clinical and laboratory data were collected from HIV infected children seen at the Pediatric HIV Clinic of UNTH between July 1st 2010 and June 30th 2012. Clinical and immunological staging of the patients were done using the WHO criteria and data analysis was with SPSS version19. Results: Two hundred and ten children were enrolled into the study. The most common route of HIV infection was vertical transmission (95.2%). Common presenting clinical and laboratory data were: anaemia (92.9%), cough (76.2%), fever (63.3%), popular rash (62.9%) and poor weight gain (61.0%). Thirty-four children (16.2%) each had severe and moderate acute malnutrition while 92 children (43.8%) were stunted. Tuberculosis, hepatitis B and C co-infections were seen in 32.4%, 1.9% and 3.3% of the children respectively. Most of the patients had either a WHO clinical stage III (42.4%) or II (39.0%) disease. Severe immunosuppression based on CD4% or count was seen in more than half of the patients (59.1%). Conclusions: Anaemia was the most common clinical/laboratory finding; followed by cough. Although our patients were likely to present with WHO clinical 2 or stage 3 disease, severe immunological suppression was common.

Practice of Asthma Management among Doctors in South-East Nigeria

The major role of airway inflammation in childhood asthma has been recognised for more than a decade; and anti-inflammatory drugs now form the mainstay of treatment. In order to optimise treatment and achieve a better outcome; different guidelines have been introduced for asthma management. Examining the practice of the medical practitioners who manage asthma will help establish the gaps and provide informed advice on the current national and international guidelines. Our objective was to investigate the appropriate treatment of acute bronchial asthma by medical practitioners in south-east Nigeria. Two hundred and eighty-five doctors were interviewed using a structured questionnaire. Evaluation for differences in asthma management by doctors with different years of practice and heath facilities was carried out. Results were analysed with Epi info version 3.5. We concluded that management based on newer trends in childhood asthma management and adherence to management guidelines is less common among doctors that work in non-tertiary health facilities and among doctors that graduated more than 15 years ago or less than 5 years ago. This needs to be improved for optimal management of these patients. The need for regular continuing medical education for all doctors cannot be over emphasised