Pregnancy Outcome of ART-experienced and ART-naïve HIV-infected Mothers at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background:Untreated maternal Human Immunodeficiency Virus (HIV) infection is associated with adverse pregnancy outcome including preterm birth, low birth weight, and mother-to-child transmission of the virus. This study aimed to compare the pregnancy outcome between HIV infected mothers who received ART in pregnancy and those who were ART-naïve. Methods:A cross-sectional study of HIV-infected mothers who brought their infants for follow up between November 2007 and May 2017 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.Relevant information obtained include: time of diagnosis, antiretroviral therapy (ART) regimen and when it was commenced, gestational age at delivery and birthweight of child, mode of delivery, infant feeding option and ARV prophylaxis. Infection status of the infant was determined by DNA PCR at 6weeks of age. Based on when ART was commenced, mothers were grouped into three [(HAART experienced (HE) if ART was started before pregnancy, HAART in pregnancy (HIP) and HAART naive (NH) if no HAART was taken in pregnancy].Main outcome measures were rates of prematurity, low birth weight, mean birth weight, birth defects and mother-to-child transmission Result:A total of 1,640 HIV-exposed infants were seen (716(43.6%) in HE, 360(22.0%) in HIPand 564(34.4%) in NH groups). There were 825(50.3%) males and 815(49.7%) females. Zidovudine/Lamivudine and Nevirapine/Efavirenz was the most frequently used combined ART in 724 (67.3%) mothers. The mean birthweight was 3.12±0.38Kg; range 1.2 –5.7Kg (3.11±0.58Kg in HE; 3.13±0.53Kg in HIP; 3.18±0.74Kg in NH) Table 3. A hundred and eighty (11.0%) babies were preterm [76(42.2%) in HE; 26(14.4%) in HIP; 78(43.3%) in NH](p=0.007), while 159(9.7%) were LBW [74(46.5%) in HE; 22(13.8%) in HIP; 63(39.6%) in NH](p=0.03). Fourteen (0.9%) babies had birth defects [5(35.7%) in HE; 9(64.3%) in HIP] (p=0.01). The commonest birth defects were neural tube defect 7(50%) and congenital heart defect 4(28.8%). Overall transmission rate was 21.4% [8% in the HE, 4.5% in HIP and 87.5% in NH groups] (p=0.001). The mean birth weights of uninfected babies were higher than their infected counterparts but was not significant (p>0.05).Conclusion:The benefits of early HAART in reducing mother-to-child transmissionmust be weighed against the risks of lower birthweight and potential teratogenic effects of drug exposure on the foetus

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

The Profile of Non-Communicable Disease in Patients Admitted into the Children's Medical Ward of the University of Port Harcourt Teaching Hospital

Background: The prevalence of non-communicable diseases (NCD) is increasing in recent years in low income countries in sub-Saharan Africa because of changing disease patterns following socioeconomic development. Nevertheless; communicable diseases (CD) still remain the predominant health problem. At present; non-communicable diseases are not a high priority in sub-Saharan Africa but the probability of death from a NCD is higher in sub-Saharan Africa than in the developed world. It is therefore important to know the existing disease burden due to NCD with a view to alerting policy makers and health workers of the trend of disease in our environment. Objectives: To determine the pattern of admission of paediatric patients seen at the children's ward of the University of Port Harcourt Teaching Hospital (UPTH) and ascertain the pattern of non communi- cable diseases. Methods: The study was retrospective and involved analysis of data from the admission records of the children's wards of the UPTH from February 2004-November 2005. Patients with non-communicable diseases were analysed for this study. Results: A total of two thousand four hundred and fourteen (2414) children were admitted during the period of study. Out of these; 479 (19.8) had non-communicable diseases consisting of 279 (58.2) males and 200 (41.8) females with a male: female ratio of 1.4:1. The top five non-communicable diseases were sickle cell disease (SCD) (17.1); malignancies (14.8); renal diseases (12.9); tetanus (10.2) and malnutrition (10.0). Conclusion: This study suggests a concomitant rise in NCD with four of them being among the top 10 disease burden when combined with communicable diseases. This poses a risk of a 'double burden' of disease which we cannot afford in our country which is fraught with poor government policies; poverty and poor funding of the health sector. Effective strategies are needed to control the risk factors for NCD

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

The Pattern of Communicable Disease in Patients Admitted into the Children Medical Ward of the University of Port Harcourt Teaching Hospital

Background: Open tibial fracture is a common orthopaedic challenge in Nigeria with adverse economic implications. The aim of study is to investigate the epidemiology of the problem.Methods: This is a prospective observational study of all open tibial fractures seen at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital (UPTH) over a twelve- month period (July 2002- June 2003). Data from a pre-designed proforma for the study was analyzed and descriptive statistics of the epidemiology is presented.Results: Seventy-two open fractures were seen in 70 patients. The male to female ratio was 2.5:1 and the peak age incidence was in the 20-29 years age group (38.6) followed by the 30-39 years agegroup (31.4). The extremes of age were least affected. Road accidents constituted most of the injuries (91.4); of which 51.5was motorcycle related. The passenger was the most at risk of injury (56.3). Gustilo and Anderson type III open injuries were the most frequent followed by the type II injuries.Conclusion: The burden of open tibial fractures in Nigeria is significant. Most fractures of the tibia are open and results from high-energy injuries. They are usually associated with other injuries; which are the major contributors to morbidity and mortality. Poverty and lack of social infra structures are contributory factors

Urinary Abnormalities in Children with Sickle Cell Anaemia

Background: Sickle cell anaemia (SCA) is a health problem worldwide. Almost all the organs of the body are affected by the combined effect of chronic hypoxia; repeated infarction and recurrent infections. Renal function may be progressively impaired in them as a result of sickling in the renal medulla. Microscopic hematuria; proteinuria; urinary concentrating defects; distal renal tubular acidosis and nephrotic syndrome are some of the renal abnormalities complicating SCA. The chronic nephropathy often seen in adults with SCA may actually have its onset in childhood.Objective: To find out whether children with SCA had significant urinary abnormalities. Method: Children with SCA in steady state (subjects) and healthy non-SCA children (controls) matched for age and sex were prospectively studied (using a dip-stick urinalysis) for significant proteinuria; significant haematuria; specific gravity and pH.Results: A total of 144 children were studied; seventy-two with sickle cell anaemia and the 72 others with HbAA (37 females and 35 males in each group).The ages of the children ranged from 16 months to 16 years. Significant proteinuria was seen in 5(7). Significant haematuria was also seen in 8(11) of the subjects. None of the controls had significant proteinuria nor haematuria. The mean serum creatinine level of the 13 children with s i g n i f i c a n t p r o t e i nu r i a / h a e m a t u r i a wa s 53.2 mol/L (range 42-65 mol/L). Defects in urinary concentrating ability was found in 13(18.1) and impaired urinary acidification in 50(69) of the subjects.Conclusion: Significant urinary abnormalities do occur in children with SCA. Urinalysis should therefore be done routinely for all children with SCA especially those older than five years as a screening test to detect at an early age any renal pathology