Challenges of Malaria Diagnosis in Paediatric Patients at a Nigerian Hospital.

Aims: This study compares the performance of routine malaria diagnostic tests, and explores the challenges of malaria diagnosis in paediatric patients in an endemic setting in South West Nigeria. Study Design: Cross sectional study Place and Duration of the Study: The study was conducted at the children’s outpatient and emergency units of the University College Hospital, Ibadan, Nigeria. Patients seen between May and August, 2013 were enrolled in the study. Methodology: The records of all 532 children aged six months to12 years who received treatment for an acute febrile illness at the hospital during the study period were reviewed. The proportion of children classified as having malaria by clinical diagnosis, Rapid Diagnostic Test (RDT) and blood smear microscopy were compared. Factors associated with test positivity were explored using multivariate analysis. Results: By clinical diagnosis 45.2% of children were diagnosed as having malaria, 37.6% tested positive to malaria parasite on RDT and 19.3% had positive blood smears on microscopy. Logistic regression showed that with RDTs, younger children were less often found to be positive than older children [OR: 0.594 (0.401-0.879)]. A similar lower probability of positivity was found for younger children on microscopy [OR0.624 (0.391-0.996)]. Positive smears were however recorded 3.9 times more often for those who gave a history of fever compared to those who did not [OR: 3.882 (1.154- 13.057)]. Conclusion: The true malaria morbidity among these paediatric patients remains questionable due to the differences in the results produced by the different diagnostic methods. The clinical implication of RDT-positive but microscopy-negative samples may be grave if microscopy results are erroneous. Quality control systems and surveillance of routine malaria diagnostics are imperative to limit misdiagnosis of malaria in this endemic setting.

Comparative Weight Gain with Ready-to-Use Therapeutic Food in Stunted HIV-Infected and -Uninfected Children in a Nigerian Hospital

Objective. To bridge the management gap between nutritional rehabilitation for severe acute malnutrition (SAM) and chronic malnutrition; this study investigated to what extent ready-to-use therapeutic food (RUTF) promotes growth in children with long-term nutrition deficit with superimposed SAM. Methods. A total of 225 (164 HIV-negative and 61 HIV-positive) chronically malnourished children (aged 6 - 60 months) with superimposed SAM were enrolled. Children were provided 92 g packets of an RUTF; Plumpy'Nut; based on an estimated requirement of 200 kcal/kg body weight (BW)/day. Children were fed Plumpy'Nut over a 2-week period; and weight was assessed weekly. Weight gain was compared for HIV-positive children and HIV-negative children.Results. On day 15; the HIV-positive group had a median weight gain of 645 g compared with 670 g in the HIV-negative group (difference 25 g; p=0.784). Similarly; rate of weight gain per kilogram BW per day was comparable for both groups of children (13.2 g/kg BW per day for HIV-negative children v. 11.9 g/kg BW per day for HIV-positive children; p=0.353). On day 15; the proportions of HIV-positive and HIV-negative children who had sustained weight gain were not significantly different. Conclusion. Chronically malnourished children with superimposed SAM benefit from the use of RUTF as much as children without chronic nutritional deprivation; regardless of HIV status

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH); Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these; 51614 (99.5) accepted HIV test and 49134 (95.2) returned for their results. Out of the tested patients; 2152 (4.2) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361(16.7) with 87 (18.6) testing positive. There were a total of 942 deliveries out of which 39.2of the mothers and 95.2of the babies respectively received ARV prophylaxis. In all; 85.8(788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing; 68.3reported for the test and 17(8.7) tested positive. There has been progress in the programme; reflected in the increase in the number of new clients accessing the PMTCT service. However; partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention