Prevalence of cryptosporidium infection among undernourished children in Jos, Central Nigeria.

This prospective study aimed at determining the prevalence data of Cryptosporidium infection in undernourished children, its seasonality and its relative frequency in diarrhoeic stool in Jos, Central Nigeria. One hundred and seventy each of undernourished and well nourished children aged 0-5 years were recruited into the study. Stool samples and clinical data were obtained using questionnaires. Results were analysed using Chi-square test. The prevalence of the infection was found to be 4.8% and all infections occurred in diarrhoeic stool. No infection with this pathogen was recorded in the well-nourished group. There was a defined seasonality of the infection. The high prevalence suggests the importance of introducing routine screening of this group of patients for cryptosporidium infection to facilitate their management.

Circulation of the novel G9 and G8 rotavirus strains in Nigeria in 1998/1999.

An epidemiological survey investigating the prevalence of rotavirus infection in infants and young children with acute diarrhoea was undertaken in Jos State, Nigeria, between January 1998 and April 1999. In total, 672 faecal specimens were collected from children aged between 1 and 60 months with acute infantile gastroenteritis. The 10-20% stool suspensions were examined by an ELISA for the presence of group A rotavirus antigen (Rotavirus IDEIA, Dako, UK). Only 116 specimens (17.3%) were positive for the group A rotavirus antigen detected by this ELISA. The rotavirus-positive specimens were analysed with monoclonal antibodies specific for rotavirus VP6 subgroup I and II, and for VP7 serotypes G1-G4, G8, and G9. Of the rotavirus strains that could be subgrouped, VP6 subgroup I and II strains circulated at similar levels. Amongst the strains that could be serotyped, VP7 G9 strains predominated occurring in 17 cases, with G3 (n = 10) and G1 (n = 9) strains occurring in lower numbers. Four G8 strains were detected and only one G2 and no G4 strains were identified. This report extends the description of the global distribution of G9 rotavirus strains.

Predominant bacterial agents of childhood septicaemia in Jos.

Blood cultures were performed on 891 children (aged 1 month-16 years) who presented at the Jos University Teaching Hospital (JUTH) with presumed diagnosis of septicaemia, over a three year period (January 1994-December 1996) in order to determine the predominant bacterial agents. One hundred and thirty-nine (15.6%) out of 891 blood cultures were positive. Five of the blood cultures yielded double isolates. Staph. aureus was the commonest bacterial agent isolated and accounted for 36.0%, of all the isolates. Klebsiella spp and Salmonella spp each accounted for 18.7% and 15.8% respectively. Other bacterial agents isolated included E. coli 7.9%, coliforms (untyped) 6.5%, Pseudomonas spp 3.6%, Proteus spp 2.2% and, miscellaneous organisms 9.3%. Ninety-six percent, 84.0% and 81.0% of Salmonella spp., Staph. aureus and Klebsiella spp. isolated were sensitive to gentamicin respectively. Forty percent of the Staph. aureus isolated was resistant to cloxacillin. Two (1.7%) of the Staph aureus isolated were resistant to all the antibiotics tested. With the exception of Pseudomonas spp (80.0% sensitive only to ceftazidime), sensitivity of most of the organisms to the third generation cephalosporins was generally excellent. It is concluded that gentamicin remains an effective drug in childhood septicaemi. Although the sensitivity to the third generation cephalosporins remains excellent, these drugs should be reserved for life-threatening cases and those that fail to respond to initial therapy with gentamicin.

Lack of association between some risk factors and hepatitis B surface antigenaemia in children with sickle cell anaemia.

The risk factors for transmission of Hepatitis B virus (HBV) as well as the relationship between HBs Antigeneamia and some socio-cultural factors including socio-economic status of the families of the children, tribe, religion, rural or urban domicile and the number of persons per bedroom, were studied among 507 children with sickle cell anaemia (SCA) and 501 controls at the Jos University Teaching Hospital (JUTH). Twenty-three percent (22.7%) of the children with SCA were HBsAg positive compared with 19.6% among the control group. None of the risk factors studied, including blood transfusion, parenteral injections, intravenous infusions, hospitalization, ulcers, traditional uvulectomy, surgery, contact with case of known hepatitis, mass immunizations, circumcision, ear piercing and traditional scarifications was significantly associated with HBV infection in both children with SCA and control group and also between children with SCA compared with controls. There was also no association between HBs Antigenaemia and the number of blood transfusions, intravenous infusion or hospitalization in both children with SCA and controls. Similarly, there was no association between the socio-cultural factors studied and HBs Antigenaemia. The result of this study suggests that HBV infection is common in children in this environment and other factors yet to, be identified may play a very important role in the transmission of HBV infection. The high prevalence of HBsAg obtained in both children with SCA and controls, and the lack of identifiable association between the risk factos studied and HBsAntigenaemia suggest that these children may have equally been exposed earlier in life.

Changing patterns of antibiotic sensitivity and resistance during an outbreak of meningococcal infection in Jos, Nigeria.

Isolates of Neisseria meningitidis from blood and cerebrospinal fluid (CSF) of 87 children admitted to the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) during an outbreak of meningococcal infection (between February and April 1996) were tested against the commonly used antibiotics in an attempt to determine the sensitivity and resistance pattern. There were 11 (15.1 per cent) positive for N. meningitidis out of 73 blood cultures and 61 (70 per cent) positive out of 87 CSF cultures. Seventy-seven and thirty-eight per cent respectively of the CSF isolates were resistant to benzylpenicillin and ampicillin. Sensitivity to chloramphenicol and erythromycin was 97 and 95 per cent, respectively. Out of the 11 positive blood cultures, 82 and 27 per cent were resistant to benzylpenicillin and ampicillin, respectively, while all the isolates (100 per cent) were sensitive to chloramphenicol and erythromycin. It is concluded that in view of the high level of resistance of the meningococci to benzylpenicillin in our environment, this drug should no longer be the drug of choice for the empirical and initial treatment of meningococcal infection. We recommend that chloramphenicol be the drug of choice for the empirical and initial treatment of meningococcal infection in our environment.

Paediatric AIDS in Jos, Nigeria.

A retrospective study of all children admitted with the diagnosis of acquired immunodeficiency syndrome (AIDS) at Jos University Teaching Hospital (JUTH) between August 1995 and October 1996 was carried out. Forty three (1.5% out of a total of 2793 children were diagnosed with HIV infection during the study period. However, only the records of 23 out. Of the 43 positive cases were available for analysis. Of the 23 cases whose records were available, 8 presented in 1995, while the remaining 15 presented between January and October 1996. The ages of the children ranged between 1 and 15 years (Mean 3.0 +/- 4.1 Years). There were 12 males and 11 females (M:F = 1:1). Sixteen (69.6 percent) out of the 23 patients were aged between 1 month and 2 years. Sixteen (69.6%) of the 23 patients acquired the infection vertically, 2 (8.9%) acquired the infection through blood transfusion, 1 (4.3%) from sexual abuse, while in 4 (17.4%) the source of infection could not be established due to inadequate data. Majority of the children presented with weight loss, chronic diarrhoea and fever, while the common findings included wasting, oralthrush, pallor, hepatosplenomegaly and lymphadenopathy. Six (26.1 percent) out of the 23 children died, 8 (34.8 percent) were discharged against medical advice and have not been seen since, 9 (39.1%) improved and were discharged to out-patient clinic followup, but all except 2 of these have been lost to follow-up. It is concluded that AIDS is increasingly becoming a major cause of childhood morbidity and mortality in our environment. All children in our environment who present with features of malnutrition should be screened for AIDS. Campaigns aimed at preventing vertical (maternal-child) transmission, including health education of young men and women on the risk of unprotected sex must be vigorously pursued and sustained.

Human Group C rotaviruses identified in Nigerian children.

A survey investigating the prevalence of rotavirus infection in infants and young children with acute diarrhoea was undertaken in Jos State, Nigeria during the first half of 1998. In total, 182 faecal specimens were collected from children aged between 1 and 60 months with acute infantile gastroenteritis. Examination with a commercial ELISA assay for the presence of group A rotavirus antigen revealed 16 specimens positive for this antigen. However, examination of the double stranded RNA of the viral genome by polyacrylamide gel electrophoresis showed the presence of three human group C rotaviruses. This is the first report of group C rotaviruses in Nigeria and West Africa.

Clinical predictors of epidemic outcome in meningococcal infection in Jos, Nigeria.

The clinical predictors of outcome in children admitted into the Emergency Paediatric Unit at the Jos University Teaching Hospital with meningococcal infection during an out-break of the disease (between February-April 1996) were studied. Eighty seven children were admitted with meningococcal infection during the period. There were 60 males and 27 females (M:F = 2.2:1), aged between five weeks and 16 years (mean 7.7 +/- 4.9 years). Overall mortality was 26.4 per cent. Eighty five per cent of the patients who presented in shock died, compared with nine per cent who presented without shock (p < 0.000001). Similarly, 65% of the patients who presented in coma died, compared with 12.5% who did not present in coma (p < 0.000001). Other factors associated with a poor outcome included age one year and below, petechial/purpuric rash on presentation and meningococcaemia. Complications were documented in 27 (31.0%) of the patients, consisting mainly of deafness, extensive vasculitis/ulceration of extremities, gangrene of legs hemiparesis and cranial nerve palsies.

Clinical pattern and outcome in children with acute severe falciparum malaria at Jos University Teaching Hospital, Nigeria.

A prospective study was undertaken to determine the clinical pattern and outcome among children admitted with acute severe malaria into the emergency paediatric unit (EPU) at the Jos University Teaching Hospital (JUTH) over a 15-month period (between August 1991-October 1992). Five hundred and one (25%) children were admitted with acute severe malaria, out of a total of 2008 admissions into the EPU during the study period. Blood smears for malaria parasites were positive in 287 (57.7%) of the children and P. falciparum was the only species identified in the study. Seventy one percent of the children admitted were aged 5 years and below. Febrile convulsions was the commonest manifestation of acute severe malaria, accounting for 49.7% of the cases. Majority (97.8%) of the children responded satisfactorily to chloroquine therapy with clearance of parasitaemia. Associated bacteraemia was documented in 35 (7%) of the 501 children. Sixteen out of the 501 children died, giving a mortality of 3.2%. Cerebral malaria, which accounted for only 17.6% of the admissions, was responsible for 56.3% of all the deaths. Mortality was also associated with hypoglycaemia, severe anaemia, shock and repeated, prolonged seizures.