The effects of maternal haemoglobin as an indicator of maternal nutritional status on, maternal measles antibodies of mother-infant pairs at birth.

BACKGROUND: Maternal measles antibodies (MMA) are actively transferred through the placenta from mother to foetus. A relationship could exist between MMA of mother-infant pairs and maternal nutritional indicator (haemoglobin). OBJECTIVES: This study reviewed the effects of maternal haemoglobin (Hb) on MMA of mother-infant pairs at birth. METHODS: One hundred and fifty three mother-infant pairs were enrolled in this study using the systematic random sampling method. Means of maternal Hb and MMA of mother-infant pairs were compared using the Student t test. Correlation coefficients of maternal Hb and MMA of mother-infant pairs were also determined. Multivariate analysis of variable (MANOVA) and covariates (MANCOVA) was used to investigate the effects of maternal Hb (fixed factor), gestational age, maternal age, birth weight (covariates) on combined MMA of mother-infant pairs (dependent factors). Benferroni adjusted Univariate linear regression was used to investigate the dependent variables separately. RESULTS: There were 78 (51%) males and 75 (49%) females. The (mean ± SD) MMA of mother-infant pairs at birth were 134.66 ± 93.31 (95% CI, 119.76 - 149.56) U/ml, and 187.49 ± 85.01 (95% CI, 173.91 - 201.07) U/ml, and their correlation was significant (p = 0.025). Ninety one (59.5 %) mothers had low Hb, 62 (40.5 %) had acceptable Hb levels. The overall mean maternal Hb was 11.01 ± 1.00 (95% CI, 10.85 - 11.17) g/dl . A positive significant correlation was observed between maternal Hb and MMA of the newborn-infant (p = 0.031). The MANOVA showed a statistically significant difference between maternal Hb on the combined dependent variables (p =0.033); however, results for the dependent variables using the Benferroni adjusted Univariate analysis was significant for only MMA of the infants, (p = 0.009). CONCLUSION: There was a significant association between aacceptable levels of maternal Hb and high MMA of the newborn-infants. Therefore, these newborn infants start out with higher MMA that could give them better protection against measles during infancy.

Passive measles immunity in a Nigerian tertiary health care facility: the influence of human immunodeficiency virus infection on measles antibody levels in mother-infant pairs at birth.

BACKGROUND: Infants are protected from measles infection by maternal measles antibodies (MMA). The level of these MMA at birth in newborn children depends on the levels in their mother and the extent of placental transfer. We investigated maternal HIV infection as a predictor of levels of MMA in mother-infant pairs in Maiduguri. METHODS: A total of 180 mother-infant pairs were tested for MMA between 15th January and 29th March 2010. Levels of MMA were measured using enzyme linked immunosorbent assay (ELISA) test. RESULTS: Fifteen (8.3%) mothers were found with HIV infection and all were on antiretroviral treatment for HIV, and all of them had protective MMA. Of these mothers with HIV infection, only one (0.6%) of their newborn infants had un-protective level of maternal measles antibody. Maternal measles antibodies in mother-infant pairs had significant correlation (p = 0.005) for both HIV-infected and HIV-uninfected groups. The mean MMA of the newborn children was lower in infants of HIV-infected mothers than in HIV-uninfected mothers (p = 0.37). Linear regression analysis showed no significant association between maternal HIV infection and MMA in mother-infant pairs (p = 0.72) for mothers and (p = 0.37) for newborn infants. CONCLUSION: Maternal HIV infection was not associated with significantly reduced MMA in mother-infant pairs, as high protective levels were evident in both mother-infant pairs at birth.

Recurrent generalized tetanus: a case report.

We describe recurrent generalized tetanus in a four-year-old unimmunized boy following recurrent suppurative otitis media (SOM) within an 11-month period. There are not many published reports on recurrent tetanus. We highlight the importance of both primary immunizations and the need for active immunization before discharge as the infection does not confer a lifelong immunity. The usefulness of booster doses of tetanus toxoid and missed opportunities for immunization are emphasized.

Clinical staging of HIV infection as a surrogate for CD4 count in HIV-infected children.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a major cause of infant and childhood mortality and morbidity; without treatment about 50% of them will succumb to HIV/AIDS before the age of two years. OBJECTIVE: to evaluate the usefulness of clinical manifestations of HIV infection as a surrogate for CD4 counts in antiretroviral-naive HIV-infected children. METHODS: newly diagnosed HIV-infected children, antiretroviral-naive attending a paediatric infectious diseases unit were enrolled. The clinical manifesta-tions, age, sex, and WHO clinical stage of each patient were determined. CD4 count and CD4% were estimated at presentation and correlated with various clinical manifestations of HIV disease. RESULTS: the study population consisted of 126 children, aged four months to 14 years with a mean of 3.2 ± 2.7 years and a male to female ratio of 1.2:1. Eighty-one percent of the children acquired HIV infection through mother-to-child transmission (MTCT). The CD4% was higher in infants (p < 0.000) and lower in children over five years of age. Eighty-six percent of them in stage 4 were children less than 24 months of age. CD4% showed a modest correlation with WHO paediatric clinical staging (r=0.62, p=0.002). Patients with lymphadenopathy (stage 1) had a high absolute CD4 count whereas patients with failure to thrive had a relatively low absolute CD4 count. CONCLUSION: WHO Paediatric clinical staging for HIV infection correlates with CD4% and can be used as a surrogate to CD4. CD4 count and CD4% vary with age and complications of the disease.

Study of hepatic functions and prevalence of hepatitis B surface antigenaemia in Nigerian children with human immunodeficiency virus infection.

BACKGROUND: HIV and hepatitis B virus (HBV) co-infected patients have a significantly increased risk of dying from liver disease especially after starting treatment with highly active antiretroviral therapy. We aim to determine the prevalence of hepatitis B surface antigenaemia in HIV-infected children and their significance in relation to hepatic functions. METHOD: Two hundred and eighty four HIV-infected children aged between 4 mouths to 15 years attending the Paediatric infectious disease clinic of University of Maiduguri Teaching Hospital (UMTH) Maiduguri, Nigeria from September 2007 to December 2007 were the subject for this study. Two hundred and seventy six HIV-negative children with served as age and sex-matched controls. They underwent investigations to evaluate the liver function (serum alanine transferase (ALT), alkaline phosphotase (ALP) and bilirubin) and the prevalence of hepatitis B surface antigen (HBsAg) using ELISA technique. RESULTS: Prevalence of HBsAg of 19% and 9.4% was observed among HIV-infected children controls (p = 0.004). Serum ALT and bilirubin concentrations were significantly higher in the HIV-infected group compared to the controls, (p < 0.05). HIV-infected children with HBs antigenaemia had significantly higher ALT and ALP concentrations compared to those without HBs antigenaemia (p < 0.05). CONCLUSION: These findings point to the high risk of HBV infection and continual paranchymal damage in HIV-infected children before commencing ART. Vaccination against HBV should eliminate this risk. Ideally HBV serology should be evaluated before starting ART to help guide therapeutic decision-making.

Prolonged Hospital Stay in Measles Patients

Background: Measles is still a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The burden of measles using length of hospital stay as a result of complications in hospitalised children with measles is reported. Methods: We carried out a two year retrospective study of children admitted with measles into the department of Paediatrics; University of Maiduguri Teaching Hospital. Results: Three hundred and nine children (11.2of Paediatric admission) aged 6-90 months (median 13 months) with a male: female ratio of 1.6: 1 were admitted with measles. Forty three (14) patients were aged less than 9-months. Seventy two per cent (223) of the subjects were not immunised against measles. Length of stay ranged between 4 and 32 days (mean; 8.7 days; median; 16 days) and total bed days were 3561 days. Forty per cent (124) of the measles admissions were for more than 14 days (prolonged hospitalisation). Infants and unvaccinated from low socio-economic class were more likely to have prolonged hospitalization. The most frequent complication associated with prolonged length of stay was bronchopneumonia (70.2). Two of the children suffered acute measles encephalopathy. Conclusions: Therapy for measles and its complications may be a major drain on medical care resources in this part of Nigeria; especially among young children who are unvaccinated and from low socio-economic class