Antibody response to pneumococcal conjugate vaccine 10 among Nigerian children under 5 years.

Introduction: Invasive pneumococcal diseases have been a major contributor to childhood mortality, particularly in the developing world and pneumococcal vaccines were introduced to reduce the burden. The Pneumococcal Conjugate Vaccine 10 (PCV 10) was incorporated into the Nigerian National Programme on Immunization (NPI) in 2014 to reduce the incidence of childhood pneumococcal infections. This study was done to determine the immunogenicity of the vaccine in our clime. Methodology: This cross-sectional study was carried out between September 2019 and January 2020 at the Children Outpatient Clinic of the Federal Medical Center, Owerri, Nigeria. Two hundred and forty five children between the ages of 20 weeks and 59 months, who had received three doses of Pneumococcal Conjugate Vaccine 10 (PCV 10) at 6, 10 and 14 weeks according to the NPI schedule, were recruited into the study. The anti-pneumococcal PCV 10 IgG concentration was determined using Human Anti-Pneumococcal CPS 10 IgG vaccine ELISA Kit ®. Simple proportions, means and median (as appropriate) were used to analyse the data. Kruskal Wallis test and Spearman's correlation were done to test association. Significance was set as p< 0.05. Results: The mean anti-pneumococcal IgG concentration was 11.01±1.23 IU/ml and all the study participants formed protective levels of anti-pneumococcal IgG. There was a slight positive correlation between antibody response and age (r=0.13, p=0.04), and the antibody response was slightly more in males than females. Conclusion: All the children under the age of five years who had received PCV 10 at 6, 10 and 14 weeks of age, who participated in this study formed protective levels of antibodies to the vaccine. Antibody levels increased slightly with age. The PCV 10 currently used in the Nigerian programme is sufficiently antigenic and a downward trend in pneumococcal diseases should soon be noticeable.

Care of the Sick Newborn in a Cottage Hospital Level in a Developing Country.

INTRODUCTION: Neonatal morbidity and mortality are high in Nigeria. The establishment of more centers that could offer adequate management of high-risk pregnancies and neonates is essential. OBJECTIVES: This study seeks to describe sick newborn care at the cottage hospital level in Southern Nigeria with the aim of drawing lessons that may be useful to similar environments. SUBJECTS AND METHODS: A description of facility upgrading and staff training in perinatal care at a public-private partnership cottage hospital with a robust community health insurance scheme in Nigeria is made. A retrospective descriptive study of the morbidity and outcomes of admitted neonates in the facility between March 2016 and February 2017 was made. RESULTS: Out of 3630 babies born in the facility (302 per month), 189 were admitted, yielding an admission rate of 52.1/1000 live births. The main morbidities were neonatal hypoglycemia (32.4%), preterm low-birth weight (24.9%), neonatal sepsis (22.8%), and neonatal jaundice (12.7%). Sixteen of the 109 neonates died giving a mortality rate of 8.5%. The main causes of deaths were birth asphyxia (7 or 43.8%), meconium aspiration (6 or 37.5%), and congenital malformation (3 or 18.8%). CONCLUSION AND RECOMMENDATIONS: The neonatal admission and mortality rates are quite low in this cottage hospital and similar to the situation even in developed environments. This salutary scenario is probably due to good antenatal and perinatal care, and a robust community health insurance scheme which enhances services uptake and public-private partnership which engenders infrastructure expansion and maintenance. This model is recommended for the hospitals in our region.

Management of Epilepsies at the Community Cottage Hospital Level in a Developing Environment.

BACKGROUND: The epilepsy problem in much of Africa is characterized by stigmatization and neglect. This article describes the efforts at a cottage hospital level to ameliorate the epilepsy problem in a resource-limited environment. METHODS: A seizure clinic was started in a cottage hospital after targeted health talks. The International League against Epilepsy (ILEA)/World Health Organization (WHO)/International Bureau for Epilepsy (IBE) manual was adopted for the training of staff and to guide management. Patients were followed up in the clinic and with the use of simple information communication technology. RESULTS: Forty-five patients with ages ranging from 3 months to 42 years (who had lived with epilepsy for periods ranging from 3 weeks to 32 years) were registered over 12 months period. The most common seizure type was generalized tonic clonic (21 or 46.67%) followed by generalized clonic (8 or 17.78%). Ten (22.22%) had comorbidities mainly cerebral palsy (4 or 8.89%) and attention-deficit hyperactivity disorder (3 or 6.67%). Most (98.15%) were placed on carbamazepine. Twenty-three (51.11%) had complete control of seizures, 21 (46.67%) had reduced frequencies of attacks, and all 8 children who had dropped out of school resumed schooling. CONCLUSION: The epilepsy challenge in the developing world can be demystified and effectively managed at the cottage hospital level. Targeted health education, affordable management regimes, and committed follow-up are keys. A training manual based on the ILEA/WHO/IBE document should be developed for Africa.

Sonographic Diagnosis and Clinical Correlates of Gallbladder Stones in Patients with Sickle Cell Disease in Calabar, Nigeria.

BACKGROUND: Sickle Cell Disease (SCD) causes chronic haemolysis which is a risk factor for cholelithiasis. AIM: To determine the prevalence and clinical correlates of cholelithiasis in SCD patients in steady state treated at the University of Calabar Teaching Hospital. METHODS: This was a prospective study that took place at the Haematology and sickle cell disease clinics, University of Calabar Teaching Hospital, Calabar, Nigeria between January and June 2018. The study population were aged between 1.5-5.5 years and confirmed to have SCD through haemoglobin electrophoresis. A brief history was obtained, and all the patients had a physical examination. Ultrasound examination was performed using a B-mode mind-ray ultrasound machine using a 3.5-5.0 MHz probe after an overnight fast. A Calculus is diagnosed when a highly echogenic structure casting a concrete shadow is detected in the lumen of the gallbladder. RESULTS: One hundred and twenty confirmed SCD patients aged between 1.5-55 years were recruited in the study, 69 (57.5%) were males, while 51 (42.5%) were females. The overall prevalence of cholelithiasis was 10%, and it increased with age. The youngest patient with cholelithiasis was 13 years old. All the patients were asymptomatic at the time of examination. At the multivariate level, age, gender, weight and gallbladder volume were associated with gallbladder stones. CONCLUSION: The prevalence of cholelithiasis in patients treated at the Sickle Cell Clinic at the University of Calabar Teaching Hospital, Calabar is fairly high. The patients were largely asymptomatic, and cholelithiasis is more common in females than males. This study showed a weak association between blood transfusion and gallbladder stone. It is recommended that routine abdominal ultrasound scan for gallbladder be done for SCD patients from the second decade of life in our environment.

How to Improve Eating Behaviour during Early Childhood.

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

Hematological indices in febrile neonates with malaria parasitaemia in Calabar.

BACKGROUND: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis. AIM: To determine the hematological indices in febrile newborn with malaria parasitemia. MATERIALS AND METHODS: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14. RESULTS: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization. CONCLUSION: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Lung function indices of children exposed to wood smoke in a fishing port in South-South Nigeria.

Children in the warm rain forest are at risk of having their lung function compromised by a variety of factors, including smoke from wood fires. A total of 358 children from a fishing port and 400 children living in a farm settlement were tested to determine their peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory volume in 1 s per cent and forced expiratory flow between 25 and 75%. The values for the PEFR, FVC, FEV1, forced expiratory volume in 1 s per cent and forced expiratory flow between 25 and 75% of the subjects were significantly lower than those of the controls (P value for males = <0.001, 0.01, 0.002, 0.01 and <0.001, respectively, whereas for their female counterparts = <0.001, 0.003, 0.001, 0.04 and <0.001, respectively). These deficits were observed to be more with increasing duration of exposure to wood smoke for PEFR, FVC and FEV1. Chronic exposure to fish drying using firewood can impair lung function in children. There is a need for alternative methods of fish preservation for those engaged in fish drying.