Non-specialized care of skin disorders: a cross-sectional survey of new patients attending dermatology clinic in a tertiary hospital in Jos, Northcentral Nigeria.

Background: Given the paucity of skin health specialists in Nigeria and the low level of awareness amongst its populace, patients seek for care for skin related disorders from different sources and are given a variety of remedies before accessing specialist care. Objectives: This study was aimed at describing outlets visited and medication received by patients with skin disorders prior to attending the dermatology outpatient clinic in JUTH. Methods: This was a cross sectional study conducted over one year. Information on socio-demography, sources and medication received prior to presentation was obtained and analysed using SPSS 23. Results: The male: female ratio among 166 consenting new patients was 1:1.4. Prior to presentation patients sought care most frequently from Health facilities (68.1%), Patent medicine vendors-PMV (30.7%) and Traditional healers (21.7%). Overall, different steroid preparations were the most commonly used medications (56.6%) across all age groups with fixed combination preparations most frequently used (32.5%). Unconventional substances reportedly used by patients for skin disorders were urine, toothpaste, tomatoes, salt, water in which a life catfish had been kept and fats from a dead dog. Only 21.1% of the patients did not use any medication prior to presentation. Conclusion: There is need to increase capacity in the care of common skin diseases at all levels of the health care system to decrease patronage of unconventional providers. Raising awareness of the general public on the potential dangers of inappropriate treatment of skin diseases and strengthen referral system is imperative to reduce the burden of skin diseases in the country.

Temporal artery thermometry in children younger than 5 years: a comparison with rectal thermometry.

BACKGROUND: Temporal artery (TA) thermometry has come as one of the new methods for temperature measurement, especially in children in whom accurate temperature monitoring can save lives. The device which is convenient and simple to use is yet to gain popularity in several parts of the world, as there are conflicting reports of its accuracy. This study compares the accuracy of the TA thermometry in children younger than 5 years using the rectal thermometry as the gold standard. METHODS: Temperature was measured simultaneously in eligible children younger than 5 years from the forehead and rectum using the TA thermometer (TAT-2000C Exergen, USA) and standard mercury in glass rectal thermometer, respectively. The difference between the mean temperatures obtained by the 2 thermometry methods was tested using the paired t test. Pearson correlation coefficient, linear regression, and Bland-Altman plot were also used to test the relationship and agreement between the 2 instruments. The sensitivity, specificity, and positive and negative predictive values were also calculated. RESULTS: Overall, the mean TA temperature (37.80°C ± 1.07°C) was significantly lower than the mean rectal temperature (38.07°C ± 0.95°C), P < 0.001. In neonates, however, the mean difference was not significant, 0.02 ± 0.59 (P = 0.810). There was a significant positive correlation between the rectal and the temporal temperatures (r = 0.80, P < 0.01). The Bland-Altman plot showed wide variation in the limit of agreement between the rectal and the TA temperatures which ranged from -1.02°C to +1.56°C. The sensitivity of the TA thermometer was 64.6% and 83.5%, respectively, at a TA fever cutoff of 38.0°C and 37.7°C. CONCLUSIONS: Temporal artery thermometer is not accurate enough for the measurement of core body temperature in children younger than 5 years. However, it may be used as a tool for screening for fever in very busy clinics and emergency room at a fever cutoff of 37.7°C.

Accuracy of subjective assessment of fever by Nigerian mothers in under-5 children.

BACKGROUND: Many mothers still rely on palpation to determine if their children have fever at home before deciding to seek medical attention or administer self-medications. This study was carried out to determine the accuracy of subjective assessment of fever by Nigerian mothers in Under-5 Children. PATIENTS AND METHODS: Each eligible child had a tactile assessment of fever by the mother after which the axillary temperature was measured. Statistical analysis was done using SPSS version 19 (IBM Inc. Chicago Illinois, USA, 2010). RESULT: A total of 113 mother/child pairs participated in the study. Palpation overestimates fever by 24.6%. Irrespective of the surface of the hand used for palpation, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of tactile assessment were 82.4%, 37.1%, 51.9% and 71.9%, respectively. The use of the palmer surface of the hand had a better sensitivity (95.2%) than the dorsum of the hand (69.2%). The use of multiple sites had better sensitivity (86.7%) than the use of single site (76.2%). CONCLUSION: Tactile assessment of childhood fevers by mothers is still a relevant screening tool for the presence or absence fever. Palpation with the palmer surface of the hand using multiple sites improves the reliability of tactile assessment of fever.

The impact of pre-existing antibody on subsequent immune responses to meningococcal A-containing vaccines.

Major epidemics of serogroup A meningococcal meningitis continue to affect the African meningitis belt. The development of an affordable conjugate vaccine against the disease became a priority for World Health Organization (WHO) in the late 1990s. Licensing of meningococcal vaccines has been based on serological correlates of protection alone, but such correlates might differ in different geographical regions. If high pre-vaccination antibody concentrations/titers impacts on the response to vaccination and possibly vaccine efficacy, is not clearly understood. We set out to define the pre-vaccination Meningococcal group A (Men A) antibody concentrations/titers in The Gambia and study their impact on the immunogenicity of Men A containing vaccines. Data from subjects originally enrolled in studies to test the safety and immunogenicity of the MenA vaccine recently developed for Africa meningococcal A polysaccharide conjugated to tetanus toxoid, MenAfriVac(®) (PsA-TT) were analyzed. Participants had been randomized to receive either the study vaccine PsA-TT or the reference quadrivalent plain polysaccharide vaccine containing meningococcal groups A, C, W, and Y, Mencevax(®) ACWY, GlaxoSmithKline (PsACWY) in a 2:1 ratio. Venous blood samples were collected before and 28 days after vaccination. Antibodies were assayed by enzyme-linked immunosorbent assay (ELISA) for geometric mean concentrations and serum bactericidal antibody (SBA) for functional antibody. The inter age group differences were compared using ANOVA and the pre and post-vaccination differences by t test. Over 80% of the ≥19 year olds had pre-vaccination antibody concentrations above putatively protective concentrations as compared to only 10% of 1-2 year olds. Ninety-five percent of those who received the study vaccine had ≥4-fold antibody responses if they had low pre-vaccination concentrations compared to 76% of those with high pre-vaccination concentrations. All subjects with low pre-vaccination titers attained ≥4-fold responses as compared to 76% with high titers where study vaccine was received. Our data confirm the presence of high pre-vaccination Men A antibody concentrations/titers within the African meningitis belt, with significantly higher concentrations in older individuals. Although all participants had significant increase in antibody levels following vaccination, the four-fold or greater response in antibody titers were significantly higher in individuals with lower pre-existing antibody titers, especially after receiving PsA-TT. This finding may have some implications for vaccination strategies adopted in the future.

Nonconsensual sexual relationship and prevalence of HIV infection in adolescent in Jos, Nigeria.

BACKGROUND: HIV infection in adolescents is promoted by sexual risky behaviours and nonconsensual sex. Nonconsensual sex ranges from forced sex/rape, unwanted touch and inducement by gifts. This study was designed to determine the prevalence of nonconsensual sex (NCS) and HIV infection in adolescents. MATERIALS AND METHODS: Eight hundred and eighty three adolescents from 10 secondary schools were randomly selected and given a questionnaire to fill. All had group pre-test counseling had HIV screening. HIV positive subjects had a confirmatory test done after individual post-test counseling. Ethical clearance was received from the relevant authorities and persons. RESULTS: Of the 883 students, 169 (19.2%) were sexually experienced. Of which 101/169 (59.8%) were males and 40.2% females. Mean age at first sexual debut was 14.4±2.6 years; males 13.3±2.7 years and females 14.6±3.2 years, P=0.006. Seventy three of 127 respondents (57.5%) indicated consensual sex and 42.5% (54/127) indicated NCS. Of the 54 subjects, 74% were females and 22% males. Mean age at first sex in NCS was 13.5 + 3.4 yrs; males, 12.5±2.9 yr in NCS and 14±2.6 in consensual, P=0.045; females 14±3.5 in NCS and 16.5±1.2 in consensual P=0.02. Circumstances of sex showed 59.3% were forced sex or rape, 7.4% was following gifts. Over 70% of NCS group use no form of protection. In the population studied 9/883 (1.02%) were HIV positive. Among the sexually experienced HIV prevalence was 2.4% (4/169), and 3.7% (2/54) among NCS. CONCLUSION: Prevalence of NCS is high, occurring at an earlier age and associated with lack of condom use as well as a higher HIV prevalence.

The effects of birth weight and gender on neonatal mortality in north central Nigeria.

BACKGROUND: Worldwide 15.5% of neonates are born with low birth weight, 95.6% of them in the developing countries. Prematurity accounts for 10% of neonatal mortality globally. The purpose of this study was to evaluate the effects of birth weight and gender on neonatal outcome. FINDINGS: The data of 278 neonates managed in the Special Care Baby Unit (SCBU) of Jos University Teaching Hospital (JUTH) over a 2 year period from July 2006 to June 2008 were analyzed.One hundred and fifty nine (57.2%) were males and 119(42.8%) females. There were 87(31.3%) preterm and 191 (68.7%) term babies. Twelve of the babies died. Seven (2.52%) and 5 (1.80%) being males and females respectively. The neonatal mortality rate by gender was not significant (p > 0.05). The neonatal mortality was 25.2 deaths per 1000 live births for boys and 18.0 for girls. The mean birth weights of the preterm and term babies were 1.88 ± 0.47 kg and 3.02 ± 0.50 kg respectively, with a mean gestational age of 30.62 ± 3.65 weeks and 38.29 ± 0.99 weeks respectively.Eighty seven (31.3%) of the babies were of low birth weight, 188(67.6%) were of normal birth weight and 3(1.1%) high birth weight. Of the low birth weight babies, 6(2.2%) were term small for gestational age. Six (2.2%) of the preterm infants had normal birth weight.Eleven of the babies that died were preterm low birth weight. The overall mortality rate was 4.32%. The birth weight specific mortality rate was 126 per 1000 for the preterm low birth weight and 5 per 1000 for the term babies. Birth weight unlike gender is a significant predictor of mortality, mortality being higher in neonates of <2.5 kg (OR = 0.04; 95% Cl 0.005-0.310, p = 0.002) (p = 0.453). Seven (58.3%) and 4(33.3%) of the pre-terms that died were appropriate and large for gestational age respectively. Gestational age is not a significant predictor of neonatal mortality (p = 0.595). Babies delivered at less than 37 weeks of gestation recorded a higher rate of mortality than those of 37 weeks and above (p = 0.000).The subjects showed one or more major clinical indications for admission. The major clinical indications for the preterm and term babies were respectively as follows: neonatal sepsis 63(22.7%) and 124(44.6%); neonatal jaundice 32(11.1%) and 71(24.7%); malaria 9(3.1%) and 13(4.5%); birth asphyxia 3(1.0%) and 7(2.4%). Neonatal sepsis was a common denominator among the babies that died. CONCLUSION: Birth weight unlike gender is a significant predictor of neonatal outcome.

Hypocholesterolemia in Nigerian children with sickle cell disease.

Reports of circulating lipids of children with sickle cell disease (SCD) in Nigeria disagree on the question of whether these children are at increased risk of cardiovascular disease (CVD). We therefore analyzed the serum of 40 females and 37 males with SCD, age 5-19 years, and equal numbers of age-matched controls for total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and homocysteine. Using bioelectrical impedance analysis, we documented a significant reduction in the per cent fat-free mass in the SCD males and increases in the per cent body fat in both the male and female children with SCD. Marked hypocholesterolemia was present in both genders (means, 100-102 mg/dl) and the LDL-cholesterol levels of the male and female subjects with SCD (54 mg/dl) were below the lower limit of the reference range (59-137 mg/dl). Serum triglycerides in the SCD subjects were in the middle of the reference range for children. Although the mean HDL-cholesterol levels of the SCD males (23.1 mg/dl) and females (24.5 mg/dl) were well below the lower limit of the reference range (35-84 mg/dl), respectively, the LDL-cholesterol/HDL-cholesterol ratios of the SCD subjects were not abnormal. The mean serum homocysteine concentrations of the male and female SCD subjects (9.4-9.6 micromol/l) were at the high end of the normal range. Collectively, these results indicate that children with SCD in northern Nigeria are not at increased risk of CVD. However, their marked hypocholesterolemia should be a cause of concern about the overall mortality and general well-being.