Diagnostic value of rapid test for malaria among febrile neonates in a tertiary hospital in North-East Nigeria: a prospective cross-sectional study.

OBJECTIVE: The WHO recommends testing using microscopy or rapid diagnostic test (RDT) before treatment for malaria. However, the use of RDT to diagnose neonatal malaria has not been widely validated with most studies limited to the first week of life. Thus, we conducted this study to determine the utility of RDT in the diagnosis of congenital and acquired malaria in febrile neonates in Nigeria. DESIGN: This prospective cross-sectional descriptive study consecutively recruited 131 febrile neonates at the Special Care Baby Unit (SCBU) of the Federal Teaching Hospital Gombe, Nigeria. All study participants concurrently had RDT (HRP2, LDH) and malaria microscopy. The performance of both methods was then compared. RESULT: Seventy-eight of 131 neonates tested for malaria by blood smear microscopy demonstrated malaria parasites; a prevalence of 59.5%. Parasite count ranged from 16 to 520 /µL and the median parasite count was 81.0 /µL with IQR (40.0-134.5). The majority of patients (93.5%) had low-density parasitaemia (≤2+). All species identified were Plasmodium falciparum. None of the 131 neonates tested positive on RDT. The sensitivity and positive predictive value of RDT for neonatal malaria was zero. Congenital malaria was the most common form of neonatal malaria, accounting for 75.6%, while acquired and transfusion-related malaria were estimated at 12.8% and 11.6%, respectively. CONCLUSION: The RDT used in this study was not sensitive in the diagnosis of congenital or acquired neonatal malaria; therefore, microscopy remains the preferred method of diagnosis of neonatal malaria.

Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022.

The complications of prematurity are the leading cause of neonatal mortality worldwide, with the highest burden in the low- and middle-income countries of South Asia and Sub-Saharan Africa. A major driver of this prematurity-related neonatal mortality is respiratory distress syndrome due to immature lungs and surfactant deficiency. The World Health Organization's Every Newborn Action Plan target is for 80% of districts to have resources available to care for small and sick newborns, including premature infants with respiratory distress syndrome. Evidence-based interventions for respiratory distress syndrome management exist for the peripartum, delivery and neonatal intensive care period- however, cost, resources, and infrastructure limit their availability in low- and middle-income countries. Existing research and implementation gaps include the safe use of antenatal corticosteroid in non-tertiary settings, establishing emergency transportation services from low to high level care facilities, optimized delivery room resuscitation, provision of affordable caffeine and surfactant as well as implementing non-traditional methods of surfactant administration. There is also a need to optimize affordable continuous positive airway pressure devices able to blend oxygen, provide humidity and deliver reliable pressure. If the high prematurity-related neonatal mortality experienced in low- and middle-income countries is to be mitigated, a concerted effort by researchers, implementers and policy developers is required to address these key modalities.

Cost implication of CPAP use in low resource settings, surmounting the oxygen administration challenge.

PURPOSE: Newborn respiratory support using Bubble Continuous positive airway pressure (bCPAP) has become acceptable in Nigeria as many centers are increasingly reporting its usefulness. There is increasing access to CPAP devices although the use of 100% oxygen for bCPAP administration is on the rise as oxygen/air blenders are not commonly available or insufficient. The cost of oxygen has become a significant contributor to hospital bills. The oxygen concentrator driven bCPAP device with blending capacity is expected to save lives and reduce cost of care. OBJECTIVE: To compare the cost saving benefit of the use of oxygen concentrator bCPAP devices for CPAP administration to oxygen based devices in a resource limited setting. METHODS: This prospective cross sectional study was done between February and December 2019. The oxygen use by CPAP devices-Improvised (IbCPAP), Fisher and Paykel and T-piece were quantified, costed, documented and compared with the same duration of use of concentrator CPAP-Diamedica. RESULTS: CPAP services was accessed by 357 babies, 154 males and 203 females of GA range from 22 to 42 weeks and Birthweights range from 264 to 4400 grams. The main indication for CPAP was respiratory distress syndrome 201(56.3%). Oxygen supply were by oxygen pipeline 250 (70%), cylinders 39 (10.9%), concentrator CPAP 44 (12.3%) mixed source 24 (6.7%). Mean duration on the CPAP devices was 5.4 days, mean cost ₦37,645 ($104) or ₦6,971 ($20)/day, highest with IbCPAP, non-existent with concentrator bCPAP. CONCLUSION: The high running cost implication of CPAP use in low resource settings could deter transitioning to quality devices hence the need for non-oxygen dependent devices.

Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria.

BACKGROUND: Congenital heart disease (CHD) is an important cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined. METHODS: This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0. RESULTS: A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD. CONCLUSIONS: The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria.

Implementing bubble continuous positive airway pressure in a lower middle-income country: a Nigerian experience.

Bubble CPAP (bCPAP) is used for respiratory distress (RD) in neonates. The leading causes of neonatal mortality can lead to severe RD. Many neonatal deaths are preventable using evidence-based interventions like bCPAP as part of a comprehensive approach. The study aimed to assess the implementation of a multi-center, comprehensive hospital-based bCPAP program in a low-middle-income country using a low-cost bCPAP device. Seven established hospitals in three Nigerian States were selected using purposive sampling. A respiratory support program was developed and implemented using the Pumani® bCPAP. Neonates <28 days old with severe RD, birth weight >1000g and breathing spontaneously, were eligible. The program lasted 22 months. Focus group discussions and in-depth interviews of healthcare workers and hospital administrators were used in program assessment. Content analysis of qualitative data completed. The staff reported that the bCPAP device was easy to use and effective. All staff reported comfort in eligible patient identification, effective set up and bCPAP administration. All study sites experienced varying degrees of electric power interruption and oxygen availability and affordability. Staff training, staffing disruptions, data collection challenges and use of improvised bCPAP contributed to low enrollment. Advocacy, direct program support, and innovation using locally available resources improved enrollment. Professional organization collaboration, competency-based training and peer mentoring contributed to program success. Thorough pre-program assessment, with comprehensive understanding of all aspects of the existing system within the local context which are likely to impact the introduction of a new program is important to implementation success.

The scope and extent of exogenous surfactant utilization in Nigerian health care facilities: benefits of its regular use to outcome of premature babies.

Background: Surfactant replacement therapy (SRT) is the standard of care in developed countries. Poor access to surfactant limits its use in low resource settings. The extent of its use and the effect of its regular use on the preterm in such settings is unknown.Objective: This study assessed the extent of exogenous surfactant utilization in Nigerian tertiary care facilities and the benefits of its regular use to the preterm population.Methods: A two-phase cross-sectional study design evaluated the response from a respondent administered structured questionnaire addressed to health care providers from 54 centers and a targeted assessment of the outcome of the regular use of exogenous surfactant in a tertiary care facility from January 2014 to December 2016.Results: SRT was available in 16.7% of 54 units evaluated nationally; three (33.3%) were located in south-south and south-west respectively, 2 (22.2%) in southeast and one (11.1%) in north-central regions of the country. Twenty-two percent of the units were private centers, 77.8% were public tertiary care facilities. Four (44.4%) units provide SRT as the standard of care while five (66.6%) provide the service on request. One thousand one hundred twenty babies were admitted to the audited tertiary facility with 550 (49%) as preterms. Only 2.72% received surfactant replacement therapy. Sixty-six percent of recipients survived whilst 33.3% died. Respiratory support positively enhanced outcome in recipients of surfactant therapy.Conclusion: There is a limited use of surfactant nationally. Its use seemed to have improved survival.

Newborn resuscitation practices and paucity of resuscitative devices in Nigeria; a call to action.

BACKGROUND: Neonatal resuscitation is a method of preventing morbidities & mortality from asphyxia. Up to 85% of facilities in sub-Saharan Africa lack supplies or skilled personnel for neonatal resuscitation. Relative to the place of birth and the skill of the birth attendant, a variety of resuscitative practice are employed to make babies cry instead of helping the baby breathe. Many painful procedures are applied when the baby is unable to cry after birth in the absence of a health care worker trained in bag-mask ventilation. OBJECTIVES: To ascertain the resuscitation practices in communities lacking bag-mask-valve devices. METHODS: Surveys on the resuscitation practices during NISONM annual community outreach and mENCC trainings for four consecutive years in different geopolitical zones of the country. RESULTS: Spanking of the baby usually in the upside down position (>90%), body massage with hot compress or salicylate containing balms, herbal concoctions, injection hydrocortisone or crystalline penicillin were used. CONCLUSION: There is an urgent need to address the issue of training on bag-mask ventilation and provision for frontline healthcare workers in Nigeria as a neonatal mortality reduction strategy.

A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria.

Background: The bubble continuous positive airway pressure (bCPAP) technique is widely applied in neonatal respiratory support. Commercial bCPAP brands are expensive in Nigeria and this has driven Nigerian paediatricians to use potentially risky improvised devices (IbCPAP). Aim: This study aimed to design, produce and trial an appropriate low-cost bCPAP machine which is functionally effective and safe. Methods: Questionnaires were distributed to assess the need for a new bCPAP design for use in Nigeria, leading to the development of a new system (politeCPAP) which was functionally and clinically validated in three Nigerian hospitals. Six months of clinical data on the new device of sufficient comparative quality were generated from one of the hospitals and compared with control data on the IbCPAP. The hospitals (n = 3) submitted data on 71 patients on IbCPAP or politeCPAP; 14 were disqualified on the basis of the elimination criteria. The infants were classified into two birthweight categories: <1000 g (extremely low birthweight, ELBW, n = 15) and 1000 g (n = 42). Results: Six ELBW neonates on politeCPAP survived; there were no ELBW survivors in the IbCPAP group (n = 9). The IbCPAP device delivered an average 90% O2-gas ratio (FiO2) whereas the politeCPAP required only 47%. Many heavier neonates in the IbCPAP group survived (23 of 26); however, supplementary warming was required for all of them whereas none of the politeCPAP infants required warming. The politeCPAP costs around US$2000 whereas standard commercial CPAP brands in Nigeria range from US$5000 to US$18,000. High oxygen requirement and iatrogenic hypothermia were serious adverse features of IbCPAP. Conclusions: The study has narrowed the gap between relatively low-cost, risky devices (e.g. IbCPAP) and high-cost commercial machines. The politeCPAP is a feasible alternative to the IbCPAP in cost-constrained settings. Abbreviations: bCPAP: bubble continuous positive airway pressure; CPAP: continuous positive airway pressure; ELBW: extremely low birthweight; FiO2: ratio of oxygen content in gas flow (%); IbCPAP: improvised bubble continuous positive airway pressure device; LBW: low birthweight; NNU: neonatal unit; PEEP: positive end expiratory pressure; politeCPAP: the newly developed commercial bCPAP machine; RDS: respiratory distress syndrome; SpO2, oxygen saturation level (%).

A Study of Malaria Parasite Density in HIV-1 Positive Under-fives in Benin City, Nigeria.

Background: Human immunodeficiency virus (HIV) and malaria are leading causes of morbidity and mortality among under-fives in sub-Saharan Africa. HIV infection could affect development of antimalarial immunity by impaired parasite clearance with predisposition to higher malaria parasitaemia. Objective: The objective of this study is to assess asymptomatic malaria parasite density (AMPD) in HIV-1-infected under-fives in a holoendemic zone. Methods: HIV-1-positive and -negative children <5 years on follow-up care were recruited and AMPD and CD4 counts were determined. Results: A total of 358 children were studied. Significantly higher malaria parasitaemia was found in HIV-infected individuals (118.7 vs. 87.3 parasite/µl, p = 0.021). Disparity in AMPD was most pronounced at infancy with similar distribution at all age brackets and consistently higher parasitaemia in the subjects. Conclusion: Parasitaemia is higher in HIV-infected than uninfected children. The burden is highest at infancy. Acquisition of antimalarial immunity is similar in both groups. Parasitaemia is not significantly affected by clinical disease stage or worsening immunosuppression.

Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study.

Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients' hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS.

Effect of HIV-1 Serostatus on the Prevalence of Asymptomatic Plasmodium falciparum Parasitemia Among Children Less Than 5 Years of Age in Benin City, Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV) infection and Plasmodium falciparum malaria are 2 of the gravest health threats in sub-Saharan Africa. Multiple repeat infections with the malaria parasite as seen in endemic areas are necessary to develop specific malaria immunity. HIV is an immunosuppressive virus and in children aged <5 years, development of malaria-specific immunity may be impaired and malaria parasite clearance in theory will be delayed; hence the predisposition to increased incidence of asymptomatic malaria or severe malaria. This cross-sectional study was carried out to examine associations between immunosuppression and asymptomatic malaria parasitemia (ASMP) in HIV-infected children aged <5 years in Benin City. METHODS: One hundred seventy-nine asymptomatic HIV-1-positive and 179 age- and sex-matched HIV-1-negative children aged <5 years were recruited. The malaria parasite was determined by Giemsa-stained blood film by certified microscopy while concomitant CD4(+) count was estimated in the HIV-infected children. RESULTS: The prevalence of ASMP in those who were HIV-infected of 34.1% was significantly higher than 17.3% in the HIV uninfected (P = .001). The prevalence of ASMP was highest (59.3%) among subjects who were severely immunosuppressed (CDC immunologic category 3). The prevalence of ASMP significantly increased with advanced immune disease in the subjects (P = .011). Severe (World Health Organization) clinical staging was also significantly associated with increased prevalence of ASMP (P = .031). The prevalence of ASMP is significantly higher among subjects not receiving cotrimoxazole, associated with threefold risk of having ASMP (P = .003: odds ratio = 3.5). CONCLUSIONS: ASMP is more common in HIV-positive children aged <5 years and is significantly associated with declining CD4(+) T-cell count and severe clinical disease. There is a need for integration of HIV- and malaria-control programs for stronger case management. Malaria-control programs may consider malaria prevention interventions and cotrimoxazole prophylaxis for preschool children who are HIV-infected and living in malaria-endemic regions.