Changing trends in newborn sepsis in Sagamu, Nigeria: bacterial aetiology, risk factors and antibiotic susceptibility.

AIM: Sepsis is a major contributor to newborn deaths in the developing world. The objective is to determine the prevalence of newborn sepsis, the bacterial pathogens and antibiotic sensitivity pattern of the isolates. METHOD: A study of consecutive babies hospitalised in Sagamu, Nigeria, with risk factors for or clinical features of sepsis was retrospectively done between January 2006 and December 2007, and prospectively between January and December 2008. Positive blood culture defined neonatal sepsis, and the antibiotic sensitivity pattern of the organisms was also determined. RESULTS: There were 1050 admissions, and 174 (16.5%) babies had positive blood culture. Of the 527 babies with risk factors and clinical features of sepsis, 174 (33.3%) had confirmed sepsis: 119 (22.5%) had early-onset sepsis, while 55 (10.4%) had late-onset sepsis. The incidence of neonatal sepsis in the hospital was 51.3/1000 live births. Weight less than 1.5 kg, prolonged labour, prolonged rupture of membranes and lower socio-economic status were risk factors for sepsis. Staphylococcus aureus (31.0%), Klebsiella (23.0%), and coagulase-negative Staphylococcus (12.6%) and Escherichia coli (11.0%) were the leading aetiologies. The isolates were most sensitive to levofloxacin (95.7%), ofloxacin (95.1%), cefotaxime (86.7%) and ceftazidime (81.3%). Their sensitivity was 56.4% to cefuroxime and gentamicin, which are commonly used. CONCLUSION: The prevalence of sepsis was high in this cohort of high-risk infants. The low in vitro sensitivity of the leading microbes to commonly used drugs is challenging. Guidelines on the reduction of emergence of drug resistance must be provided and instituted in newborn units.

Socio-demographic factors and appropriate health care-seeking behavior for childhood illnesses.

The objective of the study was to determine the influence of socio-demographic factors on healthcare-seeking behaviors for childhood illnesses. This cross-sectional survey was conducted among consecutively admitted acutely ill children in the Children Emergency Room of a Nigerian tertiary care hospital. A total of 168 respondents were surveyed out of which only 12 (7.1%) performed well with regard to all the four indicators of appropriate healthcare-seeking behaviors. Bivariate analysis showed significant association between high maternal education and early care-seeking, utilization of orthodox health facilities, and drug use at home (p < 0.001 in each case). Similarly, age of child <1 year was associated with early care-seeking, care-seeking outside home, and utilization of orthodox health services (p < 0.001 in each case). Logistic regression showed that high maternal education and high family socioeconomic status were strong predictors of early care-seeking and care-seeking outside the home. It is concluded that maternal age, maternal education, and family socioeconomic status are predictors of appropriate healthcare-seeking behaviors for childhood illnesses.

Point-of-admission hypothermia among high-risk Nigerian newborns.

BACKGROUND: Facilities which manage high-risk babies should frequently assess the burden of hypothermia and strive to reduce the incidence. OBJECTIVE: To determine the incidence and outcome of point-of-admission hypothermia among hospitalized babies. METHODS: The axillary temperatures of consecutive admissions into a Nigerian Newborn Unit were recorded. Temperature <36.5 degrees C defined hypothermia. The biodata and outcome of these babies were studied. RESULTS: Of 150 babies aged 0 to 648 hours, 93 had hypothermia with an incidence of 62%. Mild and moderate hypothermia accounted for 47.3% and 52.7% respectively. The incidence of hypothermia was highest (72.4%) among babies aged less than 24 hours. It was also higher among out-born babies compared to in-born babies (64.4% vs 58.3%). Preterm babies had significantly higher incidence of hypothermia (82.5%) compared with 54.5% of term babies (RR = 1.51; CI = 1.21 - 1.89). The incidence of hypothermia was also highest (93.3%) among very-low-birth-weight babies. The Case-Fatality-Rate was significantly higher among hypothermic babies (37.6% vs 16.7%; RR = 2.26, CI = 1.14 - 4.48) and among out-born hypothermic babies (50% vs 17.1%; RR = 0.34, CI = 0.16 - 0.74). CFR was highest among hypothermic babies with severe respiratory distress, sepsis, preterm birth and asphyxia. CONCLUSION: The high incidence and poor outcome of hypothermia among high-risk babies is important. The use of the 'warm chain' and skin-to-skin contact between mother and her infant into routine delivery services in health facilities and at home may be useful.

A comparative study of academic achievement of children with sickle cell anemia and their healthy siblings.

BACKGROUND: Sickle cell anemia (SCA) could impact negatively on academic performance of affected children. Reports so far have been inconsistent. OBJECTIVE: To do a comparative analysis of academic performance of Nigerian children with SCA and their siblings. METHODS: We studied sessional aggregate scores, pass rates and percentage scores in four core subjects (mathematics, English language, integrated science and social studies), as well as the total number of days of school absence of 52 school-age children (6-17 years) with sickle cell anemia and 42 siblings of similar sociodemographic characteristics, over one academic session. FINDINGS: School absence among the SCA patients was significantly higher than that of siblings (9.3+/-5.5 days/school year and 4.3+/-2.6 days/school year, respectively, mean+/-SD, p<0.05). Although the mean sessional aggregate score for patients was comparable with that of the siblings, there was a significantly larger proportion of below-average pupils among the patients. The mean percentage scores of the patients on mathematics, English language, integrated science and social studies compared well with those of the siblings. There was no significant correlation between school absence and academic achievement of the study population. CONCLUSION: More children with SCA are underachievers in this study, and their school underachievement is not associated with the observed higher school absence.

Hemoglobinopathy and pattern of musculoskeletal infection in children.

BACKGROUND: The bacterial pathogens associated with osteomyelitis in patients with hemoglobinopathy (HbSS) are controversial. There is insufficient data on the common musculoskeletal (MSS) infections in patients with hemoglobinopathies and the associated bacterial pathogens in Nigeria. OBJECTIVES: To identify the common MSS infections in children and the associated bacterial pathogens, especially in those with abnormal hemoglobin genotypes. METHODS: A retrospective case review was done of pediatric and adolescent patients admitted with bone and soft tissue infections over a seven-year period in a Nigerian teaching hospital. RESULTS: One-hundred-nineteen patients were studied, with mean age 7.9+/-5.6 years and male-female ratio of 1.3:1. Out of 78 patients with known genotype, 62.8% had HbAA, 20.5% HbSS, 9% HbAS, and 7.7% HbAC. The most common MSS infections were osteomyelitis (64.7%), pyomyositis (17.6%), and septic arthritis (10.1%). Others were cellulitis (5.9%), tuberculous arthritis (0.8%), and necrotizing fasciitis (0.8%). Staphylococcus aureus (S. aureus) was isolated from 62% of chronic osteomyelitis (COM) and 58% of pyomyositis, while gram-negative bacilli accounted for 34% and 42%, respectively. S. aureus was isolated from 63% of patients with HbAA, 40% with HbSS, 58% with HbAS, and 58% with HbAC, while gram-negative bacilli accounted for 33%, 60%, 33%, and 33%, respectively. Osteomyelitis and pyomyositis appear to be similarly common in patients with and without HbSS (RR 1.29; 95% CI 0.47-3.50). Osteomyelitis and soft tissue infections in general also appear to be equally common in them (RR 1.16; 95% CI 0.39-4.11). However, osteomyelitis appears to be more common among patients with HbSS than those with HbAA (RR 2.29; 95% CI 0.58-8.99) and those with other hemoglobinopathies (RR 2.23; 95% CI 0.66-7.49) CONCLUSIONS: Osteomyelitis, pyomyositis and septic arthritis are common MSS infections in hospitalized pediatric and adolescent patients, while tuberculous arthritis is uncommon. The most common bacterial pathogen in these infections is S. aureus-even in patients with HbSS and other hemoglobinopathies. Gram-negative bacilli are important causes of MSS infections in hospitalized children with HbSS. HbSS may be an independent risk factor for osteomyelitis in these patients.