Prevalence and outcome of increased nuchal translucency in usmanu danfodiyo university teaching hospital, Sokoto, Nigeria: A cohort study.

BACKGROUND: An important component of the first-trimester scan is nuchal translucency thickness at 11 weeks to 13 weeks 6 days of gestation. A nuchal translucency ≥3.3 mm is a significant early pregnancy scan finding associated with Trisomies 13, 18, and 21 and congenital heart diseases. AIMS: To determine the prevalence and outcome of increased fetal nuchal translucency among pregnant women. SUBJECTS AND METHODS: A prospective cohort study at the Obstetrics and Gynaecology Department of Usmanu Danfodiyo University Teaching Hospital Sokoto. This was a prospective study of 265 consecutively recruited women in the first trimester of pregnancy who presented to antenatal clinics over a 20-week period. An NT scan was conducted at 11 weeks to 13 weeks 6 days followed by an anomaly scan at 18-22 weeks. Patients were followed up to delivery and 6-week post-partum. The neonates were examined at delivery and at 6-week postnatal life. Data entry and analysis was done with IBM SPSS version 20. The level of significance was set at less than 0.05. Frequency distribution; student t-test and Chi-squared test. RESULTS: The 95th percentile NT was 3.3 mm and the prevalence of increased NT above 3.3 mm was 3%. The mean maternal age of the participants was 28.1 ± 5.1 years and the modal parity was Para 0. The most common anomalies associated with increased NT were ventricular septal defect and spina bifida. A congenital anomaly was significantly associated with increased NT (P < 0.001). CONCLUSIONS: The prevalence of increased fetal nuchal translucency is relatively high in our environment and is associated with congenital fetal defects. Routine screening with first-trimester ultrasound will help detect congenital anomalies early.

A validation of the Malaria Atlas Project maps and development of a new map of malaria transmission in Sokoto, Nigeria: a cross-sectional study using geographic information systems.

BACKGROUND: Malaria remains a major cause of morbidity and mortality among children in Africa. There is inadequate information regarding malaria transmission-intensity in some of the worst-affected parts of sub-Saharan Africa (SSA). The Malaria Atlas Project (MAP) was developed in 2006, to project estimates of malaria transmission intensity where this data is not available, based on the vector behaviour for malaria. Data from malariometric studies globally were obtained and modelled to provide prevalence estimates. The sensitivity of these maps, however, reduces with unavailability of data. This necessitates a validation of these maps locally, and investigation into alternative methods of predicting prevalence to guide malaria control interventions and improve their efficiency and effectiveness. This study was conducted to compare the true estimates in Sokoto, Nigeria, with the MAP projections for north-western Nigeria, and it proposes an alternative way of mapping malaria intensity in Nigeria and beyond. METHODS: A malariometric survey was conducted including children aged 2-10 years in communities in Wamakko Local Government Area (LGA) of Sokoto State, Nigeria. Children had blood examinations for the presence of malaria parasitaemia and a physical examination for the signs of clinical malaria. All the sites from which children were included in the study were geo-located using a hand-held Global Positioning System (GPS) device and compared this to MAP maps of the same area. A mapping software was also used to generate a malaria prevalence map of the study area, considering the average flight distances of the vector. RESULTS: The prevalence among children 2 to 10 years was found to be 34.8% which was within the 30-40% projected prevalence for the study area by MAPs. However, it was much lower than the projection during the dry season (20.2%) and higher than the projected estimate during the rainy season (49.3%). There was monoparasitaemia of Plasmodium falciparum throughout the study area, although the study was not specifically designed to identify other species. The prevalence of parasitaemia and splenomegaly were similar when overall and when considered by age of the participants. The study also generated a map of malaria transmission, which mapped out areas where the prevalence was confirmed or likely to be to be within the range of 30-40%, based on the sites which constituted the study area for this study. CONCLUSION: The study concludes that the prevalence of malaria and its transmission intensity in Sokoto are similar to Malaria Atlas Project predictions for the area and that, for malaria control planning purposes, the projections may be utilized, with more efforts at validation of the MAPs in other locations and terrains. Also, the vector behaviour may be used to map transmission of malaria and other vector-transmitted diseases, where this information is lacking.

A 6-year review of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Background: Tetanus is a vaccine-preventable disease but its incidence has remained unacceptably high in developing countries. Objective: To determine the prevalence, risk factors and outcome of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: A retrospective descriptive study from 1st January 2010 to 31st December 2015. Children aged 1 month to 15 years diagnosed with post-neonatal tetanus were studied. Information from the admission files was extracted. Data was analysed using SPSS version 20. Results: Total admissions during the study period were 14,458; 61 had post-neonatal tetanus, giving a prevalence of 0.4%. The M: F ratio was 1.5:1. The mean age was 7.4±3.2 years. Fifty-nine (96.7%) were not immunised against tetanus. Portal of entry for the organism was trauma injuries to the foot in 33(54.1%). Thirty-one (50.8%) were discharged, 5(8.2%) DAMA, while 25(41.0%) died, and case fatality was 41.0%. Conclusion: Post-neonatal tetanus is a major cause of morbidity and mortality in Sokoto. There is need for improved health education, sustainability of immunisation programmes and coverage to eradicate this scourge

Paediatrics HIV/AIDS: Clinical Presentation and Practical Management Challenges in Sokoto; Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH); Sokoto; Nigeria over a two-year period. Methods: This prospective study was carried out between 1st January 2001 and 31st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS; admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient was individualised. Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6) patients were aged 5 years and below. Modes of transmission were vertical in 40 (97.6); while 1 (2.4) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100); followed by fever (one month) 39 (95); chronic diarrhoea 39 (95); recurrent cough 37 (90) and oro-pharyngeal candidiasis 35 (85) in that order. Thirty- six (87.8) patients had protein - energy malnutrition (PEM); marasmus constituting 58. Thirtytwo (78) patients were in WHO clinical stage 3 while the remaining 9 (22) patients were in stage 4. The main types of infections were oral candidiasis; pneumonia; malaria; septicaemia; urinary tract infections; and tuberculosis. Case fatality rate was 91. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study. Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group