Rotavirus diarrhoea hospitalizations among children under 5 years of age in Nigeria, 2011-2016.

BACKGROUND: The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. METHODS: Routine rotavirus surveillance was conducted during 2011-2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). RESULTS: 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. CONCLUSION: The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria.

BACKGROUND: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group. OBJECTIVE: The objective of the following study is to determine the prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics. MATERIALS AND METHODS: Urine specimen of febrile children aged 1-59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity. RESULTS: A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 ± 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males ( P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above ( P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI. CONCLUSION: UTI is common in febrile under-fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.

Epidemiology of rotavirus diarrhea among children younger than 5 years in Enugu, South East, Nigeria.

BACKGROUND: Severe rotavirus diarrhea in children is a major cause of morbidity globally and mortality in developing countries. It is estimated to be responsible for >453,000 deaths in children <5 years of age globally and 232,000 in the African region. The aim of the current study was to determine the prevalence of rotavirus gastroenteritis among hospitalized children <5 years of age in Enugu and to support awareness and advocacy efforts for the introduction of rotavirus vaccines in Nigeria. METHODS: World Health Organization-standardized case forms were used to collect data from eligible children with non-bloody diarrhea from October 2010 to September 2012. Data collected included socio-demographic and clinical information. Stool samples were obtained from recruited children and tested for rotavirus antigen using the Oxoid Prospect ELISA Kit (Basingstoke, United Kingdom). RESULTS: Of the 615 diarrhea stool samples collected, 344 (56%) were positive for human rotavirus. Of the 344 positive samples, 329 (96%) were children <2 years of age, while 247 (77%) were <1 year of age. Peak rotavirus season occurred during the cold dry months of December to April during which 95% of all cases occurred. CONCLUSIONS: This study found a relatively high incidence of severe rotavirus-associated diarrhea disease in Nigeria and infants were the most affected. It highlights the urgent need for introduction of rotavirus vaccine into the national immunization program and the need to adequately equip health facilities to enable them administer intravenous fluids to severe diarrhea patients to reduce morbidity and mortality.

Bacteriology of wound infections in the surgical wards of a teaching hospital in Enugu, Nigeria.

During a 24-month period, January 2001 - December 2002, 404 wound swabs from 390 patients made up of 280 from surgical wounds, 92 from ulcers and 32 from other wounds like lacerations and discharging sinuses were studied. The prevalence of bacterial organisms and their antibiotic susceptibility pattern was analyzed, using standard bacteriologic techniques. Two hundred and sixty four organisms (69.8%) were isolated from surgical wounds, 82 (21.7%) from ulcers and 32 (8.5%) from other wounds. Coliforms were the most predominant organisms in surgical wounds (63.5%), while puste in ulcers, proteus species were the most prevalent (37.2%). Multiple microbial infections were common (22.7% and 24.6%) in surgical wounds and ulcers respectively. Antibiotic resistance by the isolates to commonly used antibiotics like Ampicillin, Tetracycline, Cotrimoxazole was high. The isolates were most sensitive to Ciprofloxacin and Ofloxacin. Restriction of the use of broadspectrum antibiotics in the treatment of wound infections should be enforced, while better collaboration between the clinical microbiologist and surgeon should be practiced especially with respect to infective preventive measures.

Prevalence of dermatophytosis in University of Nigeria Teaching Hospital, Enugu, Nigeria: any change in pattern?

A total of 344 specimens of skin, hair and nail clippings, were examined for the presence of dermatophytes during the period May 2003 - April 2004 at the UNTH.Enugu. Out of these, 65 were found positive for dermatophytes. T. soudanense was the most frequently isolated species representing 70.8% of isolates, followed by T. mentagrophytes 12.3%. Adults were more predominantly infected than children. 89.2% and 10.8% respectively. T. soudanense was the only dermatophyte that was recovered from all sites apart from the buttocks. Compared to an earlier study in 1975, there was a significant decrease in the prevalence of T. capitis (P < 0.05) and this explains the decrease in the prevalence of M. andounii, as this dermatophyte is the most common cause of T. capitis in Enugu. Nigeria. An improvement of Personal hygiene, better living conditions and improved socio economic conditions has led to a decrease of T. Capitis, as well as general awareness by the populace.

Increasing incidence of bacterial, resistance to antibiotics by isolates from the urinary tract.

This is a prospective study to determine the prevalence of antibiotic resistance among organisms causing urinary tract infections in a Teaching Hospital between August 2003 and July 2004 and to compare them with an earlier study in 1993. A total of 1,104 urine samples were collected in sterile universal containers from patients attending University of Nigeria Teaching Hospital and studied. All samples showing significant bacteriuna were studied and isolates identified using standard bacteriogical methods. Antibiotic sensitivity testing was performed on sensitivity test agar (Biotec, UK) using the disc diffusion method in accordance with the National Committee for Clinical Laboratory Standards (5). The results were compared with a previous study in 1993. A total of 3.36 urinary isolates were identified, with the coliforms being the most predominant (51.2%). followed by Staphylococcus aureus and Proteus species (28.9% and 7.1%) respectively. Compared to the earlier study, a significant increase in the resistance of the urinary pathogens to ofloxacin, ciprofloxacin and nalidixic acid was observed, however there was a decrease in the resistance to nitrofurantoin (p < 0.05) using chi-square test. The results of this study should now alert doctors about the increasing possibility of treatment failures, when ciprofloxacin, ofloxacin and nalidixic acid are used for the treatment of urinary tract infections without laboratory testing. A multi-faceted approach including continued and improved surveillance, a reduction in the unnecessary use of antibiotics and infection control are necessary.

Bacteriology of burn wounds in Enugu, Nigeria.

A retrospective study of bacterial infection in 71 burned patients over a 5-year period (1993-1997) was carried out. The commonest colonizing organism was Klebsiella species (26.7%) followed by Staph aureus (25.6%). There was a very high degree of resistance by these organisms to commonly available antibiotics in Nigeria, with the result that more expensive antibiotics such as the cephalosporins were required. The poor socioeconomic condition of most of the patients was a very important pre-disposing factor to burn wound infection, as only 25% of patients were able to afford the cost of wound microscopy and culture, thus leading to limited numbers of cultures being performed, the result being their prescription of antibiotics was made generally on an empirical basis. Restriction in the misuse of antibiotics and establishment of an infection control until will help to lower the incidence of infection.

Urinary tract infections in children due to Pseudomonas aeruginosa in Enugu, Nigeria.

During a 4-year period, March 1989 to February 1993, 22 children with proven urinary tract infections (UTI) due to Pseudomonas aeruginosa were studied retrospectively. The infections were more common in males (59 per cent), with the highest number of cases 10 (46 per cent) occurring in the 1-4 year age group. Sixty-eight per cent of the children had risk factors for infection with renal diseases, accounting for 36 per cent, followed by surgery of the urinary tract/catheters (23 per cent). The unavailability of the newer antipseudomonal antibiotics, coupled with the occurrence of predisposing factors, makes the elimination of the organisms difficult, thus leading to prolonged and costly treatment.

Acute bacterial meningitis in Enugu, Nigeria. 1 April 1989 to 31 March 1993.

A total of 84 cases of meningitis confirmed by isolation of the organisms at the University of Nigeria Hospital (UNTH) Enugu, Nigeria between 1 April 1989 and 31 March 1993 are presented. The cases are analysed by diagnosis, seasonal distribution, age and sex distribution and age specific case fatality rate. The most common type of meningitis was pneumococcal meningitis 32 cases, followed by coliform meningitis 31 cases and meningococcal meningitis, six cases. Other bacterial causes of meningitis accounted for 15 cases. The majority of cases occurred in infants, followed by children, with all cases occurring sporadically. Mortality was high with Streptococcus pneumoniae having the highest case fatality rate of 28.13 pc followed by coliforms, 25.78 pc. Fifty pc of the patients had pre-medication before presentation at the hospital, and many of the patients could not receive appropriate therapy because they were unable to afford the cost of the drugs. This probably contributed to the high mortality.

Urinary tract infection with proteus species in a teaching hospital.

This study was undertaken to assess the prevalence of urinary tract infection due to proteus species, the predisposing factors, age and sex distribution, complications and the extent of drug resistance. A total of 580 patients were studied. Proteus species comprised 33 (9%) of the total number of bacterial isolates causing urinary tract infection during a one year study period between June 1991-May 1992. Proteus urinary tract infection was found to be the most common from the age of 55 years upwards in males, while in females, they were more evenly distributed. All the proteus isolates were completely resistant to ampicillin, tetracycline and cotrimoxazole. Ofloxacin was the most potent antibiotic (94.4%) sensitive, followed by gentamicin (83.3%) sensitive. Majority of the cases occurred in surgical department with more cases being nosocomially acquired than community. All male patients had at least one predisposing factor with catheterization being the commonest. To help reduce morbidity and mortality associated with urinary tract infection due to proteus species, strict aseptic catheter techniques and more efficient infection control measures must be reinforced.

Pseudomonas aeruginosa bacteraemia in Enugu, Nigeria. A review of 24 cases.

A 4-year study of Pseudomonas aeruginosa bacteraemia was carried out at the University of Nigeria Teaching Hospital (UNTH) in Enugu, Nigeria. The average age of the patients was 14.7 years. Thirty-three per cent of the patients were between 0-6 months of age, with males being in the majority. Underlying factors/diseases were present in 70.8% of patients, with prematurity, chronic suppurative otitis media and leukaemia being the major ones in infancy and childhood and diabetes mellitus, urogenital disorders and head injuries in adults. Overall mortality was 50% and highest (16.6%) in the 0-6 months age group. Antipseudomonas antibiotics are extremely costly and therefore beyond the financial scope of many people in the developing world. In Nigeria aminoglycosides are the best affordable antibiotics.

Changing pattern of acute bacterial meningitis in Enugu, Nigeria.

A retrospective analysis of the records of 76 children with culture proven acute bacterial meningitis at UNTH, Enugu over a four year period (1 April 1989 through 30 March 1993), has revealed a striking change in the pattern of the disease especially in the causative organisms, age distribution, morbidity and mortality. Gram negative organisms accounted for 52.63% of all isolates, with coliforms being the most predominant (34.21% of total isolates). However, in a previous study by others in the same locality, gram positive organisms were more predominant, accounting for 81.2% of all isolates. In both series, Streptococcus pneumoniae was the single most predominant organism although there was a decrease in the percentage of the organism in the present study. Morbidity and mortality rates were 23.68% and 28.95% respectively, compared with 19.6% and 20.6% in the previous study. The University of Nigeria Teaching Hospital (UNTH), Enugu is the only teaching hospital in the State.