Passive measles immunity in a Nigerian tertiary health care facility: the influence of human immunodeficiency virus infection on measles antibody levels in mother-infant pairs at birth.

BACKGROUND: Infants are protected from measles infection by maternal measles antibodies (MMA). The level of these MMA at birth in newborn children depends on the levels in their mother and the extent of placental transfer. We investigated maternal HIV infection as a predictor of levels of MMA in mother-infant pairs in Maiduguri. METHODS: A total of 180 mother-infant pairs were tested for MMA between 15th January and 29th March 2010. Levels of MMA were measured using enzyme linked immunosorbent assay (ELISA) test. RESULTS: Fifteen (8.3%) mothers were found with HIV infection and all were on antiretroviral treatment for HIV, and all of them had protective MMA. Of these mothers with HIV infection, only one (0.6%) of their newborn infants had un-protective level of maternal measles antibody. Maternal measles antibodies in mother-infant pairs had significant correlation (p = 0.005) for both HIV-infected and HIV-uninfected groups. The mean MMA of the newborn children was lower in infants of HIV-infected mothers than in HIV-uninfected mothers (p = 0.37). Linear regression analysis showed no significant association between maternal HIV infection and MMA in mother-infant pairs (p = 0.72) for mothers and (p = 0.37) for newborn infants. CONCLUSION: Maternal HIV infection was not associated with significantly reduced MMA in mother-infant pairs, as high protective levels were evident in both mother-infant pairs at birth.

Clinical staging of HIV infection as a surrogate for CD4 count in HIV-infected children.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a major cause of infant and childhood mortality and morbidity; without treatment about 50% of them will succumb to HIV/AIDS before the age of two years. OBJECTIVE: to evaluate the usefulness of clinical manifestations of HIV infection as a surrogate for CD4 counts in antiretroviral-naive HIV-infected children. METHODS: newly diagnosed HIV-infected children, antiretroviral-naive attending a paediatric infectious diseases unit were enrolled. The clinical manifesta-tions, age, sex, and WHO clinical stage of each patient were determined. CD4 count and CD4% were estimated at presentation and correlated with various clinical manifestations of HIV disease. RESULTS: the study population consisted of 126 children, aged four months to 14 years with a mean of 3.2 ± 2.7 years and a male to female ratio of 1.2:1. Eighty-one percent of the children acquired HIV infection through mother-to-child transmission (MTCT). The CD4% was higher in infants (p < 0.000) and lower in children over five years of age. Eighty-six percent of them in stage 4 were children less than 24 months of age. CD4% showed a modest correlation with WHO paediatric clinical staging (r=0.62, p=0.002). Patients with lymphadenopathy (stage 1) had a high absolute CD4 count whereas patients with failure to thrive had a relatively low absolute CD4 count. CONCLUSION: WHO Paediatric clinical staging for HIV infection correlates with CD4% and can be used as a surrogate to CD4. CD4 count and CD4% vary with age and complications of the disease.

Urinary tract infection in febrile children in Maiduguri north eastern Nigeria.

One hundred and forty five children aged 1 month to sixty months who had fever at presentation to the paediatric department of University of Maiduguri Teaching Hospital were investigated for urinary tract infection in this prospective study from November 2004 to October 2005. Prevalence of urinary tract infection was found to be 13.7 per cent. While the female sex and malnutrition were found to be significantly associated with urinary tract infection, height of temperature and symptoms referable to urinary system were not. Ninety per cent of the isolates were Gram negative; mainly coliform Spp, the remaining 10 per cent were due to staphylococcus aureus. Gentamicin was still found to be effective against most of the urinary pathogens. However, clavulinic acid potentiated amoxicillin, ampicillin, nalidixic acid and cotrimoxazole were found to be poorly effective. We therefore conclude that all ill children especially younger ones presenting with fever be screened for urinary tract infection. A regular surveillance of urinary tract infection pathogens and their antibiotic sensitivity pattern is recommended.

Study of hepatic functions and prevalence of hepatitis B surface antigenaemia in Nigerian children with human immunodeficiency virus infection.

BACKGROUND: HIV and hepatitis B virus (HBV) co-infected patients have a significantly increased risk of dying from liver disease especially after starting treatment with highly active antiretroviral therapy. We aim to determine the prevalence of hepatitis B surface antigenaemia in HIV-infected children and their significance in relation to hepatic functions. METHOD: Two hundred and eighty four HIV-infected children aged between 4 mouths to 15 years attending the Paediatric infectious disease clinic of University of Maiduguri Teaching Hospital (UMTH) Maiduguri, Nigeria from September 2007 to December 2007 were the subject for this study. Two hundred and seventy six HIV-negative children with served as age and sex-matched controls. They underwent investigations to evaluate the liver function (serum alanine transferase (ALT), alkaline phosphotase (ALP) and bilirubin) and the prevalence of hepatitis B surface antigen (HBsAg) using ELISA technique. RESULTS: Prevalence of HBsAg of 19% and 9.4% was observed among HIV-infected children controls (p = 0.004). Serum ALT and bilirubin concentrations were significantly higher in the HIV-infected group compared to the controls, (p < 0.05). HIV-infected children with HBs antigenaemia had significantly higher ALT and ALP concentrations compared to those without HBs antigenaemia (p < 0.05). CONCLUSION: These findings point to the high risk of HBV infection and continual paranchymal damage in HIV-infected children before commencing ART. Vaccination against HBV should eliminate this risk. Ideally HBV serology should be evaluated before starting ART to help guide therapeutic decision-making.

More reliable data for diarrhoeal intervention programmes: rethinking on knowledge, attitude and practice studies.

The aim of this study was to propose an alternative approach to traditional knowledge, attitude and practice (KAP) studies to enhance the quality of data on which educational health programmes are based. The methodology proposed and illustrated involved a triangulation of approaches derived from linguistics, cognitive science, and medical laboratory sciences. Three diarrhoeal health talks (educational messages) as given to mothers in three primary-care facilities in Borno State (Northeast Nigeria) were subjected to a linguistics analysis. Relationships were then sought between the ontology of knowledge in the health talks as revealed by the text analysis and two other kinds of data, namely: (a) mothers' answers to a set of ecologically-sensitive reasoning questions that test how much relevant inferential knowledge the health talks allow for and (b) results of microbiological and biochemical analyses of salt-sugar rehydration solutions prepared by mothers participating in the study. The findings of the study show a relationship between contents/formatting of the health talks and the extent to which relevant inferential competence was supported or demonstrated by mothers. It was also evident that the laboratory analyses could be related either directly to the health talks or indirectly in terms of what the health talks need to emphasize on. The conclusion shows how the methodology proposed addresses shortcomings of traditional KAP studies in respect of the gap between health knowledge and practice.

Bioelectrical impedance analysis of the body composition of Nigerian children with sickle cell disease.

We used bioelectrical impedance (BIA) to investigate the body composition of children with sickle cell disease (SCD) in northern Nigeria. A total of 48 children with SCD and 51 controls between 3 and 20 years of age were studied. A significant difference was found in the weights of male subjects over the age of 10 years compared to controls (p = 0.01), but not in height. Significant differences were also observed for SCD males in the 10-18-year-old age range in body mass index (p = 0.001), fat free mass (p = 0.001), per cent fat free mass, (p = 0.02), body fat (p = 0.02), and per cent body fat (p = 0.02). No significant differences in any of these parameters between SCD subjects and controls were obtained for males under the age of 10 years. There were no significant differences in the height, weight, body mass index, or fat free mass for female SCD subjects compared to controls over the age range we studied. However, there were significant differences in the per cent fat free mass (p = 0.006), body fat (p = 0.025), and per cent body fat (p = 0.01) for female SCD subjects over the age of 10 years compared to controls. In addition to documenting differences in the body composition of adolescent boys with sickle cell disease in Nigeria, this study also demonstrated the feasibility of using bioelectrical impedance to analyse the body composition of individuals under the hot, arid conditions which prevail in sub-Saharan Africa.

Increased serum levels of N-telopeptides (NTx) of bone collagen in postmenopausal Nigerian women.

Serum levels of cross-linked N-telopeptides (NTx) of bone collagen, alkaline phosphatase (ALP), and intact parathyroid hormone (PTH) were determined in 64 premenopausal (PRM) and 86 postmenopausal (PSM) women living in northern Nigeria. Serum NTx values were correlated with ALP activity (r = 0.31-0.58, P < 0.01) and PTH (0. 32-0.35, P < 0.01)) in all of the subjects studied, and were also related to age (-0.47, P < 0.001) and body mass index (-0.45, P < 0. 001) in PRM women. Menopause had the effect of increasing the circulating concentrations of NTx and ALP activity by 15% (P = 0. 001) and 11% (P = 0.02), respectively; however, serum levels of PTH were not different between these two groups of women. Compared with Caucasian counterparts matched for age and body mass index, PSM Nigerian women had significantly increased circulating concentrations of NTx (21.7 versus 16.2 nmol BCE/liter, P = 0.01) and demonstrated a trend towards higher ALP activities and PTH levels. These results indicate that (1) discrete reference intervals should be defined for biochemical markers of bone metabolism in African populations, (2) Nigerian women have relatively higher rates of bone turnover, and (3) further investigation of the implications of increased serum NTx should be undertaken using physical methods such as dual X-ray absorptiometry (DXA) and bone ultrasound attenuation.

Presentation and outcome of HIV-1 infection in hospitalised infants and other children in north-eastern Nigeria.

There is limited information on HIV infection in children in West Africa. This prospective case series study was done to determine the size of the problem and the feasibility of selective screening for infection based on clinical presentation. It involved infants and other children admitted to the Children's Emergency Ward and Paediatric Medical Ward of the University of Maiduguri Teaching Hospital, Nigeria, from the beginning of September 1992 to the end of September 1994. Clinical evaluation followed by serologic tests (ELISA and Western blot techniques) was undertaken. Descriptive study; frequencies were compared using chi 2 test for Fisher's exact test as appropriate. One hundred and ninety nine (10.9%) of 1,822 admissions were screened. One hundred and fifty eight (79.4%) were ELISA negative and 17 (8.6%) ELISA and WB positive; a further 10 (5%) were ELISA positive but WB indeterminate and 14 (7%) were ELISA positive but WB negative in 12 or untested in two. All the infections were HIV-1. Sixteen (39%) patients (nine WB positive, three WB indeterminate and four ELISA positive only) are dead, 14 from HIV-related illnesses, two (4.9]) are alive and 23 (56.1%) lost to follow up; 11 of the HIV-related deaths involved infants. Presence of persistent diarrhoea, prolonged fever, oral thrush, hepatosplenomegaly, diagnosis of tuberculosis and severe malnutrition with gastroentereritis, and multiple (> 3) diagnosis on admission were significantly (p < 0.05) associated with WB confirmed HIV-1 seropositivity and could serve as indicators for selective screening. HIV-1 infection in hospitalised infants and children has become an important problem in Nigeria, presentation in infancy is associated with a high case fatality rate, and the practice of selective screening based on clinical presentation would appear to be feasible.

Early diagnosis of septicaemia in infants with respiratory distress in the tropics.

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%)had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining, 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive--all of which were also positive with methylene blue. Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these, 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.

PIP: A prospective study of buffy coat microscopy in newborns with respiratory distress confirmed the reliability of this procedure in the early diagnosis of neonatal septicemia or lung infection. The buffy coat smear examination was performed on 108 consecutive infants admitted to the University of Benin (Nigeria) Teaching Hospital from April to August 1991 with signs of respiratory distress (e.g., respiratory rate of 60 or more per minute, retraction score of 4 or more, and grunting respirations) during the first 48 hours of life. Bacteriologic cultures indicated that 32 infants (30.7%) were septic. When methylene blue staining was used, 30 septic infants (94%) shared organisms in the buffy coat compared to only 16 (50%) with Gram staining. Of the 76 infants with negative cultures, 24 had radiologic evidence of pulmonary infiltration consistent with pneumonia. (The lack of microbiologic evidence of infection in these infants may reflect the administration of antibiotics prior to delivery.) Of these 24 infants, 20 (83%) showed organisms in the buffy coat with both methylene blue and Gram staining. The specificity of negative buffy coat smears in the non-septic group with normal chest x-rays was greatest (88.5%) when the results of methylene blue staining and Gram staining were combined.