ABSTRACT
Background Early presentation and initiation of appropriate anticonvulsants help in controlling epilepsy and reducing morbidity and mortality associated with epilepsy. Objectives This study aimed to assess the health-seeking behavior for pediatric epilepsy among caregivers in Southeast Nigeria and the associated sociodemographic factors. Methodology This study was a cross-sectional descriptive and questionnaire-based study. The participants were recruited consecutively. Results Majority of the caregivers were mothers, had some formal education, and were employed. While 50% of these caregivers did not seek any home treatment for seizures, the other half offered various types of unorthodox home treatments. Treatments in primary and secondary levels of care were the most common form of first point of care outside the home. The most common reasons for the choice of care outside the home were advice from relations and belief in the efficacy of care offered. About 45% of the caregivers presented to tertiary level of care within 6 months of seizure onset. The major motivators for seeking care in tertiary level of care were health workers and families of children with epilepsy. Conclusion There is a need to strengthen the primary and secondary levels of care through continuous medical education of health workers in these levels of care for effective management of epilepsy. This will help in making prompt and correct diagnosis, classification, and initiation of appropriate therapy in epilepsy.
ABSTRACT
BACKGROUND AND OBJECTIVE: Above 90% of childhood HIV infections result from mother-to-child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria. METHODS: This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client's folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status. RESULTS: Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never-breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.
