Pattern of hospital admissions of children with poisoning in the Sudano-Sahelian North eastern Nigeria.

OBJECTIVE: Poisoning is a major problem in the paediatric population. In view of the paucity of literature on the subject matter in the northeastern part of Nigeria, this retrospective study was undertaken to describe the epidemiological features of accidental poisoning in children less than 13 years old who were admitted to the Emergency Paediatrics Unit (EPU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri. The specific objectives included the determination of the age range most vulnerable, the principal agents of poisoning, the annual pattern of occurrence, the commonly administered home remedy and the examination of the need for preventive strategies in this part of the country. PATIENTS AND METHODS: Data were extracted from the medical records of 113 patients with accidental poisoning during the period January 1984 to December 2003. RESULTS: One hundred and thirteen (0.74%) out of 15,196 children were admitted for accidental poisoning. Their ages ranged from 6 months to 12 years. Children aged 0 to 2 years accounted for 80 (70%) cases. There were 69 males and 44 females with a male: female ratio of 1.6:1. Fifty-nine (98.3%) out of 60 children were from low social background. Kerosene and food poisoning (Manihot esculenta) accounted for 89 (78.8%) and 19 (16.8%) of all cases of poisoning respectively. Respiratory symptoms dominated the clinical presentation in 71 (62.8%) cases. Seven patients had severely low bicarbonate levels. Home remedies were administered to 50 (44.3%) out of 113 patients. These remedies consisted of milk in 49 (92.5%) and palm oil (oil from Elais guineensis) in 17 (32.1%) cases. The mean duration of hospital stay was 0.66 (1.67) days. Severe neurological sequelae was recorded in one patient. There was no death. The highest frequency of admission was recorded during the hot and dry months of March to June. CONCLUSION: Kerosene is the commonest cause of childhood poisoning in Northeastern Nigeria and children aged 0 to 2 years are the most vulnerable age group. The highest frequency of admission coincides with the period of the hot and dry months of March to June. Education and improvement in the standards of living of the people are the key challenges for the regional governments of Northeastern Nigeria towards achieving poison control.

Preliminary assessment of the efficacy of mefloquine/-sulphadoxine/ pyrimethamine combination in the treatment of uncomplicated malaria in children in North Eastern Nigeria.

Preliminary assessment of efficacy of mefloquine/-sulphadoxine/pyrimethamine (MSP) combination in the treatment of uncomplicated Plasmodium infections was conducted in-vivo in non-immune and semi-immune children in Damboa, in the North east of Nigeria using a 7-day protocol. Six hundred and forty-six (76.4%) subjects out of 846 screened had positive Plasmodium infections. Seventy-two patients aged 6 months to 11 years were enrolled, of whom 69 (95.8%) completed the study. MSP demonstrated high clinical efficacy, producing 100% cure rate against pure P. falciparum (77.8%), pure P. malariae (18.1%) and mixed P. falciparum and P. malariae (4.2%) infections. GMPDs for P. falciparum, P. malariae and mixed infections were 4,826, 3,680 and 12,573 a sexual stages per microl of whole blood. The mean parasite clearance time (MPCT) was 4.42 days for pure P. falciparum parasitaemia and 4.82 days for P. malariae alone. No parasitologic failure occurred in the patients. Clinical response occurred rapidly; all fever cases cleared within 24 hours. Moreover, significant (P<0.05) PCV improvement occurred in 7 days from an average of 33.8 +/- 4.5% on D0 to 35.5 +/- 3.5% on D7. Besides, this drug was well tolerated by majority of patients. Details of these findings are presented and discussed against the background of increased efforts towards effective malaria treatment and control in Nigeria.

Treatment of malaria in north-eastern and south-eastern Nigeria: a population study of mefloquine, sulphadoxine, pyrimethamine combination (MSP) vs chloroquine (CQ).

In a population-based study involving 4019 patients in 20 peripheral health facilities in Nigeria, the outcome of presumptive malaria treatment with MSP was compared to that of CQ. The study was conducted between January 1995 and January 1996. Patients aged 6 months or more with a clinical diagnosis of malaria based on history of fever and axillary temperature > 37.5 degrees C were either treated with MSP (250 mg mefloquine, 500 mg sulphadoxine, and 25 mg pyrimethamine per tablet) or CQ (150 mg chloroquine base per tablet). The clinical cure rate was assessed by the disappearance of clinical signs and symptoms over a 7-day period. Tolerability was assessed by the incidence of adverse events (adverse drug reaction and intercurrent illness). The result shows that the clinical care rate of suspected malaria was 97.6% with MSP and 85.6% with CQ. The incidence of adverse event was 9.5% with MSP and 9.2% with CQ. The withdrawal rate was 2.0% with MSP and 5.0% with CQ; 3.5% of the patients in the CQ group withdrew due to adverse events compared to 0.47% with MSP. In conclusion it was observed that in addition to superior efficacy of MSP over CQ, fever clearance rate with MSP was comparable to that of CQ. The study also demonstrated that two tablets maximum dose of MSP is safe and effective in a large population of Nigeria malaria patients.

Efficacies of chloroquine, pyrimethamine/sulphadoxine and pyrimethamine/sulphalene against P. falciparum in northeastern Nigeria.

The clinical and parasitologic efficacies of oral chloroquine phosphate, pyrimethamine/sulphadoxine and pyrimethamine/sulphalene in treating Plasmodium falciparum malaria were assessed in selected sites of northeastern Nigeria (Zone D of the Primary Health Care (PHC) Programme) using a 14-day standard in-vivo protocol during 1988-1990. Of a total of 2056 children under 5 years screened for infection, for chloroquine trials, 1189 (57.8%) were positive for Plasmodium infection. One hundred and seventy (14.3%) of these positive children were enrolled into the study. Clinically, the drug demonstrated high performance in clearing symptoms of infection. However, varying degrees of parasitologic failure, ranging from delayed clearance through recrudescence to asymptomatic Type-II resistance, were encountered. For tests with pyrimethamine/sulphadoxine and pyrimethamine/sulphalene, 517 and 253 children, respectively, were screened. The corresponding infection rates were 71.6% (370 children) and 71.5% (181 children), with 59 and 34 enrollments. Both drugs were highly effective, clinically and parasitologically. These findings and their implications for the success of the PHC programme for malaria control are discussed.