RESUMEN
Background: Admissions over the years have been largely due to preventable aetiologies and the possible outcomes are discharge, death, referral or discharge against medical advice. This study aimed to understand the patterns of postneonatal paediatric admissions and outcomes from a public tertiary health facility in South-West Nigeria. Methodology: A descriptive retrospective study of paediatric admissions over a 2-year period. Information concerning age, sex, diagnosis and outcome were extracted from patients' medical records. Data was presented in numbers and percentages, Chi-square was used to compare groups and a p-value of <0.05 was accepted as significant. Results: There were a total of 875 admissions, over the 24 months period, with a male-female ratio of 1.3:1. Malaria, sepsis, sickle cell crises, pneumonia, pharyngotonsilitis and acute watery diarrhoea constituted the six leading causes of all admissions. The mortality rate for all admissions was 5.0% while the under-five mortality rate was 3.9%. Seven hundred and ninety nine (91.3%) of the admitted patients were discharged, 44 (5.0%) died, 30 (3.4%) DAMA and two (0.3%) patients were referred. Conclusion: A large percentage of children still die from preventable and treatable diseases. Prompt health seeking behaviour, enrollment of more citizens on insurance scheme, and adoption of the newly developed malaria vaccine will help reduce child mortality. Also, early referral of patients by private hospitals should be encouraged and paediatricians to have a high index of suspicion for the diagnosis of septicaemia.
RESUMEN
BACKGROUND: The success of any prevention of mother-to-child transmission (PMTCT) program is assessed by the proportion of HIV-exposed infants that sero-convert at the end of all risk exposures. Although adopting the best feeding option for HIV-exposed infants is one of the factors that impact PMTCT outcomes, there is limited data on the assessment of PMTCT success rates based on antiretroviral interventions and feeding options. This study assesses the success rate of PMTCT service based on antiretroviral interventions and feeding options. METHODS: Eighty-five HIV-infected mothers previously in care were enrolled in a prospective cohort study. Folders and structured questionnaires were used to extract data on mother-infant pair and the first CD4, count of infected mothers on enrolment at PMTCT clinic. Dry blood spot samples were obtained from exposed infants for early infant diagnosis. Results were analyzed using the SPSS software. RESULTS: The mean age of enrolled mothers was 31.3 ± 4.4 years, and an average CD4+ T-lymphocyte count of 368.6 ± 216.2 cells/µl. Seven (8.2%) of the HIV-exposed infants were positive for HIV-1 based on early infant diagnosis results. Overall PMTCT success rate (PMTCTSR) was 91.8%. HIV-1 prevalence of 5.0%, 0% and 21.1% was found among infants of patients who opted for breastfeeding, replacement feeding, and mixed feeding respectively thus yielding PMTCT success rates of 95%, 100% and 78.9%. Pediatric antiretroviral interventions success rates in HIV-exposed infants was 95.8%, 80.0% and 66.7% based on age groups ≤ 6 months, > 6 ≤ 12 months, and > 12 ≤ 18 months respectively. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Quality PMTCT service is vital for successful prevention of mother-to-child transmission of HIV. Implementation of more dynamic approaches such as adherence to option B+ guidelines in PMTCT service in our settings can further reduce mother-to-child transmission of HIV and improve outcomes.