PREVALENCE OF MALARIA PARASITAEMIA AND THE USE OF MALARIA PREVENTION MEASURES IN PREGNANT WOMEN IN IBADAN, NIGERIA.

BACKGROUND: Malaria complicates up to 58.1% of pregnancies in Nigeria. Preventive measures include intermittent preventive treatment and consistent use of insecticide-treated nets. However, uptake of these interventions can often be sub-optimal. OBJECTIVE: This study aimed to assess the prevalence of malaria in pregnancy in peri-urban and rural communities of Ibadan, Nigeria and its association with the use of preventive measures. METHODS: In this cross-sectional study, pregnant women were recruited from selected primary health centres and blood films were taken for malaria parasites. Explanatory variables were the use of bed nets and chemoprophylaxis; the primary outcome was presence of peripheral malaria parasitaemia. RESULTS: Malaria prevalence was 4.3% (67 of 1570 participants); two-thirds of women with parasitaemia had malaria symptoms. Four hundred and thirty-eight (27.9%) used prescribed sulphadoxine-pyrimethamine prophylaxis, 784 (49.9%) women reported that they consistently slept under insecticide-treated nets, and 236 (15%) complied with both interventions. Bed net use appeared more protective than chemoprophylaxis. However, the protection from malaria in those who used preventive measures was not statistically significant (p=0.075). CONCLUSION: Malaria prevalence was low. No association was determined between malaria and the use of preventive measures; the lack of association may be due to the low prevalence.

A community-based surveillance of gastrointestinal helminthiasis among pregnant women in Ibadan, South West Nigeria.

BACKGROUND: : Intestinal helminthiasis is a major public health problem in Africa. Helminthic infection in pregnant women causes loss of appetite, poor nutrient absorption, gastrointestinal impairment, iron deficiency, and iron deficiency anemia resulting in low birth weights and preterm births. The main aim of this study is to assess the prevalence of helminthic infections in pregnant women in rural and peri-urban communities of Ibadan. MATERIALS AND METHODS: : A cross-sectional descriptive study was carried out at the antenatal clinics of 12 selected primary health centers and mission homes in Ibadan, Nigeria. Open- and closed-answer questionnaires were administered to 604 consenting pregnant women, who provided fresh stool samples for microscopy. Helminthic quantification was carried out by the Kato-Katz technique. Proportions were compared using Chi-squared with IBM® SPSS® Statistics 21 for analysis. Statistical significance was set at P < 0.05. RESULTS: : Eighty-nine stool samples (14.7%) were positive for helminthiasis. Most had roundworms (13.6%); 13 (2.2%) had hookworms. The mean arithmetic eggs per gram of feces were 2,124 and 248, respectively. No participant had a heavy intensity infection; nearly all were of low intensity. Participants (P = 0.005) and their husbands (P = 0.005) who had higher education were less likely to have helminthiasis. CONCLUSION: These communities are classified as Category III, having a low prevalence and low intensity infection. Therefore, prophylactic anti-helminthic treatment in pregnancy is not recommended. The inverse relationship with education may be a function of better living conditions. Better hygiene should be advocated.

Genotypic Characterization of Cryptosporidium Species in Humans and Peri-Domestic Animals in Ekiti and Oyo States, Nigeria.

Cryptosporidiosis is one of the leading causes of diarrhea in humans and several other vertebrate species. Because surveys of Cryptosporidium genotypes from animals and humans living in the same region are rare, our understanding of the importance of zoonotic transmission in the epidemiology of cryptosporidiosis remains superficial. PCR was used to amplify a portion of the Cryptosporidium 18S small subunit ribosomal RNA gene from fecal DNA from humans and livestock living in Ekiti and Oyo states, Nigeria. PCR-positive samples were further analyzed using PCR targeting the heat-shock protein HSP-70, the actin, and the sporozoite glycoprotein gene gp60. A questionnaire was used to collect demographic information. Sixteen of 187 samples collected were Cryptosporidium 18S PCR positive. Of these, 5 samples originating from HIV-positive patients, 5 from otherwise healthy children, 2 from chickens, 3 from goats, and 1 from a dog were positive for at least 1 marker. Sequencing of the 18S rRNA amplicons revealed the presence of Cryptosporidium parvum in 2 HIV positive patients and in a child; the actin sequence confirmed the presence of this species. Two samples of HIV-positive patients amplified Cryptosporidium hominis 18S rRNA, one of them confirmed by the HSP-70, actin, and gp60 sequences. Cryptosporidium meleagridis was found in another HIV patient, while C. hominis was detected in 3 children (of which 2 were confirmed by gp60). Cryptosporidium muris was found in 1 child. In birds, we found C. meleagridis and, significantly, C. parvum, whereas we detected C. parvum and C. muris in 1 goat each. The only dog sampled was positive for Cryptosporidium canis. We conclude that, in the environment we surveyed, humans and animals are a potential part of the same transmission cycle. Measures to prevent zoonotic transmission should therefore be considered to reduce the prevalence of cryptosporidiosis.

Oxygen for children and newborns in non-tertiary hospitals in South-west Nigeria: A needs assessment.

BACKGROUND: Oxygen is important for the treatment of hypoxaemia associated with pneumonia, malaria, and other medical, obstetric, and surgical conditions. Access to oxygen therapy is limited in many of the high mortality settings where it would be of most benefit. METHODS: A needs assessment of 12 non-tertiary hospitals in south-west Nigeria, assessing structural, technical and clinical barriers to the provision of safe and effective oxygen therapy. RESULTS: Oxygen supply was reported to be a major challenge by hospital directors. All hospitals had some access to oxygen cylinders, which were expensive and frequently ran out. Nine (75%) hospitals used oxygen concentrators, which were limited by inadequate power supply and lack of maintenance capacity. Appropriate oxygen delivery and monitoring devices (nasal prongs, catheters, pulse oximeters) were poorly available, and no hospitals had clinical guidelines pertaining to the use of -oxygen for children. Oxygen was expensive to patients (median US$20/day) and to hospitals. Estimated oxygen demand is reported using both a constant mean-based estimate and adjustment for seasonal and other variability. CONCLUSIONS: Making oxygen available to sick children and neonates in Nigerian hospitals will require: improving detection of hypoxaemia through routine use of pulse oximetry; improving access to oxygen through equipment, training, and maintenance structures; and commitment to building hospital and state structures that can sustain and expand oxygen initiatives.

Environmental risk factors for acute respiratory infections in hospitalized children under 5 years of age in Ibadan, Nigeria.

BACKGROUND: Acute respiratory infections (ARIs) are the fourth major cause of morbidity and mortality among children under 5 worldwide. However, information on the risk factors that could predispose children under 5 to ARIs is scanty in Nigeria. AIM: To assess which environmental factors contribute to the acquisition of ARIs in children under 5 in Ibadan. METHODS: A case-control study was undertaken. 220 children under 5 with ARI (cases) and 220 without ARI (controls) were selected consecutively from children visiting Oni Memorial Children's Hospital and University College Hospital, Ibadan. A pre-tested six-section questionnaire was administered to mothers to elicit information on factors that contribute to the acquisition of ARIs in children under 5. RESULTS: Mean (SD) ages of cases and controls were 20·4 (14·7) and 20·3 (15·0) months, respectively. Mean (SD) household size of cases was 6·0 (1·5) compared with 4·0 (1·7) for the controls (P = 0·01). Children whose homes had more than two persons per room were found to have a 14-fold greater risk of ARI than children in houses with fewer than two persons per room. The use of a lantern at night (OR 4·1, 95% CI 2·4-6·9) and firewood for cooking (OR 9·3, 95% CI 3·6-24·1) were found to be independent risk factors for ARIs. CONCLUSION: Cases were more exposed than controls to environmental risk factors for ARIs. Increased awareness of the importance of environmental factors with regard to prevention and control of ARI is therefore important.

Normal Ultrasonographic Dimensions of the Liver in Neonates in South-West Nigeria.

BACKGROUND: Ultrasound (US) is first choice of imaging in children suspected to have liver pathology because it is cheap, quick to perform with no radiation risks. Liver size may be increased or decreased in many pathological conditions and ultrasound is ideal since clinical evaluation by palpation and/or percussion can be unreliable or inaccurate. OBJECTIVE: To our knowledge, no previous study has been done in an exclusively large neonatal population in Sub-Saharan Africa to establish reference values for the liver size. This study aims to determine by USS, the normal range of longitudinal dimensions for the liver in healthy neonates. METHODS: A prospective cross-sectional study of 508 apparently healthy neonates. Routine clinical examination and liver ultrasound scans were performed before discharge or at the immunization clinic. Liver size was taken as the longitudinal dimension in the mid-clavicular line. Normograms with point-wise 95% reference ranges were constructed using a normal approximation. RESULTS: Mean age was 9.67 ± 7.68 days and 51.4% were males. Ultrasound span of the liver ranged from 3.28-8.02 cm with a mean of 5.72 ± 0.88 cm. There was no evidence for sex difference in the liver size, p= 0.338. The liver size correlated most strongly with neonatal weight (r=0.55) and age (r=0.53) which were used in plotting the 95% reference ranges for the neonatal liver normogram. CONCLUSIONS: This study of a large neonatal population has provided the normal range of US liver dimensions for neonates in the study area, using the age and weight in plotting the 95% reference ranges for the liver normogram.

Persistent mission home delivery in ibadan: attractive role of traditional birth attendants.

BACKGROUND AND OBJECTIVE: One of the major factors responsible for high maternal and neonatal deaths in Nigeria and other developing countries is the use of Traditional Birth Attendants (TBAs). The current study was carried out to evaluate the attractive roles of the TBAs that make pregnant mothers persistently use them. METHODOLOGY: The study was conducted in Ido and Lagelu local government areas of Oyo State in Nigeria. TBA basic demographic data were collected and were then followed up for a period of six months by trained Nurses and Doctors targeting a total of ten direct observations made per TBA per ANC/delivery. RESULTS: There were a total of 146 TBAs out of which 134 fulfilled the inclusion criteria and were recruited into the study. The Male to female ratio was 1/133 and age range was 22-68 years with 70.1 % above 40 years. Seventy two per cent of them had only elementary school and 72%, 30% and 38% had been re-trained by LGA, SMOH and National TBA associations respectively. Post- partum care, counseling services, tender care in labour, easy accessibility, accommodating other relations, installmental payment were observed in all TBAs while 60-98% of them did home visit, assisted in referral and arranged for USS and laboratory services. CONCLUSIONS AND RECOMMENDATIONS: These good practices should be incorporated into formal health sector and attitudinal change in the current health workers across all health care levels should be encouraged. CHEWs should also be primarily involved in home visit in pregnancy and post-natal care services.

Achieving optimal feeds for preterm babies, recommendations and realities in practice: nigerian perspective.

Preterm deaths are responsible for the highest number of neonatal mortality in Nigeria. Preterm nutrition contributes significantly to overall outcome particularly as it relates to neurodevelopment. Recently, new guidelines for enteral feedings in premature infants were issued by the American Academy of Paediatrics and European Society of Pediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. Nevertheless, in clinical practice it is often difficult to attain suggested intakes at all times. The situation is worse in Nigeria where there are no specific national guidelines and recommendations derived from local data targeting Preterms. There is a high possibility of significant potential cumulative nutritional deficits occurring in Nigerian preterms. The inevitable suboptimal intake contributes significantly to the incidence of neonatal diseases and outcome. This review describes practical ways of optimizing nutritional intake in these vulnerable neonates with reference to Nigerian situation. Understanding the preterm gut, initiation of parenteral nutrition, need for minimal enteral feeds, ensuring adequate macro and micronutrients intake and need for follow up are discussed. There are limitations to the practice of the recommended preterm nutrition in Nigerian settings, nevertheless the interventions like early commencement of minimal enteral feeds and preference for human breast milk should be practiced optimally. Hence, all health professionals should acknowledge that preterm nutrition may be an emergency and need to improve their knowledge on when and how to achieve optimal feeds in them. There is a dare need through both clinical practice as well as research, to reduce nutritional deficits in these vulnerable infants.

Pattern, indications and review of complications of neonatal blood transfusion in ibadan, southwest Nigeria.

BACKGROUND AND OBJECTIVES: There is a huge need for blood transfusion in the newborn particularly due to the reduced marrow activity in the neonatal period. Despite widely use of blood products in the neonatal period, there is paucity of local data on the pattern, indications and reactions to blood transfusions in Nigerian newborns. This study evaluates the blood transfusion indications and patterns in special care baby unit and C1(2nd) of University College Hospital, Ibadan, Nigeria. METHODOLOGY: A cross sectional study was carried on the recruited newborns and structured questionnaires were used to obtain bio data, medical problems, indications for blood transfusion, type of blood products transfused and clinical signs. Urinalysis was performed out before and after the transfusion. RESULTS: A total of 100 neonates were recruited into the study with a male: female ratio of (M: F= 1:1). The age range was 2-34 days and their weight ranged between 0.8kg to 3.6 kg with a mean weight of 1.64 kg. The main indications for transfusion were anaemia from prematurity & neonatal sepsis(NNS) 46%; (red cell replacement), NNS, Disseminated intravascular coagulation(DIC) & anaemia 24%; (partial exchange + top up + Fresh frozen plasma), neonatal jaundice(NNJ) & anaemia 14%; (whole blood), NNJ, NNS + anaemia 6%(Blood transfusion + Fresh frozen plasma), NNS + anaemia 10% (whole blood). CONCLUSION: Blood transfusion is still frequent in the study area and prematurity, neonatal sepsis and jaundice rank high in the indications. Transfusion reactions are rare in the evaluated neonates.

Accuracy of clinical diagnosis of liver diseases at Ibadan.

BACKGROUND: Liver diseases are a major cause of morbidity and mortality in Africa and rest of the world. The contribution of specific liver disease to overall mortality has not been well documented in Nigeria. OBJECTIVE: To study aimed at determining the relative frequency of liver diseases seen at autopsy and the accuracy of ante-mortem clinical diagnosis of liver diseases relative to post-mortem findings at the University College Hospital (UCH), Ibadan. METHOD: A retrospective study of autopsies performed at the Pathology Department of the UCH, Ibadan between January 1991 and December 2000. Information obtained from the autopsy records included age, sex, ante-mortem clinical diagnosis, and post-mortem diagnosis. The data were analysed for frequencies, means, proportions and sensitivity. RESULTS: A total of 4,604 post-mortem examinations were performed over the 10-year-period with an annual average of 460.4. Of this, 3,408 (74.02%) were coroner's while 1,196 (25.98%) were routine. There were 75 autopsy diagnosis of liver disease accounting for 6.27% of the total routine autopsies and a frequency of 7.5 per annum. The liver cases at autopsy were made up of 53 (70.7%) males and 22 (29.3%) females with those in the age range 40 - 49 years accounting for about one quarter of all. There was positive correlation of the Clinical diagnoses with post-mortem diagnoses in 33 (44%) but discordance in 42 (56%) of cases. CONCLUSION: The concordance between ante-mortem clinical diagnosis and post-mortem diagnosis of liver disease is rather low. There is a need to provide facilities for efficient diagnosis of liver diseases.

Epidemiology, aetiology and management of childhood acute community-acquired pneumonia in developing countries--a review.

Childhood acute community-acquired pneumonia is one of the leading causes of morbidity and mortality in developing countries. In children who have not received prior antibiotic therapy, the main bacterial causes of clinical pneumonia in developing countries are Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), and the main viral cause is respiratory syncytial virus (RSV), but estimates of their relative importance vary in different settings. The only vaccines for the prevention of bacterial pneumonia (excluding vaccines for pertussis and measles) are Hib and pneumococcal conjugate vaccines (PCV). In children with human immunodeficiency virus (HIV) infection, bacterial infection remains a major cause of pneumonia mortality; however, Pneumocystis jirovecii and Mycobacterium tuberculosis are important causes of pneumonia in them. Studies of bacterial aetiology of acute pneumonia in severely malnourished children have implicated Klebsiella pneumoniae, Staphylococcus aureus, S. pneumoniae, Escherichia coli, and H. influenzae, with very few data on the role of respiratory viruses and tuberculosis. Studies of neonatal sepsis suggest that Gram-negative enteric organisms, particularly Klebsiella spp., and Gram-positive organisms, mainly pneumococcus, group b Streptococcus and S. aureus are causes of neonatal pneumonia. Many of the developing countries that ranked high in pneumonia mortality are preparing to introduce new pneumonia vaccines with support from Global Alliance for Vaccine and Immunization (GAVI Alliance), plan for the expansion of community-based case management and have ambitious plans for strengthening health systems. Assurance that these plans are implemented will require funding and continued public attention to pneumonia, which will help contribute to a substantial decline in childhood pneumonia deaths.

Achieving Optimal Feeds for Preterm Babies; Recommendations and Realities in Practice: Nigerian Perspective

Preterm deaths are responsible for the highest number of neonatal mortality in Nigeria. Preterm nutrition contributes significantly to overall outcome particularly as it relates to neurodevelopment. Recently; new guidelines for enteral feedings in premature infants were issued by the American Academy of Paediatrics and European Society of Pediatric Gastroenterology; Hepatology and Nutrition Committee on Nutrition. Nevertheless; in clinical practice it is often difficult to attain suggested intakes at all times. The situation is worse in Nigeria where there are no specific national guidelines and recommendations derived from local data targeting Preterms. There is a high possibility of significant potential cumulative nutritional deficits occurring in Nigerian preterms. The inevitable suboptimal intake contributes significantly to the incidence of neonatal diseases and outcome. This review describes practical ways of optimizing nutritional intake in these vulnerable neonates with reference to Nigerian situation. Understanding the preterm gut; initiation of parenteral nutrition; need for minimal enteral feeds; ensuring adequate macro and micronutrients intake and need for follow up are discussed. There are limitations to the practice of the recommended preterm nutrition in Nigerian settings; nevertheless the interventions like early commencement of minimal enteral feeds and preference for human breast milk should be practiced optimally. Hence; all health professionals should acknowledge that preterm nutrition may be an emergency and need to improve their knowledge on when and how to achieve optimal feeds in them. There is a dare need through both clinical practice as well as research; to reduce nutritional deficits in these vulnerable infants

Pattern; Indications and Review of Complications of Neonatal Blood Transfusion in Ibadan; Southwest Nigeria

Background and objectives: There is a huge need for blood transfusion in the newborn particularly due to the reduced marrow activity in the neonatal period. Despite widely use of blood products in the neonatal period; there is paucity of local data on the pattern; indications and reactions to blood transfusions in Nigerian newborns. This study evaluates the blood transfusion indications and patterns in special care baby unit and C12nd of University College Hospital; Ibadan; Nigeria. Methodology: A cross sectional study was carried on the recruited newborns and structured questionnaires were used to obtain bio data; medical problems; indications for blood transfusion; type of blood products transfused and clinical signs. Urinalysis was performed out before and after the transfusion. Results: A total of 100 neonates were recruited into the study with a male: female ratio of (M: F= 1:1). The age range was 2-34 days and their weight ranged between 0.8kg to 3.6 kg with a mean weight of 1.64 kg. The main indications for transfusion were anaemia from prematurity et neonatal sepsis(NNS) 46; (red cell replacement); NNS; Disseminated intravascular coagulation(DIC) et anaemia 24; (partial exchange + top up + Fresh frozen plasma); neonatal jaundice(NNJ) et anaemia 14; (whole blood); NNJ; NNS + anaemia 6(Blood transfusion + Fresh frozen plasma); NNS + anaemia 10(whole blood). Conclusion: Blood transfusion is still frequent in the study area and prematurity; neonatal sepsis and jaundice rank high in the indications. Transfusion reactions are rare in the evaluated neonates

Randomized comparison of chloroquine and amodiaquine in the treatment of acute, uncomplicated, Plasmodium falciparum malaria in children.

The increasing resistance of Plasmodium falciparum to chloroquine (CQ) has created an urgent need for the evaluation of alternative, effective, safe, cheap, readily available and affordable antimalarial treatments. In the present study, the efficacy of amodiaquine (AQ) in the treatment of acute, symptomatic, uncomplicated, P. falciparum malaria was compared with that of CQ, each drug being given at 10 mg/kg per day for 3 days (days 0, 1 and 2). The 210 subjects (104 given AQ and 106 CQ) were Nigerian children aged 5 months-12 years. Fever-clearance times (FCT), parasite densities on days 1-4 and parasite-clearance times (PCT) were all significantly lower with AQ than with CQ. Mean (S.D.) PCT, for example, were 2.6 (0.8) days with AQ and 3.0 (1.0) days with CQ (P = 0.001). The cure rates obtained on days 14, 21 and 28 - 98.1% v. 79.3% (P =0.000), 97.1% v. 64.2% (P = 0.00001) and 95.2% v. 58.5% (P = 0.0000000) with AQ and CQ, respectively - were all also significantly higher with AQ. All but two of the 20 subjects who were considered CQ-treatment failures by day 14 (i.e. two RIII, two RII and 16 RI) responded to subsequent treatment with AQ, with PCT (but not FCT) significantly shorter than during their initial treatment with CQ. In siblings in whom there was clustering of infections, the cure rates were 100% with AQ (N =12) and 63.6% with CQ (N = 11; P = 0.03). Adverse reactions to CQ and AQ were similar and tolerable: pruritus in 10 and 11 children in the AQ and CQ groups, respectively, and gastro-intestinal disturbances which occurred in three children from each group. Haematological parameters were not adversely affected by either drug. At least in the setting of the present study, AQ appears more effective than CQ, effective against CQ-resistant infections, and well tolerated by children with acute, uncomplicated, P. falciparum malaria. It may therefore be useful as an alternative to CQ in areas of CQ resistance.