Integrating syndromic case management of sexually transmitted diseases into primary healthcare services in Nigeria.

BACKGROUND: Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. METHODS: Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. RESULTS: Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection CONCLUSION: Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.

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.

Prevalence of rubella-specific IgG antibody in non-immunized pregnant women in Maiduguri, north eastern Nigeria.

The prevalence of IgG antibody specific to the rubella virus was assessed in 207 consenting pregnant women. The women were in the age range of 14 to 40 years (mean 25.8 years) and parity range of 0 to 8 (mean para 4), in their first and second trimesters of pregnancy. All attended the antenatal clinic of a tertiary health facility (University of Maiduguri Teaching Hospital) in northeastern Nigeria. Of the 207 serum samples tested, 112 (54.1%) were positive for rubella IgG antibody. In this area therefore, the proportion of susceptible pregnant women to rubella virus is up to 46%. The results from this study also indicated that with increased maternal age the percentage of immune women increased significantly (P = 0.04382) from 23.8% in the 14 to 19 years age group to 74.4% in the age group of 30 to 40 years. There was again a gradual increase in rubella seroprevalence from 43% amongst primigravidae to 59% and 78% in multiparous and grandmultiparous women respectively. The pregnancy outcome was normal in 27% of the women studied, with miscarriage occurring in 24.6% and 24.2% each had a premature delivery and stillbirth. There were 30 (58.8%) miscarriages, 27 (54%) premature deliveries and 30 (60%) stillbirths, with no clinically detectable malformations in 25 (44.6%) of all the deliveries from the immune women. There is therefore, an increase in the number of rubella immune women with each of the pregnancy outcomes compared to the non-iminune ones. Hence, the need to protect children of these susceptible women from contracting congenital rubella and its sequelae by including routine rubella vaccination of all women of childbearing age in the current programme on immunization.

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.

HIV infection among pregnant women. A worsening situation in Maiduguri, Nigeria.

A serosurvey of 1,233 pregnant women aged 15-41 years, and attending antenatal clinics in Maiduguri, Nigeria from July 1991 to February 1993 showed that 28 (2.3%) of the women were positive for HIV antibodies. Twenty-four (1.9%) were positive for HIV-1 only, 1 (0.08%) was positive for HIV-2 only and 3 (0.24%) were reactive for both HIV-1 and HIV-2. The overall seroprevalence rose gradually from 2.1% in 1991 to 2.3% in 1992, and to 2.6% so far in 1993. From July 1992 to February 1993 6 children aged 24 hours to 8 months were found HIV-positive in the same hospital where this survey was carried out. The only known risk factor for HIV infection applicable to the pregnant women studied was heterosexual intercourse.

PIP: In northeastern Nigeria between July, 1991, and February, 1993, health workers took blood samples from 1233 15-41 year old pregnant women attending the prenatal clinic at the University of Maiduguri Teaching Hospital to compare HIV prevalence with rates from the same hospital during September, 1988-April, 1990. Researchers did not test any of the partners for HIV infection. Overall HIV prevalence was 2.3%. This was 4.83 times higher than that of the earlier period. Yaounde, Cameroon, has experienced a similar increase in HIV infection among pregnant women (0.9-2.2%, in 1989-1991). In 1989-1990, HIV infection among pregnant women in Abidjan, Ivory Coast, was 8%. The significant increase in HIV prevalence in Maiduguri was comparable with the HIV prevalence of infants less than 24 hours to 8 months old in the same hospital between July, 1992, and February, 1993. 4, 1, and 1 of the 280 pregnant women who were tested in 1991 were positive for HIV-1, HIV-2, and both HIV-1 and HIV-2, respectively. These figures for 1992 (838 women) were 17, 0 and 2. They were 32, 0, and 0 in 1993 (115 women).