Evaluation of the Effectiveness of the Prevention of Mother-to-Child Transmission (PMTCT) Interventions in HIV-Exposed Children

Background: Mother-to-child transmission of HIV can be reduced by interventions targeted at the mother during pregnancy and at the baby after birth. Aim: To evaluate the effectiveness of the prevention of mother-to-child transmission (PMTCT) interventions in HIV-exposed infants presenting at the University of Port Harcourt Teaching Hospital; and to compare the level of interventions and outcomes at the UPTH-based programme with those elsewhere. Methods: An analytical cross-sectional study of HIV exposed infants aged 6 weeks-18 months presenting at the Paediatric HIV Clinic between November 2007 and June 2008. Information obtained included gender; age; antiretroviral drugs in pregnancy and at birth; place of antenatal care and delivery; method of delivery and feeding option. Infection status was determined by DNA PCR using dried blood spot (DBS) specimen. Results: A total of 294 children (139 males and 155 females; M:F ratio of 1:1.1) were seenwithin the study period; out of which 72 (34 males and 38 females; M:F ratio of 1:1.1) were positive giving an overall infection rate of 24.5. In 92 (31.3) mother-baby pair; there was no intervention and 53 (73.6) of the 72 babies that were infected were from this group whereas 63 (21.4) mother-baby pair received full PMTCT intervention and 1(1.4) was infected. The difference in the number of infected children in those who had no intervention and those who had at least one intervention was highly significant (?2 =41.55; p=0.00000). The transmission rates were 5.6; 7.7; 23.1and 50.4in babies delivered in UPTH; other full PMTCT implementing sites; partial PMTCT implementing sites and non-PMTCT implementing sites respectively.Conclusion: PMTCT interventions are highly effective in preventing HIV infection in exposed infants

Microalbuminuria in children with human immunodeficiency virus (HIV) infection in Port Harcourt, Nigeria.

BACKGROUND: Microalbuminuria is an early manifestation of HIV associated nephropathy (HIVAN). This study was to determine the prevalence and risk factors for microalbuminuria in children with HIV infection in Port Harcourt, Nigeria. METHODS: Urine specimen of 50 children with HIV infection seen over a 4 months period (October 2007-February 2008) was assayed for albumin and creatinine to determine urinary albumin to creatinine ratio (ACR). Microalbuminuria was defined as urinary albumin to creatinine ratio (ACR) of greater than 2.5-25 mg/mmol. The glomerular filtration rate (GFR) was calculated using the Schwartz formula. RESULTS: There were 28 (56%) males and 22 (44%) females with a male to female ratio of 1.3:1. They aged 1 month to 18 years with a mean age of 4.07 +/- 3.61 years. Microalbuminuria occurred in 6 (12%) patients; 3 males and 3 females, mean age of 5.5 +/- 4.6 years. Five (83.3%) of the patients with microalbuminuria had clinical AIDS and CD4+ cell count less than 200 cells/microL. All the patients with microalbuminuria were not receiving highly active antiretroviral therapy (HAART) at the time of study. One (16.7%) patient had overt HIV-associated nephropathy (HIVAN) with ACR greater than 2.5 mg/mmol, elevated serum creatinine 400 micrommo/L, urea of 20 mmol/L and a GFR of 69 ml/min/1.73m2. CONCLUSION: The prevalence of microalbuminuria in Nigerian children with HIV infection is high, and it occurs mainly in older children with clinical AIDS who are not on HARRT.

Perception of neonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt.

BACKGROUND: Neonatal Jaundice (NNJ) is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. OBJECTIVE: To determine the knowledge of the women attending Children Outpatient (CHOP) and Immunization clinics on the causes, treatment and complications of neonatal jaundice. METHOD: Women who brought their children/wards to the immunization/children out patient clinics at the University of Port Harcourt Teaching Hospital Port Harcourt were interviewed using structured questionaire. RESULTS: There were 255 mothers who participated in the study. Of these 30 (11.8%) have never heard of neonatal jaundice while 225 (88.2%) have heard and only those who have heard were further analyzed. The age range was from 16 to 47 yrs (mean age 27.1 +/- 3.3 years). Median parity was 2. One hundred and twenty two (54.2%) women had tertiary education. One hundred and seventy four (77.3%) correctly defined neonatal jaundice, and in 114 (44.7%) source of information was from health talk in the clinic. Seventy five (33.3%), and 50 (22.2%) erroneously believed that eating too much groundnut in pregnancy and mosquito bite respectively were the main causes while 55 (24.4%) correctly answered that it is due to mismatch of mother and baby's blood. Only a few knew that use of dusting powder on baby's cord, prematurity, and storing baby's clothes in camphor were risk factors for NNJ. One hundred and fourteen (50.7%) and 60 (26.7%), wrongly believed that exposure to sunlight and use of glucose drinks respectively were the main forms of treatment and 50 (22.2%) knew brain damage as a possible complication CONCLUSION: There is still misconception on the causes and risk factors and treatment of neonatal jaundice among our women. Also only a few women are reached by the health talk in the clinics. There is therefore urgent need for massive health enlightenment campaign.

Myelomeningocoele in dizygotic twins.

BACKGROUND: Periconceptional use of folic acid can reduce a woman's risk of having a baby with a neural-tube defect and other congenital abnormalities. METHOD: Case reports of babies OO both males, who were delivered at term by emergency caesarean section by a 21 year old woman. At birth, both twins had neural tube defects, bilateral talipes equinovarusdeformity, bladder and bowel dysfunction. Twin one in addition had hydrocephalus and a ventriculoseptal heart defect (VSD). CONCLUSION: We advocate comprehensive neural tube defect (NTD) surveillance, a folic acidsupplementation program for high-risk women who have had a NTD-affectedpregnancy and a national folic acid education campaign for allwomen of reproductive age preconceptionally.

Diarrhoea Management: an Evaluation of the Appropriateness of the Home Treatment Given by Caregivers

Background: Diarrhoea often starts at home. Early and appropriate treatment by caregivers will go a long way towards reducing the morbidity and mortality from diarrhoea. Aim: To document how acute diarrhoea is managed at home by caregivers and to determine the appropriateness of such treatment. Methods: A prospective study of children less than 5 years with diarrhoea attending the Diarrhoea Training Unit (DTU) and Children Emergency Ward (CHEW) of the University of Port Harcourt Teaching Hospital (UPTH) was conducted using a structured questionnaire administered to the caregivers. Results: A total number of 250 children were recruited for the study. Twenty-four (9.6) children had blood in stool (dysentery) while 226(90.4) had acute watery diarrhoea. Thirty-six (14.4) gave oral rehydration therapy (ORT) as the only home treatment; 60 (24.0) gave both drugs and ORT; while 151 (60.4) gave drugs alone and 3 (1.2) children received no treatment. The drugs given included antibiotics in 188 (89.1); adsorbents in 53 (25.1); antiemetic in 12 (5.7); antispasmodic in 8 (3.8); antihelminthics in 7 (3.3); and antacid in 6 (2.8). None of the cases with blood in the stool (dysentery) received the appropriate antibiotics. Parental education and social class did not seem to have an effect on the appropriateness of the care given to these children. Conclusion: Diarrhoea management at home is inadequate in terms of low utilization of oral rehydration therapy; inappropriate adminis- tration of antibiotics for cases with bloody stool; and unnecessary use of antibiotics/antidiarrhoeals for acute watery diarrhoea

HIV infection and persistent diarrhoea: a comparative study of HIV positive and HIV negative children.

Persistent diarrhoea contributes 20% of diarrhoeal disease burden and 30-50% of its 17% contribution to under-five deaths in developing countries. HIV infection increases the incidence and severity of all childhood diseases, including diarrhoea, and persistent/chronic diarrhoea is one of its presenting features. This study sought to determine the role of HIV seropositivity in persistent diarrhoeal disease morbidity in children managed at the University of Port Harcourt Teaching Hospital (UPTH) from January 1997 to March 2003. This was a retrospective study of all paediatric persistent diarrhoeal cases with known HIV serostatus who were managed at UPTH. Data extracted from their case records included the bio data, presentation, management and outcome of the index episode. EPI Info version 6.04 was used for data entry and analysis. Ninety-nine children, comprising 44.4% HIV positive and 55.6% negative; 57.6% males and 42.4% females, were studied out of which 87.9% were aged 0-23 months. HIV seropositivity was significantly associated with increased duration of diarrhoea, (p<0.007 and the presence of severe wasting, tuberculosis, chronic cough, lymphadenopathy and higher mortality. Persistent diarrhoea-related morbidity and mortality were significantly increased by the co-existence of HIV seropositivity. It is therefore needful not to only scale-up control programmes for both conditions but also to improve their management.

Haematological Parameters and Haemoglobin Genotype in Maternal and Cord Blood Pairs in Port Harcourt; Nigeria

Background: The study was conducted to ascertain the pattern of haematological parameters and haemoglobin genotype in maternal and cord blood pairs in the Port Harcourt area of the South-South geopolitical zone of Nigeria. Methods: One hundred and three (103) postpartum women and their newborns were randomly recruited into the study. Five millilitres (5ml) of blood was taken from the mothers and their respective babies and analyzed for haematological parameters and haemoglobin genotype. Results: Haemoglobin concentration (Hb) in mothers was 10.90-14.45 g/dl (PCV; 32.42-43.92Hb in cord blood was 12.50-17.68 g/dl (PCV; 37.5-52.90). Average total white blood cell count (WBC) in mothers was 3.32-10.70 X 109/l and in cord blood; 4.10-13.10X109/l. Haemoglobin genotype revealed that AS was higher in maternal blood (17.5vs 4.8) while AA was higher in cord blood (94.2vs 82.5). Conclusion: The study adds to the data base of reference haematological values in Nigeria; especially the South-South zone and suggests that the frequency of the AS genotype may be undergoing a gradual reduction in subsequent generations as malaria is being controlled makings its relative advantage less important. Testing of prospective couples and counselling of AS individuals is still very important

Foreign Body Ingestion in a Neonate

Background: Foreign body ingestion is a very common event in the paediatric age group. There are however very few reports of foreign body ingestion in neonates. Aim: To report a case of ingestion of foreign body in a neonate. Case report: A neonate with thumb tack ingestion presented with respiratory distress. She had an emergency tracheostomy and subsequent extraction of the foreign body. She was extubated after four days and was discharged on the eighth day in good clinical condition. Conclusion: Foreign body ingestion in the neonate although very uncommon is possible. Paediatricians should therefore remember that an oesophageal foreign body may be a possible cause of respiratory distress in a neonate

Neural tube defects in a university teaching hospital in southern Nigeria: trends and outcome.

BACKGROUND: There has been some increase in the proportion of Neural Tube Defects (NTD) admitted in the University of Port Harcourt Teaching Hospital recently. Fora largely preventable birth defect, this increase is both unnecessary and unacceptable. This study was undertaken to describe the admission patterns and outcome of neural tube defects in University of Port Harcourt Teaching Hospital. METHODS: A retrospective study of babies with neural tube defects who were admitted into Special Care Baby Unit (SCBU) of the University of Port Harcourt Teaching Hospital from 1st May 2002 to 30th April 2005 was carried out. Their case notes were retrieved and information on the sex, maternal drugs during pregnancy, type of defect and associated malformations, prenatal diagnosis, management and outcome were obtained. The admission rate and the incidence were then calculated. RESULTS: There were 2891 total admissions (1691 males and 1200 females) during the study period of which 37 (1.3%) were neonates with NTD. Of those with NTD, 25 were males and 12 female giving a male to female ratio of 2:1 (statistically not significant p = 0.242.) The total hospital delivery at the study period was 7,388 of which 7 had NTD giving an incidence of 0.95/1000 deliveries. The commonest type of NTD was myelomeningocoele in 31 (83.8%), and the commonest site was the thoracolumbar region (93.5%). Frontal encephalocoele was seen in 6 (16.2%). All the babies with myelomeningocoele presented with flaccid paraparesis and were incontinent of both urine and faeces. Seventeen of the babies had only spina bifida while 14 had additional defects including talipes equinovarus (8), hydrocephalus (2), frontal encephalocoele (1), and multiple malformations (3). Ten babies (27%) died, three of them after surgery. All the mothers received folic acid from the second trimester of pregnancy, but none did before pregnancy. CONCLUSION: The Incidence of NTD is on the increase in our environment. There is need to formulate/implement the policy of preconceptional folic acid therapy for all woman of childbearing age as a preventive measure

Disseminated intravascular coagulopathy in a neonate: management challenges.

BACKGROUND: Newborns are vulnerable to developing disseminated intravascular coagulopathy (DIC) following infections because of immaturity of their coagulation system. This case report highlights the diagnostic and management challenges encountered in neonates with DIC. METHOD/RESULT: The case notes of an eight day old male who presented with a three-day history of fever, convulsion, excessive crying, refusal to suck and intermittent gum bleeding was reviewed. On examination, he had signs of meningeal irritation and a grade 4 machinery murmur maximal at the 2nd left intercostal space. Investigations showed severe thrombocytopenia and deranged coagulation profile. He received intravenous antibiotics as well as three exchange blood transfusions to correct his coagulation profile and improve his clinical condition before discharge. The underlying cause of his condition was presumably an intrauterine infection. CONCLUSION: The survival of neonates with DIC depends on vigorous treatment of the underlying disorders so as to curtail the triggers of blood coagulation as well as replacement of the consumed coagulation factor.

Blood transfusion therapy in neonates admitted into the Special Care Baby Unit (SCBU) of University of Port Harcourt Teaching Hospital, Port Harcourt.

BACKGROUND: Blood transfusion is associated with potential risks and adverse effects; it is therefore pertinent to ensure that it is given only when it is indicated. The objective of this study is to determine the rate and the indications of blood transfusion in neonates admitted into the Special Care Baby Unit (SCBU) of University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. METHOD: A prospective study of Neonates admitted into SCBU between January 1st 2003 and December 31st 2004 and who had blood transfusion during their hospitalization was carried out. RESULTS: Preterm babies are more likely to be transfused and are also more likely to receive multiple blood transfusions. Severe neonatal jaundice and severe anaemia are the commonest indication for blood transfusions in the neonates. Exchange blood transfusions (EBTs) were utilized more often than top up transfusions even among preterms. Adverse events were seen more in those that had EBT CONCLUSION: The rate of blood transfusion is still very high among neonates. Concerted efforts should be made to prevent severe neonatal jaundice and severe anaemia and thus reduce the rate of blood transfusion.

Kartagener syndrome: an unusual cause of respiratory distress in the newborn.

BACKGROUND: Kartagener Syndrome (KS) a rare genetic disorder belongs to a group of disorders referred to as primary ciliary dyskinesia (PCD) where the cilia covering the respiratory epithelium is either immotile or beat in an uncoordinated fashion. It is characterized by a triad of dextrocardia (with or without situs inversus), chronic sinusitis and bronchiectasis as a result of poor mucociliary clearance of mucus and bacteria. This may lead to respiratory distress in the newborn period. METHOD: This is a case report of a 14-day old male who presented with respiratory distress (which was noticed soon afterbirth) and features suggestive of KS. CONCLUSION: KS should be suspected in neonates presenting with respiratory distress, pneumonia and no risk factors for infection.

Hookworm infestation in a 3-month old female.

BACKGROUND: Intestinal helminthiasis is a major cause of morbidity and mortality in infants and children particularly in the tropics and subtropics. This report highlights the possibility of hookworm infestation in infancy. METHOD: A case report of hookworm infestation in a three-month old infant who was managed in the University of Port Harcourt Teaching Hospital, Port Harcourt in May 2001 for failure to thrive and recurrent severe anaemia. RESULT: The patient was admitted in the children's emergency ward with passage of dark watery stools, fever, excessive crying and severe anemia and was transfused twice. Stool microscopy revealed numerous ova of hookworm and she was treated with albendazole. Three days after administration of anti-helminthic, stools became formed with normal colour and temperature was normal. She gained weight before discharge home. CONCLUSION: Hookworm infestation should be suspected as a cause of severe anaemia in infants in communities with a high risk of infestation such as fishing port communities. To the best of my knowledge, symptomatic hookworm infestation in the first year of life has not been previously documented in Nigeria.

Pattern of childhood psychiatric disorders in Port Harcourt, Niger-Delta region of Nigeria (January 1999-December 2002).

BACKGROUND: Psychiatric disorders in children are uncommon but remain a great source of anxiety to parents. In view of the paucity of such studies in Eastern Nigeria, this study has become imperative. METHOD: All children seen in the psychiatric out patient clinics, psychiatric wards and other departments were studied. Diagnosis was made with criteria of the Diagnostic and Statistical Manual (DSM) IV of 1994. RESULTS: Out of a total number of 1,645 psychiatric cases seen, 411 were children representing 25%; of these 411 cases, 235 were females (57.2%) and 176 were males (42.8%). Depressive illness constituted 35%, anxiety disorders 30%, drug related disorders 17%, conduct disorders 9%, and others 9%. Gender differences were noted in all the conditions listed above except for enuresis, mental retardation, epileptiform psychosis and schizophrenia. CONCLUSION: Government Health Policy to protect the mental health of our children so as to guarantee their full mental development should be developed and implemented.

Pattern of substance use among secondary school students in Rivers State.

BACKGROUND: The problem of substance use in our secondary schools with cultism has negatively affected learning [corrected]. The aim of this study was to determine the commonly used substances and the factors that influence their use in these adolescents. METHODOLOGY: One thousand and forty-nine students of four secondary schools in Port Harcourt were screened using a self administered 117 items-substance use questionnaires. RESULTS: Males constituted 57.2% and females, 42.8% of the study population. Eighty-seven percent were using at least one substance, at the time of the survey while 3% were past users in the last one-year. Ten percent had never used any of the substances. The substances commonly used included alcohol 65%, kolanut 63.1%, cigarettes 61%, paracetamol 41.5%, butazolidine 39.3%, pemoline 28% and cannabis 26%. Others include tetracycline 25.7% and ampicillin 24.3% and valium 24%. Those that were least used included, heroine, cocaine, latex, petrol, pethidine and ativan. The mean age of onset for alcohol was 4 years, kolanut 8 years, cigarettes 11 years, paracetamol, tetracycline, valium, cannabis was, 12 years, lexotan and ativan, was 12.5 years and, latex inhalation, petrol, pethidine, ativan, cocaine and heroine was 13.17 years. Males predominated in all the substances used. CONCLUSION: The use of substances/drugs among our youths is assuming a dangerous dimension, hence calls for immediate and enduring measures to curb this disturbing trend of abuse of substances.

Perinatal outcome among elderly nulliparae at the University of Port Harcourt Teaching Hospital.

BACKGROUND: Maternal and perinatal health is influenced by sociodemographic factors including maternal age, parity, social class and ethnicity. Elderly nulliparity is considered traditionally, to be high risk and has not been evaluated in our centre. The objective of our study was to determine the perinatal outcome in the elderly nullipara at the University of Port Harcourt Teaching Hospital. METHODS: This was a two-year retrospective case controlled study. The study population consisted of all nulliparae aged 35 years and above who delivered in the hospital during the period and the control group consisted of all nulliparae less than 35 years of age. The chi2-test was used for comparison of both groups and statistical significance set at p values of P < or = 0.05. RESULTS: Fifty-nine (2%) of 2967 women who delivered during the period were elderly nulliparae. They accounted for 4.8% of all nulliparae. Compared to other nulliparae, there was no significant difference in the rate of preterm delivery (21.8% vs. 25.8%; p = 0.6), postterm delivery (9.1% vs. 17.3%; p = 0.2), caesarean section rate (41% vs. 32.8%; p = 0.3), low birth weight (5.2% vs. 11.6%; p = 0.2), macrosomia (10.3% vs. 5.7%; p = 0.2), still birth rate (0% vs. 3.2%), birth asphyxia (31% vs. 25.4%; p = 0.4), and sex ratios of babies. There were no congenital malformations in both groups. CONCLUSION: Elderly nulliparae are not at increased risk of adverse perinatal outcome compared to younger nulliparae in our hospital.

Malaria parasitaemia in neonates in Port Harcourt, Nigeria.

Malaria is thought to be rare among neonates in malaria-endemic regions. Consequently, blood film for malaria parasite is not routinely included in the sepsis screening protocol for neonates. We examined the role of malaria in perinatal morbidity among neonates admitted into our unit with a view to determining the need or otherwise of including malaria parasitaemia in the sepsis work-up in suspected neonatal septicaemia. Fourteen babies who met our preset criteria were screened for malaria parasitaemia out of which five (35.71 per cent) had positive blood smears for Plasmodium falciparum. Eighty per cent of the neonates presenting with fever had positive blood films (Yates corrected chi2 = 3.9822; p = 0.04). All the babies responded to an oral course of chloroquine. These data have further highlighted the importance of malaria in perinatal morbidity in our environment. We recommend a multi-centred study to define clearly the role of malaria in perinatal and neonatal morbidity and mortality in malaria endemic areas.

Anthropometric indices in singleton term neonates and their possible value in predicting some metabolic problems: a preliminary study.

We studied possible sources of variations in selected anthropometric indices and their relationship to neonatal metabolic problems in seventy-four singleton neonates born at an approximate gestation of 40 weeks, by selected anthropometry. There were significant differences particularly in values obtained for birth weight, mid upper arm circumference, chest circumference and the Ponderal Index. At the moment it is not possible to set discriminant values on any of the anthropometric indices as this will require a much larger sample size, however the authors believe that the use of anthropometry in predicting metabolic problems in neonates has some potential and serial measurements of particularly chest circumference, mid upper arm circumference and the Ponderal Index could form the basis of future studies.