Diagnostic approach of childhood pulmonary tuberculosis in endemic areas of Southeast Nigeria.

UNLABELLED: There is the need to ascertain the diagnostic approach on which medical doctors based their diagnosis of childhood pulmonary tuberculosis especially in tuberculosis endemic areas. AIM OF THE STUDY: To determine the diagnostic approach used by medical doctors in the diagnosis of childhood pulmonary tuberculosis. METHODOLOGY: A cross sectional study, using structured questionnaires to collect data from medical doctors whose daily routine include seeing sick children was carried out. RESULTS: The common diagnostic approach or criteria were ranked by medical doctors in descending order of importance as follows; clinical features elicited from patients' history was ranked-1 by 56.4% (or 23 of 218); bacteriological investigation to isolate Mycobacterium Tuberculosis was ranked-2 by 22.5% or 49 of 218; radiological investigation to demonstrate typical changes consistent with active pulmonary tuberculosis was ranked-3 by 25.2% or 55 of 218; therapeutic trial with standard anti tuberculosis drugs was ranked-4 by 52.3% or 114 of 218; immunological investigation using tuberculin skin testing was ranked-5 by 30.3% or 66 of 218; and residual ranking of histological investigation using tissue biopsy was ranked-6 by 15.6% or 34 of 218. Therapeutic trial with standard anti tuberculosis drugs was consistently ranked as 4th by most groups of clinicians. CONCLUSIONS: Most clinicians from different subgroups studied followed a fairly similar order in the diagnosis of childhood pulmonary tuberculosis with a high premium placed on clinical features, bacteriologic, radiologic and therapeutic trial with anti tuberculosis drugs. The specialist in paediatric medicine relied more on clinical features and therapeutic trials for their diagnosis of childhood pulmonary tuberculosis.

Sexual abuse among juvenile female street hawkers in Anambra State, Nigeria.

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 +/- 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%). There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks.

Sexual abuse among juvenile female street hawkers in Anambra State, Nigeria

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 + 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%).. There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks. (Afr J Reprod Health 2008; 12[2]:111-119)

Pattern of pathogens in ear discharge of HIV-infected children in Nnewi, Southeast Nigeria.

OBJECTIVE: This is a descriptive, prospective, hospital-based study designed to determine the prevalent organisms in ear infections and their antimicrobial susceptibility patterns in HIV-infected children compared to age-and sex-matched HIV sero-negative patients. METHOD: Two hundred and fifty eight HIV-infected children being followed up at the Paediatric HIV clinic had their ears examined for middle ear infection. All those with discharging ears had swabs taken. Culture and antimicrobial sensitivities were ascertained. The same was done for another cohort of 57 age-and sex-matched HIV-negative patients with discharging ears. RESULTS: Twenty eight (10.9%) of 258 HIV-infected children had discharging ears and were made up of 13 females and 15 males aged between 7 and 132 months. Out of this number 85.7% had chronically discharging ears, 96.4% of the 28 children acquired the HIV infection vertically. 78.6% had been on antiretroviral drugs from one to twenty-one months. 67.9% of the patients had associated opportunistic infections. Acute ear infections were predominant among the control group. Klebsiella, Proteus, Staphylococcus and Pseudomonas were major pathogens isolated among the HIV-infected group and Streptococcus, Klebsiella and Pseudomonas for the HIV-negative group. A hundred percent sensitivity was recorded among the quinolones for all bacterial organisms isolated. CONCLUSION: HIV-infected children tend to have more of chronic than acute ear infections and this is reflected in the causative organisms. Similar antimicrobial sensitivity patterns apply to HIV-infected and HIV-negative children. There is a need to revisit the use of quinolones in children.

Breast-feeding, return of menses, sexual activity and contraceptive practices among mothers in the first six months of lactation in Onitsha, South Eastern Nigeria.

The objective of this study was to determine the exclusive breast-feeding practices, return of menstruation, sexual activity and contraceptive practices among breast-feeding mothers in the first six months of lactation. The study was based in Onitsha, South Eastern Nigeria. A structured questionnaire was used to obtain data from breast-feeding mothers on their age, educational attainment, breast-feeding practices, return of menstruation, sexual activity and contraceptive practices within the first six months of lactation at intervals of 6 weeks, 10 weeks 14 weeks and 6 months post delivery. Analysis of the information obtained showed that out of the 178 mothers who participated in the study 81% of the mothers were within the ages of 20 - 34 years. While all the mothers had formal education, the majority (59%) had secondary education. Seventy-three percent initiated breast-feeding within one hour of delivery. On discharge from hospital, all of them had already established breast-feeding which continued up to six weeks and dropped to 97.8% at six months. Exclusive breast-feeding which was practised by 100% on discharge dropped to 3.9% at six months. The feeding regimen was on demand as practised by 98.9% of the mothers. Menstrual flow had returned in 33.8% of the mothers by 6 weeks of lactation, and had risen to 70.2% at six months. There was more prolonged lactational amenorrheoa in exclusively breast-feeding mothers than in those who were not. By 6 weeks post delivery 31.6% of the mothers had resumed sexual activity and this rose to 93.6% at six months. With the resumption of sexual activity only 5% of the mothers resorted to contraceptive practices other than lactational amenorrhea and this increased to 54% at six months. There was no pregnancy in any of these women during the six months period. While appreciating the role of lactational amenorrhea in child spacing and considering the early return of sexual activity among the mothers the practice of introducing contraceptive practices needs to be encouraged especially in women whose menstruation has returned.

Drug treatment of common childhood symptoms in Nnewi: what mothers do?

OBJECTIVES: To determine how mothers treat common childhood symptoms before hospital attendance in Nnewi. MATERIALS AND METHODS: Information was obtained from 211 consecutive mothers on their children's presenting symptoms, drugs administered, source of the drugs, persons who prescribed the drugs, number of drugs administered, prior to hospital attendance through a structured questionnaire administered by the authors. RESULTS: A combination of fever, cough and catarrh topped the list of presenting symptoms in 87 (41%) of the patients while fever and diarrhea had the least frequency of 16 (7.6%). One hundred and five or 52% of the mothers decided on the drugs that were administered followed by patent medicine dealers who accounted for 59 or 29.2%. Trained health professionals whom mothers consulted before bringing their children to hospital were responsible for 28 (13.8%) of the prescriptions. Patent medicine stores were the sources of 90.6% of the drugs while health facilities accounted for 8.4%. The frequency chart of prescribed drugs were analgesics 166 (34.9%), hematinics 88 (18.5%), antibiotics and antimalarials 81 (17.1%) and 74 (15.6%) respectively while antidiarrheoals and ORT were least administered with 7 (1.5%) and 1 (0.2%) respectively. The children received an average of 2.7 drugs per prescription. CONCLUSION: With the high prescription rate of mothers for sick children at home, there is need for effective methods to educate mothers on the use and potential dangers of home medication.

Tuberculin reaction among healthy BCG vaccinated primary school, children in Nnewi, south eastern Nigeria.

OBJECTIVE: To assess the Mantoux test reaction pattern in healthy BCG vaccinated Primary School Children aged 6 -10 years in Nnewi, South -East Nigeria. MATERIALS AND METHODS: Four primary schools were randomly selected out of 43 government owned primary schools in the town. The entire BCG vaccinated pupils in each school were the sample frame. Mantoux test was administered in 662 pupils that met the inclusion criteria and had their results read 72 hours later. RESULTS: Three groups of children were identified: First group of 470 (75.6%) were negative, 76 (12.2%) had intermediate reaction, while 76 (12.2%) had positive Mantoux test. Increasing age, sex, presence of BCG scar and age at vaccination did not affect the pattern of Mantoux test reaction. CONCLUSION: The result indicates that the use of Mantoux test in the diagnosis of Tuberculosis may not be affected by BCG vaccination at birth and therefore, BCG vaccination at birth should be continued.

Drug Treatment Of Common Childhood Symptoms In Nnewi South Eastern Nigeria: What Mothers Do?

OBJECTIVES: To determine how mothers treat common childhood symptoms before hospital attendance in Nnewi. MATERIALS AND METHODS: Information was obtained from 211 consecutive mothers on their children's presenting symptoms; drugs administered; source of the drugs; persons who prescribed the drugs; number of drugs administered; prior to hospital attendance through a structured questionnaire administered by the authors. RESULTS: A combination of fever; cough and catarrh topped the list of presenting symptoms in 87 (41) of the patients while fever and diarrhea had the least frequency of 16 (7.6). One hundred and five or 52 of the mothers decided on the drugs that were administered followed by patent medicine dealers who accounted for 59 or 29.2. Trained health professionals whom mothers consulted before bringing their children to hospital were responsible for 28 (13.8) of the prescriptions. Patent medicine stores were the sources of 90.6 of the drugs while health facilities accounted for 8.4. The frequency chart of prescribed drugs were analgesics 166 (34.9); hematinics 88 (18.5); antibiotics and antimalarials 81 (17.1) and 74 (15.6) respectively while antidiarrheoals and ORT were least administered with 7 (1.5) and 1 (0.2) respectively. The children received an average of 2.7 drugs per prescription. CONCLUSION: With the high prescription rate of mothers for sick children at home; there is need for effective methods to educate mothers on the use and potential dangers of home medication

Tuberculin Reaction Among Healthy BCG Vaccinated Primary School Children In Nnewi; South Eastern Nigeria

Objective: To assess the Mantoux test reaction pattern in healthy BCG vaccinated Primary School Children aged 6 -10 years in Nnewi; South-East Nigeria. Materials and methods:Four Primary Schools were randomly selected out of 43 government owned primary schools in the town. The entire BCG vaccinated pupils in each school were the sample frame. Mantoux test was administered in 662 pupils that met the inclusion criteria and had their results read 72 hours later. Results: Three groups of children were identified: First group of 470 (75.6) were negative; 76 (12.2) had intermediate reaction; while 76 (12.2) had positive Mantoux test. Increasing age; sex; presence of BCG scar and age at vaccination did not affect the pattern of Mantoux test reaction. Conclusion: The result indicates that the use of Mantoux test in the diagnosis of Tuberculosis may not be affected by BCG vaccination at birth and therefore; BCG vaccination at birth should be continued

Breast feeding practices in Onitsha South Eastern Nigeria - 2 years after baby friendly initiative

"Objective: To study the impact of ""baby friendly hospital initiative"" on breast feeding practices in Onitsha South Eastern Nigeria; 2 years after introduction. Setting: Holy Rosary Maternity Hospital Onitsha. Materials and methods: A structured questionnaire was used to collect data from 178 breast feeding mothers on maternal age; mothers' educational attainment; attendance at breast talks; and acceptance of exclusive breast feeding. Information was also obtained on feeding in the post natal ward; breast feeding practices at 6 weeks; 10 weeks; 14 weeks; 6 months; 9 months; 12 months; 18 months and 24 months post delivery. The data obtained was analyzed. Results: Breast feeding practices was studied among 178 breast feeding mothers attending the infant welfare clinics of Holy Rosary Maternity Hospital Onitsha; 2 years after it was made a ""Baby Friendly Hospital"". A total of 145 or 81.4 of the mothers were between the ages of 20 and 34 years; and all of them had some level of formal education with 59 of them acquiring secondary education. About one third or 33.1 of them were full time housewives while the rest engaged in one form of professional activity. While two thirds or 67.4 of the mothers attended breast feeding talk sessions 89 had knowledge of breast feeding support group and utilized their services during ante natal visits. Seventy three percent initiated breast feeding within less than an hour of delivery. All most all the mothers (99.4) established breast feeding by the time they were leaving the hospital on discharge and continued breast feeding up to 6 weeks post discharge. This proportion dropped to 84.3 at 12 months and to 1.1 at 24 months. Exclusive breast feeding rate fell from 99.4 on discharge to 3.9 at 6 months; while ""on-demand"" was practiced by 99.9 of the study population. Conclusion: We therefore recommend that the Campaign on Baby Friendly Initiative activities should continue and be strengthened to effect the ""The ten steps to successful breast feeding."