Prevalence of rotavirus-induced diarrhea among children under 5 years in Ilorin, Nigeria.

Diarrhoea disease is an important cause of morbidity and mortality in Nigerian children and rotavirus has been identified as an important causative agent among children below 5 years. We determined the prevalence of rotavirus-induced diarrhoea among under-5 s by electrophenotyping. Stool samples were collected from eligible subjects who presented with acute diarrhoea. The samples were processed for viral studies by electrophenotyping. Among the 299 subjects recruited, 55.9% were positive for rotavirus. Eighty percent of the recruited patients were below 24 months. There was a significant decrease (p-value = 0.00001) in the prevalence of rotavirus among diarrhoea patients above the age of 24 months when compared with those below this age group. Rotavirus was associated with higher morbidity and mortality. We conclude that rotavirus is the most important cause of diarrhoea among children <5 years in Ilorin, Nigeria and its prevalence is highest in the first 2 years of life. Adequate rehydration should be regarded as the mainstay of management.

Malaria in children in Ilorin, Nigeria.

OBJECTIVES: To determine the prevalence of paediatric malaria admissions in an area of stable malaria transmission and to ascertain the relative contributions of different forms of severe malaria to morbidity and mortality. DESIGN: A descriptive restrospective study. SETTING: Olanrewaju hospital, a general practice health facility in a malaria holoendemic city in Nigeria. SUBJECTS AND METHODS: Case files of paediatric (age < 15years) admissions between 1/1/98 and 31/12/98with a diagnosis of acute malaria were retrieved and relevant information including demographic data, clinical signs, laboratory records, treatments received and diagnosis on discharge were extracted. Grouped age-associated prevalence rates were calculated; characteristics of different groups were compared using standard statistical methods. RESULTS: Children with Falciparum malaria accounted for 95 (18%) of the 526 medical admissions. The proportion of children admitted with severe malaria was significantly higher among the under-fives compared to those over five years (p < 0.001; RR = 5.36, 95% CI of 2.58 to 11.2). Thirty two (33.7%) children had severe malaria. Fifteen (15.8%) had convulsions without coma, 13 (13.68%) had malaria-associated anaemia and four (4.2%) were diagnosed as having had cerebral malaria. Seizures were significantly more frequent in the under-fives (p=0.001, RR=6.0; 95% CI of 1.8 to 19.6). There was a significant negative correlation between age and severe anaemia/blood transfusions (p = 0.002). Cerebral malaria carried the greatest risk of fatality (CFR=25%; RR=7, 95% CI of 1.5 to 91). CONCLUSION: High prevalence of paediatric malaria admissions in this study underscores the morbidity burden in Nigerian children, especially in under-fives in whom the severe forms are more common. A high incidence of anaemia requiring blood transfusions further increases the risk of paediatric HIV infection in Nigeria where organised control programmes are rudimentary.

Bacterial pathogens and outcome determinants of childhood pyogenic meningitis in Ilorin, Nigeria.

Empirical antimicrobial therapy remainsjustifiable in childhood pyogenic meningitis (CPM), but the continuing efficacy in a particular setting requires periodic microbiological surveillance. It was this need that informed the present five-year retrospective study of consecutive admissions for CPM at the Emergency Paediatric Unit (EPU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Of the 71 cerebro-spinal fluid [CSF] analyses, 41 (57.6%) were Gram-smear positive (GSP). Gram-positive cocci (GPC) were identified in 23 (56.1%) smears, while 14 (34.2.%) had Gram-negative bacilli (GNB). Only three (7.3%) had Gram-negative diplococci (GND). Despite corroborative biochemical findings, the remaining 30 (42.3%), including two with tuberculous meningitis proved smear-negative. GPC cases had a mean age of 4.49 +/- 5.3yrs, GNB, 3.06 +/- 4.8yrs and GND, 4.47 +/- 4.9yrs. CSF isolates were made in 28 (39.4%) cases. Streptococcus pneumoniae accounted for a predominant 22 (78.6%) (P = 0.00), Haemophilus influenzae for 2 (7.1%), and Neisseria meningitidis for only 1 (3.5%) case. Whereas Strept. pneumoniae and H. influenzae isolates were uniformly sensitive to each of sultamicillin, cefuroxime, ceftriaxone and ceftazidime, 7.7% of Strept. pneumoniae were resistant to crystalline penicillin, 6.7% to ampicillin, and 69.2% to chloramphenicol; one of the two H. influenzae isolates was chloramphenicol-resistant. Amongst the 30 (42.3%) fatal cases, the length of stay was significantly shorter in GNB-positive cases (P = 0.045). Mortality was significantly higher amongst cases with purulent/turbid CSF at admission (P = 0.03), and in those with CSF protein of >150mg/dl (P = 0.02) and glucose <1mg/dl (P = 0.047). The present aetiological preponderance of GPC and Strept. pneumoniae in our study population, the high case-fatality, and the emerging resistance profile suggest the need for exploring additional control options including vaccination. We emphasize the need for periodic auditing of local antimicrobial policies in CPM.

Chloroquine-resistant Plasmodium falciparum malaria in Ilorin, Nigeria: prevalence and risk factors for treatment failure.

Presumptive treatment of fever with Chloroquine (CQ) remains the major strategy for malaria control in Nigeria. Efficacy surveillance of CQ must therefore be continuous for this strategy to remain valid. In this study we determined the efficacy of CQ in 120 patients aged 6m to 34yr who presented with acute uncomplicated Plasmodium falciparum malaria. Clinical success was 86.6%. Parasitological cure was 56.7%. Mean fever and parasite clearance times were 2.5 +/- 1.2D and 4.2 +/- 1.6D, respectively. Recrudescence rate was 24.45%. Twenty-four patients (20%) showed R11 response while 6 patients (5%) showed R111 response. Risk of treatment failure was significantly higher among children (< or = 15 yr) [P = 0.02, RR = 2.35 ] and among patients whose level of parasitaemia on day 2 was higher than day zero value. [P = 0.04; RR = 6.54]. Although malnutrition was not associated with higher risk of parasitological failure (P = 0.52), the proportion of children with R11/R111 response compared to R1 response was significantly higher among malnourished children compared to children with satisfactory nutritional status (OR 2.92; p = 0.001). The findings suggests the need for extra vigilance of CQ-Resistant P. falciparum (CRPF) malaria in children in general, and malnourished children in particular if potentially serious complications are to be averted.

Malaria in the neonate: report of 2 cases.

Two cases of neonatal malaria are reported, both presenting with signs similar to neonatal sepsis. The first baby responded to oral Chloroquine (CQ) with fever and parasite clearance times of 48 h and 60 h respectively. The CQ treatment failed in the second baby and was subsequently treated successfully with oral Halofantrine hydrochloride. These cases indicate a need for routine blood film for malaria parasite as part of initial screening for neonatal sepsis.