Necrotizing fasciitis following measles vaccine administration: a case report.

BACKGROUND: The occurrence of adverse events following immunization (AEFI) in national immunization programmes is very rare; however, if they occur causality assessment is conducted to identify the associated cause. In the report, we describe a case of severe necrotizing fasciitis in the left arm of a 9-month old boy following administration of the measles vaccine. CASE PRESENTATION: A 9-month old boy presented with swelling on the left upper arm and adjoining the chest area, low-grade continuous fever, frequent passage of loose watery stool and persistent cries 24 h after measles vaccine was administered on the left upper arm. On examination, he was mildly pale, febrile, anicteric. Extensive erythema of the left upper arm occurred thereafter with extensive scalded skin lesions involving the deltoid area, the upper chest wall and arm. This was followed by desquamation of the affected areas and severe necrosis. A diagnosis of severe necrotizing fasciitis was made. A causality assessment was conducted by the state AEFI committee using the detailed AEFI investigation forms to identify the cause of the incidence. CONCLUSION: Here we present a rare case of necrotizing fasciitis which could have been caused by incorrect use of reconstituted measles vaccine. Hence we recommend training of routine immunization service providers on proper vaccine management as well as intensified supervision of immunization sessions.

Breastfeeding practices of physician-mothers in Ife and Ilesa zones, Osun State, Nigeria.

BACKGROUND: Physician-mothers' breastfeeding behaviour is being studied because it is believed to impact their anticipatory guidance to their patients, which in turn influences patients' breastfeeding initiation and continuation. Study assessed the breastfeeding practices of physician-mothers; their reasons for stopping exclusive breastfeeding and factors associated with their breastfeeding practices. METHODS: Study design was cross-sectional, conducted in Osun East Senatorial District, Nigeria. A self-administered semi-structured questionnaire was administered to all eligible 56 physician-mothers in public primary, secondary and tertiary health facilities in the reproductive age-group whose youngest child was aged d"five years. Informed consent was obtained. Outcome measures were time breastfeeding was initiated, duration of exclusive breastfeeding; reasons for stopping exclusive breastfeeding and duration of continued breastfeeding. Data was analysed using SPSS version 17, statistical significance was determined at p-value < 0.05. RESULTS: Fifty (89.3%) responded. Seventy per cent initiated breastfeeding within 1 hour after birth; exclusive breastfeeding rate was 28.0% with a mean duration of 4.1 +/- 1.9 months. Mean duration of continued breastfeeding was 14.5 +/- 4.5 months. Commonest reason for stopping exclusive breastfeeding was 'baby old enough' (35.8%). Mode of delivery was statistically significantly associated with time to initiate breastfeeding. Time to initiate breastfeeding was statistically significantly associated with duration of exclusive breastfeeding. CONCLUSION: Breastfeeding practices of physician-mothers do not conform to the standards in the Innocenti Declaration. The impact of this on their professional support to clients' should be measured in further studies. It is recommended that targeted interventions be done to improve the attitude and breastfeeding practices of physician-mothers.