A Comparison of Birth Weight for Gestational Age among Newborn Infants of HIV-Positive and Negative Mothers in a Southeast Nigerian Tertiary Hospital.

BACKGROUND: HIV infection in pregnant women is a known cause of low birth weight (LBW) and small for gestational age (SGA). This study compared the birth weight for gestational age (GA) of HIV exposed and non-exposed babies in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. SUBJECTS AND METHODS: A retrospective comparative appraisal of birth weights for GA of babies born to HIV- positive and negative women, over a 7-year period (January 2009-December 2015), was conducted. Data were abstracted from PMTCT database, ANC and Labor ward registers of NAUTH. RESULTS: A total of 3459 babies (1782 males, 1677 females) were enrolled, out of which 1829 were HIV- exposed and 1630 were not. GA spanned from 26-42 weeks (mean 38.7 ± 2.2 weeks) and birth weights (BW) from 400-5300g (mean 3072.5 ± 630g). The mean BW of exposed babies was significantly lower than the unexposed babies (p=0.048). LBW occurred in 12.0% of exposed and 13.5% of non-exposed babies (p<0.001). Using either percentile or Z-score cut-offs, HIV-exposed babies had twice the proportion of SGA compared to their non-exposed counterparts. Using Z-score, maternal antiretroviral use for >5 years was significantly associated with the lowest proportion of SGA compared to shorter duration of use. CONCLUSION: Maternal HIV infection is associated with SGA. However, maternal ARV use in excess of 5 years is associated with better BW outcome. Targeted enhancement of maternal nutrition and strict adherence to ARV therapy prior to and during pregnancy will improve birth outcome.

The influence of maternal anthropometric characteristics on the birth size of term singleton South-East Nigerian newborn infants.

OBJECTIVE: This study examined the usefulness of maternal anthropometry in predicting the birth size of term singleton newborn infants at NAUTH, Nnewi, Nigeria. MATERIALS AND METHODS: A cross-sectional study was conducted among 301 mother/newborn infant pairs. RESULTS: The mean birth weight was 3.27 ± 0.60 kg whereas the incidence of low birth weight and fetal macrosomia were 8.0% and 11.3%, respectively. The anthropometric indices varied in their ability to detect newborn babies who experienced abnormal intrauterine growth. The rate of subnormal intrauterine growth was 9.0%, 11.6%m and 18.6% using weight-for-gestational age (GA), ponderal index (PI), and mid-arm circumference (MAC)/occipito-frontal circumference (OFC) criteria, respectively. On the other hand, the rate of excessive intrauterine growth was 16.6% and 12.0% using weight-for-GA and PI criteria, respectively. Apart from maternal height, all the assessed maternal anthropometric parameters had a significant relationship with size at birth. Mothers of newborn infants who experienced subnormal intrauterine growth were more likely to have MAC < 25 cm, intrapartum weight < 65 kg, intrapartum BMI < 25 kg/m2, and rate of third trimester weight gain < 250 g/week. On the other hand, mothers of newborn infants who experienced excessive intrauterine growth were more likely to have MAC > 30 cm, intrapartum BMI ≥ 30 kg/m2, and rate of third trimester weight gain ≥ 500 g/week. Conclusion/Recommendation: Maternal anthropometry is a very useful tool in identifying mothers at risk of having newborn infants who experienced abnormal intrauterine growth. Therefore, its routine application is recommended to enable such mothers benefit from interventions targeted at ensuring optimal intrauterine growth and improved pregnancy outcomes.

Malaria parasitaemia among febrile under-five children at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria.

Background: Malaria is an infectious disease caused by Plasmodium and transmitted by the bite of an infected female Anopheles mosquito. It continues to be a global challenge with about half of the world's population being at risk of the disease and under­5 children being the most vulnerable. Aims and Obejectives: To determine the prevalence of malaria parasitaemia and some associated symptoms among febrile under-five children presenting at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. Materials and Methods: A total of 200 children under the age of five years were recruited for the study. Data on socio-demographic characteristics and symptoms were collected through interviewer administered questionnaire. They were physically examine and blood sample was collected from each of them. The Blood smear was Giemsa stained and examined microscopically for malaria parasite. Result: There were 118 males and 82 females, giving a male: female ratio of 1.44:1. Their ages ranged from 3-59 months and the average age was 27+17.49 months. Those in the age range of 12-23 months and 24-35 months constitute the highest number (23%) each. Forty-seven (23.5%) came from the rural area while 153(76.5%) came from the urban area. Average number of days the subjects had fever before presentation were 3.78+1.95 days with a range of 1-30 0 days. Body temperature ranged from 35.9-40.4 C with average of 37.7+0.8oC. Forty (20%) were positive to microscopy. Those in the age range of 47-59 months have the highest prevalence of malaria. Parasite density ranged from 40-136,000/µL with a mean of 18,687.2+3360/µL. All the children who are positive by microcopy had Plasmodium falciparium as the specie causing malaria. Conclusion: Malaria parasitaemia among these under-5 children is 20%.

Nutritional Contents of Lunch Packs of Primary School Children in Nnewi; Nigeria

Background: Lunch packs play a significant role in the nutritional status and academic performance of school children. Available data show a high prevalence of malnutrition among school-age children. Aims: The aim of this study is to document the nutritional contents of lunch packs of primary school children in Nnewi; Anambra state; Nigeria. Subjects and Methods: A cross-sectional study was conducted among 1018 primary 1-6 pupils selected by stratified systematic random sampling from six primary schools; two each of private; - mission; - and government (public) - owned schools in Nnewi metropolis with the aid of the semi-structured questionnaire. Lunch packs of the pupils were examined. Results: Majority of the pupils (77.8[792/1018]) had lunch packs although about half of pupils in public schools had no lunch pack. Only 12.4 (98/792) and 19.2 (152/792) of pupils with lunch packs had balanced meals and fruits/vegetables in their lunch packs; respectively. The odds of not coming to school with packed lunch was about 13 and 12 times higher for mothers with no formal education or only primary education; respectively; compared with those with tertiary education. Type of school had a strong influence on possession and contents of lunch pack (?2 = 2.88; P 0.001; phi coefficient

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.

The outcome of prevention of mother to child transmission (PMTCT) of HIV infection programme in Nnewi, southeast Nigeria.

BACKGROUND: A lot of challenges face the current efforts at reducing Mother to Child transmission of HIV infection (MTCT) in Sub Saharan Africa due to limited access to Highly active antiretroviral therapy (HAART) and breast feeding practices. A regular review of progress is necessary in order to identify areas of need. METHOD: This is a one year prospective descriptive study of seven hundred and twenty six mother-infant pairs managed in the PMTCT programme in Nnamdi Azikiwe University Teaching Hospital, Nnewi Southeast Nigeria. The babies HIV status was tested with PCR for HIV DNA while the mothers provided information on infant feeding pattern and the use of antiretroviral (ARV) drugs including prophylaxis for the baby. Information was augmented from the antenatal records. RESULT: The transmission rate was 2.8% for mothers, who were on HAART, did not breastfeed and whose babies received ARV prophylactic therapy. But for mothers who did not receive HAART, did breastfeed and whose babies did not received ARV prophylactic therapy, the transmission rate was 37.5%. When both the mother and child received ARV drugs, the transmission rate was significantly lower in those who did not breastfeed (2.8%) than in those who breastfed (12.5%)(P < 0.001). When both the mother and child did not receive ARV drugs, the transmission rate significantly lower in those who did not breastfeed (21.1%)than in those who breastfed (37.5%) (P < 0.02). CONCLUSION: The use of HAART in PMTCT programme in the under resourced areas can achieve similar success rates to that in the industrialized countries. Breastfeeding reduces the efficacy achieved by the use of ARV drugs. Provision of wider access to HAART as well as adequate counselling and support for safer infant feeding practices is recommended.

Early infant diagnosis of HIV infection in southeastern Nigeria: prevalence of HIV infection among HIV-exposed babies.

BACKGROUND: Vertical transmission of HIV-1 is responsible for a high level of infant mortality necessitating early infant diagnosis. Serologic tests are not useful because of persistence of maternal antibodies in infants. Amplification of the integrated viral genome by PCR is the preferred method of diagnosis of HIV infection in these children. OBJECTIVE: To determine the prevalence of HIV among a cohort of HIV-exposed babies. METHODS: HIV-exposed infants were recruited for DNA PCR (early infant diagnosis). Babies were enrolled from six weeks of age. Relevant data were collected with the aid of a proforma. Mothers were given pre-test counselling. Heel or finger prick samples of blood on Whatman filter paper were used for DNA PCR testing. RESULTS: Data on the initial 304 babies enrolled for DNA PCR were analyzed. Seven (3.6%) of 192 mother-baby pairs who had received requisite prophylactic anti-retrovirals (PARV) were PCR-positive. In 23 (8.7%) PCR positive babies, their mothers received PARV but the babies had no post exposure prophylaxis (PEP), while two (12.5%) of 16 babies who had received PARV without their mothers turned out PCR-positive. Thirty nine (53.4%) of 73 mother-baby pairs who had no PARV were infected. Exclusive breastfeeding (EBF) rate was 35.5%. In these babies five (18.5%) were infected, while 288 (75%) of babies were exclusive formula fed (EFF), out of which 11 (4.8%) were infected. Forty-seven (15.5%) of the babies were mixed-fed, and 32 (68.0%) of them were infected. CONCLUSION: Prophylactic ARV in mothers and babies gave a marked reduction in Mother-to-Child-Transmission (MTCT) rate. Feeding BMS conferred a superior protection against (MTCT) than EBF.

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.

Clinical spectrum of paediatric HIV in Nnewi, Nigeria.

BACKGROUND: HIV/AIDS is increasingly becoming a predominant cause of childhood morbidity and mortality in this part of the world. STUDY DESIGN: A descriptive, prospective study was carried out at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria, to ascertain the clinical features and probable modes of transmission of HIV infection in Children. RESULTS: Out of 128 HIV -infected children, 53.1% were males and 46.9% females, giving a male: female ratio 1.1:1. They were aged from 3 months to 16 years, with a mean of 4.78 (+/- 3.97) years. Those in the 1-5 year age bracket made up 47.7%. The presumed route of infection was mother-to-child in 79.7% and blood transfusion in 16.4%. Majority (82.0%) presented with WHO clinical stage 3 disease and 55.7% were severely immunosuppressed. The most frequent clinical features were recurrent/persistent fever, persistent cough,weight loss/failure to thrive and generalised lymphadenopathy. There was co-infection with tuberculosis in 15.6% of patients. Eighteen patients (14.0%) were lost to follow up. Six children (4.7%) died during the period under review. They all presented in WHO stage 3 and 4. A hundred percent of the dead children had severe weight loss, 83.3% had generalized lymphadenopathy and recurrent or persistent fever respectively. Fifty percent presented with diarrhea and oral thrush. There was no gender difference in mortality. Mortality was highest among infants. CONCLUSION: The high rate of vertical transmission of HIV reinforces the need for effective PMTCT interventions in reducing the incidence of HIV in children. A high index of suspicion and awareness of modes of presentation of HIV infection in children is needed for early diagnosis of those infected with HIV.