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

The Profile of Non-Communicable Disease in Patients Admitted into the Children's Medical Ward of the University of Port Harcourt Teaching Hospital

Background: The prevalence of non-communicable diseases (NCD) is increasing in recent years in low income countries in sub-Saharan Africa because of changing disease patterns following socioeconomic development. Nevertheless; communicable diseases (CD) still remain the predominant health problem. At present; non-communicable diseases are not a high priority in sub-Saharan Africa but the probability of death from a NCD is higher in sub-Saharan Africa than in the developed world. It is therefore important to know the existing disease burden due to NCD with a view to alerting policy makers and health workers of the trend of disease in our environment. Objectives: To determine the pattern of admission of paediatric patients seen at the children's ward of the University of Port Harcourt Teaching Hospital (UPTH) and ascertain the pattern of non communi- cable diseases. Methods: The study was retrospective and involved analysis of data from the admission records of the children's wards of the UPTH from February 2004-November 2005. Patients with non-communicable diseases were analysed for this study. Results: A total of two thousand four hundred and fourteen (2414) children were admitted during the period of study. Out of these; 479 (19.8) had non-communicable diseases consisting of 279 (58.2) males and 200 (41.8) females with a male: female ratio of 1.4:1. The top five non-communicable diseases were sickle cell disease (SCD) (17.1); malignancies (14.8); renal diseases (12.9); tetanus (10.2) and malnutrition (10.0). Conclusion: This study suggests a concomitant rise in NCD with four of them being among the top 10 disease burden when combined with communicable diseases. This poses a risk of a 'double burden' of disease which we cannot afford in our country which is fraught with poor government policies; poverty and poor funding of the health sector. Effective strategies are needed to control the risk factors for NCD

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.

The Pattern of Communicable Disease in Patients Admitted into the Children Medical Ward of the University of Port Harcourt Teaching Hospital

Background: Open tibial fracture is a common orthopaedic challenge in Nigeria with adverse economic implications. The aim of study is to investigate the epidemiology of the problem.Methods: This is a prospective observational study of all open tibial fractures seen at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital (UPTH) over a twelve- month period (July 2002- June 2003). Data from a pre-designed proforma for the study was analyzed and descriptive statistics of the epidemiology is presented.Results: Seventy-two open fractures were seen in 70 patients. The male to female ratio was 2.5:1 and the peak age incidence was in the 20-29 years age group (38.6) followed by the 30-39 years agegroup (31.4). The extremes of age were least affected. Road accidents constituted most of the injuries (91.4); of which 51.5was motorcycle related. The passenger was the most at risk of injury (56.3). Gustilo and Anderson type III open injuries were the most frequent followed by the type II injuries.Conclusion: The burden of open tibial fractures in Nigeria is significant. Most fractures of the tibia are open and results from high-energy injuries. They are usually associated with other injuries; which are the major contributors to morbidity and mortality. Poverty and lack of social infra structures are contributory factors

Urinary Abnormalities in Children with Sickle Cell Anaemia

Background: Sickle cell anaemia (SCA) is a health problem worldwide. Almost all the organs of the body are affected by the combined effect of chronic hypoxia; repeated infarction and recurrent infections. Renal function may be progressively impaired in them as a result of sickling in the renal medulla. Microscopic hematuria; proteinuria; urinary concentrating defects; distal renal tubular acidosis and nephrotic syndrome are some of the renal abnormalities complicating SCA. The chronic nephropathy often seen in adults with SCA may actually have its onset in childhood.Objective: To find out whether children with SCA had significant urinary abnormalities. Method: Children with SCA in steady state (subjects) and healthy non-SCA children (controls) matched for age and sex were prospectively studied (using a dip-stick urinalysis) for significant proteinuria; significant haematuria; specific gravity and pH.Results: A total of 144 children were studied; seventy-two with sickle cell anaemia and the 72 others with HbAA (37 females and 35 males in each group).The ages of the children ranged from 16 months to 16 years. Significant proteinuria was seen in 5(7). Significant haematuria was also seen in 8(11) of the subjects. None of the controls had significant proteinuria nor haematuria. The mean serum creatinine level of the 13 children with s i g n i f i c a n t p r o t e i nu r i a / h a e m a t u r i a wa s 53.2 mol/L (range 42-65 mol/L). Defects in urinary concentrating ability was found in 13(18.1) and impaired urinary acidification in 50(69) of the subjects.Conclusion: Significant urinary abnormalities do occur in children with SCA. Urinalysis should therefore be done routinely for all children with SCA especially those older than five years as a screening test to detect at an early age any renal pathology

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.

Impaired acidification of urine in children aged two months to two years with acute gastroenteritis complicated by acidosis.

BACKGROUND: In some children with acute gastroenteritis and acidosis, the urine pH may be abnormally high thus simulating distal Renal Tubular Acidosis (dRTA). This inability to acidify urine properly in the presence of metabolic acidosis has been shown to be due to poor delivery of sodium to the distal nephron which prevents full excretion of a hydrogen ion load, instead of an intrinsic defect in the ability of the distal tubule to acidify urine. The aim of this study is to determine the prevalence of transient urinary acidification defect in children aged two months to two years with acute gastroenteritis, dehydration and acidosis, and the relationship between urine pH and urine sodium concentration. METHOD: A prospective study of children aged two months to two years admitted for the treatment of acute gastroenteritis and dehydration at the Children's Emergency Ward (CHEW) of the University of Port Harcourt Teaching Hospital, Rivers State. RESULTS: Of the 196 children (140 males and 56 females) studied with spontaneous acidosis which developed as a result of acute gastroenteritis, seventy-three of them had impaired acidification of urine, giving a prevalence of 37.2%. There was no significant difference in the age, duration of symptoms, degree of acidosis, degree of dehydration and serum potassium concentration between the children with impaired and those with proper urine acidification. Those with impaired acidification of urine however had a significantly lower serum sodium and urine sodium concentrations and a significantly higher urine potassium concentration and urine anion gap than those children with proper urine acidification. All urine samples with sodium concentration less than or equal to 25 mmol/L (52) had urine pH greater than 5.5. CONCLUSION: Mere presence of acidosis and high urine pH should not lead to a diagnosis of Distal Renal Tubular Acidosis (dRTA). The urine anion gap (UAG) should be calculated using the formula: urine [Na+] + [K+] [Cl], and if negative, it suggests a high ammonium excretion, which makes the diagnosis of dRTA unlikely.