Salmonella Bacteremia Among Children in Central and Northwest Nigeria, 2008-2015.

BACKGROUND: Etiologic agents of childhood bacteremia remain poorly defined in Nigeria. The absence of such data promotes indiscriminate use of antibiotics and delays implementation of appropriate preventive strategies. METHODS: We established diagnostic laboratories for bacteremia surveillance at regional sites in central and northwest Nigeria. Acutely ill children aged <5 years with clinically suspected bacteremia were evaluated at rural and urban clinical facilities in the Federal Capital Territory, central region and in Kano, northwest Nigeria. Blood was cultured using the automated Bactec incubator system. RESULTS: Between September 2008 and April 2015, we screened 10,133 children. Clinically significant bacteremia was detected in 609 of 4051 (15%) in the northwest and 457 of 6082 (7.5%) in the central region. Across both regions, Salmonella species account for 24%-59.8% of bacteremias and are the commonest cause of childhood bacteremia, with a predominance of Salmonella enterica serovar Typhi. The prevalence of resistance to ampicillin, chloramphenicol, and cotrimoxazole was 38.11%, with regional differences in susceptibility to different antibiotics but high prevalence of resistance to readily available oral antibiotics. CONCLUSIONS: Salmonella Typhi is the leading cause of childhood bacteremia in central Nigeria. Expanded surveillance is planned to define the dynamics of transmission. The high prevalence of multidrug-resistant strains calls for improvement in environmental sanitation in the long term and vaccination in the short term.

Neonatal mortality in an urban population in Ibadan, Nigeria.

BACKGROUND: Neonatal mortality remains a major contributor to death among children younger than 5 years in developing countries. This study was undertaken to determine the neonatal mortality rate (NMR), causes of death, and associated risk factors among hospital live births in a suburban population in Nigeria. PATIENTS AND METHODS: A total of 1058 consecutive live newborns at Adeoyo Maternity Hospital, Ibadan, were enrolled at birth and followed up in their homes for 28 days. The causes of death were extracted from hospital records, and verbal autopsy was used to determine the causes of death outside the hospital. RESULTS: The NMR was 32.1 per 1000 live births. The leading causes of death were severe perinatal asphyxia (79.4%), low birth weight (LBW: 55.9%), and infections (41.2%). The associated risk factors were lack of antenatal care [relative risk (RR)=45.18; 95% confidence interval (CI)=7.80, 261.60]; prolonged rupture of membranes (RR=4.47; 95% CI=1.95, 10.25); maternal peripartal fever (RR=5.42; 95% CI=2.35, 12.52); prematurity (RR=7.53; 95% CI=4.91, 11.55); and LBW (RR=5.50; 95% CI=3.88, 7.80). CONCLUSION: NMR is high among hospital live births in Ibadan. There is a need for programs encouraging the use of antenatal care, improving skills on neonatal resuscitation and care of LBW infants; as well as implementation of community-based newborn survival strategies.