Determinants of maternal near miss events among women admitted to tertiary hospitals in Mogadishu, Somalia: a facility-based case-control study.

BACKGROUND: A maternal near-miss is a situation in which a woman was on the verge of death but survived a life-threatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy's termination. Survivors of near-miss events share several features with mothers who have died and identifying determinants of maternal near miss will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Therefore, this study was designed to identify determinants of maternal near miss incidents among women hospitalized to tertiary hospitals in Mogadishu, Somalia. METHODS: A facility-based unmatched case-control study was conducted in four tertiary hospitals in Mogadishu from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were involved in the study. The discharge period, cases were recruited consecutively as they emerged, whereas controls were chosen using systematic sampling approach based on every fifth interval of those delivered through normal spontaneous vaginal delivery. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases, while women who were admitted and gave birth by normal vaginal delivery and resealed from the hospital without experiencing severe obstetric complications were considered controls. Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire and the medical records were reviewed to identify maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05. RESULTS: The most common maternal near-miss morbidities identified were severe anemia (32%), severe pre-eclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%), eclampsia (6.1%), ICU admission (5.6%), severe PPH (2.8%) and severe systemic infections (2.8%). The main factors associated with maternal near-miss were rural residency [OR = 2.685, 95%CI: (1.702-4.235)], age below 20 years [OR = 2.728, 95%CI: (1.604-4.5640)], unmarried [OR = 2.18, 2.18, 95%CI (1.247-3.81)], lack of formal education [OR = 2.829, 95%CI: (1.262-6.341)], husband's unemployment [OR = 2.992, 95%CI: (1.886-4.745)], low family income [OR = 3.333, 95%CI (1.055-10.530)], first pregnancy before 18 years of age [OR = 3.091, 95% CI: (2.044-4.674)], short birth interval [OR = 5.922, 95%CI: (3.891-9.014)], previous history of obstetric complication [OR = 6.568, 95%CI: (4.286-10.066)], never attended ANC services [OR = 2.687, 95%CI: (1.802-4.006)], lack of autonomy in seeking medical help [OR = 3.538, 95%CI: (1.468-8.524)], delivery at non-health facility setting [OR = 4.672, 95%CI: (3.105-7.029)], experiencing the second delay [OR = 1.773, 95% CI: (1.212-2.595)] and stillbirth of the last pregnancy [OR = 5.543, 95%CI: (2.880-10.668)]. CONCLUSION: and recommendation. Lack of maternal education, lack of antenatal care, lack of autonomy to seek medical assistance, short birth interval, rural residence and delay in accessing obstetric services were identified as factors associated with maternal near-miss morbidity. As a result, the study suggests that those modifiable characteristics must be improved in order to avoid severe maternal complications and consequent maternal death.

Midsagittal Plane First: Building a Strong Facial Reference Frame for Computer-Aided Surgical Simulation.

PURPOSE: A facial reference frame is a 3-dimensional Cartesian coordinate system that includes 3 perpendicular planes: midsagittal, axial, and coronal. The order in which one defines the planes matters. The purposes of this study are to determine the following: 1) what sequence (axial-midsagittal-coronal vs midsagittal-axial-coronal) produced more appropriate reference frames and 2) whether orbital or auricular dystopia influenced the outcomes. METHODS: This study is an ambispective cross-sectional study. Fifty-four subjects with facial asymmetry were included. The facial reference frames of each subject (outcome variable) were constructed using 2 methods (independent variable): axial plane first and midsagittal plane first. Two board-certified orthodontists together blindly evaluated the results using a 3-point categorical scale based on their careful inspection and expert intuition. The covariant for stratification was the existence of orbital or auricular dystopia. Finally, Wilcoxon signed rank tests were performed. RESULTS: The facial reference frames defined by the midsagittal plane first method was statistically significantly different from ones defined by the axial plane first method (P = .001). Using the midsagittal plane first method, the reference frames were more appropriately defined in 22 (40.7%) subjects, equivalent in 26 (48.1%) and less appropriately defined in 6 (11.1%). After stratified by orbital or auricular dystopia, the results also showed that the reference frame computed using midsagittal plane first method was statistically significantly more appropriate in both subject groups regardless of the existence of orbital or auricular dystopia (27 with orbital or auricular dystopia and 27 without, both P < .05). CONCLUSIONS: The midsagittal plane first sequence improves the facial reference frames compared with the traditional axial plane first approach. However, regardless of the sequence used, clinicians need to judge the correctness of the reference frame before diagnosis or surgical planning.

Unlocking the potential of novel RTS, S/AS01, and R21/Matrix-M™ malaria vaccines in African nations.

Introduction: Mass malaria vaccination, rather than vaccinating only children below age 5, has been proven to have the potential to reduce morbidity and mortality among those vaccinated, both young and old. Addressing vaccine scepticism and misinformation is crucial in African nations to build public trust in malaria prevention. Therefore, including a wider range of demographics in vaccine trials is necessary for equitable representation and achieving herd immunity against malaria. Aim: This present article aims to identify some of the obstacles that impede malaria vaccination usage and acceptability in African Nations in combating malaria in the region as it continues to pose a significant global public health problem. Methodology: A literature search was done on the Malaria vaccine between 2000 and 2023. Past and present articles/studies on this topic were consulted on PubMed, Google Scholar, Scopus and Web of Science using the following keywords; "Malaria," "Vaccines," "African Nations," "Obstacles, Strategies," and "Public Health." Results: The recently approved RTS, S/AS01, and R21/Matrix-M™ Malaria vaccines have the potential to prevent numerous deaths and cases of Malaria in Africa. These vaccines Malaria vaccines are cost-effective in African areas with moderate to high plasmodium falciparum and can be delivered through routine immunization. Conclusion: To combat malaria effectively in African Nations, African leaders need to set up a comprehensive approach that involves; prevention, healthcare access, implementation research strategies towards adoption and acceptance of malaria vaccines in Africa as well as community engagement with the religious leaders, the market women, community heads, schools, as well as students' union towards the willingness and acceptability of the malaria vaccines among the African populations.

Dentinogenic ghost cell tumor associated with odontoma: report of a rare case and review of literature.

Dentinogenic ghost cell tumor (DGCT) is an uncommon odontogenic tumor considered to be the solid, tumorous variant of calcifying odontogenic cyst. DGCT is characterized by islands of ameloblastoma-like epithelial cells that resemble the enamel organ, the presence of ghost cells, and dentinoid material. This article reports a rare case of dentinogenic ghost cell tumor associated with an odontoma in an adult patient, with a review of the literature. To the best of the authors' knowledge, there have only been four case reports of DGCT associated with odontoma, all of which occurred in children and adults younger than 30 years old.

Prevalence, patterns, and determinants of gender-based violence among women and girls in IDP camps, Mogadishu-Somalia.

Background: Gender-based violence (GBV) against women and girls, is a global pandemic that affects 1 in 3 women in their lifetime. Somalia is one of the leading countries in human rights violations and has one of the highest rates of sexual and gender-based violence (SGBV) worldwide. Such violence is more prevalent among women and girls in internally displaced persons (IDP) camps who lack livelihood and civil protections. Therefore, this study was designed to identify the prevalence and the determinants of gender-based violence in IDP camps in Deynile district, Somalia. Methods: This is a cross-sectional study design conducted in IDP camps in Deynile District from August 1 to September 30, 2022. A total of three hundred eighty-four women and girls aged 18 years and above living in the selected IDP camps were involved in the study. The camps were selected randomly while households and participants were selected systematic random sampling. The recall period was set at 12 months (August 2021 to July 2022). Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire. Data was entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05. Result: The study revealed that gender-based violence was quite common in the IDP camps in Mogadishu's Deynile area. Physical abuse was the most prevalent type of GBV, which was primarily committed by intimate partners, parents, and other family members. The main factors associated with gender-based violence were young age (OR=4.77, 95% CI: 1.96-11.63, p<0.001), extended family structure (OR=7.89, 95% CI: 4.30-14.47, p<0.001), household size >5 individuals (OR=1.86, 95% CI:1.04-3.30, p<0.005), employment (OR=1.57, 95% CI: 1.0.41-2.32, p<0.05), substance misuse (OR=3.25, 95% CI: 1.57-6.73, p<0.05), a long distance to the nearest police station (OR=2.75, 95% CI:1.51-5.00, p<0.005), and camp safety protection (OR=1.94, 95% CI:1.24-3.30, p<0.005). Conclusion and recommendations: There was a high prevalence of gender-based violence in the IDP camps in Mogadishu's Deynile area. The most common form of GBV was physical violence mainly perpetuated by intimate partners. The study recommends improving some of the modifiable factors that were strongly associated with gender-based violence.

Prevalence, antimicrobial susceptibility profile, and associated risk factors of uropathogenic Escherichia coli among pregnant women attending Dr. Sumait Hospital Mogadishu, Somalia.

Background: Uropathogenic Escherichia coli (UPEC) is a strain of E. coli commonly associated with urinary tract infections. In addition, antibiotic resistance in UPEC is one of the most significant health problems. This study was conducted to determine the prevalence, antimicrobial resistance, and factors linked to uropathogenic Escherichia coli (UPEC) in pregnant women. Methods: This cross-sectional study was conducted within a hospital setting between August 2022 and December 2022. Using consecutive convenient sampling, the research enrolled 220 pregnant women. The urine samples obtained from these women were cultured on MacConkey and blood agar and incubated at 37°C overnight, followed by sub-culturing on Mueller Hinton media. Bacterial identification involved Gram staining and biochemical characterization (TSI, indole, citrate, methyl red, urea agar, and motility tests). Conversely, susceptibility tests were performed using the Kirby-Bauer disk diffusion method. A binary logistic regression model and analysis of odds ratios (ORs) were employed to evaluate the risk factors associated with E. coli infection, and statistical significance was attributed to p-values of ≤0.05. Results: Out of the 220 urine samples examined, 42 (19%) exhibited a positive culture, indicating an E. coli infection in pregnant women. Our analysis revealed that income, gestational age, and history of UTIs were identified as risk factors associated with E. coli infection. Most E. coli isolates demonstrated sensitivity to amikacin (100%), nitrofurantoin (85.7%), amoxicillin/clavulanic acid, and meropenem (83.3%). Conclusion: The prevalence of E. coli was remarkable. It could be recommended that pregnant women in antenatal care have routine culture and antimicrobial susceptibility tests to prevent transmission of resistant pathogens and complications in both pregnant mothers and the unborn baby.

The prevalence of urolithiasis in subjects undergoing computer tomography in selected referral diagnostic centers in Mogadishu, Somalia.

Introduction and objectives: Somalia was predicted to be in the global stone belt with high urolithiasis prevalence. We aimed to determine the prevalence of urolithiasis and their demographic and computer tomography (CT) characteristics among subjects under CT scans in Mogadishu, Somalia. Materials and Methods: From March 2014 to November 2022, a total of 7,276 patients who underwent an abdominopelvic non-contrast CT scan for various indications were retrospectively reviewed. The mean age was 45.6 years with a standard deviation of 21.1 (range, 0.2-110 years). Patients were subdivided into two categories: adults (≥18 years) and pediatric (≤17 years). Results: Of the 7,276 patients, 1,075 (14.8%) were diagnosed with urolithiasis. Among those with urolithiasis, 702 (65.3%) were male patients, and 373 (34.7%) were female patients. Among them, adults accounted for 92.7%, while children were 7.3%. Renal stones (nephrolithiasis) were the most common, representing 57% followed by ureteric stones at 35.5%, making upper urinary stones 92.5%. Approximately 70 patients (6.5%) had bladder stones; of these, 26 of them (37%) were accompanied by benign prostatic hyperplasia (BPH). There were 10 urethral stones (0.9%) recorded in the study, all were found in male patients, 8 localized in prostatic urethra, and 2 in the bulbar urethra. The overall mean stone size was 13.2 mm, and 60% of them ranged from 5 to 22 mm. Only 24% of the patients were asymptomatic. Single stones were almost 70%, while staghorn calculi were 8.2%. More than 60% of the patients with urolithiasis showed some degree of hydronephrosis ranging between mild to severe. Conclusion: A CT scan-based urolithiasis prevalence indicates 14.8% in Mogadishu, Somalia, and these results are consistent with the probability calculation of the weights-of-evidence (WofE) methodology based on several risk factors including temperature, climate change, mineral deposit, drinking water quality, and distribution of carbonated rocks. Considering the high prevalence of the disease, Somalia needs to invest more in prevention and treatment facilities while also training urologists that are capable of utilizing minimally invasive techniques in the country.

Investigation of severe acute respiratory syndrome coronavirus 2 antibodies among the paediatric population in Mogadishu, Somalia.

BACKGROUND: We undertook this cross-sectional study to determine the level of circulating anti-severe acute respiratory syndrome coronavirus 2 immunoglobulins (IgM and IgG) in children, as well as to evaluate other potential risk factors. METHODS: Children attending the outpatient department of the SOS and Benadir Hospitals in Mogadishu from 26 July to 8 August 2021 were selected following parental consent. The children (aged <18 y) were screened using the coronavirus disease 2019 (COVID-19) rapid test lateral flow immune-assay kit. RESULTS: Of the 500 children screened for COVID-19, 32 (6.4%) tested positive, out of which 26 (5.2%) had IgG antibodies, while five (1%) had IgM, with the other child (0.2%) having both circulating IgG and IgM antibodies. Also, 46.9% of the COVID-19-positive children were asymptomatic without any clinical signs of the disease. Children aged >6 y and those attending school were the most affected (p=0.002). The most common clinical features among positive children were fever (22.6%), cough (22.2%), shortness of breath (5.8%) and loss of smell (2.6%) and taste (2.2%). Similarly, not wearing a facemask as a preventive measure was found to be a significant risk factor (p=0.007). CONCLUSIONS: This study shows that children are at risk of contracting COVID-19 infection. Our study also shows evidence of a high rate of IgG antibodies in school-aged children having close contact with infected adults, in those not wearing facemasks, as well as in those with a family history of comorbidities.

Extreme climatic effects hamper livestock production in Somalia.

Given the enormous impact of the livestock sector on Somalia's economy and its vulnerability to climate variations, this study investigates short and long-term changes in climatic effects on livestock production by using data spanning from 1985 to 2016. To this end, the ARDL bounds testing and causality techniques were employed to model the long-run and short-run relationships, and direction of causality among sampled variables. Overall, the empirical results confirmed the existence of a stable long-run cointegration between variables. Rainfall and temperature patterns were found to have a significant positive and negative impact on livestock production both in the long run and short run, respectively. The observed carbon dioxide emissions have no significant impact on livestock production in the long run but enhance livestock production in the short run. Interestingly, growth in rural population declines livestock production in the long run but not in the short run. Besides, a unidirectional causality is confirmed from temperature to rainfall and CO2 whereas livestock production has a bidirectional causal relationship with rainfall and temperature. While CO2 emissions granger cause livestock production, a unidirectional causation is observed from rural population to temperature and livestock production. This study suggests adaptation and mitigation policies that combat the negative consequences of climate change.

Deep transfer learning with multimodal embedding to tackle cold-start and sparsity issues in recommendation system.

Recommender systems (RSs) have become increasingly vital in the modern information era and connected economy. They play a key role in business operations by generating personalized suggestions and minimizing information overload. However, the performance of traditional RSs is limited by data sparseness and cold-start issues. Though deep learning-based recommender systems (DLRSs) are very popular, they underperform when considering rating matrices with sparse entries. Despite their performance improvements, DLRSs also suffer from data sparsity, cold start, serendipity, and generalizability issues. We propose a multistage model that uses multimodal data embedding and deep transfer learning for effective and personalized product recommendations, and is designed to overcome data sparsity and cold-start issues. The proposed model includes two phases. In the first-offline-phase, a deep learning technique is implemented to learn hidden features from a large image dataset (targeting new item cold start), and a multimodal data embedding is used to produce dense user feature and item feature vectors (targeting user cold start). This phase produces three different similarity matrices that are used as inputs for the second-online-phase to generate a list of top-n relevant items for a target user. We analyzed the accuracy and effectiveness of the proposed model against the existing baseline RSs using a Brazilian E-commerce dataset. The results show that our model scored 0.5882 for MAE and 0.4011 for RMSE which is lower than baseline RSs which indicates that the model achieved an improved accuracy and was able to minimize the typical cold start and data sparseness issues during the recommendation process.

Seroprevalence of SARS-CoV-2 virus antibodies and sociodemographic features of pregnant women in Mogadishu, Somalia: a cross-sectional survey study.

OBJECTIVE: Recent investigations have revealed that COVID-19 during pregnancy substantially increases the risk of harmful outcomes for mothers and neonates, including preterm death and stillbirth as well as severe maternal morbidity and mortality. Hence, the urgent need to understand the prevalence rate and level of awareness about COVID-19 (SARS-CoV-2 virus infection) and the practice of preventive measures against the disease among pregnant women in Somalia. This study aims to determine the prevalence of COVID-19 among pregnant women seeking antenatal care in the Benadir region (Mogadishu) of Somalia and to assess their knowledge and preventive practices towards COVID-19. SETTING: A hospital-based cross-sectional study involving two major referral maternity hospitals in Mogadishu, Somalia. PARTICIPANTS: Pregnant women seeking antenatal services were included in our study. METHODS: A total of 477 blood samples were collected from pregnant women attending the two referral hospitals in Mogadishu and screened for COVID-19. The participants were subjected to questionnaire interviews where their detailed history and practice of prevention against COVID-19 were evaluated. RESULTS: The results showed that 175 (36.7%) were positive while 302 (63.3%) samples were negative for SARS-CoV-2 virus antibodies. Also, out of the 141 pregnant women who had two children or less, 19.4% were positive for IgG/IgM antibodies. Participants who had close contact with patients with COVID-19 were significantly associated for testing positive with a p value 0.0001. Students, teachers, employed people and individuals reported COVID-19 like symptoms were all associated with COVID-19 seropositivity outcomes. CONCLUSION: Pregnant women and those with commorbidies should be given special preventive care and health education about COVID-19 transmission.

COVID-19 Vaccine Coverage and Potential Drivers of Vaccine Uptake among Healthcare Workers in SOMALIA: A Cross-Sectional Study.

Healthcare workers (HCWs) are one of the most vulnerable groups for contracting COVID-19 and dying as a result of it. Over 10,000 HCWs in Africa have been infected with COVID-19, according to the World Health Organization, making it a substantial occupational health threat for HCWs. To that end, Somalia's Ministry of Health has ordered that all healthcare personnel obtain the COVID-19 vaccination to safeguard themselves and the community they serve. In this investigation, we aimed to assess the COVID-19 vaccination coverage and its associated factors among healthcare workers in Somalia. A cross-sectional study was employed to examine COVID-19 vaccination coverage among healthcare personnel in Somalia. The data were obtained via an online questionnaire supplied by Google forms between December 2021 and February 2022, where a total of 1281 healthcare workers from the various federal states of Somalia were recruited. A multinomial regression analysis was used to analyse the factors associated with COVID-19 vaccine uptake. Overall, 1281 HCWs participated (630 females, 651 males) with a mean age and standard deviation of 27.7 years ± 7.1. The overall vaccine coverage was 37.4%. Sex, age, the state of residency, education level, specialization, hospital COVID-19 policy, vaccine availability at the centre, COVID-19 treatment centre, and health facility level were the factors that influenced the COVID-19 vaccine uptake among health professionals in Somalia. Male healthcare employees were 2.2 times (odds ratio-OR = 2.2; confidence interval-CI: 1.70, 2.75, p < 0.001) more likely than female healthcare workers to be fully vaccinated. The survey discovered that the COVID-19 vaccine coverage among health professionals was quite low, with the major contributing factors being accessibility, security challenges and literary prowess. Additional efforts to enhance vaccination uptake are needed to improve the COVID-19 vaccination coverage.

Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey.

BACKGROUND: Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries. METHODS: The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income. RESULTS: Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05). CONCLUSIONS: Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.

Hypothyroidism following sistrunk procedure: Thyroglossal duct cyst or ectopic thyroid?

Thyroglossal duct cyst is the most common cause of anterior midline neck swelling in children, but ectopic thyroid is an important but rare differential diagnosis. Establishing the orthotopic thyroid gland status is crucial as inadvertent removal of a lone functioning ectopic thyroid tissue in young children could lead to fluttering of growth and development if not identified early. We report the case of a 2 years 10-month-old boy who had Sistrunk's procedure for 'thyroglossal duct cyst': Diagnosed using USS, defaulted follow-up and presented subsequently with growth retardation from hypothyroidism.

Phenotypic detection of methicillin-resistant Staphylococcus aureus in village chickens from poultry markets in Maiduguri, Nigeria.

OBJECTIVE: The study was carried out to detect the carriage of methicillin-resistant Staphylococcus aureus (MRSA) and their antimicrobial susceptibilities in village chickens sold at Maiduguri poultry markets using phenotypic characterization. MATERIALS AND METHODS: This was a cross-sectional study where 120 samples comprised 50% each of Nasal and cloacal swabs, were, respectively, collected from live village chickens sold at Maiduguri poultry markets and examined for the presence MRSA based on bacterial culture, biochemical characteristics, growth on oxacillin resistant screening agar base, and antimicrobial susceptibility tests. RESULTS: The study revealed an overall occurrence of 38.33% S. aureus and 32.60% MRSA, respectively. Antimicrobial susceptibility test was carried out on MRSA positive isolates against seven antimicrobials. All the isolates (100%) exhibited resistance against cefoxitin, whereas the least antimicrobial resistance was recorded against erythromycin and streptomycin each with 26.6%, respectively. In the same way, the highest antibiotic susceptibility in this study was observed against erythromycin (60%) and least susceptibility was against vancomycin and streptomycin with 20% each. A varying intermediate antibiotic susceptibility ranging from 13.33% to 53.33% was observed. Multiple-drug resistance patterns were exhibited by MRSA isolates from this study with 73.3% of the isolates exhibiting resistance to two or more antibiotics. CONCLUSION: This study has shown the carriage of MRSA by village chickens which calls for serious public health concern and concludes that these birds might have acquired these pathogens from the environment or infected humans since they normally receive no less medical attention.

Prevalence and Pattern of Human Immunodeficiency Virus-Associated Nephropathy among Human Immunodeficiency Virus-Positive Children at the University of Maiduguri Teaching Hospital, Nigeria.

The kidney is an important target organ in human immunodeficiency virus (HIV) infection, and a variety of renal disorders could occur throughout the course of the disease. HIV- associated nephropathy (HIVAN) is the most common form of kidney disease resulting directly from HIV infection. The true prevalence of HIVAN among infected African children is unknown largely due to lack of surveillance and reporting. We thus aimed to determine the prevalence of HIVAN and associated factors among HIV-infected children at the University of Maiduguri Teaching Hospital. This was a cross-sectional study carried out at the Pediatric Infectious Clinic. Children aged ≤15 years were recruited through systematic random sampling. Relevant sociodemographic and clinical information were obtained. Spot urine sample was analyzed using a multistix (Combi-Screen 10SL Analyticon Biotechnologies AG, Germany), and proteinuria of ≥2+ was considered significant. The CD4+ count and CD4+% (for those <5 years) were obtained using a PARTEC™ CD4+ easy count kit. The obtained data were entered and analyzed using Statistical Package for the Social Sciences version 16.0. A total of 250 children were recruited. Eighty-five (34%) of them had HIVAN. Sex, social class, and mode of transmission were not significantly associated with HIVAN (P >0.05). However, age, medication status (highly active antiretroviral therapy [HAART]), duration on HAART, and disease severity (both clinical and immunological) all had a significant association to HIVAN (p = 0.005, 0.004, 0.008, and <0.001, respectively). These factors also showed a positive but weak correlation to HIVAN; while age had the least correlation coefficient (0.157), immunological class had the highest r = 0.458. However, these relationships were all significant (P <0.5). HIVAN is highly prevalent among children living with HIV in Maiduguri. Routine screening through urina-lysis and early commencement of HAART is recommended.

Urinary schistosomiasis in Boko Haram-related internally displaced Nigerian children.

We aimed to determine the prevalence of urinary schistosomiasis among internally displaced children in Maiduguri, Nigeria. Data on the children's sociodemographic characteristics and risk factors for schistosomiasis were collected, over a period of six months, using an interview-based questionnaire. Ten milliliter of urine sample was collected from each child and investigated for hematuria and ova of Schistosoma haematobium. Two hundred and thirty-eight of 385 children had urinary schistosomiasis (62.0%); of this, 125 (53.0%) were males, with a male:female ratio of 1.1:1. Urinary schistosomiasis was the most common among 5-9 years' age group, low social class children, and children of farmers, P <0.05. Stunting was significantly associated with urinary schistosomiasis, P <0.05. It is concluded that urinary schistosomiasis in children was more frequently associated with stunting and low social class. It was a very common disease among internally displaced children in Nigeria.

Neonatal Tetanus Immunity in Nigeria: The Effect of HIV Infection on Serum Levels and Transplacental Transfer of Antibodies.

Background. Tetanus toxoid immunisation of pregnant mother has remained the most effective strategy in eliminating neonatal tetanus. Impaired production and/or transplacental transfer of antibodies may affect the effectiveness of this strategy. We studied the effect of maternal HIV infection on serum levels and transplacental transfer of anti-tetanus antibodies. Methods. A total of 162 mother-baby paired serum samples were taken and analysed for anti-tetanus antibody levels using ELISA. Maternal HIV status was also determined by double ELISA technique. Maternal TT vaccination status was also documented. Results. Thirty-eight (23.5%) mothers and 41 (25.3%) babies were seronegative, out of whom 8 mothers were HIV positive and 9 babies were HIV exposed. HIV infected mothers and HIV exposed infants were, respectively, 16.27 times (OR = 16.27, 95% CI = 3.28 to 80.61) and 33.75 times (OR = 33.75, 95% CI = 4.12 to 276.40) more likely to be seronegative for anti-tetanus antibody. Similarly, HIV positive mother-newborn pairs were 7.46 times more likely to have a poor transplacental transfer of tetanus antibodies (OR = 7.46, 95% CI = 1.96 to 28.41). Conclusions. Maternal HIV infection is associated with impaired maternofoetal transfer of anti-tetanus antibodies and seronegativity among mothers and their newborns. Hence, this may hinder efforts to eliminate neonatal tetanus.

Brucella melitensis Biovar 1 and Brucella abortus S19 Vaccine Strain Infections in Milkers Working at Cattle Farms in the Khartoum Area, Sudan.

BACKGROUND: Human brucellosis is a preventable zoonoses that may become persistent, causing, if left untreated, severe localized disease. Occupational exposure to infected animals or animal products and consumption of fresh contaminated dairy are main risk factors. METHODS: One hundred farmworkers employed at two cattle farms one in Khartoum North and one in Omdurman were screened for the presence of specific antibodies and seropositive workers were invited to donate a blood sample for blood culture. Molecular typing was used to characterize Brucella isolates. RESULTS: Ten percent of farmworkers tested seropositive and while Brucella melitensis biovar 1 was isolated from the blood of three individuals, an isolate identical to the B. abortus S19 vaccine strain was isolated from a fourth person. All four bacteremic individuals were employed as milkers and did not have obvious disease. CONCLUSIONS: The isolation of the highly infectious pathogen B. melitensis from seropositive workers is consistent with the notion that the pathogen may persist in the blood without causing overt disease. While vaccination with strain S19 is essential for the control of bovine brucellosis the vaccine strain may be transmitted to the human population and protective measures remain important to prevent exposure also in view of the presence of B. melitensis. To create awareness for this potentially severe disease more information on the prevalence of the pathogen in different risk groups and in livestock in the Sudan is needed.

Uncomplicated malaria in children: The place of rapid diagnostic test.

BACKGROUND: Malaria has remained a major cause of morbidity and mortality among the under-five children in Nigeria. Prompt and accurate diagnosis of malaria is necessary in controlling this high burden and preventing unnecessary use of anti-malarial drugs. Malaria rapid diagnostic test (MRDT) offers the hope of achieving this goal. However, the performance of these kits among the most vulnerable age group to malaria is inadequate. MATERIALS AND METHODS: In this cross-sectional study, 433 out-patients, aged <5 years with fever or history of fever were enrolled. Each candidate was tested for malaria parasitaemia using ACON; malaria pf. Thick and thin films were also prepared from the same finger prick blood for each candidate. RESULT: Malaria rapid diagnostic test had sensitivity of 8.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 74%. The sensitivity of MRDT increased with increasing age. This effect of age on sensitivity was statistically significant (P = 0.007). Similarly parasite density had significant effect on the sensitivity of MRDT (P = <0.001). CONCLUSION: Histidine-rich protein-2 based MRDT is not a reliable mean of diagnosing malaria in the under-five age children with acute uncomplicated malaria.