Review of four unusual cases of HIV-positive infants; cryptic pregnancy scam and mother-to-child transmission of HIV in Nigeria.

BACKGROUND: Cryptic pregnancy is defined as lack of awareness of pregnancy until the last weeks of gestation or during labour and delivery but in cryptic pregnancy scam, mothers feigned pregnancies that never existed. METHODS: We report a total of four cases of HIV infected infants said to have been delivered by HIV negative mothers. All the mothers are above 40 years of age with a range of 9 to 18 years of infertility in marriage. The cryptic pregnancy scam was neither confirmed by pregnancy test nor obstetric scan. Diagnosis of HIV infection was made at infancy following positive rapid test and HIV antigen test. CONCLUSION: The menace of cryptic pregnancy scam in Nigeria is setting back the gains of HIV prevention and control. Desperate infertile women are made to believe that they are pregnant while babies are bought and brought to them at said date of delivery. These mothers never had proper antenatal care and so were never screened for HIV. Cryptic pregnancy scam is real amongst desperate barren women who become easy prey to the perpetuators. Awareness creation and sensitization on its harm is advocated.

Equilibration time of haemoglobin concentration after packed red blood cell transfusion in children seen in the emergency unit of a tertiary hospital in Southeast, Nigeria.

Blood transfusion is an important treatment modality for severe anaemia. Monitoring post-transfusion haemoglobin (Hb) concentration helps the clinician in assessing the success of blood transfusion. Previous authors have reported different timings for post-transfusion equilibration using varied time intervals for post-transfusion Hb concentration assessment. This study was therefore aimed at determining the appropriate time to assess Hb concentration after packed red blood cell (pRBC) transfusion in children using 5 different time intervals. It was a longitudinal observational study carried out in a tertiary care hospital in Southeast, Nigeria and involved 108 children aged 1-10 years without active bleeding or significant haemolysis that were transfused with pRBC. The Hb concentration was measured using a portable haemoglobinometer just before the blood transfusion and after the blood transfusion at 1, 6, 12, 24, and 48th-hour. The 1-hour (6.8 ± 1.5 g/dl) post-transfusion Hb concentration was significantly different (p 0.001) from the 6th-hour (10.2 ± 1.5 g/dl), but no further significant (p > 0.05) changes occurred after the 6th-hour till the 48th-hour. This finding suggests that equilibration of Hb concentration had occurred by the 6th hour after blood transfusion. This study, therefore, recommends that Hb concentration assessment in children without ongoing bleeding or haemolysis can be done at the 6th hour after pRBC transfusion.

Sexual maturation of HIV-infected and uninfected male children in Abakaliki, South-East, Nigeria: a cross-sectional study.

Introduction: HIV infection, through various mechanisms causes a derangement in sexual maturation. This study compared the Marshal and Tanner staging of HIV-infected and uninfected males. The aim of the study was to determine the sexual maturation in male children infected with HIV on HAART in Abakaliki. Methods: this was a cross-sectional and comparative study involving 80 HIV-infected boys aged 8-17 years and 80 uninfected counterparts matched for age and socio-economic class. Stages of sexual maturation (testicular size and pubic hair) were determined according to the method proposed by Marshall and Tanner. The testicular size was measured using an orchidometer. Data analysis was done with SPSS version 20. Structured questionnaire was used to collect information on socio-demographics. Results: assessment of pubic hair development, showed that 45 (56.2%) of the subjects were in the pre-pubertal stage compared to 27 (33.8%) among the controls, this relationship was statistically significant (p=0.005, OR = 2.5, C.I=1.3-4.8). The mean testicular volume among subjects was found to be 8.29 ± 8.26mls compared to 11.57 ± 8.26mls found in controls. This relationship was also statistically significant. There were significant statistical relationships between duration on HAART and clinical stages of disease with both pubic hair development and testicular volume of subjects and controls. Conclusion: HIV-infected males had significantly delayed onset and progression of sexual maturation. Routine assessment of the sexual maturation of HIV-infected children as well as addressing the modifiable variables influencing sexual maturity is recommended.

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever.

BACKGROUND: Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago-the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. METHODOLOGY: We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. RESULTS: A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. CONCLUSIONS: This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level.

Prevalence of sexual harassment and its relationship with family birth order among female undergraduates: New findings from institutional-based cross-sectional study in the south east, Nigeria.

Family is the microcosm of a larger society that provides care that shapes the behavior of children. However, the different levels of attention children receive from their parents may affect their behaviour and self-esteem, which can lead to them being more vulnerable to sexual harassment. An institutional-based cross-sectional survey was conducted from March - August 2021, to assess the relationship between family birth order and prevalence of sexual harassment. The multistage sampling procedure was used to draw 1070 participants. The data was analyzed using percentages, mean, and multivariate logistic regression statistics. The multivariate logistic regression was used to estimate adjusted odds ratios (AOR) along with 95% confidence intervals (CIs). The level of significance was set at P < 0.05. The findings revealed prevalence (73.6%) of sexual harassment, and the two forms such as verbal ( = 2.63) and non-verbal sexual harassment ( = 2.56) were high. The multivariate logistic regression odds ratios adjusted shows that the middle born were approximately 2 folds (AOR = 1.62; CI = 1.14 - 2.30; P = 0.008 0.05) more likely to predict sexual harassment. The study recommended amongst others that parents in South Eastern Nigeria should refrain from given special attention to a particular child as this may predispose the unfavoured child to sexual harassment.

Positivity Rate, Predictors, and Outcome of Paediatric Lassa Fever Disease (LFD) in a Lassa Fever Endemic State, South-East Nigeria.

Background: The pattern and case fatality rate of Paediatric Lassa fever disease (LFD) is not well documented even in Lassa fever endemic communities. Aim and Objective: This prospective observational study was aimed at determining the pattern and outcome of Paediatric LFD. Methodology: A total of 183 children that met the criteria for LFD suspects were subjected to the Lassa virus PCR test. The suspects that tested positive were recruited into the study and a structured questionnaire was used to collect information on socio-demographics. Results: Of the 183 LFD suspects that were tested, 24 of them were positive to Lassa virus PCR, giving a positivity rate of 13.1%. The mean duration of illness before hospital presentation was 8.54 ± 3.83 days. All the subjects had a history of fever. Abdominal pain and vomiting were the two highest presenting complaints after fever. Seven out of 24 children died during the study period, giving a case fatality rate (CFR) of 29.2%. Subjects who presented with convulsions and unconsciousness (OR =10.00, 95% CI= 1.2, 81.81, p=0.020), bleeding (OR =40.00, 95% CI= 12.96, 539.67, p=0.020), poor urine output (OR =40.00, 95% CI= 12.96, 539.67, p=0.020) were more likely to die of LFD compared to their colleagues without such symptoms. Conclusion: The positivity rate and case fatality rate of LFD in children were high. Public enlightenment on the common features of Lassa fever disease and the need to seek health care early for children with febrile illness is advocated.

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report.

BACKGROUND: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. CASE DESCRIPTION: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. DISCUSSION: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. CONCLUSION: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.

Perception and utilization of insecticide-treated mosquito net among caregivers of children in Abakaliki, Nigeria.

Background: Malaria contributes significantly to under-5 morbidity and mortality in Sub-Saharan African countries including Nigeria. The rollback malaria (RBM) initiative and millennium developmental goal 6 are the programs targeted at reduction in malaria burden. The target year here is 2015; it would be needful to determine the impact of these programs on lives of at-risk population. Objectives: To determine caregivers' perception and utilization of insecticide-treated mosquito net (ITN) for their children/wards under 5 years of age. Methods: It was a cross-sectional, descriptive, hospital-based study conducted at Federal Teaching Hospital, Abakaliki, between April 1, 2014, and October 31, 2014. A structured questionnaire was used to assess caregivers' perception and utilization of ITN. Relevant information collected from the respondents included awareness of what ITN is and its use, ownership, source and utilization of ITN, and frequency of antimalaria use for febrile episodes. Data were analyzed using Statistical Package for the Social Sciences (SPSS) Windows Program (SPSS Inc., Chicago, IL, USA) version 20.0 while the level of statistical significance was set at P < 0.05. Results: A total of 410 caregivers were interviewed; 362 (88.3%) were mothers. Three-hundred and eighty-four (93.7%) participants knew that ITN prevents mosquito bite that cause malaria infection, 81.2% (333/410) have at least one ITN in their homes, but only 215 (52.4%) use the ITN every night. Caregivers who used ITN regularly used antimalaria for their under-5 quarterly (34.9%) and rarely (33.9%). A significant relationship existed among socioeconomic class, knowledge of ITN, source of knowledge of ITN, frequency of anti-malaria use, and utilization of ITN. Conclusion: The study observed that awareness and ownership of ITN are high among study participants, but its utilization was suboptimal compared to RBM target for 2010 (80.0%). Health education and free distribution of ITNs should be further strengthened particularly among mothers of childbearing age and younger children.

RésuméArrière-plan: Le paludisme contribue de manière significative à sous-5 Taux de morbidité et de mortalité au Nigéria. Le programme Faire reculer le paludisme (RBM) et objectif de développement du millénaire 6 (OMD 6), ont été des programmes ciblés sur la lutte contre le paludisme fardeau. L'année cible 2015 est ici, il serait nécessaire de déterminer l'impact de ces programmes sur la vie des populations à risque. Objectif:évaluer les connaissances des intervenants en soins de santé et l'utilisation des MII pour leurs enfants/pupilles de <5 ans. Méthodes: Il s'agissait d'une étude basée sur l'hôpital descriptive effectuée dans FETHA entre avril et octobre 2014. Un questionnaire structuré a été utilisé pour évaluer les connaissances des intervenants en soins de santé et l'utilisation des MII. Critères utilisés comprenaient la conscience de ce que MII et son utilisation, la propriété, la source et l'utilisation des MII et de la fréquence de l'anti-malaria utiliser pour les épisodes fébriles. L'analyse a été effectuée à l'aide de SPSS version 20. Niveau de signification a été P < 0.05. Résultats: un total de 410 personnes soignantes ont été interviewés, 362 (88,3%) étaient des femmes. Trois cent quatre-vingt-quatre (93,7%) participants savaient qu'ITN empêche piqûre de moustique qui causent l'infection palustre, 81,2% (333/410) ont au moins une MII dans leurs foyers mais seulement 215 (52,4%) utilisent l'ITN chaque nuit. Les aidants naturels qui utilisaient régulièrement de MII utilisé contre la malaria pour leurs enfants de moins de cinq ans (34,9%) trimestriel et rarement (33,9%). Une relation significative existe entre la classe socio-économique, la connaissance de l'ITN, source de connaissance de l'ITN, la fréquence d'utilisation de lutte contre le paludisme et l'utilisation des MII. Conclusion: l'étude a observé que la sensibilisation et la propriété de l'ITN est élevée parmi les participants à l'étude, mais son utilisation est encore sous-optimale par rapport à faire reculer le paludisme Cible pour 2010 (80,0%). Mots clés: des moustiquaires imprégnées d'insecticide (MII), les connaissances, l'utilisation, le paludisme, les OMD, LA GESTION AXÉE SUR LES RÉSULTATS.