PREVALENCE OF BACTERAEMIA AMONGST CHILDREN WITH FEBRILE SEIZURES AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN.

BACKGROUND: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children. OBJECTIVES: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children's emergency room of the University College Hospital, Ibadan, Nigeria. METHODOS: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite. RESULTS: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus. CONCLUSION: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.

Responses to spread of.Ebola virus disease epidemic in West Africa: A review.

BACKGROUND: The first Ebola virus disease (EVD) epidemic in West Africa is unprecedented in its spread, complexity and severity. Comparing responses to spread of the virus in the three most affected countries - Guinea, Sierra Leone and Liberia- with that in Nigeria, Senegal and Mali where the epidemic was quickly brought under control may guide future mitigation efforts. METHODS: Literature from Pubmed. Google,Center for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR), World Health Organization's Updates and Ebola Response Reports: Results: The epidemic spread undiagnosed for three months from Meliandou in Guinea to its four rural prefectures and its. capital Conakry, two countires in Liberia and two districts in Sierra Leone. Control measures were hampered by traditional and faith healers offering -inappropriate treatments, as well as secret societies encouraging unsafe burial rituals. Whereas, in Nigeria, a case imported from Liberia on 20 July 2014 was diagnosed on the 3rd day; all primary, secondary and tertiary contacts were traced. Also, at a formal meeting, officials of Lagos state government discouraged treatment of EVD by faith healers. In Senegal, a single case imported from Guinea on 20 August 2014 was diagnosed on the 9th day, treated and further spread was prevented. In Mali, there were two waves of transmissions identified on 23 October and 12 November 2014 within 15 days of importation and the epidemic was controlled.There were no cases of EVD treated by any traditional healers or faith healers in Nigeria, Senegal and Mali. CONCLUSION: Education of traditional and faith healers on EVD will complement control measures for EVD epidemic.

Pre-hospital management of febrile seizures in children seen at the university college hospital, ibadan, Nigeria.

BACKGROUND: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome. OBJECTIVES: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria. METHODS: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded. RESULTS: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socio-economic class of the caregivers (P=0.008). CONCLUSIONS: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria.

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH), Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these, 51614 (99.5%) accepted HIV test and 49134 (95.2%) returned for their results. Out of the tested patients, 2152 (4.2%) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361 (16.7%) with 87 (18.6%) testing positive. There were a total of 942 deliveries out of which 39.2% of the mothers and 95.2% of the babies respectively received ARV prophylaxis. In all, 85.8% (788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing, 68.3% reported for the test and 17 (8.7%) tested positive. There has been progress in the programme, reflected in the increase in the number of new clients accessing the PMTCT service. However, partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention.

Mycobacterium tuberculosis and Mycobacterium africanum in stools from children attending an immunization clinic in Ibadan, Nigeria.

BACKGROUND: Tuberculosis is a major cause of childhood morbidity and mortality in Nigeria. Diagnosis of childhood tuberculosis is a global challenge making early treatment a mirage. In this study we investigated the stools of children for the presence of mycobacteria. METHODS: Stool samples from children aged 3 days to 3 years who presented for postnatal immunization at a large university-based clinic in Nigeria, were subjected to Ziehl-Neelsen staining. Samples with acid-fast bacilli were further processed using mycobacterial culture, spoligotyping, and deletion typing. RESULTS: One hundred and ninety-two stool samples from different children were collected and processed. Thirty (15.6%) had acid-fast bacilli. Of these, eight had Mycobacterium tuberculosis and one had Mycobacterium africanum. CONCLUSIONS: Approximately 5% (9/192) of apparently well children had evidence of potentially serious tuberculosis infection. The usefulness of stool specimens for diagnosing pediatric tuberculosis warrants further investigation.

Situation analysis of the existing infant feeding pattern at the commencement of the prevention of mother to child transmission (PMTCT) of HIV programme in Ibadan.

OBJECTIVES: To evaluate breastfeeding and weaning practices associated socio-demographic factors and knowledge about mother-to-child transmission of HIV among mothers in Ibadan. METHODS: A cross sectional survey was conducted among 513 mothers of children aged 6- 24 months, attending infant welfare clinics. Data collection was by a structured questionnaire, which was supplemented by focus group discussions to further explore some of the issues covered in the survey. RESULTS: Breast-feeding rate was 99.4%, the duration of which ranged from 1-22 months with a median of 14 months among those who had stopped breastfeeding. Only 145 (28.3%) mothers breastfed their babies exclusively for six months and 259(50.8%) initiated breastfeeding within one hour of birth; both were associated with at least secondary level of education. The main obstacle to exclusive breastfeeding was the belief that water is required to quench thirst in babies. Expression of breast milk was not favoured by majority of the mothers (68%) most of whom felt that the milk would get contaminated. Wet nursing was rarely practiced (0.4%). Most of the mothers, 436 (85%) were aware that HIV could be transmitted through breast milk but the attitude towards a mother who did not breast feed was negative in 96.8% ofrespondents. CONCLUSIONS: Adherence to recommended infant feeding options for HIV-exposed infants are likely to be faced with challenges in a culture where breastfeeding is the norm and exclusive breastfeeding rate is low. There is need for counseling and health education on prevention of mother-to-child transmission of HIV.

A case of human bite by an 11-year old HIV positive girl in a paediatrics ward.

Biting is a possible mode of transmission of HIV infection, though the risk of such transmission is believed to be low. Children infected with HIV are at risk of psychological complications as a result of direct or indirect effects associated with the disease. We report the case of an 11 year old HIV positive girl with clinical stage IV disease, who was involved in multiple disputes while on admission on the ward. During one of the disputes she inflicted a deep bite injury on a 10-year old boy, HIV post-exposure prophylaxis (PEP) was commenced 6 hours after the bite and he has remained HIV negative 12 months later. What is peculiar about this case is that the incident occurred in a hospital setting and biting is not usually expected among children of this age. In the era of HIV/AIDS, it is recommended that persons involved in childcare be aware of this potential risk during interactions among children. It is also essential for health care personnel to have sufficient knowledge about PEP in order to reduce the risk of HIV transmission in similar settings. In addition, a multidisciplinary approach to the management of children living with HIV is important in order to identify and address psychosocial factors that may influence symptoms and medical treatment outcome. The risk of transmission of HIV through human bites and the psychosocial impact of the disease on children are also discussed.

A five-year review of childhood mortality at the University College Hospital, Ibadan.

INTRODUCTION: The present study sought to provide a comprehensive description of causes of mortality in a local Nigerian children population as a measure of their health status. METHODS AND PATIENTS: A retrospective study of the pattern of mortality among 12,522 children admitted into all the six wards of the department of Paediatrics, University College Hospital, Ibadan during a five-year period (January 1996 - December 2000) was done. RESULTS: There were 1,185 deaths with an overall mortality rate of 9.5 per cent. There was no significant change in childhood mortality rate over the five years reviewed. Of the 1185 deaths, 48.8 % occurred within 24 hours and neonatal deaths accounted for 50.8 % of the total number of deaths. The leading causes of death were neonatal tetanus, Prematurity/low birth weight, neonatal septicaemia, severe birth asphyxia, meningitis, severe malaria, pneumonia, septicaemia, severe malnutrition, and measles. Deaths from sickle cell anaemia were found only among children above 5 years of age. CONCLUSIONS: Majority of deaths occurred in neonates and were preventable.

Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood.

OBJECTIVE: To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6-7 years. SUBJECTS AND METHODS: A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6-7 years in 31 primary schools randomly selected among 272 in Ibadan. RESULTS: Data was collected from 1,704 children (797 boys and 907 girls; M:F ratio 1:1.14), giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls (rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%), except for wheezing, which was higher in boys (9.0%) than girls (5.6%), p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. CONCLUSION: The study demonstrates a high prevalence of atopic conditions among children 6-7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age.

Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anaemia in Ibadan, Nigeria.

UNLABELLED: As part of a larger project on childhood urinary tract infection, antimicrobial sensitivity tests were carried out on the bacterial isolates from the urine of febrile children seen at the University College Hospital, Ibadan, Nigeria. METHODOLOGY: Midstream urine specimens were collected from 171 sickle cell anaemia children and from an equal number of haemoglobin-A controls and cultured by standard methods. Sensitivity to eleven antimicrobials was tested using the disc-diffusion technique of Stokes. RESULTS: Significant bacteriuria was obtained from 37 children with sickle cell anemia and 27 controls. The isolates were Escherichia coli, Klebsiella species, Non-haemolytic streptococcus, beta-haemolytic Streptococcus, Salmonella, Proteus and Pseudomonas species. Sensitivity was highest to Pefloxacin to which over 94% of the organisms were sensitive followed by Ceftriaxone (over 85%) and ceftazidime (over 85%). Sensitivities to nalidixic acid and cefuroxime were between 67.6% and 74.1%. Most of the isolates were resistant to gentamicin, amoxycillin, cotrimoxazole and ampicillin. In general the sensitivity pattern in the sickle cell anaemia group was similar to the pattern in the control group. CONCLUSION: Aetiological agents of childhood UTI in this environment are resistant to most of the drugs commonly recommended for its treatment. Nalixidic acid and cefuroxime are recommended as first line drugs while awaiting results of sensitivity testing. Ceftriazone and ceftazidime should be reserved for cases of non-response to first line drugs and in severe cases. Pefloxacin should be considered potential drug of treatment particularly in multi-drug resistant infections.

Urinary tract infection in febrile children with sickle cell anaemia in Ibadan, Nigeria.

A prospective study to determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia (SCA) was carried out at University College Hospital, Ibadan. Altogether, 171 febrile children (aged 1-15 years) with SCA and 171 age- and sex-matched controls were studied. After obtaining a history of the illness from the parents or guardians, each child was physically examined and a mid-stream urine specimen collected and subjected to microscopy and culture. The prevalence of bacteriuria in children with SCA was 21.6% compared with 15.8% in the controls. Escherichia coli and Klebsiella species were the predominant isolates from the urine, accounting for 64.9% and 18.9%, respectively, of the isolates from the SCA group and 63% and 22.2%, respectively, in the controls. In the SCA group, significant bacteriuria also occurred with other conditions such as pneumonia and osteomyelitis. Urinary tract infection (UTI) is common in children with SCA. Routine screening for it is therefore recommended during febrile illnesses. Children with fever from other overt causes, however, should not be exempted from the urine screening procedure in case there might be concomitant UTI.

Aetiological agents, clinical features and outcome of septicaemia in infants in Ibadan.

UNLABELLED: The present study sought to determine the prevalence, clinical features and bacterial aetiological agents of septicaemia in post-neonatal infants (age 1-12 months) presenting with fever at the University College Hospital, Ibadan, Nigeria. STUDY SETTING: It was carried out at the Otunba Tunwase Children Emergency Ward (OTCHEW) (a 40 bedded ward) of the Department of Paediatrics, University College Hospital, Ibadan, Nigeria. PATIENTS: All postneonatal infants aged 1-12 months presenting with fever and who had not had antibiotic treatment in the week prior to presentation during the period June to November 1998 were enrolled in the study. Each child had a full clinical evaluation followed by a blood culture. RESULTS: The infants comprised 56 (54.9%) males and 46 (45.1%) females. The mean age was 5.6 (SD 0.3) months. The prevalence of septicaemia in the infants studied was 38.2%. Clinical features associated with increased risk of septicaemia among these infants were age < or = 6 months, restlessness and a total white cell count > or = 15000/mm3. The organisms isolated in the infants studied were Escherichia coli (35.9% of positive cultures). Staphylococcus aureus (33.3%), Klebsiella species (10.3%), Streptococcus species (7.7%), Proteus species (5.1%), Pseudomonas species (5.1%) and Salmonella species (2.6%). Mortality was significantly higher in patients with septicaemia (25.7% compared with those without septicaemia (7.9%). CONCLUSIONS: Thirty eight percent of febrile infants presenting in this study had positive bacteria blood cultures, the most common organisms being Escherichia coli and Staphylococcus aureus. Few clinical features distinguished febrile infants with septicaemia from those without. It is recommended that febrile infants in our setting with clinical features associated with increased risk of septicaemia should be treated emprically with antibiotics since the probability of having septicaemia is significant.

Reexpansion pulmonary oedema as a complication of pleural drainage.

One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

Influence of placental malaria infection and maternal hypergammaglobulinaemia on materno-foetal transfer of measles and tetanus antibodies in a rural west African population.

Placental malaria infection jeopardizes pregnancy outcome, and its influence may also impair the transplacental transfer of some antibodies. Two hundred and thirteen Gambian mother-baby pairs were studied to determine the influence of placental malaria infection and maternal hypergammaglobulinaemia on transplacental transfer of measles and tetanus antibodies in Gambian population. Placental blood and tissue were collected for placental malaria diagnosis. Cord and maternal sera were tested for total IgG concentration by laser nephelometry and for IgG antibody to tetanus toxoid and measles by ELISA. The prevalence of placental malaria infection was 51.1%. Mothers whose placentae were parasitized had a significantly higher mean total serum IgG (22.0 g/L vs 11.3 g/L, p < 0.001) and measles antibody level (4.02 IU/mL vs 1.21 IU/mL, p < 0.01), but not tetanus antibody, than mothers with non-parasitized placentae. Results of multiple regression analysis showed that placental malaria infection and maternal hypergammaglobulinaemia were associated with the reduction of 72% (95% CI 67.84) and 86% (95% CI 76.91) in transplacental transfer of measles antibody respectively but did not influence the transfer of tetanus antibody. It is concluded that the combined influence of placental malaria infection and maternal hypergammaglobulinaemia is significantly associated with the transfer of impaired measles antibody in this population.

Vitamin A status of pre-school children in Ibadan (South West Nigeria), risk factors and comparison of methods of diagnosis.

Vitamin A deficiency (VAD) and protein energy malnutrition (PEM), sharing common aetiological factors, are important public health problems in many developing, countries. A cross-sectional survey of the vitamin A status of 128 well nourished and 230 malnourished pre-school children was carried out in order to define factors associated with increased risks of VAD and also to determine the predictive values of CIC-T in identifying serum retinol of < 10 microg/dl in these children. The proportional morbidity rates of VAD defined by serum retinol concentrations (7.3%) and CIC-T (6.2%) was similar (p>0.05), and children aged < 3 years accounted for 70% of VAD cases. VAD occurred in 6.3% and 7.8% of well-nourished and malnourished children respectively. The risk of VAD was increased following measles, history of persistent diarrhoea and wasting. The predictive value of CIC-T is highly dependent on CIC-T such that abnormal and normal smears classification appears to be very robust and predictive of serum retinol of < 10 microg/dl, with sensitivity of 83.3% (95%CI: 61.8-94.5), and specificity of 73.3% (95%CI: 68.3-78.5). Judging by the proportional morbidity rate in this study, VAD appears to be a significant public health problem in both malnourished and well-nourished Nigerian children, especially in children < 3 years of age. The history of measles and persistent diarrhoea appear to increase the risk of VAD. The simplicity, sensitivity and specificity of CIC-T suggest that this procedure is a good screening tool for epidemiological survey of vitamin A status.

The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria.

The histological findings in renal biopsy specimens obtained from 41 children with the nephrotic syndrome in Ibadan, Nigeria, between July, 1989 and June, 1996 are presented. The patients consisted of 26 male and 15 female children and their ages ranged from 2-13 years. The predominant histological type was membranoproliferative glomerulonephritis (MPGN) which occurred in 21 (51.2%). Membranous nephropathy and minimal change nephropathy (MCN) accounted for 4 (9.8%) patients each. The prevalence of MPGN was 33.3% in children less than 5 years of age compared with 56.2% amongst children who were > or = 5 years. All the three patients with MCN who were treated with a course of prednisolone had complete remission of the disease. It is concluded that MPGN is the predominant histological lesion seen in childhood nephrotic syndrome in Ibadan and that MCN remains an uncommon lesion. Therefore, renal biopsy is recommended as a prelude to a trial of steroid therapy in these patients since MCN (which is generally associated with steroid-responsiveness) is an uncommon finding among them.

Conjunctival impression cytology with transfer in the assessment of vitamin A status in Nigerian children.

OBJECTIVE: To determine vitamin A status by conjunctival impression cytology with transfer (CIC-T) and assess its ability to predict low and deficient serum retinol concentrations. STUDY DESIGN: CIC-T was performed on 128 healthy, well-nourished and 230 malnourished children aged under 6 years by a 3-5-second application of cellulose acetate paper to each bulbar conjunctiva followed by transfer of the adhered cells onto glass slides. The slides were stained with Alcian green 2GX, and smears were classified as normal, borderline normal, borderline abnormal and deficient. Corresponding serum retinol levels were determined in each subject. RESULTS: The results showed that CIC-T is a simple procedure with a failure rate of 7.3% caused by tearing and agitation. The power of CIC-T to predict vitamin A status varied with both the CIC-T smear classification used and serum retinol concentration threshold. CIC-T smear classification as abnormal and normal appears to be the most robust and predictive of serum retinol, < 10 and > 10 < 20 micrograms/dL, respectively. CONCLUSION: The simplicity, sensitivity and specificity of CIC-T suggest that this procedure is a good screening tool for epidemiologic survey of vitamin A status.

Acute laryngotracheobronchitis in Nigerian children.

In a prospective study of cases of severe acute respiratory infections seen at the University College Hospital, Ibadan over a 30-month period, 39 cases were found to have acute upper airway obstruction; out of this number, acute laryngotracheobronchitis (croup) accounted for 35 (90%). The ages of the 35 ranged from 2 to 53 months with 86% being less than 3 years old, while there was a male preponderance (M:F ratio, 1.7:1). Croup was associated with bronchopneumonia in 29%, measles in 2.9%, and with both in 40% of the 35 cases. The mean respiratory rate in patients in whom croup co-existed with measles and pneumonia was significantly higher than that in patients with croup alone (P < 0.001). Six (55%) of the eleven viral identifications made were Parainfluenza virus types 1-3, while Respiratory syncytial virus was identified in three patients. Of the 18 blood cultures done, only one was positive, yielding Klebsiella pneumoniae in a two-year old undernourished child with associated measles and bronchopneumonia. Mortality was 11%; all the four children who died had associated bronchopneumonia, which complicated measles infection in three. The findings in this study support the view that antibiotic therapy is not routinely indicated in the management of croup. Furthermore, measles and bronchopneumonia were identified as indicators of poor prognosis requiring extra care in management.