Serum cystatin C levels in Nigerian children: reference intervals and relationship to demographic and anthropometric variables.

BACKGROUND: Cystatin C has been recognized as a good marker of kidney function but reference ranges have not been determined in Nigerian children. OBJECTIVE: To determine the reference range of serum cystatin C in Nigerian children with no overt signs of kidney disease and to determine and compare the relationship of serum cystatin C and serum creatinine with demographic and anthropometric variables. METHODS: Fifty-nine children aged two years to 16 years with no evidence of overt kidney disease were recruited from the Paediatric Clinics of the Lagos University Teaching Hospital. Serum cystatin C levels were measured using ELISA method while serum creatinine was measured by a rate-blanked and compensated Jaffe method using a Roche/Hitachi 902 auto-analyser. Both were measured using the same serum sample. RESULTS: The mean (±1.96SD) serum cystatin C level was 0.73 (0.41-1.04) mg/L and was similar among male and female children (P=0.640) and between children younger than five years and those five years and older (P=0.596). Unlike cystatin C, serum creatinine was higher among children five years or older. In contrast to serum creatinine, serum cystatin showed no significant correlation with age (r=0.153, P=0.246), weight (r=0.062, P=0.641) and length (r=0.067, P=0.612). CONCLUSION: Serum cystatin C reference range in Nigerian children is similar to that reported for children in other regions of the world and appears to be independent of gender, weight, height, body mass index and age after two years.

Prospective audit of perinatal mortality among inborn babies in a tertiary health center in Lagos, Nigeria.

BACKGROUND: The perinatal mortality rate remains an important indicator of maternal care and maternal health and nutrition, and also reflects the quality of obstetric and pediatric care available. The causes of most of the perinatal deaths are preventable, thus making it important to identify the risk factors in each health environment. OBJECTIVE: The aim was to prospectively audit the perinatal mortality and associated risk factors in a tertiary health facility in a developing country. MATERIALS AND METHODS: Data for all consecutive deliveries in the labor ward complex of Lagos University Teaching Hospital (LUTH) between June 2002 and November 2002 were obtained from the patients' record and by interviewing the mothers using a questionnaire. The babies were followed up for 7 days post delivery. RESULTS: There were 51 (8.5%) perinatal deaths made up of 43 (7.1%) stillbirths (15 fresh and 28 macerated) and 8 (6.1%) early neonatal deaths giving a perinatal mortality rate of 84.6/1000. Maternal factors that significantly affected perinatal deaths were maternal age, parity, antenatal care booking and the hospital where the mother was booked for antenatal care, number of previous child deaths, and complications of pregnancy. Mode of delivery and complications of labor were the significant intrapartum factors. Fetal factors that influenced perinatal deaths were fetal presentation, birth weight, and Apgar scores at 1 and 5 min. When multiple logistic regression (multivariable analysis) of perinatal mortality on possible risk factors was done, only the Apgar score at 5 min, birth weight, and parity were significant risk factors. CONCLUSION: The study shows a high perinatal mortality rate with majority of perinatal deaths occurring before the delivery. Significant risk factors are a low Apgar score at 5 min, low birth weight, and high parity.

Clinical presentation of congenital malaria at the Lagos University Teaching Hospital.

BACKGROUND: Congenital malaria has been increasingly documented in endemic regions. It is important to recognize those clinical features that are due to congenital malaria, which if undetected, might worsen the morbidity of the newborn. The aim of this study was to document the clinical presentation of neonates with congenital malaria born at the Lagos University Teaching Hospital and followed up for 28 days. METHODS: A total of 100 consecutive mothers and their newborns were recruited between August and October 2002 (during the rainy season) from the labour ward and followed up from birth to 28 days of age. Blood films from the placentae and babies were stained with Giemsa stain within 24 hours of collection. All parasitaemic babies that became symptomatic were screened for sepsis using acute phase responses and cultures. All data were entered into a prepared proforma. Symptoms were attributed to malaria when sepsis screening was negative. RESULTS: Congenital malaria was documented in 13.6% of babies at delivery. Jaundice, irritability and poor feeding were most common symptoms associated with congenital malaria. Irritability and poor feeding had positive predictive values (PPV) of 100% on Day 14. CONCLUSION: Babies who present with poor feeding and irritability on Day 14 of life should be screened for malaria in addition to the routine investigations for neonatal sepsis.

Anthropometric indices of infants born to HIV-1-infected mothers: a prospective cohort study in Lagos, Nigeria.

Numerous studies have reported that HIV-infected pregnant women are at increased risk of delivery of low birth weight (LBW) infants, of preterm deliveries and of intrauterine growth restriction. The objective of the study was to determine the effect of maternal HIV infection on the anthropometric characteristics of the babies at birth. A prospective study was carried out at the Lagos University Teaching Hospital, Nigeria. There were three times more LBW babies in the HIV-positive group than in the uninfected mothers (odds ratio = 3.47, 95% confidence interval = 1.69, 7.27; chi(2) = 12.99, P = 0.0003).The maternal weight (t = 15.85; P = 0.0001), maternal body mass index (BMI) (t = 15.07; P = 0.0003), birth weight of infants (t = 27.17; P = 0.0001) and birth length (t = 31.20; P = 0.001) were significantly less in HIV-positive mothers than in controls. In conclusion, poor maternal bodyweight and low BMI are significant contributors to LBW in HIV-infected women. Nutritional counselling, dietary intake and weight monitoring during pregnancy should be emphasized to improve pregnancy outcome in HIV-infected women.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children.

OBJECTIVE: To investigate the effect of antiretroviral (ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children.

OBJECTIVE: To investigate the effect of antiretroviral ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.

Maternal HIV infection and intrauterine growth: a prospective study in Lagos, Nigeria.

BACKGROUND: Low birth weight (LBW) is the most important cause of perinatal mortality and morbidity worldwide and particularly so in developing countries. Maternal HIV (Human Immunodeficiency Virus) infection has been identified as one of the risk factors to the development of low birth weight babies. OBJECTIVE: To evaluate the effect of maternal HIV infection on the birth weight of the newborn at tertiary hospital in West Africa. METHODS: The anthropometry of all HIV seropositive women who delivered in LUTH as well as that of their babies was determined using standard methods. Controls consisted of HIV seronegative women and their babies matched for age and parity with the above subjects. RESULTS: There were a total of 262 subjects of whom 132 (50.4%) were HIV seropositive and 130 (49.6%) were HIV seronegative controls. There were five times more low birth weight (LBW) infants in the HIV seropositive group than in the controls (OR 5.77, CI=2.19-16.80; p=0.000075). The mean maternal body mass index, BMI (p=0.0003), mean maternal weight (p=0.0004) and mean birth weight of newborns (p=0.0002) were significantly lower in the HIV seropositive group than in the controls. Maternal weight and gestational age were significantly associated with low birth weight (OR 15.3, CI=2.6-316.0; p=0.002) and (OR 3.78, CI=1.37-10.9; p=0.007) respectively. CONCLUSION: Maternal HIV infection is strongly associated with low maternal BMI and low birth weight in their offspring.

Estimation of the rate of mother to child transmission of HIV in Nigeria.

Definitive diagnosis of HIV infection in infants < 18 months of age who were born to HIV-infected mothers is still posing some difficulty in Nigeria and other developing countries. Within this age definitive diagnosis can only be carried out by antigen based techniques which are indeed not available in these developing countries. This has resulted in the absence of authoritative data on the rate of mother-to-child transmission in these countries. Nigeria inclusive. The present pilot study was therefore carried out to generate some information on the rate of mother to child transmission in Nigeria using the PCR technique. Plasma samples were obtained from 68 children of both sexes less than 18 months of age and who were born to HIV infected mothers. The samples were collected from two pediatric departments. in Lagos and in Benin. The presence of HIV 1 RNA in each of the samples. was determined using the Amplicor Monitor V 1.5 technique (Roche Diagnostics). Data showed that HIV-1 RNA was detected in 15 of the 68 samples tested. This gave an HIV-1 RNA detection rate of 22%. Among women who had some intervention, the rate of transmission of infection was 11% while the rate among those without intervention was 30%. The 22% transmission rate recorded in this study is close to the range of 25 to 35% that has been reported in several developed and a few developing countries. A multicenter nationwide study will still be needed to determine the national mother to child transmission rate in Nigeria.

Prevalence of Skin Diseases in Children with Human Immunodeficiency Syndrome Infection in Paediatric HIV Clinic of A Tertiary Hospital in Nigeria.

BACKGROUND: HIV infection/AIDS being a multi-systemic disease affects the skin at various stages in course of the illness. A knowledge of the common skin diseases associated with HIV infection can lead to early detection, appropriate staging and commencement of appropriate care in the infected patients. OBJECTIVE: The study was to document the prevalence and pattern of skin diseases in children with HIV infection seen at the Paediatric department of a tertiary centre in Nigeria. METHODS: HIV positive children attending the PEPFAR HIV clinic of Lagos University Teaching Hospital, Nigeria were examined for the presence of skin lesions. Anthropometric measurements were also obtained. Blood samples Were taken for CD4+ cell count, viral load and full blood count. RESULTS: Two hundred and fourteen (214) patients were studied, consisting of 107 HIV infected children and 107 uninfected children as controls. Skin lesions were observed in 89 (83%) of the HIV infected patients, while only 72 uninfected controls had skin lesions. (p = 0.035). The predominant skin disease in the HIV infected children was Pruritic papular eruption (PPE) with a frequency of 25.9%, followed by fungal infections (24.6%). Herpes zoster was found only in HIV infected children (p = 0.041). There was a strong correlation between the degree of immunosuppression (as reflected by the value of age dependent CD4+ cell count/CD4+ percentage). and the prevalence of skin disease in the HIV infected patients. The presence of pruritic papular eruptions and Herpes zoster was associated with advanced immunosuppression. CONCLUSION: Skin diseases are common in HIV infection in our environment. Early detection of HIV infection can be made in the presence of skin diseases like Pruritic papular eruption and Herpes zoster.

Bacteria causing septicaemia in neonates with tetanus.

105 consecutively admitted neonates with tetanus were screened for sepsis to determine the prevalence of sepsis in neonatal Tetanus (NNT) patients and identify the bacterial pathogens causing septicaemia in them. The presence of omphalitis, poor colour, hypothermia and hyperthermia were found to be sensitive predictors of septicaemia in NNT patients. 50 bacterial pathogens were isolated from 50 babies. Klebsiella pneumoniae (20.7%), and Enterobacter cloacae (19.0%) were the leading gram negatives, while staphylococcus aureus (19.2%) was the prevalent gram positive organism isolated. Antimicrobial susceptibility profile heavily favours ofloxacin but a combination of cloxacillin and gentamicin is recommended as first line. Ceftazidime with about 60% susceptibility across board is the favoured cephalosporin.

Bacterial eye infection in neonates, a prospective study in a neonatal unit.

One hundred and fifty five neonates with conjunctivitis admitted into the neonatal unit at the Lagos University Teaching Hospital were microbiologically investigated. This was to determine the bacterial aetiologic agent(s) in neonatal eye infection and highlight some risk factors. Antimicrobial susceptibility testing was done on the pathogens isolated using the diskagar diffusion method. The incidence of conjuctivitis in the newborn was 18 per 1000 live births. Predisposing factor noted were vaginal delivery, asphyxia neonatorum and prolonged rupture of membrane. Pathogens predominantly isolated were Staphylococcus aureus (37.4%), Coagilase negative Staphylococci (12.3%), Klebsiella pneumoniae (12.9%) and Pseudomonas aeruginosa (8.2%). Antimicrobial suscepibility results revealed varied degrees of susceptibility to ofloxacin (75%), Cloxacillin, erythromycin, Gentamicin and augumentin (30%) by the gram positive bacteria while most of the gram negative were susceptible to colistin and ofloxacin (above 90%). The high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adoption of stringent aseptic measures in the care of the neonate.

Outcome of low birth weight neonates in a tertiary health care centre in Lagos, Nigeria.

The records of all low birth weight (LBW) neonates admitted into the Neonatal Unit of the Lagos University Teaching Hospital (LUTH) from January 1997 to December 2001 were retrospectively analysed in order to determine the outcome and risk factors associated with mortality. There were 535 LBW admissions of which 411(76.8%) survived while 124(23.2%) died. The birth weight specific mortality rate for the < 1000g neonates was 818 per 1000, 451 per 1000 for the 1000-1499g, 216 per 1000 for the 1500-1999g, and 67 per 1000 for the 2000-2499g neonates (X2 = 127.70, p = 0.0001). Primary indications for admission were neonatal sepsis (25.2%), perinatal asphyxia (23.0%) and neonatal jaundice (19.6%) with case fatality rates of 20.0%, 34.1% and 10.5% respectively (X2 = 34.24, p = 0.00001). Death occurred within 48 hours of admission in 45.2% of subjects and by the 7th day, 72.6% had died (X2 = 70.07, p = 0.0001). Significant risk factors associated with mortality were birth weight [OR 4.24, 95% CI = 3.14-5.72] and category of LBW [OR 2.79, 95% CI = 1.65-4.69]. Sex, twinning, booking status and mode of delivery had no significant influence on mortality. Since the provision of adequate intensive care for these vulnerable infants remains a major challenge in countries with poor resources, efforts should be intensified to implement effective strategies for the reduction of low birth weight deliveries.

Physical health status of pupils in a school for the mentally disabled in Lagos.

The study set out to assess the health status of pupils of a school for children with mental disability. The school is Modupe Cole Memorial Child Care and Treatment Home School, Akoka, Lagos. The records of 211 pupils were reviewed and the pupils were clinically examined by the author. Seventy-four (35.1%) of the subjects had complete immunization, 48(22.7%) had incomplete immunization while 44(20.9%) received no immunization. The probable aetiology of mental disability in the subjects was due to postnatal causes (96; 45.5%), natal causes (44; 20.8%), prenatal causes (12; 5.7%) and unknown (59; 28.0%). The most abnormal findings on physical examination were in the central nervous system (199; 94.3%), the musculoskeletal system (137; 64.9%), the mouth/teeth (125; 59.2%) and the skin (98; 46.4%). These findings were worse amongst the residential students than in the non-residential students (p < 0.001). The information obtained from this study will help to serve as a reference for purposes of health planning and policy formulation for children with mental disability.

Clinical and management factors related to outcome in neonatal tetanus.

Although tetanus is a well-recognised, well-described, preventable and eradicable infection, it continues to ravage the lives of children in developing countries, especially among neonates. A cross-sectional review of cases of neonatal tetanus seen in LUTH was carried out retrospectively. Thirty-nine (39) cases were studied, comprising 26 (63.4%) males and 15 (36.6%) females, giving a male: female ratio of 1.6:1. Case fatality rate was 10.3%, thirty-five (89.7%) cases survived, of which nine (23.8%) survived with complications. Clinical factors that influence outcome were: a short interval between onset and presentation (p = 0.03), low tetanus score below 6.0 (p = 0.002), hyperpyrexia (p = 0.0001), heart failure (p = 0.035), cyanosis (p = 0.008) and crepitations (p = 0.003). Although several management factors were associated with mortality, these failed to meet statistical significance (p > 0.05). In this study, clinical factors, including presentation interval, were the principal determinants of outcome. The need for intensification and sustenance of preventive measures, early recognition and presentation, prompt treatment as well as improved care are emphasised. We recommend periodic audit of patient clinical data towards improving quality of care.

Prevalence and outcome of higher order multiple pregnancies in Lagos, Nigeria.

OBJECTIVE: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria. METHODS: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012. RESULTS: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1-72.3, p = 0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2-189.9, p = 0.000) and birth weight <1000 g for live births (p = 0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality. CONCLUSION: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.

Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital.

This study was conducted to determine the incidence of meconium staining of the amniotic fluid (MSAF) and its associated factors in a Nigerian teaching hospital. Perinatal data on 80 consecutive live, singleton infants of booked mothers born through meconium-stained liquor from March - June 2003 were analysed and compared with babies born through clear liquor. The incidence of MSAF was 20.4% for 393 deliveries. The rate increased with gestational age: no case was found below 37 weeks (p = 0.001). Primiparity, prolonged rupture of fetal membranes and obstructed labour were more often associated with MSAF (p = 0.005, p = 0.0013 and p = 0.0000002, respectively) as were tachycardia or bradycardia and low Apgar scores (p = 0.0000001 and p = 0.046, respectively). It is concluded that meconium-staining is common. It is related to gestational maturity and stressful peripartum conditions and associated with adverse symptomatology in the fetus and newborn.

Haematological abnormalities associated with paediatric HIV/AIDS in Lagos.

INTRODUCTION: In HIV-1-infected children, haematological disturbances include bone marrow abnormalities and peripheral cytopenias. All three major cell lineages can be depressed. METHODS: A cross-sectional study of baseline haematological parameters was undertaken in 68 children with confirmed HIV infection. In all cases, a complete blood count was done and some had CD4+ counts and HIV RNA PCR. The CD4+ count was analysed by the Coulter manual latex particle monoclonal antibody method and HIV RNA PCR by Roche Amplicor Monitor, version 1.5. RESULTS: Anaemia (< 100 g/L) was present in 77.9%, severe (< 60 g/L) in 5.9%, moderate (60-70 g/L) in 32.3% and mild (80-99 g/L) in 39.7%. The mean haemoglobin concentration decreased as disease progressed (p < 0.05); 6% had leucopenia, 17.5% had neutropenia and 2.5% (one case) had thrombocytopenia; also, the four (6%) subjects with leucopenia were in clinical stages B and C. Neutropenia, lymphocytopenia and thrombocytopenia were seen more in clinical stages B and C, though this relationship was not statistically significant. CONCLUSION: Both the erythroid and other cells lines are affected by HIV/AIDS and other associated factors. Anaemia is the most common haematological abnormality. The severity of peripheral cytopenias is related to the disease burden.

Congenital malaria among inborn babies at a tertiary centre in Lagos, Nigeria.

Congenital malaria is increasingly reported among babies born to mothers continually residing in endemic areas. Given the high morbidity and mortality associated with malaria it is pertinent to determine its current status among newborns in Lagos, Nigeria. The aim was to determine the incidence of congenital malaria in newborn babies delivered at the Lagos University Teaching Hospital and also to determine the frequency of parasitaemia in their mothers and placentae. A cross-sectional study of mothers attending the antenatal clinic of the Lagos University Teaching Hospital was done. The Sociodemographic and clinical characteristics of mothers were documented. Samples of maternal, placental, cord and neonatal blood were taken and stained with Giemsa and examined for malaria parasites. Neonatal samples were examined at birth, on days 3, 7, 14 and 28. One hundred mothers and their placentae, as well as 104 babies and their cord blood were studied. The incidence of congenital malaria was 16/104 (15.3%) and parasite counts ranged from 47 to 1019/mul. Plasmodium falciparum was the predominant species. There was a strong association between placental, maternal, cord and neonatal parasitaemia. All the babies with congenital malaria had infected mothers, placentae and cords (p < 0.0001). In conclusion congenital malaria is not uncommon in Lagos nowadays, and there are relatively high rates of maternal, placental and cord blood parasitaemia. It is, therefore, recommended that babies born to mothers with malaria should be screened for congenital malaria.