Comparison of point-of-care glucometers and laboratory based glucose oxidase test in determining blood glucose levels.

Introduction: Alterations in blood glucose levels are common and an important determinant of a patient's admission outcomes, point-of-care glucometers, which are affected by a variety of factors, are increasingly used in clinical care. In this study we compared blood glucose levels determined by two commonly used glucometers (One Touch® and Accu-check®) with those of a standard laboratory method and determined the effect of haematocrit on glucose readings. Methods: Blood glucose levels were measured with One Touch® and Accu-Check® glucometers and the glucose oxidase method at the same time in 295 children aged 0 to 15 years over a 6-month period. Bland-Altman and correlation analysis were used to explore biases among the three methods. For all statistical tests, a p-value of less than 0.05 was considered statistically significant. Results: Most were males (51.2%) and the median (range) age was 1 year (1 day, 12 years). There was a significant correlation between each of the glucometer methods and laboratory blood sugar, and the correlation between the two glucometers was strong and significant. This correlation remained statistically significant even after controlling for haematocrit values. There was an acceptable level of bias (3.9 mg/dL) between the One Touch® and Accu-check® glucometers, but each had a remarkably large bias compared with the glucose oxidase method. Conclusion: The use of a tested glucometer in clinical settings can aid in rapid decision-making, but there is a need to periodically cross-check with the glucose oxidase method in the laboratory to optimise treatment outcomes for children with dysglycaemia.

Influence of placental malaria infection on foetal outcome in the Gambia: twenty years after Ian Mcgregor.

Malaria infection in pregnancy has serious health consequences among mothers and offspring. The influence of placental malaria infection on foetal outcome was studied in a Gambian rural setting where few pregnant women take antimalarial chemoprophylaxis. During July-December 1997, three hundred thirteen mother-newborn pairs (singletons only) were consecutively recruited into a study of the effects of placental malaria infection on the outcome of pregnancy. Placental blood and tissue were collected at delivery. Babies were clinically assessed until discharge. The overall prevalence of placental malaria infection was 51.1% by placental histology and 37.1% by blood smear. The primigravid women were more susceptible to placental malaria than the multigravidae (65.3% vs 44.7%, p=0.01). Placental malaria was significantly associated with pre-term deliveryand intrauterine growth retardation (p<0.01), and there was a four-fold risk of delivering low-birth-weight babies if mothers had parasitized placentae [OR=4.42, 95% confidence interval (CI) 2.10-9.27]. A reduction of mean birth-weight of babies by 320 g was associated with placental malaria infection (p<0.001). Similarly, a two-fold risk of stillbirth delivery (OR=2.22, 95% CI 1.04-4.72) was observed among the infected mothers. The findings showed that there was still an overall poor foetal outcome associated with placental malaria infection. The findings of this study confirm the findings of an earlier study by McGregor in the Gambia that the low birth-weight rate is significantly higher if the placenta is parasitized. In addition, this study observed that the high stillbirth and prematurity rates were associated with placental malaria infection. The findings of the present study suggest undertaking of effective malaria-control strategies during pregnancy, such as use of insecticide-impregnated bednets, intermittent and early treatment for malaria, and antimalarial chemoprophylaxis, in the Gambia.

Neonatal mortality in an urban population in Ibadan, Nigeria.

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