Human rotavirus genotypes causing acute watery diarrhea among under-five children in Benin City, Nigeria.

BACKGROUND: Diarrhea is a major cause of childhood morbidity and mortality in the developing countries. Rotavirus is a major cause of acute watery diarrhea. AIM: This study aims at characterizing the prevalent rotavirus G-genotypes among under-five children presenting with acute watery diarrhea in Benin City, Nigeria. METHODOLOGY: A total of 470 children <5 years presenting with diarrhea of <2 weeks duration, were over a period of 1 year consecutively recruited for the study. Stool samples were collected for rotavirus antigen detection using Enzyme-Linked Immunosorbent Assay (ELISA) and further analyzed with reverse transcriptase polymerase chain reaction (RT-PCR) for VP7 genotyping. RESULTS: Comparing the ability of the two methods to detect rotavirus in stool samples, 65 (13.8%) and 90 (19.2%) of the stools tested positive for rotavirus using ELISA and RT-PCR, respectively. Using VP7 primers, genotypes G1 were detected in 49 out of 90 stool samples (54.4%), G2 in 26 out of 90 stool samples (28.9%), G3 in 19 out of 90 stool samples (21.1%), G4 in 34 out of 90 stool samples (37.8%) and G9 in 8 of the 90 stool samples (8.9%). Some strains were observed to be reactive with 2 or more of the primers yielding dual or triple VP7 genotype reactivity. CONCLUSION: Rotavirus of varying genotypes as shown cause acute watery diarrhea among under-five children and vaccine with strains peculiar to this environment should be introduced. Techniques such as RT-PCR rather than ELISA, where affordable, should be used in stool rotavirus screening.

Knowledge and attitude of youth (ages 15-25 years) to HIV/AIDS and to routine HIV screening.

BACKGROUND: AIDS is still an incurable disease and is very costly to control. Since the first case of Acquired Immune Deficiency Syndrome (AIDS) in Nigeria was reported in 1986, the human immune deficiency virus (HIV) infection has attained epidemic proportion. In an effort to control this rapid spread, certain preventive measures have been developed. In spite of these and the campaigns to control it, the knowledge and attitudes of youths towards HIV/AIDS leaves much to be desired. OBJECTIVE: To determine knowledge and attitude of youths (15 - 25 years) of HIV/AIDS and to Routine HIV Screening. STUDY DESIGN: The study was cross-sectional. SETTING: The study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria, between January and December 2003. RESULTS: Five thousand three hundred and twenty STUDY POPULATION: The knowledge and attitude of youths (15 - 25 years) of HIV/AIDS and to routine HIV screening was assessed, using anonymous questionnaires, among 9500 respondents, 4950 males and 4550 females. 5750 respondents were from the University of Benin with a population of 20,000 students while 3750 were from some of the Secondary Schools (post primary Schools) randomly selected in Benin City, Nigeria. The University of Benin Teaching Hospital where the work was done is adjacent to the University of Benin. The Secondary Schools selected where the work was done were within a radius of 20 kilometers of the Teaching Hospital and were 5 in numbers with average of 750 students selected per school. Subjects (56%) indicated that they have heard about HIV/AIDS, 4180 (44%) had no knowledge of HIV/AIDS at all. 2240 of 5320 (42.1%) had some knowledge; 1593 (29.9%) had adequate knowledge and only 1487 (28.0%) had sufficient knowledge. 6365 (67%) did not believe it exists and as a result they are not bothered by it. 825 of the 3750 secondary school students had multiple sexual partners. Majority had single partners for those who had at all. While among the University students 2990 (52%) had multiple sexual partners, while others had between one and two sexual partners. Only 36210 (38%) believe it is real and a killer disease frightened about it and are already changing their sexual behaviours; 1900 (20%) believe it is a western propaganda to enslave the developing world. Three thousand nine hundred and ninety respondents (42%) would agree to routine HIV screening and 5510 (58%) would not agree to routine screening. The reasons adduced for rejecting routine HIV screening included psychological trauma, not necessarily high cost of and lack of anti-retroviral drugs, infringement on fundamental human rights, fear of living with positive screening, stigmatization and victimization at place of work if positive. CONCLUSION: Intensive massive awareness campaign through Radio, Televisions jingles and education about HIV/AIDS of the population is recommended to alter their current negative attitude to routine HIV testing and increase their knowledge about HIV/AIDS and perhaps help to change their sexual behaviours.

Survey of childhood enuresis in the Ehor community, the EDO State, Nigeria.

A community survey of enuresis was carried out in November/December 2002 among 300 apparently healthy children aged 5-16 years selected systematically from the Ehor Local Government Area in Edo State, Nigeria. This was done with the aim of ascertaining the true prevalence of the disease and the contributions of some organic causative factors. The overall prevalence of enuresis was 21.3%. Of the 64 children who were enuretic, 58 (91%) had only nocturnal enuresis. No strict daytime enuresis was recorded. Combined daytime and night time enuresis accounted for only six (9.4%) cases. Ninety-four percent of cases of enuresis were primary, while only six were secondary. Prevalence of enuresis declined significantly with increasing age (chi2= 14 .93, df= 3; p = 002). There was a strong association between enuresis and family history of bed wetting (more so with siblings) (chi2 = 45.09, p < 0.000). Though not statistically significant, enuresis was more common in males, in children drawn from families of poor socio-economic status, among first order births, and among those with asymptomatic bacteriuria. Also, there was no significant association between enuresis and hemoglobin genotype. Organic conditions played a minimal role in the etiology of enuresis in the study location, but the morbidity occurred frequently enough to warrant health attention. A community approach is advocated because only an insignificant proportion is seen in orthodox health facilities.

Upsurge in neonatal tetanus in Benin City, Nigeria.

BACKGROUND: Neonatal tetanus was on the decline from mid 1970's to mid 1990's due to the various efforts by many governments of the developing countries and such agencies as World Health Organisation (WHO) and United Nation's Children's Fund (UNICEF). However recently there appear to be an increase in neonatal tetanus despite these interventions leading to increasing neonatal morbidity and mortality. OBJECTIVE: To study the upsurge in neonatal tetanus despite the various interventions, examine possible causes responsible for it and proffer suggestions for eliminating neonatal tetanus by new target date of 2005 set by World Health Organisation. DESIGN: A prospective study. SETTING: The study was done at the University of Benin Teaching Hospital, Benin city and Modic Medical Centre, a private paediatric hospital in Benin City, Nigeria between January 1997 to December 2001. SUBJECTS: In 1996, it was noticed that cases of neonatal tetanus had increased suddenly among the total admissions. Morbidity and mortality among the under six months children had also increased and about ten percent of it was due to neonatal tetanus. It became imperative therefore to determine the magnitude of this problem. Consequently, cases of neonatal tetanus admitted to Special Care Baby Unit (SCBU) of the University of Benin Teaching Hospital and the Intensive Care Unit (ICU) of the Modic Medical Centre, a private paediatric hospital in Benin over a five year period January 1997 to December 2001 were examined. One hundred and fifty three tetanus cases were recorded during the period comprising 87 (56.9%) males and 66 (43.1%) females. RESULTS: The annual incidence in UBTH was 6.9% (99/1425) and 5.3% (54/1021) in Modic Centre. Forty three point eight percent (67/153) survived while 56.2% (86/153) died. There was a yearly increase in incidence of neonatal tetanus of total neonatal admissions. Average age on admission was 8.8 days and incubation period was 5-22 days. Only 40 (26.1%) did not have any antenatal care. Eighteen of the 40 (45%) mothers who had antenatal care had two doses of tetanus toxoid only. Many of the mothers were ignorant about immunisation, feared about the consequences of immunisation, some got disenchanted with it because of the out of stock syndromes associated with the vaccines whenever they visited the health centres. Some of them did not even know about antenatal care. CONCLUSION: Problem identified included lack of awareness of antenatal services among the target population, under utilisation of antenatal service, non immunisation with tetanus toxoid vaccines, negative cultural beliefs, primordial cord care, lack of economic and decision making empowerment of the target population and lack of government commitment towards elimination of neonatal tetanus. The following recommendations which may lead to elimination of Neonatal Tetanus were made: Strengthening school health programmes, intensive mobilisation and advocacy, regular availability of tetanus toxoid vaccines, empowerment of the target population, training and retraining personnel including Traditional Birth Attendants and increasing commitment by various tiers of government.

Fibrinolytic activity in children with Plasmodium falciparum malaria.

BACKGROUND: Malaria infection is still one of the major causes of morbidity and mortality among the under five year children in tropical Africa. Clinical and laboratory methods of assessing the risk factors for severity in order to adequately manage these children, therefore needs to be identified so that prompt and adequate treatment can be instituted early. Fibrinolytic activity has been postulated as one of the risk factors associated with severity of malaria infection. OBJECTIVE: To measure fibrinolytic activity euglobulin lysis time, (ELT) and fibrinogen levels in 50 Nigerian children with Plasmodium falciparum infection. DESIGN: A cross sectional study. SETTING: University of Benin Teaching Hospital, Benin City, Nigeria between January and December 2002. SUBJECTS: Fifty Nigerian children who were admitted with Plasmodium falciparum malaria infection in the paediatric wards of the hospital were recruited into the study. Thirty-four apparently healthy children who did not have malaria fever but who came for growth monitoring exercise and had some investigations done as part of this exercise were used as control for the study. The fibrinolytic activity in all the 84 children (both that had malaria infection and those who did not have malaria infection) were estimated by measuring the euglobulin lysis time (ELT). The fibrinogen levels in all the children were also estimated. The packed cell volume of the children was determined and some severely anaemic children had blood transfusions. RESULTS: Euglobin lysis time (ELT) was found to be higher in children with Plasmodium falciparum malaria infection (430 +/- 149) than in the controls (158 +/- 21.7, P< 0.01). Fibrinogen levels of 3.40 +/- 0.98 in children with malaria infection were high when compared to 2.21 +/- 0.81 in the controls. The children with malaria infection therefore had a decreased fibrinolytic activity and a proportionately high fibrinogen level. The average packed cell volume of the children with malaria infection was 29.64 +/- 2.13 while in the control it was 36.41 +/- 3.24. The study also showed that 50% of children with malaria had severe anaemia and subsequently had blood transfusions. Twenty percent of those who had transfusions died while being transfused. CONCLUSION: Children who have malaria infection have decreased fibrinolytic activity and proportionately high fibrinogen level which may contribute to the possible thromboembolic process in these children and hence higher risk of mortality from Plasmodium falciparum malaria infection.

Vitamin A status and nutritional intake of carotenoids of preschool children in Ijaye Orile community in Nigeria.

This study was carried out to determine the vitamin A status and nutritional intake of carotenoids of 213 children between the ages of 6 months and 6 years in a rural community in Nigeria. There were 109 males and 104 females. A total of 57 (26.8 per cent) children were deficient in serum retinol levels (< 10 microg/dl) while 102 (47.9 per cent) had low levels (10-19 microg/dl). The highest prevalence of serum retinol deficiency was in the 6-12 months age group, most of whom were breastfeeding and there was poor correlation between duration of breastfeeding and serum retinol levels. The prevalence of night-blindness was 1.5 per cent; however, none of the children had xerophthalmia. Chronically malnourished children had lower mean serum retinol levels than well nourished children. There was a high consumption of carotenoid-containing food, but despite this there was a high prevalence of vitamin A deficiency. We therefore suggest that measures to combat vitamin A deficiency should include vitamin A supplementation on a short-term basis. On a long-term basis parents should be educated on the importance of the consumption of locally available sources of provitamin A and pre-formed vitamin A rich foods, and the avoidance of overcooking. Parents should also be encouraged to grow more beta-carotene containing foods.

Association of malarial parasitaemia with dehydrating diarrhoea in Nigerian children.

Records of 402 children--216 (53.7%) males and 186 (46.3%) females--aged 1-36 month(s), admitted to the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital, Benin city, Nigeria, during July 1993-June 1996, were reviewed to document the relationship between dehydration and malaria parasitaemia. There was a significant association between severity of dehydration and malaria parasitaemia (p < 0.0001). Association of parasitaemia (p < 0.006) with dehydration (p < 0.0001) was significantly more marked in patients with acute watery diarrhoea than in those with persistent and bloody diarrhoea. Parasitaemia was demonstrated in 50.5% of those not initially suspected to have malaria. Parasitaemia was also significantly associated with fever (p < 0.001) and fever coexisting with vomiting (p < 0.01). The prevalence of malaria-associated diarrhoea was 61.7%. More infants (75.6%) than older children had diarrhoea. It was concluded that the prevalence of malaria-associated diarrhoea was high and that children with dehydration are more likely to manifest malaria parasitaemia.

Indian childhood-like cirrhosis in three Saudi Arabian siblings.

Three Saudi siblings, two girls and one boy, presented at the ages of 7, 6 and 2.5 years, respectively, and were diagnosed as having features of Indian childhood cirrhosis (ICC). The two girls presented at a late stage of the disease and the boy was diagnosed during routine examination of the family. The initial presenting complaint was abdominal distention and pruritus. All three had a rapid and fatal course. There was no evidence of increased copper ingestion by the families, supporting the suggestion of a hereditary metabolic role in the aetiology of ICC. As far as we are aware, this is the first report of ICC in Saudi Arabian children.

Epidemiology and clinicopathologic characteristics of childhood nephrotic syndrome in Benin-City, Nigeria.

Medical records of 58 children, 38 (65.5%) males and 20 (34.5%) females with nephrotic syndrome (NS) admitted to the paediatric wards of the University of Benin Teaching Hospital (UBTH) Benin-City, Nigeria, between January, 1991 and December, 1995 were reviewed. The aim of the study was to document the epidemiologic as well as certain clinico-pathologic characteristics of the disease in Benin-City. More males than females (ratio of 1.9:1) and older children (mean +/- (SEM) 8.2 +/- 0.5 years; range 2-15 years) were affected. About 62% of the patients were aged 7 years and above. There was a high incidence of hypertension (41.4%) and microscopic haematuria (60%) in the patients. Hypercholesterolaemia and hypoalbuminaemia were seen in only 21.6% and 30.2% of evaluated patients respectively. Hypercholesterolaemia and hypoalbuminaemia as diagnostic criteria for NS in our locale may not be very useful. About 51.7% of patients responded to the initial course of prednisolone, out of whom 43.3% relapsed (26.7%) frequently and 16.7% infrequently. Mortality rate was 6.9%. Urinary tract infection (UTI) occurred in 44.8% of the patients and was caused largely by Staphylococcus aureus and untyped coliform organisms.

Asymptomatic rotavirus infection within Benin City urban community, Nigeria.

This study was carried out in Benin City urban community, Nigeria as a follow-up of an earlier study carried out on patients admitted to the University of Benin Teaching Hospital. The aim of the present study was to determine the prevalence of asymptomatic rotavirus infection amongst urban children and adults. Eight hundred and twenty one subjects from 200 homes were screened for rotavirus infection between August and December 1990. The 821 stool samples collected from the subjects (541 children and 280 adults) were subjected to studies at the University of Benin Teaching Hospital. Detection of rotavirus antigen was done by the ELISA method. The overall prevalence of asymptomatic rotavirus infection in this study was 30.8%. The results reflect a high source of reservoir for spread of rotavirus infection within the community.

Aetiological considerations in the febrile unconscious child in the rainforest and arid regions of Nigeria.

An analysis of hospital admissions in two areas of Nigeria indicates that the burden of coma/convulsions with fever and malaria is higher in the rainforest region whereas that of bacterial meningitis (BM) and focal extracranial infection (FEI), mainly acute respiratory infections, is higher in the arid region. The burden of malaria has increased and chloroquine-resistant malaria has become a problem in clinical practice. There is the need to revise the current policy of initiation of treatment with chloroquine in severe malaria being practised in some centres; quinine would be a suitable alternative based on current trends. Co-existing infections, especially the association of other infections with BM, are an important feature in both wet and arid regions of Nigeria and point to the need for "routine" diagnostic spinal taps in order to minimise the chances of a missed diagnosis of BM.

The micro-erythrocyte sedimentation rate as a screening test for bacteraemia in young children with non-focal infections.

The micro-erythrocyte sedimentation rate (micro-ESR) was evaluated in 349 patients without focal signs of infection with bacteraemia, bacteraemia/malaria, malaria (218) and fever of undetermined origin(100). There were significant differences between the diagnoses in their mean micro-ESR uncorrected for anaemia (F ratio = 3.66, p = 0.013 for one way analysis of variance). The sensitivity of uncorrected micro-ESR > 20mm/hr for bacteraemia was moderate (53%) and specificity was low (32%); for bacteraemia/malaria sensitivity was high (88%) but specificity was also low (33%). The positive predictive value of micro-ESR > 20mm/hr was low for bacteraemia (3%) and bacteraemia/malaria (6%) whereas the negative predictive value was high for bacteraemia (94%) and very high for bacteraemia/malaria (98%). We conclude that a low micro-ESR (< 20mm/hr) may be helpful in ruling out bacteraemia, especially bacteraemia/malaria, in young febrile children without focal signs.

Nosocomial rotavirus infection in newborns.

A total of 252 faecal samples were collected from 84 neonates and examined for rotavirus antigen, using the enzyme-linked immunosorbent assay (ELISA). Nosocomial rotavirus infection was detected in 23.8%. This was made up of 12 (26.7%) of 45 neonates who had diarrhoea and 8 (20.5%) of 39 neonates without diarrhoea. However, rotavirus antigen was detected more in those that stayed for more than one week during hospital admission.

The prevalence of hepatitis Be antigen and anti-HBE in adults in Benin City.

Two hundred and seventy four adults in Benin City were screened for HBeAg in their sera using the ELISA method. The overall HBe-Antigenemia prevalence was 7.3%. 12.7% of adult males and 5.4% of 203 adult females were positive for HBeAg. Of the 91 samples available for screening for anti-HBe, an overall positivity rate of 8.8% was obtained. 10.3% of 68 adult males and 4.4% of 23 adult females were positive for anti-HBe. Reports of high carrier rate for Hepatitis B virus (HBV) markers in Nigeria is further confirmed. The high HBeAg positivity rate could further explain the high transmission rate of HBeAg from chronic carriers in this country. Compared to the Far East countries, Prevalence of HBe-antigenemia is relatively lower and may further confirm that the vertical, that is neonatal maternal infant hepatitis B virus transmission might play a less important role than the later horizontal transmission in this country. Therefore in considering immunization programme, the use of hepatitis B vaccine alone, without the additional, much more expensive hepatitis B Immunoglobulin (HBIG) might be an adequate prophylactic measure. The high HBe-antigenemia as well as the already well documented endemicity of hepatitis B virus in this country however calls for urgent steps to ensure introduction of this vaccine into neonatal practice in this country.

Presenting features of bacterial meningitis in young infants.

More guidance is required in the management of acutely ill, febrile young infants. Of 94 young infants undergoing lumbar puncture (LP) as part of their management, 26 of the 60 (43.3%) presenting with seizures and fever and six of the 34 (17.7%) without seizures had bacterial meningitis (BM) (relative risk (95% confidence interval) = 2.46 (1.12, 5.37), p = 0.012). Except for the presence of a bulging fontanelle and focal seizures, no other presenting signs or symptoms were significantly associated with BM; seven of the 26 infants with BM who presented with seizures and two of the six without seizures lacked a bulging fontanelle. Overall, the ratio of BM to other illnesses was 1:1.94; of those with BM, 13 of the 32 (40.6%) had co-existing acute respiratory infections and four of the 32 (12.5%) had asexual malaria parasitaemia. Seizures with fever are an important presenting feature of BM in young infants and a screening LP should be considered mandatory to confirm or exclude BM in febrile young infants with seizures, unless certain contraindications apply.

Childhood bacterial meningitis beyond the neonatal period in southern Nigeria: changes in organisms/antibiotic susceptibility.

Of 253 culture proven cases of bacterial meningitis in infants aged over a month and children up to one year old in Benin City, Nigeria, from 1985-1990, 49.8% were due to N. meningitidis, 21.4% S. pneumoniae, 15.4% H. influenzae and 13.4% other organisms, including S. aureus and enterobacteriaceae. Compared to the period 1974-1984 in Southern Nigeria, N. meningitidis has replaced S. pneumoniae as the commonest organism. N. meningitidis was relatively infrequent below two years of age while H. influenzae was rare after five years. Approximately half of isolates of S. aureus and enterobacteriaceae were in infants aged six months or less. The proportions of sensitive strains of three common organisms to three commonly used drugs were chloramphenicol (95.3%) > ampicillin (83.9%) > penicillin (67.6%). Resistance to penicillin has increased while simultaneous resistance to ampicillin and chloramphenicol has emerged as a new problem among the three common bacteria. It is concluded that although the combination of ampicillin and chloramphenicol is still reasonable for initial "blind" therapy of meningitis, the emergence of multiple drug resistance suggests the need for consideration of a revision of current practice. The third generation cephalosporins are suggested as a suitable alternative.

Prevalence of nosocomial rotavirus infection in hospitalized children in Benin City, Nigeria.

A total of 1496 stool samples from 445 children admitted into the paediatric wards of the University of Benin Teaching Hospital, Benin City between November 1989 and April 1990 were examined for the presence of rotavirus antigen. The total prevalence of rotavirus infection in this study was 28.1% (125 in 445). Fifty-four (12.1%) of the 445 children had nosocomial rotavirus infection: 22 (9.6%) of the 230 children (neonates, infants and young children) who had diarrhoea and 32 (14.9%) of the 215 children (neonates, infants and young children) who had no diarrhoea. The importance of maintaining strict hygiene in hospital wards cannot be overemphasized.

Convulsions with malaria: febrile or indicative of cerebral involvement?

Evaluation of 446 infants and young children (6 months to 5 years olds) with malaria parasitaemia showed a significant relationship (P < 0.05- < 0.001) (a) between coma and age, pattern of convulsions, haematocrit, and blood glucose, and (b) between the severity of parasitaemia and risk of convulsions, prevalence of hepatosplenomegaly, and severe anaemia. No significant relationship was observed between convulsions and temperature or haematocrit. Comatose children were older and had a higher prevalence of repeated convulsions, severe anaemia, and hypoglycaemia than non-comatose children. Convulsions, hepatosplenomegaly, and severe anaemia were more prevalent in children with moderate-severe parasitaemia. It is concluded that convulsions with malaria are more often a manifestation of cerebral dysfunction rather than being simply febrile in nature. All forms of cerebral dysfunction in malaria, including repeated convulsions, should be managed as being clinical manifestations of cerebral malaria.

Pattern of infections in children under-six years old presenting with convulsions associated with fever of acute onset in a children's emergency room in Benin City, Nigeria.

Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.