Diagnostic accuracy of Xpert MTB/RIF Ultra for childhood tuberculosis in West Africa - a multicenter pragmatic study.

OBJECTIVE: To evaluate the performance of Xpert Mycobacterium Tuberculosis/rifampicin (MTB/RIF) Ultra (Ultra) for diagnosis of childhood tuberculosis (TB) within public health systems. METHODS: In this cross-sectional study, children aged <15 years with presumptive pulmonary TB were consecutively recruited and evaluated for TB at tertiary-level hospitals in Benin, Mali, and Ghana. Bivariate random-effects models were used to determine the pooled sensitivity and specificity of Ultra against culture. We also estimated its diagnostic yield against a composite microbiological reference standard (cMRS) of positive culture or Ultra. RESULTS: Overall, 193 children were included in the analyses with a median (interquartile range) age of 4.0 (1.1-9.2) years, 88 (45.6%) were female, and 36 (18.7%) were HIV-positive. Thirty-one (16.1%) children had confirmed TB, 39 (20.2%) had unconfirmed TB, and 123 (63.7%) had unlikely TB. The pooled sensitivity and specificity of Ultra verified by culture were 55.0% (95% confidence interval [CI]: 28.0-79.0%) and 95.0% (95% CI: 88.0-98.0%), respectively. Against the cMRS, the diagnostic yield of Ultra and culture were 67.7% (95% CI: 48.6-83.3%) and 70.9% (95% CI: 51.9-85.8%), respectively. CONCLUSION: Ultra has suboptimal sensitivity in children with TB that were investigated under routine conditions in tertiary-level hospitals in three West African countries.

Monkeypox: How Globalization, Host Immunity, and Viral Evolution Create a New Pathogen.

Monkeypox is an Orthopoxvirus, endemic to West Africa and the Congo Basin. It causes an illness characterized by fever, myalgias, lymphadenopathy, and a disseminated vesicular rash. Although similar to smallpox, monkeypox is typically milder, with a lower mortality rate. Endemicity in Africa was previously reduced owing to cross-protection from smallpox vaccine but has been increasing since cessation of universal vaccination. Sporadic cases have been imported to the United States (US), with a few secondary cases. A large global outbreak in 2022 has demonstrated changing epidemiology and increased person-to-person transmission. In May 2022, a returned traveler in Massachusetts presented with monkeypox. As of October 7, 2022, 71,096 cases had been reported in 107 countries, and 26,577 of those were in the US. Most cases have been in younger people without previous smallpox vaccination and in men who have sex with men, a previously unrecognized mode of transmission. [Pediatr Ann. 2022;51(11):e431-e435.].

COVID-19 vaccine hesitancy in six geopolitical zones in Nigeria: a cross-sectional survey.

Introduction: the high expectations that heralded the development of COVID-19 vaccines has been plagued with vaccine hesitancy (VH). The prevalence and associated factors of COVID-19 VH in the six geopolitical zones in Nigeria are explored. Methods: using a cross sectional survey, a pre-tested and validated questionnaire on a "Google form" was distributed via social media platforms and hard copies in the six geopolitical zones of Nigeria. Included, using a chain-reference sampling technique, were healthcare workers (HCW), university students and adults in the general population. Participants who expressed unwillingness to receive COVID-19 vaccine in the event of an available vaccine were considered to have vaccine hesitancy. Frequency and percentage were used to describe categorical variables. Multivariable logistic regression analysis was used to assess for factors associated with VH. Level of significance was set at 5% on two-sided tails test. Results: among 1615 respondents, mean (standard deviation) age was 36.7 (11.3) years, and 847 (52.4%) were males. More than half were healthcare workers (943; 58.4%), 97.4% had at least secondary level of education, and majority 60.5% belonged to the upper social class. The prevalence of VH was 68.5% (1107/1615), and 67.2% preferred foreign manufactured COVID-19 vaccines. On multivariable regression analysis, residence in Northeast (AOR 6.01, 95% CI 2.24, 16.10) and Northwest (AOR 3.33, 95% CI 1, 48, 7.48) geopolitical zones, the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22), Christians (AOR 1.86, 95% 1.10, 3.14), nurses (AOR 3.50, 95% CI 1.25, 9.80), pharmacist (AOR 5.82, 95% CI 2.12, 16.32) and participants without confidence in foreign vaccines (AOR 4.13, 95% CI 2.99, 5.72) were at higher likelihood of VH. Conclusion: vaccine hesitancy is high among adults in Nigeria, with higher likelihood among the Igbo ethnic group, Christian faith, residence in Northeast and Northwest geopolitical zones and those with an aversion to foreign-made vaccines. Targeted interventions are required for the desired COVID-19 vaccine uptake rate and herd immunity.

Surveillance of Pretreatment Drug Resistance Among HIV-Infected Children in Ibadan, Nigeria.

There are about 2.1 million children infected with HIV globally and about 120,000 deaths annually. Nigeria has one of the highest rates of pediatric HIV infection globally. Pretreatment HIV drug resistance data inform the choice of first- and second-line antiretroviral therapy (ART) regimens. This study investigated the prevalence of HIV drug-resistant strains among ART-naive children in Ibadan, Nigeria. A total of 20 children aged <15 years were enrolled. Demographic, clinical, and laboratory data were documented. Total nucleic acid was extracted from blood samples after which amplification of HIV-1 pol gene was done using polymerase chain reaction. Amplified gene was sequenced using big dye sequencing method. The sequenced HIV-1 pol gene was typed and analyzed for identification of mutations indicative of drug resistance across the different classes of ART. HIV-1 RNA pol gene was successfully amplified in 12/20 (60%) children. All were identified as HIV-1 and the subtypes were G and CRF 02AG, recombinant of 02_AG/G and recombinant of 02_AG/A1. Drug-resistant mutations (DRMs) were identified in 4/12 (33%). Three out of the four mutations were identified as non-nucleoside reverse transcriptase inhibitors DRM (K103N), whereas the fourth had nucleoside reverse transcriptase inhibitors DRM (M184V). Results from this preliminary study show that drug resistance among ART-naive children is a problem in Ibadan. Pretreatment drug resistance testing is desirable in children before initiation of ART to guide effective treatment.

Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa.

Zero to 19 year-old children in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases, however, factors such as underequipped health systems, disease outbreaks, conflict, and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic's impact on child health outcomes are discussed. IMPACT: Children in sub-Saharan Africa bear a disproportionate burden of communicable and non-communicable diseases globally; this remains true even as the COVID-19 pandemic persists. Amidst the fast-expanding COVID-19 literature, there is little comprehensive coverage of the pandemic's indirect impact on child health in sub-Saharan Africa. This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub-Saharan Africa. It discusses the potential impact of SARS-CoV-2 co-infections/co-morbidities, highlights research gaps, and advocates for data and action to mitigate the ripple effects of the pandemic on this population.

Rifabutin pharmacokinetics and safety among TB/HIV-coinfected children receiving lopinavir/ritonavir-containing second-line ART.

BACKGROUND: Treatment options are limited for TB/HIV-coinfected children who require PI-based ART. Rifabutin is the preferred rifamycin for adults on PIs, but the one study evaluating rifabutin with PIs among children was stopped early due to severe neutropenia. METHODS: We evaluated rifabutin safety and plasma pharmacokinetics among coinfected children 3-15 years of age receiving rifabutin 2.5 mg/kg daily with standard doses of lopinavir/ritonavir. The AUC0-24 at 2, 4 and 8 weeks after rifabutin initiation was described using intensive sampling and non-compartmental analysis. Clinical and laboratory toxicities were intensively monitored at 12 visits throughout the study. RESULTS: Among 15 children with median (IQR) age 13.1 (10.9-14.0) years and weight 25.5 (22.3-30.5) kg, the median (IQR) rifabutin AUC0-24 was 5.21 (4.38-6.60) µg·h/mL. Four participants had AUC0-24 below 3.8 µg·h/mL (a target for the population average exposure) at week 2 and all had AUC0-24 higher than 3.8 µg·h/mL at the 4 and 8 week visits. Of 506 laboratory evaluations during rifabutin, grade 3 and grade 4 abnormalities occurred in 16 (3%) and 2 (0.4%) instances, respectively, involving 9 (60%) children. Specifically, grade 3 (n = 4) and grade 4 (n = 1) neutropenia resolved without treatment interruption or clinical sequelae in all patients. One child died at week 4 of HIV-related complications. CONCLUSIONS: In children, rifabutin 2.5 mg/kg daily achieved AUC0-24 comparable to adults and favourable HIV and TB treatment outcomes were observed. Severe neutropenia was relatively uncommon and improved with ongoing rifabutin therapy. These data support the use of rifabutin for TB/HIV-coinfected children who require lopinavir/ritonavir.

Clinical Course and Outcome of Human Monkeypox in Nigeria.

In a retrospective review of hospital records of 40 human monkeypox cases from Nigeria, the majority developed fever and self-limiting vesiculopustular skin eruptions. Five deaths were reported. Compared to human immunodeficiency virus (HIV)-negative cases, HIV type 1-coinfected cases had more prolonged illness, larger lesions, and higher rates of both secondary bacterial skin infections and genital ulcers.

Safety and efficacy of rifabutin among HIV/TB-coinfected children on lopinavir/ritonavir-based ART.

BACKGROUND: TB is the leading cause of death among HIV-infected children, yet treatment options for those who require PI-based ART are suboptimal. Rifabutin is the preferred rifamycin for adults on PI-based ART; only one study has evaluated its use among children on PIs and two of six children developed treatment-limiting neutropenia. METHODS: Since 2009, rifabutin has been available for HIV/TB-coinfected children requiring PI-based ART in the Harvard/APIN programme in Nigeria. We retrospectively analysed laboratory and clinical toxicities at baseline and during rifabutin therapy, and examined HIV/TB outcomes. RESULTS: Between 2009 and 2015, 48 children received rifabutin-containing TB therapy with PI (lopinavir/ritonavir)-based ART: 50% were female with a median (IQR) baseline age of 1.7 (0.9-5.0) years and a median (IQR) CD4+ cell percentage of 15% (9%-25%); 52% were ART experienced. Eighty-five percent completed the 6 month rifabutin course with resolution of TB symptoms and 79% were retained in care at 12 months. Adverse events (grade 1-4) were more common at baseline (27%) than during rifabutin treatment (15%) (P = 0.006). Absolute neutrophil count was lower during rifabutin compared with baseline (median = 1762 versus 2976 cells/mm3, respectively), but only one instance (2%) of grade 3 neutropenia occurred during rifabutin treatment. CONCLUSIONS: With clinical and laboratory monitoring, our data suggest that rifabutin is a safe option for TB therapy among children on PI-based ART. By contrast with the only other study of this combination in children, severe neutropenia was rare. Furthermore, outcomes from this cohort suggest that rifabutin is effective, and a novel option for children who require PI-based ART. Additional study of rifabutin plus PIs in children is urgently needed.

Time to sputum culture conversion and treatment outcome among the first cohort of multidrug resistant tuberculosis patients in a high burden country.

BACKGROUND: Sputum conversion considered the most important interim indicator of the efficacy of anti-tuberculosis treatment was assessed at varying time points among the first cohort of multidrug resistant tuberculosis (MDR-TB) patients in a National TB Control Programme. METHODS: A retrospective study was conducted for the period between 2010 and 2013, at the premiere MDR-TB treatment center in Nigeria. Genexpert, culture and drug susceptibility tests were carried out. Total duration of treatment was 20 months. RESULTS: A total of 115 patients were studied consisting of 76 (66.1%) males and 39 (33.9%) females with ages ranging between 15 and 65 years. Median time to sputum conversion was 2.06 months (95% confident interval [CI] = 1.82, 2.30). At the end of the first month, 43 (37.4%) patients sputum converted, increasing to 104 (90.4%) at the end of three months. There was no significant interaction with Human Immunodeficiency Virus (HIV) status. Overall treatment success was 69.4%. The default rate was 8.7% (10/115) and 25 (21.7%) deaths were recorded. CONCLUSION: The treatment success rate in the study was high with most of cases with or without HIV infection, achieving sputum culture conversion within 2 months of commencing treatment. Expansion of MDR-TB treatment services is necessary to reduce the death rate.

Skin pH and Transepidermal Water Loss Values in Children with Diaper Dermatitis in Ibadan, Nigeria.

BACKGROUND/OBJECTIVES: Diaper dermatitis (DD) is one of the most common skin conditions in infants and young children. Among the factors associated with greater frequency of DD are high skin pH and transepidermal water loss (TEWL). This study examined the prevalence of DD in healthy black children in Nigeria and evaluated the association between skin surface pH, TEWL, and DD in this population. METHODS: The study was cross-sectional in design and involved children younger than 2 years attending eight immunization clinics in Ibadan, Nigeria (N = 424). Children were recruited into the study using multistage sampling. Information collected included sociodemographic data, diapering and feeding practices. Physical examination of the diaper area was performed on each child to determine whether dermatitis was present. TEWL and skin pH were measured on the anterior chest wall and gluteal areas of each child. RESULTS: A total of 165 (38.9%) children had clinical evidence of DD. The mean skin pH and TEWL values were higher in the gluteal area than the anterior chest wall in all subjects, with or without dermatitis. The mean skin pH and TEWL were significantly higher on the anterior chest wall and in the gluteal area in children with DD. CONCLUSION: In Nigerian children with DD, skin pH and TEWL are higher in the diaper area and at an unaffected skin site.

Blood Transfusion-Associated HIV Infection in Children in Ibadan, Nigeria.

INTRODUCTION: This study describes the epidemiologic features and clinical course of children with blood transfusion-associated HIV infection (TAHI) in Ibadan, Nigeria. METHODOLOGY: All children diagnosed to have TAHI at the University College Hospital, Ibadan, were studied and compared with children who acquired HIV vertically using the pediatric HIV database in the hospital. RESULTS: Transfusion-associated HIV infection accounted for 14 (2.3%) of the 597 children diagnosed to have HIV infection between January 2004 and December 2011. The mean age at diagnosis of TAHI was 10.2 years and that of vertically acquired HIV infection was 3.9 years ( P < .001). In 9 cases, blood transfusion took place in private hospitals and in 5 cases in public hospitals. Median interval between infection and diagnosis of AIDS was 84 months in cases with TAHI and 48 months in vertically acquired cases ( P = .542). CONCLUSION: Optimal blood safety practices are advocated for prevention of TAHI in Nigeria.

Clinical characterisation and phylogeny of respiratory syncytial virus infection in hospitalised children at Red Cross War Memorial Children's Hospital, Cape Town.

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting. METHODS: The clinical presentation, patient and phylogenetic characteristicsof laboratory-confirmed cases of RSV, as well as risk factors for nosocomial infectionat Red Cross War Memorial Children's Hospital in Cape Town were analysed. A multiplex PCR assay that detects 7 respiratory viruses was used to identify RSV nucleic acid on respiratory specimens. RESULTS: A total of 226 children were studied, ages ranging between 1 week and 92.5 months (median: 2.8 months, IQR: 1.3-6.3 months) and 51.8 % were males. The median duration of symptoms prior to diagnosis was 2 days (IQR: 1-4 days). Nosocomial infections wereidentified in 22 (9.7 %) children. There were pre-existing medical conditions in 113 (50.0 %) excluding HIV, most commonly prematurity (n = 58, 50.0 %) and congenital heart disease (n = 34, 29.3 %). The commonest presenting symptoms were cough (196, 86.7 %), difficulty in breathing (115, 50.9 %) and fever (91, 41.6 %).A case fatality rate of 0.9 % was recorded. RSV group A predominated (n = 181, 80.1 %) while group B accounted for only 45 (19.9 %) of the infections. The prevalent genotypes were NA1 (n = 127,70.1 %), ON1 (n = 45,24.9 %) and NA2 (n = 9,5.0 %) for group A while the only circulating RSV B genotype was BA4. There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections. Age ≥ 6 months was independently associated with nosocomial infection. CONCLUSIONS: A large percentage of children with RSV infection had pre-existing conditions. Approximately one tenth of the infections were nosocomial with age 6 months or older being a risk factor. Though both RSV groups co-circulated during the season, group A was predominant and included the novel ON1 genotype. Continued surveillance is necessary to identify prevalent and newly emerging genotypes ahead of vaccine development and efficacy studies.

Mucocutaneous Disorders of Pediatric HIV in South West Nigeria: Surrogates for Immunologic and Virologic Indices.

OBJECTIVES: Nigeria has the world's highest burden of pediatric HIV. In the face of paucity of monitoring tests in Nigeria, we studied the spectrum of pediatric mucocutaneous manifestations and evaluated their clinical utility as surrogate markers for immunodeficiency and plasma viral load levels. METHODS: Cross-sectional study comparing mucocutaneous manifestations in 155 HIV-positive children aged 12 weeks to 14 years with 155 HIV-negative children. Relationships between mucocutaneous manifestations in HIV-infected patients and their immunologic and virologic indices were analyzed. RESULTS: Mucocutaneous lesions were seen in 53.5% of HIV-infected children compared with 18.1% of the controls. Prevalence of lesions increased with worsening levels of immunodeficiency and increasing viral loads (P < .01). Oral candidiasis, angular stomatitis, and fluffy hair were associated with more severe degrees of immunodeficiency. CONCLUSION: Mucocutaneous disorders are common in HIV-infected children. Oral candidiasis and nutritional dermatoses can be used as surrogates for advanced or severe immunodeficiency.

Parotid gland enlargement in pediatric HIV population.

OBJECTIVES: To establish the significance of parotid enlargement, state frequency, cytological features and effect of antiretroviral therapy (ART) on parotid enlargement among a pediatric HIV population. STUDY DESIGN: A 6 month cross sectional survey that utilised clinical features, serial immunological indices and fine needle aspiration cytology. RESULTS: 287 HIV positive children were seen at special paediatric clinic of the University College Hospital, Ibadan, Nigeria, 114 (39.7%) had oral features and among these 24 (8.4%) had parotid involvement comprising of 10 males and 14 females. The overall mean age was 43.4 + 39.7 months compared with 59.6 + 36.5 months in the parotid enlargement group (p = 0.03). Mean ages of parotid enlargement and non enlargement group was significantly different (p = 0.03). The mode of transmission was vertical in (91.7%), 87.5% was bilateral (87.5%) and (75%) presented as a syndrome state with generalised lymphadenopathy. The predominant cytology was lymphoid hyperplasia (62.5%). ART resulted in marked clinical reduction in all the cases and statistically significant improvement in serum indices of CD4 count, CD4% and viral load (p = 0.001, 0.000 & 0.009 respectively). CONCLUSION: HIV positive children often present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of lymphoid hyperplasia predominated. ART resulted in satisfactory reduction of the swellings in most of the cases with no need for further intervention.

Disseminated herpes zoster ophthalmicus in an immunocompetent 8-year old boy.

Varicella results from a primary infection with the varicella virus while herpes zoster is caused by a reactivation of a latent infection. Dissemination of herpes zoster is uncommon in immunocompetent individuals. Reports of disseminated herpes zoster in children are even less common than in adults. An unusual case of disseminated herpes zoster ophthalmicus in an 8-year old immunocompetent black boy is presented. He had a previous primary Varicella zoster virus infection at three years of age. In the current report, he presented during an on-going chicken pox outbreak and survived with no significant complications. A breakthrough varicella virus re-infection or a reactivation is possible, both of which could present as zoster. This case emphasizes the need for prevention of varicella virus infection through universal childhood immunization and effective infection control strategies in health care settings.

Oral lesions and their association with CD4 count and viral load in HIV positive Nigerian children.

BACKGROUND: ral lesions may indicate the presence of HIV infection and may differ in children and adults in different regions. AIM: To determine the prevalence, types of oral lesions in HIV positive children and their association with the clinical stage, CD4 count and viral load. METHODS: A cross-sectional study involving consecutive HIV positive children whose sero-positive status was confirmed with ELISA screening and Western immunoblot. Oral lesions were diagnosed clinically by a trained dental surgeon using previously established classification. Data obtained was analyzed with SPSS 15.0. RESULTS: There were 127 children with age range of 3 to 204 months (median: 60 months) and male preponderance of 58.3% (n=74). 55.9% (n=71) of the subjects had oral lesions and pseudomembranous candidiasis (55.9%) was the commonest followed by caries (12.7%), xerostomia (7.8%) and gingivitis (6.9%). Correlation between prevalence of oral lesions and clinical stage of the disease did not reveal any statistically significant association (p=0.354). Also there is no statistically significant difference in prevalence of oral lesions between children on Antiretroviral Therapy (ART) and those who are not on ART (p=0.875). Incidence of oral lesions was however associated with lower mean baseline CD4 count (p= 0.004) but not with mean log10 viral load (p=0.256). CONCLUSION: This study has shown that HIV associated oral lesions are prevalent in our environment and antiretroviral therapy does not have significant correlation with occurrence of these lesions in HIV infected children. CD4 count is a better indicator of disease progression than viral load.

Prevalence and clinical pattern of paediatric HIV infection at the University College Hospital, Ibadan, Nigeria: a prospective cross-sectional study.

BACKGROUND: The prevalence of Paediatric HIV infection is largely unknown in many countries in sub-Saharan Africa. This study was aimed at determining the prevalence, clinical pattern of HIV infection and outcome among new patients aged <15 years using age-specific diagnostic methods. METHODS: A prospective cross sectional study was carried out using the provider initiated HIV testing and counselling (PITC) model. HIV rapid test in parallel was used for screening and confirmation was with HIV DNA PCR in children <18 months and Western Blot in children ≥ 18 months. RESULTS: A total of 600 children were enrolled with ages ranging between one day and 179 months. Male: female ratio was 1.2:1. HIV seroprevalence was 12.3% and after confirmatory tests, the prevalence was 10%. Fourteen (37.8%) of the children aged less 18 months were exposed but not infected. Mother-to-child transmission accounted for 93.3% of cases. Features predictive of HIV infection were diarrhoea, cough, weight loss, ear discharge generalized lymphadenopathy, presence of skin lesions, parotid swelling and oral thrush. About 75% presented in advanced or severe clinical stages of the disease, 56.8% had severe immunodeficiency while 50% had viral loads more than 100,000 copies/ml. Mortality rate was 14.3% among HIV positive compared with 11.3% in HIV negative children but was not significant. Among the HIV positive children, 26.7% were orphans. CONCLUSIONS: The prevalence rate of HIV infection among new patients screened using the PITC model was high, majority resulting from mother-to-child transmission. Most children presented in advanced stages of the disease and mortality rate among them was high. Though, the study site being a referral centre might have contributed to the high prevalence observed in this study, there is a need to expand access to PMTCT services, ensure implementation of PITC in paediatric settings and expand support services for HIV infected children.

Disclosure of HIV status to infected children in a Nigerian HIV Care Programme.

With increasing survival of HIV-infected children, parents face the challenges of disclosure to the children. The aim of this study was to assess the rate of HIV disclosure to children in Ibadan and the factors influencing it in order to guide design of strategies for successful disclosure. A semi-structured questionnaire was administered to consecutive consenting caregivers of HIV-infected children aged ≥6 years attending the Paediatric Infectious Disease Clinic of the University College Hospital, Ibadan, between November 2008 and October 2009. Caregivers of 96 children (46 boys, 50 girls) infected with HIV were interviewed. The ages of the children ranged from 6 to 14 years with a mean (SD) of 8.8 (2.2) years. Disclosure had been done in only 13 (13.5%) of the children; ages at disclosure ranged from 4.5 to 13 years with a mean of 8.7 (SD = 2.2). Disclosure was associated with age above 10 years. Reasons given by carers for non-disclosure in 83 caregivers included inability of the children to understand in 53 (63.9%), fear of disclosure to other children 34 (41.0%), fear of disclosure to family/friends in 28 (33.7%), fear of psychological disturbance of the children in 26 (31.3%) and fear of blaming the parents in 22 (26.5%). Twenty (20.8%) of the children have asked questions relating to their diagnosis and the responses are often evasive. Caregivers felt disclosure had helped adherence to antiretroviral therapy in 7 (63.6%) of the 11 children on antiretroviral drugs in whom there was disclosure but no effect on the remaining. There is a need to assist parents and health care providers in successfully disclosing HIV status to infected children without adverse consequences.

Clinical and Immunological Profile of Pediatric HIV Infection in Ibadan, Nigeria.

In spite of the increasing number of children living with HIV in Nigeria, published data on their clinical profile are few. We describe the clinical profile at presentation of HIV-infected children at the University College Hospital, Ibadan, in a prospective study. Among 272 children studied (149 [54.8%] males; mean age 4.2 years [range 2 months to 15 years]), infection was acquired through vertical transmission in 252 (92.6%), blood transfusion in 5 (1.80%), and undetermined routes in 15 (5.5%) cases. Clinical features included weight loss (62.5%), prolonged fever (55.4%), generalized lymphadenopathy (48.6%), chronic cough (45.4%), and persistent diarrhea (28.3%). Tuberculosis was present in 45.3%, World Health Organization (WHO) clinical stages 3 and 4 disease in 70.6% and severe immunosuppression in 44.5% of cases. Pediatric HIV in Ibadan is acquired mainly vertically and most cases present with severe disease. Improved access to prevention services and early diagnosis are recommended.

Proximate predictors of early antenatal registration among Nigerian pregnant women.

BACKGROUND: Provision of antenatal care (ANC) is included in the pillars of maternal health care promoted as effective answers to maternal mortality. Early antenatal registration has been linked with optimal utilization and appreciable reduction of perinatal morbidity and mortality. This study aimed to determine the profile and possible predictors of pregnant women who presented early for antenatal registration. METHODS: A cross-sectional study was conducted among 796 women presented for antenatal registration at a tertiary hospital. Information was obtained by a self-administered open- and closed-ended questionnaire and analyzed with Statistical Package of Social Science (SPSS) 12.0 software. RESULTS: The mean gestational age at booking was 20 weeks. Univariate analysis showed that first trimester booking was significantly with more educated women, professionals, women of lower parity and those who have had previous stillbirths (P < 0.05). Low parity (OR 1.76, 95% CI 2.79-1.11) and previous stillbirth (OR 2.97, 95% CI 1.61-5.51) were significant predictors of early booking on multivariate analysis. CONCLUSION: Long-term advocacy and investment in female education will contribute significantly to primary prevention of late or non-attendance of ANC. Pre-conception clinics and community awareness campaigns would be necessary tools to reach these women and encourage them to register early when pregnant.