CASE FATALITY RATE OF CHILDHOOD TUBERCULOSIS: EXPERIENCE FROM FEDERAL TEACHING HOSPITAL GOMBE: A TWO DECADE REVIEW.

Introduction: Tuberculosis (TB) was the leading cause of death from an infectious agent worldwide, until the Coronavirus (COVID-19) pandemic, ranking above HIV/AIDS. Nigeria ranks 6th among the 30 TB high-burden countries (TB, TB/HIV, DRTB) and 1st in Africa. The estimated case fatality rate (CFR) of TB in Sub-Sahara Africa (SSA) is 15%. Objective: To review the Tuberculosis case fatality rate (TCFR) in children diagnosed with TB from 2000-2019 in Federal Teaching Hospital Gombe. Methodology: All cases of Tuberculosis (TB) diagnosed in children using ICD 10 classification were retrieved and analyzed. These included deaths from TB. The mainstay of TB diagnosis was clinical using TB Score (81%), Gene Xpert was 7%, and AFB was 10%. Results: 26,716 children were admitted; 383 had TB out of which 208(54.3%) were males and 175 (45.7%) females. TB constituted 1.4% of Paediatric admissions. Children 0 -5 years constituted 46.7% (179/383) of cases and 11 - 18 years were 31.3% (120/383). Fulani, Hausa, and Tangale constituted 43.6% (167), 21.1% (81), and 6.8% (26) of TB cases respectively. TB admissions were highest between 2015 and 2019 (31.8%). TB adenitis was the most common extrapulmonary TB. Tuberculosis/HIV co-infection accounted for 103(27%), out of which 74% (44) died. Overall TCFR was 15.6%; TCFR was 16.3% in males and 14.8% in females. The TCFR was 46.7% in 0-5yrs; 15% in 6-9yrs and 38.3% in 10-18yrs.Fulani had the highest CFR (11.9%). Tuberculosis CFR was highest between 2010-2014 (30.0%) and lowest in 2005-2009 (21.6%). Conclusion: The Tuberculosis CFR is comparable to SSA CFR.

REVEALING THE VARIED REALITY OF MALARIA-RELATED DEATHS IN CHILDREN ACROSS GENDER, AGE, AND ETHNICITY IN FEDERAL TEACHING HOSPITAL GOMBE OVER 20 YEARS: AN ESSENTIAL EPIDEMIOLOGIC IMPERATIVE.

Introduction: Nigeria recorded 31% of 619,000 malaria deaths globally and accounts for 25-30% of all childhood mortality in the country. Few studies in Nigeria, have reported malaria's case fatality rate over a long period. Objective: To determine Malaria Case Fatality Rate among Children admitted from 2000-2019. Methodology: All severe malaria cases and deaths amongst children aged 0-18 over the last two decades were analysed using ICD-10. The diagnosis was based on clinical and microscopic findings. Results: 26,716 children were admitted, 2494 (9.3%) were diagnosed with malaria and 209 died. Malaria constituted 5.3% (209/3956) of all childhood mortality. Males constituted 58.9 % (1468/2494) while 65% (1642/2494) were aged 0-5 years. Of the malaria admissions, Fulani and Hausa constituted 948(38%) and 438(17.6%) respectively. Admissions were highest in October (15%) and in 2012 (9.6%). The overall malaria CFR was 8.3%; 8.8% in Females (91/1026) and 8.03% in Males P-value <0.05 (X2=54.735); 8.6% in children aged 0-5years, 8.2% in 6-10 years and 7.4% in 11-18 years, P-value <0.05 (X2=893.164). CFR was highest in April (11.4%)and lowest in November (5.2%). Kanuri and Igbo had CFR of 70% and 38.4% respectively while it was lowest in Tera tribe (4.3%), P-value<0.05. The CFR was highest in the year 2004 (22%), 3.5% in 2000 and 2006. Over the years, case fatality rate was 15.9% between 2000-2004, 6.1% from 2005-2009. Between 2010-2015, it was 7.3% and 8.5% from 2016-2019. Conclusion: This study revealed the deadly reality of severe malaria with increased CFR among females, aged 0-5 and the Kanuri tribe.

EPIDEMIOLOGIC TREND AND CASE FATALITY OF CHILDHOOD TETANUS IN FEDERAL TEACHING HOSPITAL GOMBE; A 20YEARS REVIEW.

Introduction: Tetanus is a vaccine-preventable disease, it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods, especially in developing countries with limited health facilities and inadequate vaccination. The overall case fatality rate (CFR) is 13.2% globally, highest in the neonatal period and in sub-Saharan Africa. CFR is 64%, 47%, and 43% in Nigeria, Uganda, and Tanzania respectively. Objectives: To determine the Case Fatality Rate of Childhood tetanus in FTHG from 2000-2019. Methodology: All cases and deaths from tetanus amongst children aged 0-18 years in paediatric medical ward of FTHG over the last two decades diagnosed clinically and classified using ICD-10 were analysed. Results: 95 cases of tetanus out of 26,716 total admissions constituting 0.004%. There were 49 tetanus deaths out of 3956 total childhood deaths (0.012%) over the study period. Males constituted 66% (63/95). 30% (28/95) were aged 0-28 days; 23.1% (22/95) were adolescents. Fulani and Hausa constituted 37% (34/95) and 31% (29/95) respectively. Admission was highest in the dry season 52% (50/95 %). The overall tetanus CFR was 51.6%; 78% of deaths were in males (38/49), 30% in neonates, and 23% in adolescents. CFR was highest during the dry season (67.3%). Hausa and Fulani had CFR of 51% and 40% respectively. P-value <0.05 The CFR was 88% between 2000-2004, 72% from 2005-2009, 71% between 2010-2014 and 33% from 2015-2019. Conclusion: Tetanus CFR is still high among neonates and adolescents. Maternal tetanus vaccine and booster doses in children need strengthening.

IN-PATIENT PNEUMONIA BURDEN AND CASE FATALITY RATES IN CHILDREN OVER TWO DECADES IN FEDERAL TEACHING HOSPITAL, GOMBE (FTHG).

Introduction: Pneumonia is the leading cause of death among children globally accounting for an estimated 1.2 million (18%) total deaths annually. The number of childhood-related deaths from pneumonia is approximately 2000-fold higher in developing than in developed countries. Nigeria contributes the highest of pneumonia-related deaths globally. Objectives: To determine the case fatality rates (CFR) of pneumonia from 2000-2019 in paediatric ward, FTHG. Methodology: All cases of pneumonia admissions and deaths in patients aged 0-18 years, using ICD-10 classification, were retrieved and analysed. The mainstay of diagnosis is clinical and/or radiographic features. Results: A total of 26,716 children were admitted during this period, 1151 had pneumonia (4.3%) and 118 died. Males constituted 647 (56.2%) and females 43.8% of the total pneumonia admissions. Children aged 0-5 years had the highest pneumonia admissions, followed by 6-9 years. Admissions were highest in the wet than the dry season. Pneumonia CFR was 10.2%; 10.9% in females and 9.7% in males. Under-5 constituted 84% (969/1151) of pneumonia admission with a CFR of 9.3%. CFR were 10.3% and 21% in 6-10 years, and 11-18 years respectively. The CFR between2000-2004 was 14.1%, 2005-2009:21.1%, 2010-2014:10.2% and 2015-2019:7.2%. Kanuri had the highest CFR of 56.2%.(P <0.05) Other ethnic groups were 29.4% in Waja, 25% in Tula, 21.4% in Igbo, 16.6% in Yoruba, 12.1% in Tangale, 10.2% in Hausa, 8.8%in Bolewa and 8.3% in Fulani. The CFR was highest in February20.2%. Conclusion: Pneumonia Case fatality is high.

Is sequential feeding of whole wheat more efficient than ground wheat in laying hens?

The impact of sequential feeding of whole or ground wheat on the performance of layer hen was investigated using ISABROWN hens from 19 to 42 weeks of age. In addition, the effect of reduced dietary energy content of a complete diet was also investigated. Four treatments were tested. Whole wheat was alternated with a protein-mineral concentrate (balancer diet) in a treatment (sequential whole wheat: SWW), while another treatment alternated ground wheat (sequential ground wheat: SGW) with the same balancer diet. The control (C) was fed a complete layer diet conventionally. Another treatment (low energy: LE) was fed a complete diet conventionally. The diet contained lower energy (10.7 v. 11.6 MJ/kg) compared to the C. Each treatment was allocated 16 cages and each cage contained five birds. Light was provided 16 h daily (0400 to 2000 h). Feed offered was controlled (121 g/bird per day) and distributed twice (2 × 60.5 g) at 4 and 11 h after lights on. In the sequential treatment, only wheat (whole or ground) was fed during the first distribution and the balancer diet during the second distribution. Left over feed was always removed before the next distribution. The total feed intake was not different between SWW and SGW, but the two were lower than C (P < 0.05). Wheat intake was however, lowered with SGW compared to SWW (P < 0.05). Egg production and egg mass (EM) were not different between treatments. Egg weight was lower with SGW than with SWW (P < 0.05), but the two were similar to C. Body weight (BW) was lowered (P < 0.01) with SGW relative to SWW and C, SWW BW being also lower than the C one. The efficiency of egg production was increased (P < 0.01) with the SWW and SGW relative to the control. Birds fed LE had higher feed intake (P < 0.05) but they had similar egg production and EM compared to the two sequential treatments. The efficiency of feed utilization was also reduced (P < 0.01) with LE compared to SWW and SGW. It was concluded that sequential feeding is more efficient than conventional feeding. In addition, whole wheat appeared more efficient than ground wheat in terms of egg and BW.

Adaptation of wheat and protein-mineral concentrate intakes by individual hens fed ad libitum in sequential or in loose-mix systems.

1. Feed intake and performance of birds given sequential or loose-mix feeding was investigated from 19 to 42 weeks of age. A complete diet was fed as control (C). A balancer diet (50) was fed either sequentially (S50) or in a loose-mix (L50) with wheat. This diet was formulated to provide a similar nutritive value as C assuming a 50 : 50 diet and wheat intake. Another balancer diet (25) was fed sequentially (S25) or in a loose-mix (L25) with wheat. The diet was to provide a similar nutritive value as C assuming 75 : 25 diet and wheat intakes. In sequential feeding, only wheat was fed in the morning (4 h after lights-on) and the balancer diet in the late afternoon (4 h before lights-off). In the loose-mix treatment, a mixture of the two diets was fed throughout the 16-h daily light. Each treatment was given ad libitum to 25 birds in individual cages. 2. Birds fed on L25 had lower total feed intakes than those receiving C, S50 or S25. Protein intake was reduced with L25 compared to C, S50, S25 and L50. Metabolisable energy (ME) intake was, however, similar among all treatments. Egg production and weight were reduced with L25 compared to S50 and S25. Body weight (BW) was lowered with L25. However, there was high individual variation in all variables. 3. Feeding system (sequential vs loose-mix) had no effect on ME intake. However, the loose-mix treatment reduced feed and protein intake due to lower balancer diet intake. It also resulted in low egg production, egg and BWs compared to sequential feeding. The weights of pancreas and gizzard were heavier with sequential and loose-mix compared to the control. 4. The loose-mix treatment reduced egg-laying performance. Sequential feeding resulted in similar egg-laying performance to conventional feeding and thus could be used to advantage in situations where it is applicable.

Sequential feeding using whole wheat and a separate protein-mineral concentrate improved feed efficiency in laying hens.

The effect of feeding nutritionally different diets in sequential or loose-mix systems on the performance of laying hen was investigated from 16 to 46 wk of age. Equal proportions of whole wheat grain and protein-mineral concentrate (balancer diet) were fed either alternatively (sequential) or together (loose-mix) to ISA Brown hens. The control was fed a complete layer diet conventionally. Each treatment was allocated 16 cages and each cage contained 5 birds. Light was provided 16 h daily (0400 to 2000 h). Feed offered was controlled (121 g/bird per d) and distributed twice (4 and 11 h after lights-on). In the sequential treatment, only wheat was fed at first distribution, followed by balancer diet at the second distribution. In loose-mix, the 2 rations were mixed and fed together during the 2 distributions. Leftover feed was always removed before the next distribution. Sequential feeding reduced total feed intake when compared with loose-mix and control. It had lower wheat (-9 g/bird per d) but higher balancer (+1.7 g/bird per d) intakes than loose-mix. Egg production, egg mass, and egg weight were similar among treatments. This led to an improvement in efficiency of feed utilization in sequential compared with loose-mix and control (10 and 5%, respectively). Birds fed sequentially had lower calculated ME (kcal/bird per d) intake than those fed in loose-mix and control. Calculated CP (g/bird per d) intake was reduced in sequential compared with loose-mix and control. Sequentially fed hens were lighter in BW. However, they had heavier gizzard, pancreas, and liver. Similar liver lipid was observed among treatments. Liver glycogen was higher in loose-mix than the 2 other treatments. It was concluded that feeding whole wheat and balancer diet, sequentially or loosely mixed, had no negative effect on performance in laying hens. Thus, the 2 systems are alternative to conventional feeding. The increased efficiency of feed utilization in sequential feeding is an added advantage compared with loose-mix and thus could be employed in situations where it is practicable.

Immunochemical studies on gastric and intestinal digestion of soybean glycinin and beta-conglycinin in vivo.

Two experiments were conducted to study gastric and small intestinal digestion of soybean glycinin and beta-conglycinin in preruminant calves fed milk replacers containing a mixture of skim milk powder and antigenic heated soybean flour. In experiment 1, duodenal passage of immunoreactive beta-conglycinin lasted for a much longer time after the morning meal than that of glycinin. Western blotting revealed the early abomasal outflow of glycinin subunits that associated nearly intact basic polypeptides to partially degraded acidic polypeptides. Intact beta-conglycinin was evidenced at most sampling times. In experiment 2, intact basic glycinin (M(r) = 21000) associated with partially digested acidic glycinin (7000 < M(r) < 25000) was demonstrated in ileal digesta up to 8-10 h after the meal. beta-Conglycinin immunoreactivity could not be evidenced by Western blotting in ileal digesta.

Analytical criteria for predicting apparent digestibility of soybean protein in preruminant calves.

A series of experiments on the use of soybean as a protein source in milk replacers for veal calves was undertaken to determine the relationships between the physicochemical and antinutritional properties and apparent digestibilities of nine soybean products. Soybean provided between 58 and 71% of dietary CP, and skim milk or whey powder provided the remainder. Soybean products were analyzed for CP, native protein, aggregated protein, carbohydrate-linked protein, peptides, antitryptic activity, and immunoreactivity of lectin, glycinin, alpha-conglycinin, and beta-conglycinin. The apparent digestibility of N calculated for soybean protein varied between 59 and 84%. Simple linear correlations were significant between apparent digestibility of soybean N and concentrations of native protein, antitryptic activity, glycinin, alpha-conglycinin, and beta-conglycinin. However, only variation in antitryptic activity, alpha-conglycinin, and beta-conglycinin contributed significantly to an explanation for the variation in apparent digestibility of soybean N in a multiple linear equation. Under our experimental conditions, beta-conglycinin was the best predictor of digestibility of soybean N. Antitryptic activity became the best predictor when soybean products had no detectable beta-conglycinin.

Digestibility, blood levels of nutrients and skin responses of calves fed soyabean and lupin proteins.

Three milk substitute diets in which the protein was provided either by skim milk only (control diet) or mainly (71%) by a commercial soyabean or lupin concentrate (soyabean or lupin diet, respectively) were given to intact or ileo-caecal-cannulated preruminant calves. In vitro tests showed that both concentrates were partially proteolysed and had low antigenic and antitryptic activities. The low antigenicity was confirmed in vivo since none of the calves produced specific plasma antibodies against dietary proteins, and skin reactions following the injection of these proteins were minor. Postprandial plasma level of triglycerides was higher with the 2 legume diets, suggesting faster abomasal emptying of fat and probably protein. Apparent faecal nitrogen digestibility was lower (P < or = 0.05) with the soyabean and lupin diets than with the control diet (0.86, 0.88 and 0.95, respectively). At the ileal level, the differences were smaller and non-significant (0.90, 0.88 and 0.92) for nitrogen, but remained significant for valine and tyrosine with the soyabean diet, and for proline, valine, methionine, leucine and lysine with the lupin diet. However, the differences were small enough to conclude that proper denaturation of soyabean and lupin proteins by processes including partial hydrolysis can suppress their antigenicity and render them very digestible.