Compliance With Guidelines on Seasonal Malaria Chemoprevention in Kwara State, Northcentral Nigeria.

BACKGROUND: Seasonal malaria chemoprevention (SMC) is an effective strategy for reducing malaria morbidity and mortality in children aged 3-59 months in areas with seasonal malaria transmission. Sulphadoxine-pyrimethamine plus amodiaquine is given to an eligible child at monthly intervals during the peak malaria transmission season. The aim of this study was to determine the level of compliance with SMC guidelines by community drug distributors during SMC implementation in Kwara State. METHOD: Caregivers of eligible children from six Local Government Areas were interviewed using a structured questionnaire on the KoboCollect app downloaded on hand-held android devices. The questionnaire was composed of questions on caregiver's demographics, SMC drug administration, and adherence to SMC protocol. RESULTS: A total of 1,314 caregivers were interviewed, most of them were female 1076 (81.9%), married 1200 (91.3%) and literate 795 (60.5%). The mean SMC coverage for the 4 cycles was 1183(88.5%). SMC information was received by 1166 (88.7%) of caregivers. Most of the caregivers 1166 (88.7%) heard about SMC. Overall, SPAQ administration was directly observed in most cases 1169 (91.5%), second dose was given 1226 (96.0%) and drugs were fully ingested 1140(89.3%). Poor compliance was observed in home visits by lead mothers 988 (77.4%). The report of adverse drug reactions was low 132 (10.3% [95% CI: 8.8-12.3%]), the commonest being severe vomiting 50 (37.9%). There were significant (P<0.05) variations in SMC implementation across the 6 LGAs in virtually all the performance indicators. SPAQ administration to over-age children was low 128 (10.0%). CONCLUSION: Overall, the compliance with SMC implementation guidelines in Kwara state was good though significant differences in performance were observed across the six LGAs. Home visits by lead mothers were generally poor. The self-reported coverage of SMC by caregivers was commendable.

CONTEXTE: La chimioprévention saisonnière du paludisme (CSP) est une stratégie efficace pour réduire la morbidité et la mortalité liées au paludisme chez les enfants âgés de 3 à 59 mois dans les zones à transmission saisonnière du paludisme. La sulfadoxine-pyriméthamine associée à l'amodiaquine est administrée à un enfant éligible à intervalles mensuels pendant la saison de transmission maximale du paludisme. L'objectif de cette étude était de déterminer le niveau de conformité aux directives de la CSP par les distributeurs de médicaments communautaires lors de la mise en œuvre de la CSP dans l'État de Kwara. MÉTHODE: Les aidants des enfants éligibles de six zones de gouvernement local ont été interrogés à l'aide d'un questionnaire structuré sur l'application KoboCollect sur des appareils android portables. Le questionnaire comprenait des questions sur les caractéristiques démographiques des aidants, l'administration des médicaments de la CSP et l'adhésion au protocole de la CSP. RÉSULTATS: Au total, 1 314 aidants ont été interrogés, la plupart étaient des femmes 1 076 (81,9 %), mariées 1 200 (91,3 %) et alphabétisées 795 (60,5 %). La couverture moyenne de la CSP pour les 4 cycles était de 1 183 (88,5 %). La plupart des aidants 1 166 (88,7 %) avaient entendu parler de la CSP. Dans l'ensemble, la première administration de SPAQ a été observée directement dans la plupart des cas 1 169 (91,5 %), la deuxième dose a été administrée par 1 226 (96,0 %) aidants et les médicaments ont été entièrement ingérés sans cracher partiellement ou totalement par 1 140 (89,3 %) enfants. Une mauvaise conformité a été observée lors des visites à domicile par les mères responsables 988 (77,4 %). Le signalement des réactions indésirables aux médicaments était faible 132 (10,3 % [IC à 95 % : 8,8-12,3 %]), la plus courante étant les vomissements sévères 50 (37,9 %). Des variations significatives (P<0,05) dans la mise en œuvre de la CSP ont été observées dans les 6 LGAs pour pratiquement tous les indicateurs de performance. L'administration de SPAQ aux enfants plus âgés était faible 128 (10,0 %). CONCLUSION: Dans l'ensemble, la conformité aux directives de mise en œuvre de la CSP dans l'État de Kwara était bonne bien que des différences significatives dans les performances aient été observées dans les six LGAs. Les visites à domicile par les mères responsables étaient généralement mauvaises. La couverture autodéclarée de la CSP par les aidants était louable. MOTS-CLÉS: Chimioprévention saisonnière du paludisme, SPAQ, Conformité, Enfants, Centre-nord du Nigeria, Saison des pluies.

Macrosomic births in abuja: A case-control study of predisposing factors and early neonatal outcome.

BACKGROUND: Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja. METHODS: Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births. RESULTS: The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia. CONCLUSION: Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.

Pattern of perinatal mortality in babies delivered at the university of ilorin teaching hospital, ilorin, Nigeria.

BACKGROUND: Perinatal mortality remains a significant aspect of under-5 mortality, accounting for over 20% of under-five mortality in Nigeria. OBJECTIVE: To determine the pattern of perinatal mortality in the University of Ilorin Teaching Hospital, Ilorin. METHODS: This was a prospective study conducted at the University of Ilorin Teaching Hospital. Data on socio-biologic, antenatal and peripartum characteristics of 1969 gravid women was obtained over a 7-month period (April 2006-October 2006). Data on the 2042 babies delivered was also taken and these babies were followed up till discharge or death. RESULTS: There were 166 perinatal deaths (106 stillbirths and 60 perinatal deaths) out of the 2042 live and stillbirths during the study period (%). The perinatal mortality rate was 81 per 1000 live and stillbirths with a stillbirth rate of 52 per 1000 live and stillbirths and an early neonatal mortality rate of 31 per 1000 livebirths. Among the stillbirths, fresh stillbirths predominated over macerated stillbirths (1.4:1). Severe perinatal asphyxia was the most important cause of death in all birthweight categories except in extremely low birthweight babies were immaturity was more important. Prolonged labour was responsible for 42.6 % of those with severe perinatal asphyxia. CONCLUSIONS: There is an urgent need to improve the monitoring of women in labour to reduce the prevalence of prolonged obstructed labour and increase capacity to provide essential newborn care. There is also need to improve on capacity and facilities for the management of babies with severe perinatal asphyxia and prematurity.

Haemophilus meningitis in an African neonate: time for active surveillance and institution of appropriate control measure.

BACKGROUND: Childhood routine immunization in Nigeria, like most developing nations, do not include vaccination against Haemophilus influenzae type b (Hib) infection. This is probably because infection with Hib is uncommon in children younger than two months due to passive acquisition of maternal antibodies which protects newborn till about four to six months of life. OBJECTIVE: To illustrate a case of neonatal meningitis caused by Haemophilus influenzae and to highlight its other peculiarities. METHODS: A 22-day old baby presented with excessive crying, refusal of feed, progressive abdominal distension, fever and vomiting. Besides clinical assessment, body fluids were cultured. RESULTS: The baby had tachypnoea (90 bpm), tachycardia (182 bpm), and tympanitic and hypoactive abdomen. The musculoskeletal and central nervous systems appeared clinically normal. Haemophilus influenzae was isolated by culture from the cerebrospinal fluid. The baby responded well to treatment with ceftriaxone and gentamycin. Neurological examination has remained normal after discharge for up to three months at follow-up visit. CONCLUSION: There is the need to provide serological and molecular facilities for typing Nigerian Haemophilus infulenzae strain(s) to enhance the development of appropriate vaccine that will be most suitable for prevention of infection due to this organism in Nigeria. However, presently available Haemophilus influenzae vaccine needs to be listed in the National Programme for Immunization (NPI) for the control of infections associated with this organism especially in childhood.

Determinants of mortality of preterm babies in the university of Ilorin Teaching Hospital, Ilorin Nigeria.

AIMS AND OBJECTIVES: A prospective study to identify the determinants of mortality among 185 preterm babies at the University of Ilorin Teaching Hospital, Ilorin. SUBJECTS AND METHODS: Data on 185 preterm babies and their mothers were collected over a nine month period in a tertiary hospital to identify the determinants of mortality among these babies. RESULTS: Factors identified as significant determinants of mortality were severe perinatal asphyxia (p = 0.000; OR = 71.31; 95% CI = 17.63-308.24), apnoea (p = 0.000; OR = 178.20; 95% CI = 20.64-7709.02), necrotizing entero-colitis (p = 0.001) and resuscitation duration (p = 0.003; OR = 5.33; 95% CI = 1.62-19.02). CONCLUSION: The primary causes of death are severe perinatal asphyxia, respiratory distress syndrome and infection. In Nigeria, survival below 28 weeks gestation is less than 20%. The findings in this study highlight the need for prompt and effective resuscitation of these infants by a trained health worker with verifiable competence in newborn resuscitation. It also highlights the need for availability of functional facilities like ventilators and resources like surfactant.

Digitally recycled incubators: better economic alternatives to modern systems in low-income countries.

UNLABELLED: The need to maintain a neutral thermal environment is critical to newborn care. AIM: To investigate reasons for the insufficiency of functional incubators and develop a cost-effective technique for using electronic digital components to recycle obsolete incubators in Nigeria. METHODS: Following interview of 84 clinicians and administrators in Nigerian hospitals, it was identified that inadequate funding was the main reason for lack of functional incubators. Two groups of incubator units were then created and their performance compared. Sixteen units of modern (group A) and 19 units of obsolete (group B) incubators were obtained from six hospitals. An assembly design applying independent generic components for recycling systems was specified and produced. These were sourced through the internet at competitive cost and fitted into the reconstructed panels of the obsolete systems. The functional performance of each recycled system was rigorously monitored for 6 months and graded using ten performance indices. The same indices were used to quantify group A systems. RESULTS: The performance of the recycled incubators (group B) was found to be similar to those of modern incubators. Group B's cost index was found to be 25% of that of group A's. CONCLUSION: Appropriate incubator recycling is a cost-effective method of re-equipping hospitals in low-income countries.

Drug use among adolescents in Ilorin, Nigeria.

The types and frequency of drug use among 1200 students aged 10-19 years was investigated and a prevalence rate of 40.1% found; currently used drugs included mild stimulants such as kolanut and coffee 294 (26.2%), alcohol 164 (14.5%), sniffing agents 80 (7.2%), amphetamine and ephedrine 66 (6.7%), cigarette 54 (4.8%), heroin 45 (4%) cocaine 40 (3.6%) and cannabis 38 (3.4%). Multiple drug use was found among the students, with the abuse of cannabis, cocaine and heroin being significant among those who smoked cigarette (P<0.001). The relative risk (RR) for cannabis use when cigarette was smoked was 37.4 (24.1-57.8); RR for cigarette smoking when alcohol was used, 6.8, while RR for cocaine abuse when cigarette was used, 21.8 (13.9-34.5) and 52.8 (29.2-95.5) when cannabis was used. It is therefore concluded that the use of the licit and "socially" acceptable drugs may pave the way for the abuse of illicit ones.

Sexual activity among adolescents in Ilorin, Kwara State, Nigeria.

With the aid of a self-administered questionnaire, sexual activity was investigated among 1,200 students aged 10-19 years. Two hundred and sixty-four (23.7%) respondents indicated they were sexually active. The mean age at first intercourse was 11.3 years (SD=5.8 years), while the average number of sex partner was 2-3. Multiple sexual partners were found in 99 (69.2%) of the males and in 16 (32.7%) of the females (P < 0.05). Males were more sexually active, 189 (32.8%) compared with 73 (13.7%) females (P=0.000001; RR=2.4 (1.88-3.05). Two hundred and fifty-three (23.4%) ofthose respondents who claimed to be highly religious had sexual intercourse compared with 7 (50%) of those who claimed not to be religious (P=0.02; PR=0.47 (0.27-0.80). Those whose parents lived together were less likely to be sexually active. 184 (21.2%) versus 47 (34.8%) (P=0.005). It is therefore concluded that our adolescents especially males remain sexually active. It also demonstrates the dramatic lowering of age at first intercourse. Family supervision and level of religious activity were recognized as factors that have significant impact on sexual activity. Preventive efforts must therefore focus on these issues with the active involvement of the Pediatrician, parents and religious leaders.

Russell-Silver Syndrome in a Nigerian infant with intrauterine growth retardation.

Russell-Silver Syndrome (RSS) is a rare cause of pre-natal dwarfism, associated with recognizable dysmorphic features and limb asymmetry. The propositus was a term infant of unrelated Nigerian parents, whose 35-year-old mother had peri-conceptual haloperidol for schizophrenia. Anthropometric values suggested severe prenatal stunting in a term infant with asymmetric "head sparing" intrauterine growth retardation (IUGR). A syndromic consideration of Russell-Silver dwarfism was subsequently predicated on the distinctive dysmorphic craniofacial features of a triangular facial profile with a broad forehead and hypoplastic mandible, right upper and lower limb rhizomelia, clinodactyly of the little fingers, micro-penis, and (unilateral) cryptochidism. Routine care of a small-for-gestational-age infant was pursued, but postnatal growth remained slow (despite adequate caloric provision) until a parent-pressured discharge at 4 weeks. His subsequent demise was said to have occurred "suddenly" 2 weeks post-discharge. Despite the limitations posed by the local paucity of modern investigative tools for genetic disorders, the current case report underscores the diagnostic reality of RSS in a non-white African population. While emphasizing the need for a high index of diagnostic suspicion for congenital malformations and syndromic causes of IUGR in the African sub-region, we suspect a possible etiologic association of haloperidol embryopathy with RSS in the current case. The characteristic features, differential diagnoses, etiologic postulates/current cytogenetic and molecular genetic findings of RSS are fully reviewed in the discussion.

Packed red cell volume pattern in Nigerian preterm babies.

Weekly packed red cell volume (PCV) was estimated in 57 Nigerian preterm babies whose gestational ages were less than 34 weeks. Babies were excluded if they required exchange blood transfusion or had major congenital malformations. The mean (SD) PCV at birth was 54.6% (8.3). The nadir of the PCV drop was at the 10th-11th week of life. The PCV at the nadir was 29.3% (SD 2.9). The rate of drop in the PCV was most rapid in the 1st 2 weeks (velocity -4.6% per week), but by the 7th week this had decreased to -1.2% per week. The findings indicate a slower rate of postnatal fall in PCV among Nigerian preterms. We recommend that PCV and systemic signs of anaemia be monitored for the 1st 12 weeks of life.

Evaluation of neonates with risk for infection/suspected sepsis: is routine lumbar puncture necessary in the first 72 hours of life?

To determine whether lumbar puncture is necessary in the evaluation of neonates with risk for infection or suspected sepsis in the first 72 hours of life, we reviewed the laboratory and medical records of 506 infants who had lumbar punctures between January 1988 and December 1990. Neonates < 72 hours of age accounted for 52% of all lumbar punctures, but no case of meningitis. This led to a policy shift from routinely performing lumbar punctures to reserving them for infants with signs of severe sepsis (i.e. lethargy, hypothermia, hypotonia, poor perfusion or apnoea), specific neurological signs or clinical deterioration. This new policy was monitored prospectively from July 1991 to December 1993. Three times fewer procedures were performed in neonates < 72 hours, and there was no diagnosed or missed case of meningitis. Given that meningitis is rare within the first 72 hours of life and the yield of lumbar puncture virtually zero, we recommend that lumbar punctures be reserved for selected infants.

Tuberculous laryngitis in a Nigerian child.

A 12.5-year-old Nigerian child presented with progressively worsening hoarseness of 9 months duration, without overt features of chronic ill health. Superficial discrete cervical adenitis, radiological evidence of miliary tuberculosis and hilar adenopathy were identified on admission. The laryngoscopic findings comprised fully mobile but 'beefy' red, oedematous vocal cords and interarytenoid region. The diagnosis of tuberculous laryngitis was made on the basis of the laryngoscopic, radiological and clinical improvement that followed antituberculous therapy. The possible pathogeneses of tuberculous laryngitis are discussed. We emphasize the importance of considering tuberculous laryngitis in a child with persistent hoarseness.

Chloramphenicol-resistant Haemophilus influenzae meningitis in young urban Nigerian children.

In a developing country like Nigeria, the unusual emergence of Haemophilus influenzae type b, resistant to cost-effective antimicrobials, is of serious concern. We report three cases of H. influenzae type b meningitis in young Nigerian children in whom clinical and bacteriological features of resistance to chloramphenicol were identified. One of the cases had concomitant resistance to ampicillin (multiple-drug resistance). Significant anaemia was an associated feature in two cases, one of whom had a recent measles infection. All three cases were malnourished. The possible mechanisms of antimicrobial resistance in H. influenzae infections are highlighted while the need for periodic surveillance of antibiotic resistance profiles in resource-poor countries is emphasized. The potential value of prophylactic measures like H. influenzae type b conjugate immunization is discussed.