Randomized Controlled Clinical Trial of Bivalent Oral Poliovirus Vaccine and Inactivated Poliovirus Vaccine in Nigerian Children.

BACKGROUND: We conducted a trial in Nigeria to assess the immunogenicity of the new bivalent oral poliovirus vaccine + inactivated poliovirus vaccine (bOPV+IPV) immunization schedule and gains in type 2 immunity with addition of second dose of IPV. The trial was conducted in August 2016-March 2017, well past the trivalent OPV-bOPV switch in April 2016. METHODS: This was an open-label, 2-arm, noninferiority, multicenter, randomized, controlled trial. We enrolled 572 infants aged ≤14 days and randomized them into 2 arms. Arm A received bOPV at birth, 6, and 10 weeks, bOPV+IPV at week 14, and IPV at week 18. Arm B received IPV each at 6, 10, and 14 weeks and bOPV at 18 weeks of age. RESULTS: Seroconversion rates for poliovirus types 1 and 3, respectively, were 98.9% (95% confidence interval [CI], 96.7-99.8) and 98.1% (95% CI, 88.2-94.8) in Arm A and 89.6% (95% CI, 85.4-93.0) and 98.5% (95% CI, 96.3-99.6) in Arm B. Type 2 seroconversion with 1 dose IPV in Arm A was 72.0% (95% CI, 66.2-77.3), which increased significantly with addition of second dose to 95.9% (95% CI, 92.8-97.9). CONCLUSIONS: This first trial on the new Expanded Program on Immunization (EPI) schedule in a sub-Saharan African country demonstrated excellent immunogenicity against poliovirus types 1 and 3 and substantial/enhanced immunogenicity against poliovirus type 2 after 1 to 2 doses of IPV, respectively.

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria.

BACKGROUND: Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. OBJECTIVE: To evaluate and document the currently available paediatric cardiac services in Nigeria. METHODS: In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. RESULTS: Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). CONCLUSIONS: Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

Health-Care Workers' Perspectives on Ebola Virus Vaccine: A Focus Group and In-Depth Interview Interventional Study.

Health-care workers (HCWs) will require Ebola virus vaccine (EVV) when it is introduced because of the high risk of exposure to the disease. Evaluations of factors that facilitate or limit vaccine uptake are critical for a successful vaccine program. Nigerian HCWs were interviewed to evaluate their knowledge, levels of acceptance, determinants of acceptance, and willingness to pay for EVV. The significance level was set at P ≤ 0.05. None of the 193 participating HCWs had correct knowledge of EVV; 34.7% (67/193) of workers thought that EVV was an extract of the serum of Ebola virus patients. About 77.3% (51/66) of workers in a region that reported Ebola cases (Lagos) were willing to be vaccinated, compared with 4.7% (3/61) in Enugu and 13.6% (9/66) in Abia (P = 0.0001). After health education, the proportion of HCWs willing to receive EVV increased (P = 0.006) except for doctors (P < 0.1). The percentage of HCWs willing to pay for EVV was 86.4%, 72.1%, and 59% in Lagos, Enugu, and Abia, respectively. The workers had fears about EVV based on nonfactual assumptions. Therefore, the EVV introduction strategy should include a strong awareness campaign with adequate explanation about the content of EVV.

Pattern of childhood epilepsies in Sagumu, Nigeria.

OBJECTIVE: To determine the prevalence, aetiology and clinical pattern of childhood epilepsies in a Nigerian tertiary hospital. METHODS: A review of hospital records of children managed for epilepsies at the Pediatric Neurology Clinic. Data studied included the age at presentation, sex, socio-economic class, probable aetiology, clinical type of seizure, Electroencephalopgraphic (EEG) pattern and presence of other neurologic disorders co-existing with seizures. RESULTS: Out of 183 children, 138 had epilepsies giving a prevalence of 75.4%. Sixty nine (54.7%) were aged 6 months to 3 years at the first visit and 115 (69.9%) belonged to lower socio-economic classes IV and V. Birth asphyxia 47 (37.3%) and brain infections in 28 (21.9%) were the leading aetiologies. Generalized tonic-clonic seizures, complex partial seizures and rolandic seizures occurred in 55 (76.9%), 8 (6.3%) and 2 (4.8%) children respectively. Inter-ictal EEG abnormalities were recorded among 72/77 children. Seizures co-existed with other neurologic deficits in 86 (68.3%) of all epileptic cases. 95 (75.4%) children had defaulted from the clinic as at the time of the study. 21 (19.6%) had poor response to drug treatment. Presence of other neurological disorders (p = 0.029) and multiple aetiologies (p = 0.0000) were associated with poor response to drug treatment. CONCLUSION: Most cases of childhood epilepsy in Sagamu, Nigeria are due to preventable perinatal and neonatal conditions. Therefore, improved obstetric and neonatal care may reduce the prevalence of this condition.

Congenital nephrotic syndrome in a Nigerian infant.

Although nephrotic syndrome is common among African children, the congenital forms of it are rare. This report describes the clinical presentation of a 6-week-old Nigerian infant who presented with marked pedal oedema, heavy proteinuria and serum hypoproteinaemia leading to the diagnosis of congenital nephrotic syndrome. This case is being reported to create awareness about this condition and to highlight diagnostic and therapeutic challenges.

Prevalence, types and demographic features of child labour among school children in Nigeria.

BACKGROUND: To determine the prevalence, types and demographic features of child labour among school children in Nigeria. METHODS: A cross-sectional interview study of 1675 randomly selected public primary and secondary school pupils aged 5 to less than 18 years was conducted in the Sagamu Local Government Area of Ogun State, Nigeria from October 1998 to September 1999. RESULTS: The overall prevalence of child labour was 64.5%: 68.6% among primary and 50.3% among secondary school pupils. Major economic activities included street trading (43.6%), selling in kiosks and shops (25.4%) and farming (23.6%). No child was involved in bonded labour or prostitution. Girls were more often involved in labour activities than boys (66.8% versus 62.1%, p = 0.048): this difference was most obvious with street trading (p = 0.0004). Most of the children (82.2%) involved in labour activities did so on the instruction of one or both parents in order to contribute to family income. Children of parents with low socio-economic status or of poorly educated parents were significantly involved in labour activities (p = 0.01 and p = 0.001 respectively). Child labour was also significantly associated with increasing number of children in the family size (p = 0.002). A higher prevalence rate of child labour was observed among children living with parents and relations than among those living with unrelated guardians. CONCLUSION: It is concluded that smaller family size, parental education and family economic enhancement would reduce the pressure on parents to engage their children in labour activities.