Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020-May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2 (0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

CONTEXTE ET OBJECTIFS: La maladie de coronavirus 2019 (COVID-19) est une pandémie mondiale. Les personnes âgées et celles qui présentent des comorbidités mal contrôlées ont un risque de mortalité plus élevé. Cette étude a été menée pour mettre en évidence les caractéristiques cliniques, les défis de la gestion et le résultat des patients que nous avons vus dans notre centre au cours de la dernière année. MÉTHODES: Il s'agissait d'une étude transversale rétrospective impliquant tous les patients admis dans l'unité d'isolement COVID- 19 de l'University of Uyo Teaching Hospital (UUTH) de juin 2020 à mai 2021. Les informations cliniques et de laboratoire ont été obtenues à partir des notes de cas des patients. L'autorisation éthique pour la réalisation de l'étude a été obtenue auprès du comité d'éthique de l'UUTH, Uyo. Les données ont été analysées avec STATA version 13. RÉSULTATS: Trente-trois (37,9%) patients étaient positifs à la PCR COVID-19. L'âge moyen ± SD des patients positifs au COVID-19 PCR était de 57,3 ± 13,4 ans, la majorité (69,7%) ayant plus de 50 ans. Il y avait une prépondérance masculine (75 %). Onze (34,4 %) patients sont décédés et 21 (65,6 %) sont sortis de l'hôpital. La comorbidité la plus importante associée à la mortalité de COVID-19 était le diabète miletus (7 sur 11 : 63 : 6 %). Les investigations de soutien pour la gestion des patients COVID-19 ont été peu utilisées. Une température corporelle élevée (P=0,0006), une faible SPO2 (0,00004), une fréquence respiratoire élevée (0,0009) à l'admission et une durée d'admission plus courte (0,0002) étaient associées à la mortalité. CONCLUSION: La présence de comorbidités, de fièvre, d'une faible SPO2 et d'une fréquence respiratoire élevée à l'admission est associée à une mortalité accrue de la maladie de COVID-19. Le manque d'investigations de soutien a été un défi majeur pour la gestion de la maladie COVID-19. Nous recommandons donc le renforcement de la capacité de nos laboratoires. Mots clés: COVID-19, défis, gestion des cas, Nigeria.

Prevalence and Determinants of the use of Enema in under-five children in Akwa Ibom State

Background: Use of enema in children across clinical and community settings are associated with risks. This study seeks to determine the prevalence of enema practice in under-five children, substances used as enema and the reasons for enema practice by mothers. Materials and Methods: This was a descriptive cross sectional study among 252 consecutively recruited mothers of under-five children attending immunization/well babies clinics in 2 health centres in Akwa Ibom state using a semi-structured self and interviewer administered questionnaire for data collection. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 at a level of significance of P<0.05. Results: One hundred and sixty-nine (67.1%) respondents had ever given enema to their children. Mothers (69.2%) administered enema to their children which most often (72.8%) was recommended to them by others. Herbal enema was preferred to chemical and plain water enema. Common reasons for enema administration were in preparation for administration of antimalarial to ensure its effectiveness (60.4%), to relief constipation (49.7%) and abdominal pains (46.7%) and treatment of fevers (41.4%). Predictors of enema practice were age of the child (OR 0.4, 95% CI 0.212-0.765, p=0.005) and ethnic origin of the mothers (OR 9.4,95% CI 4.024-22.104, p<0.001). Conclusion: The practice of enema is common in the study area. Health practitioners should be aware of this practice in the communities, seek for this history during clinical consultation and make concerted effort in educating the mothers and other caregivers against this practice.

Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Rate of BCG Immunization in HIV-Exposed Infants in a Selected Primary Health Centre in Southern Nigeria: Implications of No Vaccine Policy for HIV-Positive Infants.

BACKGROUND: Maternal and infant HIV status influences the decision of BCG immunization of infants at birth. The objective of this study was to determine the HIV status of HIV-exposed infants (HEIs) by the first HIV DNA PCR test and the rate of BCG uptake among the HEIs who were confirmed HIV negative. METHODS: This was a retrospective descriptive cross-sectional study involving the review of results of 99 dried blood samples (DBS) for the first HIV DNA PCR test of HEIs whose mothers were diagnosed HIV positive on presentation of the infants at first immunization visit at a Primary Health Centre from January 2018 to January 2019. RESULTS: Of the 99 DBS examined, 86; 86.9% (95% CI 80.1-93.6) were HIV negative, 9; 9.1% (95% CI 3.3-14.8) were positive while the results of 4 (4.0%) infants were not in the register. Only 7; 7.1% (95% CI 1.9-12.2) of the 99 HEIs returned for BCG immunization at the centre. BCG immunization status of the HEIs after first PCR results was not significantly associated with sex of the infants or availability of phone number of the guardians (p = 0.70 and 0.12, respectively). CONCLUSION: The majority of HEIs were HIV negative at first HIV DNA PCR test. Few of these HIV negative infants returned for BCG immunization. Hence, all HEIs should be given BCG immunization according to WHO GAVCS committee recommendation on BCG immunization for settings with poor HIV diagnostic and treatment facilities for mothers and infants.

Latent Tuberculosis in a Paediatric Health Worker: A Case Report.

BACKGROUND: Latent Tuberculosis (LTBI) affects approximately a third of the world population. Paediatric health workers caring for adolescent Tuberculosis (TB) patients in high TB endemic regions are particularly susceptible as they are exposed to TB in the community and in the work place. However, there is a paucity of reports on LTBI in paediatric health workers. OBJECTIVES: To identify the factors that could have resulted in latent TB in a paediatric health worker Methods/Results: We present a case of a 38-year old female paediatrician who was diagnosed with LTBI by a positive QuantiFERON-TB gold test during the routine new entry immigrant screening for tuberculosis on arrival in the United Kingdom for postgraduate studies. She was treated with three months course of Rifampicin and Isoniazid (plus pyridoxine). CONCLUSION: Latent TB infection may have been acquired from her involvement in the management of adolescents with adult type TB without the use of personal protective equipment. In this case, routine systematic screening of an at risk individual helped to eliminate TB infection. RECOMMENDATION: Paediatric health workers should use personal protective equipment when managing childhood TB and should also be routinely screened for latent TB.

PREVALENCE, CO-PREVALENCE AND RISK FACTORS OF PULMONARY PARAGONIMIASIS AND PULMONARY TUBERCULOSIS IN NIGERIAN CHILDREN IN THE NIGER DELTA AREA.

BACKGROUND: Nigeria has the highest burden of paragonimiasis in Africa and it is also among the high burden countries with tuberculosis. The true prevalence of these reemerging diseases is unknown in the country. OBJECTIVE: To determine the prevalence and co-prevalence of thesere-emerging diseases among children in a rural Nigerian community. DESIGN: Descriptive cross-sectional study. SETTING: Ewang, a rural fishing community in Mbo Local government Area of Akwa Ibom State, Nigeria. SUBJECTS: Primary and secondary school children aged 5-18years living in Ewang village, Mbo Local government Area of Akwa Ibom State, Nigeria. RESULTS: A total of 204 children were examined: 91(44.6%) were males, while 113(55.4%) were females. Ten of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 4.9%,while six children were sputum positive for pulmonary tuberculosis with a prevalence rate of 2.9%. There was no case of co-infection. The peak age prevalence of paragonimus ova-positive and Acid and Alcohol fast positive subjects was recorded in the five to nine year old age group with prevalence rate of 5.6% and7.4% respectively. There was a female preponderance among the paragonimus ova-positive subjects (90%) and the AAFB positive subjects (66.7%). CONCLUSIONS: The findings show that paragonimiasis is an emerging/re-emerging disease in southern Nigeria and further confirmed that the prevalence of tuberculosis is still on an upward rise.