COVID-19 vaccine trials with children: ethics pointers.

As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children. We set out some of the ethical questions to keep in mind before, during, and after the implementation of phase III COVID-19 vaccine trials in limited resource settings. Specifically, we discuss and offer succinct answers to the following questions: How relevant will the trial vaccine be for the population participating in the trial? Should vaccines that have not been approved for use among adults be approved for use in trials with children? Which children should be involved in COVID-19 vaccine trials? What criteria of informed consent are to be adopted with minors? Placebo versus an existing already approved vaccine? What specific duties of ancillary care should be taken into consideration for COVID-19 vaccines especially in low-income and middle-income countries? The answers we offer are considerations that can serve as 'things to think about' when reviewing or implementing COVID-19 trials involving children in low-income settings.

Impacts of Seasonal Malaria Chemoprevention on Malaria Burden among under Five-Year-Old Children in Borno State, Nigeria.

Malaria disproportionately affects all ages with a high burden among children below five years. Thus, control measures are deployed including Seasonal Malaria Chemoprevention (SMC). The present study assessed the impacts of SMC on malaria burden among subjects aged 3-59 months in Borno State, Nigeria. Twenty (20) clusters were randomly selected from accessible 16 Local Government Areas (LGAs) of Borno State, Nigeria, and SMC was deployed in 10 of the clusters by administering a full dose of amodiaquine plus sulfadoxine-pyrimethamine at monthly intervals for 4 months consecutively. Three hundred and ninety-nine children were enrolled in the study. A structured questionnaire was used to obtain demographic and malaria-related data. Thick blood smear, thin blood smear, and capillary sample were collected two weeks after the 4th cycle of SMC. The prevalence of malaria and anaemia was determined among the subjects and for the clusters. The proportions of the female (46.4%; 185/399) and male (53.6%; 214/399) subjects were similar (p > 0.05) with subjects aged 24-47 months (35.8%; 143/399) accounting for the highest proportion (p < 0.05). Malaria prevalence was 10.3% (41/399) and was higher among non-SMC subjects (15.9%; 31/195) than among SMC subjects (4.9%; 10/204) (p < 0.05, df = 1, χ 2 = 10.8). Malaria prevalence was higher in non-SMC clusters (80.0%; 8/10) than in SMC clusters (30.0%; 3/10) (p < 0.05, df = 1, χ 2 = 40.5). The mean haematocrit of the 399 subjects was 34.0 ± 5.3% with an anaemia prevalence of 18.1% (72/399). The mean haematocrit was higher among SMC subjects (35.4 ± 5.0% vs. 33.1 ± 4.2%; p < 0.05) while anaemia prevalence was higher among non-SMC subjects (21.5% vs. 14.6%; p < 0.05, df = 1, χ 2 = 2.8). Of the SMC subjects, 4.9% reported adverse drug reactions. SMC is safe and significantly reduced malaria burden among children in Borno State, and thus, the measure could be deployed in the state for effective malaria control.

Bone marrow invasion by aspergillus specie in a sickle cell trait patient with invasive aspergillosis: a fatal case in association with disseminated intravascular coagulation

Background: Invasive aspergillosis has been predominantly associated with pulmonary infection, particularly amongst immunocompromised individuals. Extrapulmonary infections with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, haematopoietic stem cell and solid organ transplantation, advanced AIDS, and chronic granulomatous disease. The most frequently involved specie is Aspergillus fumigatus that constitutes over 90% of cases, followed by Aspergillus flavus, usually associated with a primary skin infection. Haematogenous spread to the bone causing osteomyelitis is the commonest form of disseminated aspergillosis and a surprisingly high proportion of these patients have no immunosuppression. We present a rare case of bone marrow invasion by Aspergillusspp. in a 3-year-old patient with sickle cell trait and chronic Aspergillosis. Case report: A 3-year-old patient with sickle cell trait was brought to the paediatric unit with recurrent diarrhoea, abdominal distention, weight loss and persistent cough. The child was severely wasted with generalised peripheral lymphadenopathy. She had marked respiratory distress and hepatosplenomegaly but no demonstrable ascites. Haematologic examination revealed leukaemoid reaction (leukocyte count of 44.0 x 109/L) with monocytosis (10%) and thrombocytopenia (platelet count of 97,000/mm3); no blast cells were seen on blood film. The bone marrow was hypercellular with a myeloid/erythroid ratio of 20:1, consistent with infection. Bone Marrow culture yielded Aspergillus spp. and other results of sepsis work up were negative. Conclusion: Cases of extrapulmonary invasive aspergillosis have been reported rarely in both immunocompetent and immunocompromised patients. Haematogenous spread to the bone is the commonest form of disseminated disease

Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria.

AIMS AND OBJECTIVES: The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population. PATIENTS AND METHODS: This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur. RESULTS: A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000. CONCLUSIONS: Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

Prevalence and clinical manifestation of lymphomas in North Eastern Nigeria.

BACKGROUND: Lymphomas are one of the commonest childhood malignancies. Due to varied clinical features many patients are misdiagnosed and treated for other diseases. It is imperative to keep health workers informed about the current trend of lymphomas in northeastern Nigeria to facilitate prompt diagnosis and treatment. OBJECTIVE: To evaluate the extent of lymphomas at presentation and to define the pattern of presentation in relation to gender and site. MATERIALS AND METHODS: Retrospective analysis of cases of lymphomas over a 15 year period was conducted. Structured questionnaires were used to document demographic characteristics and clinical features. The non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) cases were categorized using standard classification schemes. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 16, Illinois, Chicago, USA. Spearman's correlation and Student's t-test were applied where appropriate. A P value < 0.05 was considered significant. RESULTS: Fifty cases of lymphoma, 10 (20%) belong to HL and 40 (80%) belong to NHL. Lymphoma is common in male, though the male to female preponderance was not significant in both the cases (P = 0.107 and 0.320, respectively). Maxilla was the commonest site of primary malignancy (36%) and late presentation of patients were observed. New trend was noticed, the NHL patients present commonly with severe symptoms than HL (P = 0.038). HL was dominated by lymphocytic predominant type, while NHL was dominated by the small non cleaved cells (Burkitt's) lymphoma (70%). CONCLUSION: Childhood lymphoma in northeastern Nigeria has a slight shift in varied clinical presentation in favor of NHL. Patients in this study had late presentation.

Retrospective study of childhood burkitts lymphoma in north eastern Nigeria.

BACKGROUND: Burkitt's lymphoma (BL) is one of the leading childhood cancers in tropical Africa. Despite this, after extensive literature search most literature reviews on BL found were old. Therefore, it is useful to learn the trend in the epidemiology of BL in north eastern Nigeria especially now that changing ecology of the disease are being published. OBJECTIVE: To determine the prevalence of BL, and the pattern of distribution of the tumour in relation to gender, sites and socio-demographic background of children. METHODS: A retrospective study of cases of BL over a 20 year period in the Paediatric Department of University of Maiduguri Teaching Hospital (UMTH) was conducted. A structured questionnaire was used to document socio-demographic characteristics and clinical features for all cases. Data were analyzed using SPSS software version 16 Illinois, Chicago USA and a computer program for epidemiologist (PEPI version 3.01). Student t test was used to test for significance of means. Kendall's rank correlation coefficient (tau b) hand Jonckheere-Terpstra test of relationship of socio-demographic variables and presenting symptoms of BL were determined. Likely ratio Chi-square (c2) by William's criterion was used to investigate association between yearly prevalence and trends in time and also between anatomical sites and staging of BL. RESULTS: During the period, 49 cases, 32 (65.3%) males and 17 (34.7%) females, were identified out of the 29,636 total paediatric admissions during the period under review. The prevalence of BL was 0.17%. , The 6-10-year age bracket were mostly affected by BL 31 (63.3%) and males had the disease more than females (p = 0.021). The majority of children affected by BL were the Fulani ethnic group 15 (30.6%), those from Borno state 18 (36.7%) and rural dwellers 20 (40.8%). Most patients presented with stage C disease 27 (42.9%), and the most common primary site was the maxilla 11 (40.7). There was no significant change in yearly prevalence of Burkitts lymphoma (P = 0.983). The association between anatomical sites and staging of BL was significant (p = 0.003). CONCLUSIONS: Males were more prone to BL than females and most cases of BL presented late to the hospital. There is no significant change in the yearly occurrence of BL. Socio-demographic and clinical features did not contribute significantly to the epidemiology of BL.

The effects of maternal haemoglobin as an indicator of maternal nutritional status on, maternal measles antibodies of mother-infant pairs at birth.

BACKGROUND: Maternal measles antibodies (MMA) are actively transferred through the placenta from mother to foetus. A relationship could exist between MMA of mother-infant pairs and maternal nutritional indicator (haemoglobin). OBJECTIVES: This study reviewed the effects of maternal haemoglobin (Hb) on MMA of mother-infant pairs at birth. METHODS: One hundred and fifty three mother-infant pairs were enrolled in this study using the systematic random sampling method. Means of maternal Hb and MMA of mother-infant pairs were compared using the Student t test. Correlation coefficients of maternal Hb and MMA of mother-infant pairs were also determined. Multivariate analysis of variable (MANOVA) and covariates (MANCOVA) was used to investigate the effects of maternal Hb (fixed factor), gestational age, maternal age, birth weight (covariates) on combined MMA of mother-infant pairs (dependent factors). Benferroni adjusted Univariate linear regression was used to investigate the dependent variables separately. RESULTS: There were 78 (51%) males and 75 (49%) females. The (mean ± SD) MMA of mother-infant pairs at birth were 134.66 ± 93.31 (95% CI, 119.76 - 149.56) U/ml, and 187.49 ± 85.01 (95% CI, 173.91 - 201.07) U/ml, and their correlation was significant (p = 0.025). Ninety one (59.5 %) mothers had low Hb, 62 (40.5 %) had acceptable Hb levels. The overall mean maternal Hb was 11.01 ± 1.00 (95% CI, 10.85 - 11.17) g/dl . A positive significant correlation was observed between maternal Hb and MMA of the newborn-infant (p = 0.031). The MANOVA showed a statistically significant difference between maternal Hb on the combined dependent variables (p =0.033); however, results for the dependent variables using the Benferroni adjusted Univariate analysis was significant for only MMA of the infants, (p = 0.009). CONCLUSION: There was a significant association between aacceptable levels of maternal Hb and high MMA of the newborn-infants. Therefore, these newborn infants start out with higher MMA that could give them better protection against measles during infancy.

Clinical features of sickle cell anaemia in northern nigerian children.

BACKGROUND: Sickle cell disease (SCD) is a more common and severe disease in Africa. Nigeria the most populous black nation in Africa has the largest number of sickle cell anaemia (SCA) patients in the world. Borno and Yobe State has the largest number of sickle cell trait in Nigeria with prevalence of 27.9% and 32.6% respectively. Sickle cell anaemia survival to adulthood in Africa was reported to be 10-15% in the first decade of life, with the death rate of about 5% during subsequent decades. Large portion that died have shown no overt chronic organ failure but died during acute episodes of pain, infections, acute chest syndrome, stroke and anaemic crises. OBJECTIVE: To review the morbidity pattern among SCA children in the University of Maiduguri Teaching Hospital, North-Eastern Nigeria. METHODS: This was a retrospective study of SCA patients seen from 1994 to 2003. There were 333 case notes retrieved and reviewed with their age, sex, clinical features at diagnosis and other morbidities documented and analysed. RESULTS: Sickle cell anaemia is commonly diagnosed in infants aged 6-11 months, with hand-foot swelling and jaundice being the commonest symptoms at presentation. Anaemic and vaso-occlusive crises were seen more common in children aged 1-5 years. The over-all morbidity pattern is same in both sexes with diseases such as bronchopneumonia, malaria, osteomyelitis, urinary tract infections, septicaemia and septic arthritis being common. Age has been found to influence morbidity pattern in our studied patients. CONCLUSION: There is need for early diagnosis and counseling, so that mothers or caregivers will be able to assist in prompt identification of these morbidities and to seek for prompt and appropriate treatment in the health facilities.

Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anemia in Maiduguri, Nigeria.

BACKGROUND: Patients with sickle cell disease have increased tendency to develop frequent and severe infections, especially of bones and urinary tract. OBJECTIVE: The knowledge of antimicrobial sensitivity pattern of common etiological agents will serve as a guide to empiric treatment while results of urine culture and sensitivity are being awaited. MATERIALS AND METHODS: Antimicrobial sensitivity test was carried out on bacterial isolates from the urine of febrile children with sickle cell anemia (SCA) and children with HbAA in Maiduguri. Urine specimens were collected and cultured by standard methods. Sensitivity to 15 antimicrobials (based on availability of sensitivity disc) was tested using the disc-diffusion technique of stokes. RESULTS: Significant bacteriuria was obtained from 65 (26%) of the 250 children with SCA and 51 (20.4%) of the 250 controls. The isolates were E. coli, Klebsiella, Coliforms, Proteus, Staph aureus and Salmonella. Sensitivity was highest to 3 rd generation cephalosporins, followed by the quinolones: ciprofloxacin (86.2%), ofloxacin (83.1%), and peflacine (73.8%). Sensitivity of the organisms to some of the commonly used antibiotics like ampicillin, cotrimoxazole, and nalidixic acid was generally low. In general, the pattern of bacteriuria and their sensitivity in the SCA group was similar to the pattern in the control group. CONCLUSION: Etiological agents of childhood urinary tract infections (UTI) in this environment are resistant to most of the drugs commonly recommended for its treatment. Amoxicillin/clavulanic acid, cefuroxime, and gentamicin, are recommended as first-line drugs for treatment of UTI while awaiting results of culture and sensitivity. Ceftriaxone and ceftazidime should be reserved for case of non response to first-line drugs and severe infections.

A survey for neutralizing antibodies to the three types of poliovirus among children in Maiduguri, Nigeria.

The milestone in polio eradication program is to protect effectively children aged 0-5 years against the three serotypes of poliovirus. It became necessary to measure the level of neutralizing antibodies to the three poliovirus types in an endemic State in Nigeria. Neutralizing antibodies to the poliovirus types among children aged 0-5 years was estimated using micro neutralization assay. Of 129 children, 99 (76.8%), 95 (73.6%), and 95 (73.6%) had neutralizing antibodies with the geometric mean titer of 42.7, 31.3, and 33.2 for the poliovirus type 1, 2, and 3, respectively. Fifty-three percent of the children were protected against the three types of poliovirus. Combination of poliovirus types 1 and 2, 1 and 3, and 2 and 3 were neutralized by 62.8, 58.9, and 61.2% of the children studied, respectively. Only poliovirus type 1 induced antibody titres ≥1:1,024. The number of children with neutralizing antibodies after receiving three doses was significantly higher than those who received one or two doses of oral polio vaccine (P ≤ 0.05). However, those who received more than three doses of oral polio vaccine showed no significant difference in their antibody response. The existence of immunity gap poses a risk of re-emergence of the paralytic poliovirus. The existence of unimmunized and unprotected children along with high birth rate could impede the success of polio vaccination in Nigeria. Elimination of non-compliance to polio vaccine, promotion of health education and documented evidence of vaccination of each child with the parents may facilitate the success of polio eradication program in Nigeria.

Significance of pyuria in the diagnosis of urinary tract infection in children with sickle cell anaemia in Maiduguri, Nigeria

Urinary tract infection (UTI) is a significant cause of morbidity and mortality in children; especially in those with sickle cell disease; who are at higher risk of infections. It will be useful to have a simple test which can be used in resource limited health facilities as a means of screening such children for UTI with the view to instituting prompt treatment. This study is carried out to determine the usefulness of significant pyuria in detecting UTI in febrile children with sickle cell anaemia (SCA). Two hundred and fifty febrile children with sickle cell anaemia that attended State Specialist Hospital and University of Maiduguri Teaching Hospital (UMTH) were prospectively studied with their consent. Urine sample was collected using standard procedure; examined for pus cells and was cultured at the Microbiology laboratory of UMTH. The study showed UTI prevalence of 26. Significant pyuria was found to have sensitivity of 55.4; specificity of 77.8; the efficacy of the test was 72.0and the test has low positive predictive value of 46.8in detecting bacteriuria in SCA patients. The significant pyuria observed in this study support its usefulness in the diagnosis of UTI among children with SCA especially in communities having limited facilities or personnel for carrying out urine culture

Evaluation of the Nitrite Test in Screening for Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia in Maiduguri- Nigeria.

BACKGROUND: Urinary tract infection is a significant cause of morbidity in children with sickle cell anaemia (SCA). Individuals with SCA have increased risk of urinary tract infection (UTI). Facilities for urine culture may not be available in most rural and even some urban areas in most developing countries like Nigeria. It will therefore be useful to have a simple means of screening such children for UTI with the intent of prompt treatment. MATERIALS AND METHODS: The study will evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. This study was carried out in the Department of Paediatrics University of Maiduguri Teaching Hospital and State Specialist Hospital Maiduguri. RESULTS: The study consisted of 250 children aged 6 months to 15 years with SCA presenting with fever (temperature ≥ 37. 5°C). Midstream urine specimen was collected from older children and suprapubic bladder aspiration of urine specimen was collected from infants. Samples were subjected to nitrite test, culture and sensitivity. There was significant bacteriuria in 65 (26+) children with SCA. A positive test for nitrite was obtained in 43 of the 65 (66.2+) children. The nitrite test has a specificity of 93.5+ in detecting bacteriuria, a sensitivity of 66.2+, a positive predictive value of 78.2+ and a negative predictive value of 93.5+. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. CONCLUSIONS: From this study, the nitrite test is useful as a screening test for UTI in SCA children. However in sick children with SCA, microscopy, culture and sensitivity should still be done in spite of a negative nitrite test.

Urinary tract infection in febrile children with sickle cell anaemia.

BACKGROUND: Sickle cell anaemia (SCA) is very common in Maiduguri, North-Eastern Nigeria. Children with this disease have increased tendency to develop frequent and severe infections especially of the urinary tract, bones and lungs. The prevalence of urinary tract infection (UTI) has however not been reported in this part of the Nigeria. OBJECTIVE: To determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia. METHODS: This was a prospective study carried out on 250 children with SCA and 250 controls with HbAA aged 6 months to 15 years. Following clinical assessment, midstream urine or urine obtained by suprapubic bladder aspiration was collected and subjected to microscopy and culture. RESULTS: Bacteriuria was found in 65 (26%) of children with SCA and controls 514 (20.4%) of controls, p>0.05. Escherichia coli [16 (27.7%)] and Klebsiella species [16(24.6%)] were the predominant isolates in SCA group, while Escherichia coli [13(37.3%)] and Coliforms (25.4%) were predominant in the control group. Significant bacteruria occurred in patients with other clinical conditions such as pneumonia and septicaemia. CONCLUSION: Urinary tract infection is common in children with SCA. Routine screening is therefore recommended during febrile illnesses.

Pattern and outcome of congenital malformations in newborn babies in a Nigerian teaching hospital.

BACKGROUND: Several types of congenital malformations have been seen in our settings, but the frequencies and pattern are not known. OBJECTIVES: To review the prevalence and pattern of congenital malformation in the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital, Maiduguri, over a 10-year period. METHODS: This was a retrospective study carried out in a semi-urban Nigerian Teaching Hospital. All admissions into SCBU from 1991 to 2000 were reviewed, using both the admission and discharge records. The information extracted from the case note of each patient included sex, age and weight on presentation, maternal age and parity, gestational age, presence of associated neonatal illnesses such as jaundice, sepsis and the type of malformation on physical examination only. RESULTS: Three hundred and ten (13.9%) of 2233 admissions had major congenital malformation. Thirty one (10%) gave a history of antenatal care while 279(90%) had no record of receiving antenatal care. Of the 310 babies, 140 (45.2%) abnormalities were of the gastro-intestinal system and 75 (24.2%) of central nervous system. Anterior abdominal wall defect 77(24.8%) was the commonest type of malformation seen followed by neural tube defect 63(20.3%) and imperforate anus 31(10.0%). Gastro-intestinal malformations were associated with a mortality rate of 60.9% as compared with 21.1% in those with central nervous system malformations. CONCLUSION: The high prevalence of malformation seen in this study could be associated with the fact that majority (75.4%) of the mothers delivered their babies outside the teaching hospital, whose antenatal care are unknown. The occurrence of congenital malformations is very high in North Eastern Nigeria, Environmental factors may have a role.

A review of preterm admissions into special care baby unit, in University of Maiduguri Teaching Hospital: a four year experience.

There is little or no report of preterm (babies born less than 37 completed weeks of gestation) admission from this part of Sahel Savannah of Nigeria. This study of four-year period is presented to identify areas that require improvement, such as in the Labour ward and neonatal care. The case files of the 428 preterm newborns admitted into Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital were reviewed. Preterms constituted 54.9% of the overall admissions, 53.4% being Low birth weight newborns (=2500 gm). Premature rupture of membrane, previous preterm deliveries, twin gestation and pregnancy induced hypertension were some of the common maternal factors that were associated with preterm deliveries. Birth asphyxia, Apnoea, Small for gestation age 9weight less than 10th centile), respiratatory distress were the main problem observed among the preterm newborns. Neonatal mortality rate was 349/1000 live birth; 62.1% of the death were preterm infants. Mortalities were common among babies weighing 1000 gm or less and also of babies of lower gestational age. We can improve on this, by implementing simple common measures such as educating our mothers on the need for good antenatal care and hospital deliveries, so that those with pregnancy induced hypertension, premature rupture of membrane, previous preterm delivery can be detected early and institute proper management.

Review of neonatal infections in University of Maiduguri Teaching Hospital: common bacterial pathogens seen.

BACKGROUND: Bacterial infections are important causes of morbidity in the neonatal period. Therefore identification of infecting organisms and the risk factors for possible bacterial infection in the newborn is of great importance. Institution early appropriate therapy is an important step in combating morbidity and mortality in this age group. METHODS: Medical records of patients admitted into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital (UMTH) were reviewed over a 5-yaer period (1995-1999) RESULTS: Of the 1,304 newborn admissions over the study period, 813 (62.3%) had risk factors for neonatal infections. Staphyloccus aureus (46.2%) was the predominant organism isolated from blood culture, followed by Klebsiella spp (24.8%). Streptococcus pneumoniae and Pseudomonas are the least encountered in this series. Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pneumoniae were the predominant pathogens in pyogenic meningitis. Most of the delivery occurred outside the teaching hospital, even those that delivered in the hospital, some come in during labour. CONCLUSION: Neonatal bacterial infections are still a cause of high morbidity and mortality of the newborn in our setting. To reduce the morbidity and mortality from neonatal bacterial infections, mothers need to attend antenatal clinic, so that those who at risk can be taken care off immediately.

Perceptions, beliefs and practices of mothers in sub-urban and rural areas towards measles and measles vaccination in Northern Nigeria.

Measles is of particular concern in Nigeria because of the high fatality rate, and high morbidity rate, particularly in young children. Measles and its complications are a common reason for hospitalization, indicating very low immunization coverage. This study was carried out to elucidate the contributing factors from attitudes, beliefs and practices of mothers towards measles and its vaccination. A cross-sectional survey was conducted in Konduga Local Government Area. One per cent of the 500 mothers interviewed believed that measles is prevented by immunization, 16% that it is contagious or due to an infectious agent, 26% that it is caused by evil spirits, witchcraft and heat, and 25% had never heard of measles immunization. Twenty-seven per cent said they did not believe immunization was effective and 4% were not allowed to go for immunization by their husbands. Of those mothers whose children had developed measles, only 31% had been treated in formal health facilities. These results indicate an unfavourable attitude and practice by mothers in relation to measles and measles vaccination. There is the need for an intensive health education campaign to improve this state of affairs and to reduce the morbidity and mortality from measles.

Associated morbidities in children with sickle-cell anaemia presenting with severe anaemia in a malarious area.

A prospective study of 104 consecutive cases of patients with sickle-cell anaemia (SCA) presenting with severe anaemia (packed cell volume < or = 15%) was carried out in the Children's Emergency Ward of the University College Hospital, Ibadan, in 1991. The patients were classified according to the type of anaemic crisis, by physical findings, serum bilirubin and reticulocyte counts. Other investigations included a blood film for malaria parasites, blood culture, radiological investigation and lumbar puncture when necessary. The most common problems associated with SCA patients in anaemic crisis were malaria and bacterial infections--68 (66%) and 18 (17.3%) of cases, respectively. Acute chest syndrome was significantly more frequent in patients with hyperhaemolytic and acute splenic sequestration crisis compared with aplastic crisis (P < 0.05). Conjugated hyperbilirubinaemia was also significantly more frequent among patients with hyperhaemolytic crisis compared with all other anaemic crises (chi2 = 13.18, P = 0.001). The overall case fatality was 86.5/1,000 SCAs, with no fatalities in those with aplastic crisis. There were complications in six of the nine mortalities. Co-existing bacterial infections and conjugated hyperbilirubinaemia were associated with increased morbidity and mortality in patients with anaemic crisis. Patients with SCA crisis should have early evaluation and prompt treatment for associated infections.