Evaluation of Prevention of Mother to Child Transmission Programme at a Tertiary Healthcare Facility in Southwestern Nigeria.

Most children acquire human immunodeficiency virus (HIV) infection through mother-to-child transmission (MTCT). The risk of MTCT of HIV is generally 15%-40% without prophylaxis. MTCT has been responsible for approximately 370,000 infant HIV infections worldwide, with Nigeria accounting for 30% of cases. The study evaluated the effectiveness of a prevention program for MTCT of HIV infection by determining the rate of MTCT of HIV in infants who underwent the program by reviewing health records of mother-infant pairs at the Olabisi Onabanjo University Teaching Hospital. This cross-sectional study conducted over 12 years used medical records of 545 mother-infant pairs. The rate of MTCT of HIV infection was 2.9% in this study compared to 7.1% reported by the center earlier. The rate of MTCT of HIV infection was the lowest among mother-infant pairs who received prophylaxis. Ages at recruitment are a strong determinant of the risk of infection. Late usage of the MTCT prevention service is a risk for HIV infection in exposed infants.

Neurological diseases at the Pediatric Neurology Clinic in a semi-urban Nigerian tertiary hospital.

Neurological diseases in children may be associated with mortality and long-term morbidity when they recover from acute ailments. The pattern of neurological disorders in an outpatient service may highlight the burden of these diseases. The objective of the present study is to describe the pattern of neurological disorders at the Pediatric Neurology Clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. A retrospective analysis of consecutive patients in a Pediatric Neurology Clinic of OOUTH, from 1st January 2011 till 31st December 2014, was carried out. A total of 4,476 patients attended the pediatric outpatient unit. Of these, 433 children had neurological disorders with a prevalence of 9.67%. The most frequent pediatric neurological disorders included seizure disorders (37.7%), cerebral palsy (37.7%), and central nervous system infections with complications (6.2%). The subjects with cerebral palsy were the youngest, while the subjects with seizures were the oldest. This study emphasizes that neurological disease contributes substantially to childhood morbidity in a semi-urban African tertiary hospital.

Pattern of serum bilirubin changes following double volume exchange blood transfusion in neonates at a tertiary health facility in Nigeria.

INTRODUCTION: exchange blood transfusion (EBT) is a form of massive transfusion useful in rapidly reducing serum bilirubin levels, but serum bilirubin levels frequently rebound within hours of completing the procedure, due to equilibration of extravascular bilirubin as well as on-going hemolysis. The study was carried out to determine the pattern of reduction in serum bilirubin levels following EBT among neonates with severe hyperbilirubinemia, as well as the factors contributing to this pattern, so as to establish evidence-based expectations following EBT. METHODS: a retrospective descriptive study covering a two-year period in a Nigerian tertiary hospital. Details of the EBT procedures, including serial serum bilirubin levels, were obtained from the hospital records of all newborn babies who had double volume EBT done for severe hyperbilirubinaemia during the study period. Data was analyzed using the statistical software SPSS version 21.0. RESULTS: the mean total serum bilirubin (TSB) before EBT in the 36 babies was 17.9 ± 6.3 mg/dl. The mean percentage decrease in TSB immediately following EBT was 44.3 ± 10.2%. Six hours after EBT, TSB levels had increased from the immediate post-EBT values by an average of 57.5 ± 32.2%. Twenty-four hours after the procedure, TSB values in most (87.1%) cases were still higher than the immediate post-EBT values, but lower than the pre-EBT values. Post-EBT anemia was recorded among 33.3% of the babies. CONCLUSION: EBT is effective in rapidly reducing serum bilirubin levels and preventing acute bilirubin encephalopathy in neonates with severe hyperbilirubinemia, despite the rebound increase that occurs in TSB values after the procedure.

Clitoral sizes and anogenital distances in term newborns in Nigeria.

BACKGROUND: Previous studies suggest significant ethnic and racial differences in clitoral sizes and anogenital distances in the newborn. This study aimed to document normative data on clitoral sizes and anogenital distances of apparently normal term female infants in Sagamu. METHODS: The study was a multi-center, cross-sectional descriptive research carried out among 317 female term infants within the first 72 h of life. Interviewer-based questionnaire was applied to obtain sociodemographic data, pregnancy and birth history. A sliding digital caliper was used for measurement. Data analysis was with SPSS version 20.0. RESULTS: The mean clitoral length was 6.7 ± 1.6 mm while the mean clitoral width was 5.6 ± 0.8 mm. The mean fourchette-clitoris distance, anus-clitoris distance and anus-fourchette distance were 21.9 ± 2.1 mm, 35.5 ± 2.5 mm and 17.0 ± 2.6 mm respectively. The anus-clitoris and anus-fourchette distances significantly correlated with the anthropometric parameters while the clitoral measurements did not. CONCLUSION: The mean values recorded in this study were higher than observed in most previous studies. This simple, affordable and non-invasive evaluation could aid early diagnosis and treatment of female infants with potentially harmful conditions such as congenital adrenal hyperplasia.

Normative data on penile and anogenital measurements of term male infants in Sagamu, Nigeria.

AIM: To document normative data on penile size and anogenital distances of apparently normal term male infants in Sagamu, Nigeria. METHODS: This cross-sectional study was carried out on 303 term male infants within the first 72 hours of life. Stretched penile length, penile width and three measures of anogenital distances were recorded: anogenital distance-1, anogenital distance-2 and anoscrotal distance. RESULTS: The mean (±SD) stretched penile length and penile width were 39.4 ± 4.2 mm and 11.0 ± 1.0 mm, respectively. The mean values for anogenital distance-1, anogenital distance-2 and the anoscrotal distance were 48.7 ± 3.9 mm, 42.8 ± 4.6 mm and 25.5 ± 3.9 mm, respectively. Only penile width and anogenital distance-1 significantly correlated with all the anthropometric parameters but anogenital distance-1 had the strongest correlation (p < 0.01 for all). CONCLUSION: The observed mean stretched penile length was greater than previously reported. Local references are preferable in interpreting anogenital measurements in newborns to avoid diagnostic errors. There is need for a consensus on the definition of micropenis.

Factors associated with clinical outcomes among neonates admitted with acute bilirubin and hypoxic-ischaemic encephalopathies at a tertiary hospital in south-west Nigeria

Background:Babies who are delivered outside hospital are most at risk of serious illnesses such as perinatal asphyxia and severe hyperbilirubinaemia. These conditions are major contributors to neonatal mortalities in resource-poor settings. Objective: To explore the relationship between pre-admission and intra-facility care and immediate outcomes among neonates with acute bilirubin and hypoxic-ischaemic encephalopathies. Methods: Using a retrospective design, the outcome of outborn babies with acute bilirubin encephalopathy (ABE) and hypoxic-ischaemic encephalopathy (HIE) were studied in a Nigerian hospital between 2012 and 2016. Results: A total of 40 and 80 babies with ABE and HIE were studied. Among babies with ABE, 67.5% arrived at the hospital on self-referral and of the babies with official referral, only 61.5% had had a serum bilirubin check prior to referral. Among the babies with ABE, 25.0% had both social and facility-related challenges, 45.0% had only facility-related challenges and 20.0% had only social challenges. All the babies with ABE who died had either social or facility-related challenges. For the babies with HIE, 56.2% came on self-referral while 70% received no care prior to presentation at the hospital. Some 40% of babies with HIE had both social and facility-related challenges while 12.5% had only facility-related challenges. None of the babies who died presented early. Comparable proportions of babies who died or survived had social challenges and facility-related challenges. Conclusion: Most of the outborn babies with HIE and ABE who arrived at the hospital on self-referral and facility-based care were hindered by social issues and facility-related challenges

Does infant feeding method influence the incidence and pattern of morbidities among human immunodeficiency virus-exposed uninfected nigerian infants?

BACKGROUND: Human immunodeficiency virus (HIV)-exposed infants enrolled into the prevention of mother-to-child transmission of HIV program generally receive antiretroviral therapy (ARV), but the feeding methods differ based on several socioeconomic and cultural differences. OBJECTIVE: The objective of the study was to examine the incidence and pattern of morbidities among HIV-exposed uninfected (HEU) Nigerian infants and determine any relationship with infant feeding methods. METHODS: A review of the hospital records of all HEU infants attending the Virology Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between July 2013 and June 2015, was done. The recorded data included biodemographic profile, social parameters, feeding methods, anthropometry, and morbidities. The feeding method groups were statistically compared in relation to the various morbidities. RESULTS: Out of 119 children, 81.5% were exclusively breastfed, whereas 18.5% had exclusive breast milk substitute feeding. About half had various morbidities which included upper airway infections (UAIs) (16.8%), malaria (15.9%), malnutrition (8.4%), diarrhea (8.4%), and pneumonia (2.5%). The frequencies of these conditions were similar among infant groups irrespective of feeding method. The infants with and without morbidities were comparable in terms of the frequency of exclusive breastfeeding (80.3% vs. 82.8%). Low family socioeconomic status (SES) (odds ratio [OR] = 7.7) and ARV use (OR = 0.4) among infants were predictors of morbidities among HEU infants. CONCLUSION: The incidence and pattern of morbidities among HEU infants showed no relation to the mode of feeding. Rather, family SES and the use of antiretroviral drugs were predictors of morbidities among HEU infants.

Infantile hypertrophic pyloric stenosis with unusual presentations in Sagamu, Nigeria: a case report and review of the literature.

A 24-day old female Nigerian neonate presented with protracted vomiting, fever and dehydration but without palpable abdominal tumour or visible gastric peristalsis. There was no derangement of serum electrolytes. The initial working diagnosis was Late-Onset Sepsis but abdominal ultrasonography showed features consistent with the diagnosis of IHPS. This case report highlights the atypical presentation of this surgical condition and the need to investigate cases of protracted vomiting in the newborn with at least, ultrasonography to minimize complications and reduce the risk of mortality in a resource-poor setting.

Risk factors for mortality in neonatal tetanus: a 15-year experience in Sagamu, Nigeria.

BACKGROUND: Neonatal tetanus (NNT) is a major cause of newborn deaths especially in the developing world. While efforts aimed at eradicating NNT should be sustained, it is equally imperative to reduce death among affected infants. Therefore, the factors associated with mortality rate in this condition need to be studied. METHODS: The records of infants with NNT over a 15-year period (1991-2005) were reviewed. A statistical comparison of the survivors and fatalities for relevant clinical characteristics was done, and the determinants of fatality rate were also determined using logistic regression. RESULTS: Ninety-six of 151 newborns with NNT died, giving a mortality rate of 63.6%. The case fatality rate during the study period varied between 33.3% and 100%. More deaths occurred in the infants with low birth weight (P=0.004) within 1 day at the onset of symptoms (P<0.001), whose mothers aged 18 years or less (P=0.001) belonged to socio-economic class V (P=0.001). Determinants of mortality in these infants with NNT included low socio-economic class (P=0.002), no antitetanus vaccination (P=0.006), presentation with spasms (P<0.001), and non-administration of anti-tetanus serum during treatment (P=0.013). CONCLUSIONS: The mortality rate in infants with NNT remains signifi cantly high in Nigeria. Improved maternal anti-tetanus vaccination and timely recognition and treatment of affected infants may jointly reduce the incidence and fatality rate of NNT.

Neonatal tetanus in the babies of Nigerian mothers immunised against Tetanus.

The objective of this study was to describe the clinical characteristics of babies with neonatal tetanus (NNT) whose mothers were immunised against tetanus and determine the outcome of their hospitalisation. The hospital records of babies affected by NNT whose mothers received at least two doses of anti-tetanus vaccine during pregnancy were identified and compared with similarly affected babies whose mothers were not immunised against tetanus during pregnancy in a Nigerian hospital. Out of 175 cases of NNT, the mothers of 24 (13.7%) babies were immunised against tetanus during pregnancy while the mothers of 151 (86.3%) were not. The proportions of babies of immunised mothers and unimmunised mothers who presented within the first three days of life, within a day of the onset of symptoms and with spasms were similar. Nevertheless, the survival rate was higher (62.5% vs. 26.5%; P = 0.0004) among babies of immunised mothers. Despite similarities in clinical presentation of babies of mothers with and without anti-tetanus vaccination, the survival rate was higher for the former.