Where have all the parasites gone? Unusual Plasmodium falciparum monoparasitaemia in a cross-sectional malariometric survey in northern Nigeria.

Background: Malaria is caused by one of five currently known Plasmodium parasite species causing disease in humans. While modelling has provided information of the vector, the same is not entirely the case for the parasite. The World Malaria reports of 2014 to 2016 reported 100% of confirmed cases from Nigeria being due to Plasmodium falciparum. Generally, about 98% of cases of uncomplicated malaria in most regions surveyed in Nigeria recently is due to P. falciparum, with the remainder being due to P. malariae. This study aimed to determine the proportions of Plasmodium parasites causing uncomplicated malaria in Wamakko Local Government Area of Sokoto State, north-western Nigeria. Methods: The study was a descriptive, cross-sectional study conducted during the rainy season and dry season in north-western Nigeria. The area has a 'local steppe' climate and Sudanian Savannah vegetation. Sampling was via multistage cluster sampling. Selected participants were examined for pallor, palpable splenomegaly and signs of complicated malaria. Blood samples were also taken for rapid diagnosis of malaria and thick and thin films to identify parasitaemia and the parasite species. Participants found to have malaria were treated with Artemether/Lumefantrine and those with complicated malaria were referred to the nearest hospital.  Results: We found a parasite prevalence of 34.8% overall, which was higher in the rainy season (49.3%) than in the dry season (20.2%). There was monoparasitaemia of Plasmodium falciparum throughout the study area, irrespective of the clinical status of the participant. Mapping of the parasite was extended throughout the Local Government Area and the State. Conclusions: Despite the intermediate endemicity in the area. P. falciparum monoparasitaemia affirms theories of disappearance of other parasite species, either due to faltering control of P. falciparum or more efficient control of other species.

Factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria.

INTRODUCTION: When breast milk alone is no longer sufficient to meet a child's nutritional needs, foods other than breast milk are introduced gradually into the baby's diet, first to complement breast feeding and progressively to replace it and get the child used to adult diet. This study aimed to assess the factors influencing complementary and weaning practices among women in rural communities of Sokoto state, Nigeria. METHODS: It was a cross-sectional study. Using a multi-staged sampling technique, 296 mothers of children 6-24 months were recruited. Data was collected using a pretested structured questionnaire and analyzed using IBM SPSS version 20. Chi square test was used to test associations between categorical variables. Binary logistic and multinomial regression was used to compute the determinants of complementary and weaning practices. The level of significance was set at p < 0.05. Ethical approval was obtained from the State Ethical Committee. RESULTS: Timely introduction of complementary feeds was commenced in 54% of the children. Only 6.2% weaned their children at 6 months; 90.5% weaned their children gradually and 63.5% bottle fed. Factors influencing complementary and weaning practices was found to be child's age; maternal age and family setting. CONCLUSION: The respect of World Health Organization (WHO) recommendations on complementary and weaning practices was suboptimal. It was also evident from this study that complementary and weaning practices were influenced by maternal and house-hold factors. It is therefore important to develop interventions aimed at bridging the gap between these practices in rural settings and WHO recommendations.

Foetal congenital anomalies: An experience from a tertiary health institution in north-west nigeria (2011-2013).

BACKGROUND: Structural or functional defects present at birth may lead to physical or mental disabilities. They contribute significantly to perinatal morbidity and mortality. AIMS AND OBJECTIVES: The study aimed to determine the prevalence of congenital anomalies among women delivering in the labour room suites of a tertiary health institution in North-Western Nigeria. Various maternal risk factors were also correlated and analysed. SUBJECTS AND METHODS: This was a 3-year hospital-based prospective study carried out in the Department of Obstetrics and Gynaecology in association with the Department of Paediatrics in a tertiary health care centre in North-Western Nigeria. All neonates delivered in the labour rooms were examined for congenital abnormalities (CAs) soon after birth. The study group included all live births along with stillbirths delivered after the 28th week of gestation. Those diagnosed with congenital anomaly were admitted to the special care baby unit for observation and documentation. RESULTS: A total of 72 congenital anomalies were documented among 10,163 deliveries. Central nervous system (CNS) anomalies had the highest prevalence 34.7% (25/72) and were followed by those of the musculoskeletal system 22.2% (16/72). Spina bifida/meningocoele were the most common anomalies of the CNS 44% (11/25) followed by hydrocephaly 28% (7/25). Most of the anomalies involved single organs 59/72 (81.9%). Majority of the CA 84.7% (61/72) were prevalent within the maternal age range of 16-35 years, while 12.5% were seen in teenage pregnancy. Diagnosis of most of the anomalies was made after delivery 69.4% (50/72). History of maternal febrile illness during pregnancy was present in 75% (54/72) and in 50% (27/54) of cases with CNS anomaly. CONCLUSION: Central nervous system anomalies were the most prevalent congenital anomalies observed. Improved maternal health, pre-conception care, folic acid supplementation and routine foetal anomaly scan may help to reduce these anomalies.

Fetal outcome following cesarean section in a university teaching hospital.

OBJECTIVE: To evaluate fetal outcome for the various indications for cesarean section. METHODOLOGY: A review of all cases of cesarean section that were done in the maternity unit at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between January 2006 and April 2007, with emphasis on indications and perinatal outcome. RESULTS: There were 2562 total deliveries within the study period and 112 perinatal deaths giving a perinatal mortality rate of 43.7 per 1000 live births. Cesarean section accounted for 216 of the deliveries (8.4%) with 24 perinatal deaths (11.1%). Perinatal mortality from Cesarean sections accounted for 21.4% of the total deaths with severe birth asphyxia responsible for most perinatal deaths, 17 of 24 (70.8%). There were 174 emergency sections with 22 perinatal deaths, while 42 elective sections had 2 perinatal deaths. The main indications for cesarean section were cephalopelvic disproportion, 86 (39.8%); previous section plus an obstetric abnormality, 39 (18.1%); and prolonged obstructed labor, (10.2%), with perinatal deaths of 3, 2 and 1, respectively. CONCLUSIONS: The perinatal mortality among the cesarean deliveries were 11.1%, and the main cause of death was severe birth asphyxia. Emergency cesarean section was more likely than elective to result in a perinatal loss. The indication with the poorest fetal outcome was prolonged obstructed labor.

Pattern of pediatric HIV/AIDS: a five-year experience in a tertiary hospital.

OBJECTIVES: to determine the mode of transmission, clinical presentation and the outcome in children with HIV/AIDS at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. METHODOLOGY: a five-year retrospective study of children with HIV/AIDS from January 2001 to December 2005. Screening was based on World Health Organization criteria. Confirmation of HIV seropositivity was from a positive ELISA and then a western blot assay. RESULTS: 10,107 children were admitted over the said five-year period; 1,359 died, giving a mortality rate of 13.5%. Eight-hundred-forty (8.3%) of the admitted children had HIV/AIDS; 305 (36.3%) died. Mother-to-child transmission accounted for the highest mode of transmission, 794(94.5%). There were 44 (5.3%) cases of unidentified route of infection and two (0.2%) cases of sexual abuse in males aged 11 and 13 years. Fever (81.3%), diarrhea (75.0%), vomiting (41.4%), difficulty in breathing (39.8%) and refusal of feeds (39.8%) were the commonly encountered clinical features. Septicemia (49.5%) and acute respiratory tract infections (40.9%) were the major admitting diagnoses and major causes of deaths. Deaths from HIV infection accounted for 22.4% of the total deaths for the study period. CONCLUSIONS: Mother-to-child transmission of HIV is still high in the area of study, and pediatric HIV/AIDS remains a significant cause of childhood morbidity and mortality. Present efforts to strengthen and sustain prevention of mother to child transmission are highly encouraged. Advocacy for protection of children against sexual abuse should be strengthened.