Infant Care Practices at Home in the First Weeks of Life in Ibadan, South-West Nigeria.

BACKGROUND: The World Health Organization recommends essential newborn care, which includes components that should be provided at home and in the community, to improve newborn outcomes. This study was carried out to assess infant care practices at home in the first week of life and how they conform to the provisions of essential newborn care. METHODS: A total of 678 mothers who delivered their babies at Adeoyo Maternity Hospital, Ibadan were visited at home between the 8th and 10th days of delivery. Information on infant care practices with respect to hygiene, feeding, provision of warmth, eye care, cord care, immunization and health seeking behaviour was obtained. RESULTS: Only 9.3% of the mothers washed their hands always before handling their babies, 83.3% did sometimes and 94.0% did so after diaper change. Breastfeeding was the first feed given by 93.8% of mothers, but only 21.6% of them started within one-hour of life. At the end of the first week, 71.2% were still breastfeeding exclusively. Only 16.6% of mothers bathed their newborns on the first day of life. To keep newborns warm, 82.0% shut their windows all day, and 9% lit kerosine-wick lanterns indoors. Mothers used alcohol (97.2%) and breastmilk drops (18.2%) for umbilical cord and eye care, respectively. Only 58.6% and 14.5% of babies had received any vaccination or had postnatal visit, respectively. CONCLUSION: Infant care practices at home for newborns in Ibadan did not substantially conform to the provisions of essential newborn care and many practices were harmful. The need for supportive supervision in addition to health education for essential newborn care is indicated.

CONTEXTE: L'Organisation mondiale de la santé recommande des soins essentiels pour les nouveau-nés, qui comprennent des éléments qui devraient être fournis à domicile et dans la communauté, afin d'améliorer les résultats des nouveau-nés. Cette étude a été menée pour évaluer les pratiques de soins aux nourrissons à domicile au cours de la première semaine de vie et leur conformité aux dispositions des soins essentiels aux nouveau-nés. MÉTHODES: 678 mères ayant accouché à la maternité d'Adeoyo, Ibadan, ont été visitées à leur domicile entre le 8e et le 10e jour de l'accouchement. Des informations sur les pratiques de soins du nourrisson en matière d'hygiène, d'alimentation, d'apport de chaleur, de soins oculaires, de soins du cordon, de vaccination et de comportement de recherche de santé ont été obtenues. RÉSULTATS: Seulement 9,3% des mères se lavaient toujours les mains avant de manipuler leur bébé, 83,3% le faisaient parfois et 94,0% le faisaient après le changement de couche. L'allaitement maternel était le premier aliment donné par 93,8% des mères, mais seulement 21,6% d'entre elles ont commencé dans l'heure qui suit la naissance. A la fin de la première semaine, 71,2% étaient encore en train d'allaiter exclusivement. Seuls 16,6 % des mères ont donné un bain à leur nouveau-né le premier jour de sa vie. Pour garder les nouveau-nés au chaud, 82,0% fermaient leurs fenêtres toute la journée et 9% allumaient des lanternes à mèche de kérosène à l'intérieur. Les mères utilisaient de l'alcool (97,2%) et des gouttes de lait maternel (18,2%) pour les soins du cordon ombilical et des yeux, respectivement. Seuls 58,6% et 14,5% des bébés avaient reçu une vaccination ou une visite postnatale, respectivement. CONCLUSION: Les pratiques de soins à domicile pour les nouveaunés à Ibadan n'étaient pas essentiellement conformes aux dispositions des soins essentiels pour les nouveau-nés et de nombreuses pratiques étaient néfastes. La nécessité d'une supervision de soutien en plus de l'éducation sanitaire pour les soins essentiels aux nouveau-nés est indiquée. Mots clés: Soins aux nourrissons ; Domicile; Nouveau-nés; Première semaine; Communauté.

Ultrasonographic Hepatosplenic Parenchymal and Blood Flow Changes in Children with Acute Falciparum Malaria.

BACKGROUND: Malaria, a major cause of morbidity and mortality in Nigerian children, is associated with biochemical, haematological, blood flow and clinical multiorgan changes, including changes in the spleen and the liver. OBJECTIVES: To investigate hepatosplenic pathologies in a Nigerian children cohort with acute P. falciparum malaria. METHODS: A prospective case-control study of 260 children (65 uncomplicated malaria (UCM),65 complicated malaria (CM) cases and 130 controls) aged six months to six years. All subjects had laboratory tests and hepatosplenic parenchymal and blood-flow ultrasonographic evaluation. RESULTS: Mean splenic length was 8.13cm (95% CI: 7.84cm, 8.41cm) and 7.42cm (95% CI: 7.13cm, 7.71cm) in CM and UCM (p=0.001) respectively, liver span was significantly different in controls and CM (p<0.001); controls and UCM (p=0.014). Portal vein flow velocity was 32.5cm/s, 25.4cm/s and 26.5cm/s in controls, UCM and CM (p=<0.001 and 0.004 respectively) while splenic flow velocity was 30.7cm/s and 25.8cm/s in controls and CM (p=0.022). Splenic artery peak systolic velocity (PSV) =73.78cm/s, 66.52cm/s and 59.35cm/s (p = 0.008) among controls, UCM and CM respectively. There was significant correlation between malaria parasite (MP) density and splenic length (r =0.239, p = 0.007), splenic artery pulsatility index (PI) (r = 0.300, p = 0.001), splenic artery resistivity index (RI) (r = 0.260, p = 0.003) and liver span. CONCLUSION: In children with acute malaria, the splenic vessels and portal vein blood flow velocities were reduced. High malaria parasite density evokes direct relationship with spleen and liver span, splenic artery RI and PI and portalvein diameter.

CONTEXTE: Le paludisme, une cause majeure de morbidité et de mortalité chez les enfants nigérians, est associé à des modifications biochimiques, hématologiques, de la circulation sanguine et de plusieurs organes cliniques, y compris des modifications de la rate et du foie. OBJECTIFS: Étudier les pathologies hépatospléniques dans une cohorte d'enfants nigérians atteints de paludisme aigu à P. falciparum. MÉTHODES: Une étude prospective cas-témoins de 260 enfants, 65 cas de paludisme simple (UCM), 65 cas de paludisme compliqué (CM) et 130 témoins) âgés de six mois à six ans. Tous les sujets ont subi des tests de laboratoire et une évaluation parenchymateuse hépatosplénique et échographique du flux sanguin. RÉSULTATS: La longueur splénique moyenne était de 8,13 cm (IC à95%: 7,84 cm, 8,41 cm) et 7,42 cm (IC à 95%: 7,13 cm, 7,71 cm) en CM et UCM (p = 0,001) respectivement, la contrôles et CM (p<0,001); contrôles et UCM (p = 0,014). La vitesse d'écoulement de la veine porte était de 32,5 cm / s, 25,4 cm / s et 26,5 cm / s chez les témoins, UCM et CM (p = <0,001 et 0,004 respectivement) tandis que la vitesse d'écoulement splénique était de 30,7 cm / s et 25,8 cm/ s chez les témoins et CM (p = 0,022). Vitesse systolique maximale de l'artère splénique (PSV) = 73,78 cm / s, 66,52 cm / s et 59,35 cm /s (p = 0,008) parmi les témoins, UCM et CM respectivement. Il y avait une corrélation significative entre la densité du parasite du paludisme (MP) et la longueur splénique (r = 0,239, p = 0,007), l'indice de pulsatilité de l'artère splénique (IP) (r = 0,300, p = 0,001), l'indice de résistivité de l'artère splénique (RI) (r = 0,260, p = 0,003) et la durée hépatique. CONCLUSION: Chez les enfants atteints de paludisme aigu, les vaisseaux spléniques et la vitesse du flux sanguin de la veine porte ont été réduits. Une densité parasitaire élevée du paludisme évoque une relation directe avec la rate et le foie, l'artère splénique RI et PI et le diamètre de la veine porte. MOTS CLÉS: Paludisme aigu à falciparum, foie, rate, circulation sanguine, échographie.

Obesity Affects Health-Related Quality of Life in Schools Functioning Among Adolescents in Southwest of Nigeria.

BACKGROUND: The relationship between body mass index (BMI) and health-related quality of life (HRQoL) in adolescence is important but there is a dearth of this information among developing countries such as Nigeria. To assess the relationship between BMI and HRQoL among healthy schooling adolescents in Southwestern Nigeria. AIMS: We assessed the relationship between BMI and HRQoL among healthy schooling adolescents in southwestern Nigeria. METHODS: In a cross-sectional study design, 650 adolescents were selected and interviewed about their quality of life in the preceding 1 month using a validated instrument with contents adapted from the Pediatric Quality of Life Inventory (PedsQLTM) questionnaire. The BMI was calculated and plotted on the Center for Disease Control and Prevention percentile chart to categorize as underweight, normal, overweight, or obese. Comparisons were made using Student's t-test, ANOVA, and linear regression model at P = 0.05. RESULTS: Participants mean BMI and overall HRQoL score was 19.0 ± 3.0 kg/m2 and 73.7 ± 11.7, respectively. The prevalence of underweight, overweight, and obesity was 6.9%, 2.3%, and 0.6%, respectively. Females (72.3 ± 12.2) had a significantly lower overall mean HRQoL score than males (75.0 ± 11.1), P = 0.048. Post-hoc ANOVA showed that obese adolescents had significantly lower mean HRQoL in school functioning domain (55.0 ± 20.8) than underweight (83.5 ± 14.), and normal BMI (81.3 ± 16.3) participants (P < 0.05). CONCLUSION: Obesity reduces HRQoL in the school functioning domain among adolescents in Ibadan, Nigeria. Our finding buttresses the need to monitor body mass and size in high schools for enhancing quality of life.

Comparative evaluation of three histidine-rich Protein-2 based rapid diagnostic tests, microscopy and PCR for guiding malaria treatment in Ibadan, Southwest Nigeria.

BACKGROUND: Malaria rapid diagnostic tests (mRDTs) are the preferred option for programmatic deployment. AIMS: There are numerous mRDTs on the Nigerian market and there is a need to guide practitioners on the relative performance of the commonly used brands of mRDT in Nigeria. SUBJECTS AND METHODS: The performance of three commonly used Histidine-Rich-Protein-2-based mRDTs (SD-Bioline™, Carestart™ and Paracheck-Pf™) against microscopy of Giemsa stained blood and polymerase chain reaction (PCR) was evaluated among 190 febrile under-5 children in Ibadan, Nigeria. We calculated the sensitivity, specificity, predictive values, accuracy, and agreements. RESULTS: There were 53.2% males. The prevalence of malaria parasite by microscopy was 46.8% and 57.9% by PCR. Malaria parasite detection by SD-Bioline™ was 60.5%, Carestart™: 60.0% and Paracheck-Pf™ 60.0%. Using microscopy as the gold standard, the sensitivities of SD-Bioline™, Carestart™ and Paracheck-Pf™ mRDT were 97.8%, 96.7% and 97.8% respectively while the specificities were 73.0%, 72.0% and 74.0% respectively. Using PCR as the gold standard, the sensitivity for both SD-Bioline™ and Paracheck-Pf™ was 85.5% and for CareStart was 84.6% while the specificity of SD-Bioline™, Carestart™, and Paracheck-Pf™ was 73.8%, 72.4%, and 75.0% respectively. The test accuracy was 81.0% for both SD-Bioline™ and Paracheck-Pf™ and 80.0% for Caresatrt™. The kappa coefficient of agreement between PCR and each of SD-Bioline™, Carestart, ParaCheck™ and microscopy was 0.597, 0.578, 0.609 and 0.739 respectively. CONCLUSION: The performance of the three mRDTs is a proof that any of the three is suitable for use in the diagnosis of malaria in the southwest of Nigeria.

Sex-specific prevalence and trends in acute respiratory infection episodes among children less than 5 years in Nigeria.

BACKGROUND: Biological sex is an important factor that influences childhood morbidity and mortality but its role in acute respiratory infections (ARI) in children is not well understood. We investigated the trends in sex-specific prevalence of childhood ARI episodes and associated factors in Nigerian children from 1990 to 2013. METHODS: This secondary analysis used data from the Nigerian Demographic Health Surveys (NDHS) collected in 1990, 1999, 2003, 2008 and 2013. Variables extracted include: two ARI-related questions, household characteristics, children's anthropometry and vaccination status. We defined ARI as maternal report of cough accompanied by short, rapid breathing. Univariate and bivariate analyses were carried out to estimate prevalence of suspected ARI and compared between male and female children. RESULTS: We found an initial increase followed by a decreasing trend in prevalence of ARI-related symptoms among under-5 children; from 6.7% in 1990 to 11.6% in 1999 then to 3.8% in 2013 without consistent sex differences regardless of other factors except malnutrition. In the 2003 survey, more male than female children had ARI among underweight [OR = 1.22 (95% CI: 1.04, 1.43)] and stunted [OR = 1.23 (95% CI: 1.07, 1.43)] children. Similarly, the 2008 survey showed that more male (5.8%) than female (5.4%) children in the wasted category had ARI [OR = 1.13 (95% CI: 1.07, 2.01)]. The highest prevalence of suspected ARI was consistently recorded in the North-East region. CONCLUSION: The Nigeria Demographic Health Surveys demonstrated no consistent sex differences in burden and trends of childhood pneumonia-like episodes over a 24-year period. Malnutrition has some influence on the burden of ARI-related symptoms.

Predictors of hypoxaemia during steady-state among children with Sickle Cell Anaemia in North-Western Nigeria.

UNLABELLED: Abstract BACKGROUND: Haemoglobin desaturation, which presents as hypoxaemia, is a known phenomenon in the cycle of red blood cells sickling in sickle cell anaemia (SCA). Thus, early and accurate recognition of hypoxaemia is important in order to ameliorate its adverse effects on vital organs. This study was carried out to investigate clinical and laboratory features that predict hypoxaemia in children with SCA during steady-state. METHODS: We prospectively measured percutaneous haemoglobin saturation of 208 children with SCA in room air during steady-state at a secondary health facility in the north-west of Nigeria. Demographic, clinical and laboratory features and anthropometry were recorded. Hypoxaemia was defined as haemoglobin saturation < 90%. Chi square test and logistic regression were used to assess the associations of selected factors with hypoxaemia. RESULTS: Participants comprised 132 males and 76 females and their age ranged from 9 to 168 months. Prevalence of hypoxaemia was 17.3%. Though hypoxaemia was significantly associated with age, time of first symptom to presentation, body mass index (BMI), weight-for-height z-score < 2.0, tachycardia, chest retraction and palpable spleen, age (OR = 0.78; 95% CI = 0.62, 0.96), time of first symptom to presentation (OR = 1.28; 95% = 1.03, 1.59), BMI (OR = 0.87; 95% = 0.76, 0.92) and palpable spleen (OR = 2.87; 95% CI = 1.43, 16.65) remained independent predictors in the logistic regression model. CONCLUSION: Careful consideration should be given to time of first symptom to presentation, body mass index and palpable spleen when evaluating children with sickle cell anaemia for hypoxaemia in resource limited settings.

Development and validation of the Ibadan Simplified Developmental Screening chart.

Background: Developmental assessment remains an integral part of the routine evaluation of the wellbeing of every child. Children in resource-poor countries are not routinely assessed for signs of developmental delay and developmental disorders are frequently overlooked. A major gap exists in the availability of culturally appropriate and cost-effective developmental screening tools in many low and middle income countries (LMICs) with large populations. Objective: To bridge the existing gap, we describe the process of the development and validation of the Ibadan Simplified Developmental Screening (ISDS) chart, for routine developmental screening in Nigerian children. Methods: We developed an item pool across 4 domains of development namely, the gross motor, vision-fine motor, communication and socio-behavioural domains. The ISDS chart consists of 3-4 item questions for each domain of development, and responses are to be provided by the caregiver. Each chart is age-specific, from 6 weeks to 12 months. A total score derived from the summation of the scores in each domain are plotted on the ISDS scoring guide with a pass or fail score. Each child was evaluated by the Ages and Stages Questionnaire as the standard. Results: A total of 950 infants; 453 males and 497 females were enrolled. The estimates of internal consistency between the two instruments ranged between 0.7-1.0. Using the ASQ as the gold standard, the ISDS chart demonstrated a sensitivity of 98.8%, 78.4% and 99.7% in the gross motor, communication and the social and emotional domains respectively, for detecting infants who might require further assessment for developmental delays. Conclusion: The indigenous tool fills a major gap in the need for cost-effective interventions for developmental monitoring in LMICs. Future work should include the deployment of the tool in the wider population, using digital health approaches that could underpin policy making in the region.

Electrocardiographic features in children with severe falciparum malaria at the University College Hospital, Ibadan.

Introduction: The high burden of Malaria morbidity and mortality in children is due to its potential to cause multi-organ dysfunction. There is however limited information on the specific electrocardiographic features in falciparum malaria in paediatric age group. Aim: To investigate the electrocardiographic (ECG) features in children with (complicated) severe falciparum malaria (SM) and acute uncomplicated malaria (AUM) at the University College Hospital, Ibadan. Methods: This was a comparative cross-sectional study conducted among 398 children with symptomatic and confirmed Plasmodium falciparum malaria and apparently healthy controls. The frequencies of ECG features were described and compared among these children. Results: The prevalence of ECG abnormality was 79.7% and 63.2% in Severe Malaria SM and Acute uncomplicated malaria AUM patients, respectively. Sinus tachycardia was significantly more frequent in SM than AUM and control groups (p <0.001). The risk of an ECG abnormality was about three times higher in SM than healthy children (p<0.001; OR=2.89;95%CI[1.68,4.99). Conclusion: Severe malaria patients had significant ECG abnormalities (Sinus Tachycardia).

Introduction: Le fardeau élevé de la morbidité et de la mortalité du paludisme chez les enfants est dû à son potentiel de provoquer un dysfonctionnement de plusieurs organes. Il existe cependant des informations limitées sur les caractéristiques électro cardiographiques spécifiques du paludisme à falciparum dans le groupe d'âge pédiatrique. Objectif de l'étude: Étudier les caractéristiques électro cardiographiques (ECG) chez les enfants atteints de paludisme à falciparum sévère (compliqué) et de paludisme aigu non compliqué (AUM) dans l'hôpital du collège universitaire d'Ibadan. Méthode de l'étude: Il s'agissait d'une étude transversale comparative menée auprès de 398 enfants atteints de paludisme à plasmodium falciparum symptomatique et confirmé et de témoins apparemment sains. Les fréquences des caractéristiques ECG ont été décrites et comparées chez ces enfants. Résultat de l'étude: La prévalence des anomalies de l'ECG était de 79,7 % et 63,2 % chez les patients atteints de paludisme grave SM et de paludisme aigu non compliqué AUM, respectivement. La tachycardie sinusale était significativement plus fréquente dans les groupes SM que dans les groupes AUM et témoin (p <0,001). Le risque d'anomalie de l'ECG était environ trois fois plus élevé chez les SM que chez les enfants sains (p<0,001; OR=2,89; IC95 %[1,68, 4,99]). Conclusion: les patients atteints de paludisme grave présentaient des anomalies significatives de l'ECG (tachycardie sinusale).

Challenges of caregivers and needs of children with parents in a Nigerian prison.

Background: Separation of a parent from the family as a result of incarceration has both short-term and long-term effects on the family, even after release from prison. This study is a report of factors and challenges of the family left to adapt to the changed circumstances of separation from parent(s) who are incarcerated. Methods: This was a cross sectional study carried out on 89 caregivers of children whose parents are incarcerated at the Agodi prison, Ibadan who gave informed and written consent to interview their families. Results: Most caregivers had little or no formal education (69.7%) and 67.4% are into petty trading or subsistence farming. A majority of the caregivers reported the need of schooling (85.4%), provision of food (84.3%) and medical care (71.9%) as major challenges, only 25% received any form of support to meet these needs. Twenty-nine (32.6%) respondents reported receiving financial support to provide for the child's feeding. Some caregivers 21 (23.6%), obtained loans to cope with the financial needs of the children while only 3 (3.4%) received support from family or other non-governmental organisations. Conclusion: The caregivers of children of prison inmates face significant challenges in meeting the needs of feeding, health and schooling. Support structures and policies to address these gaps are required.

Co-existing sickle cell anaemia and inflammatory bowel disease: case report and review of the literature.

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

Prevalence of dermatological lesions in hospitalized children at the University College Hospital, Ibadan, Nigeria.

OBJECTIVE: Skin disorders constitute a significant proportion of consultations in children's clinics; however, there is a paucity of data on the prevalence of dermatological lesions in hospitalized children in Nigeria. This study determines the prevalence of dermatological lesions in hospitalized children. MATERIALS AND METHODS: In this cross-sectional study, 402 children aged three months to twelve years admitted in the Pediatric wards of the University College Hospital, Ibadan, were enrolled over a six-month period. Examination of the skin and its appendages was done for each patient. Data on the socioeconomic status, hygiene, and health-related factors were also obtained using a structured questionnaire. RESULTS: Over 96% of the children had at least one identifiable skin lesion. The five leading skin lesions were post-inflammatory hyperpigmentation (49.5%), BCG scar (28.4%), Mongolian spots (27.1%), junctional melanocytic nevi (20.1%), and cafι-au-lait macules (18.4%). The leading infectious skin disease was pyoderma (13.4%), followed by tinea capitis (6.7%). Scarification marks (P=0.001), tinea capitis (P=0.014), plantar fissuring (P=0.001), and impetigo (P=0.016) were associated with low socioeconomic classes, while the presence of BCG scar (50.0%) was associated with the high socioeconomic class. CONCLUSIONS: This study shows that dermatologic lesions are common in hospitalized children. Identifying them will provide an opportunity for pediatricians to educate parents on the various causes as well as prevention of lesions.

PERSISTENCE OF PLASMODIUM FALCIPARUM HRP2 ANTIGEN AFTER EFFECTIVE ANTIMALARIAL THERAPY.

Introduction: Histidine Rich Protein 2 based (HRP2-based) malaria rapid diagnostic tests (mRDTs) have been shown to perform as well as routine light microscopy, however, they are limited by some factors including persistence of HRP2 antigenemia. In this paper we report the evaluation of an HRP2-based mRDT in a prospective study that enrolled children and followed them up for 28 days. Methods: Children aged below five years, with acute episode of fever/pyrexia, were enrolled. The enrolled participants had expert malaria microscopy and RDT done at enrolment (Day 0), and on days 1, 2, 3, 7, 14, 21, and 28. The malaria RDT test was considered positive when the antigen and control lines were visible in their respective windows, negative when only the control band was visible and invalid when the control band was not visible. Faint test lines were considered positive. The RDT results were compared to those of expert microscopy. Results: Two hundred and twenty-six children aged 29.2 ± 15.5 months were enrolled. The proportion of children positive by expert malaria microscopy and RDT was 100% and 95.6% respectively. During the 28 day follow up of the children the proportions positive by microscopy and RDT on days 3, 7, 14, and 28 were 1% and 94.6%, 0% and 93.5%, 0% and 91%, and 16.5% and 80.6% respectively. Gender and age dependent analysis of proportion of positive children were similar. Proportion of children with persistence of HRP2 antigen appeared to be lower in those with parasite density below 200/µL, however, this observation requires further evaluation in larger studies. Conclusion: the study revealed a high proportion of persistence of HRP2 antigen in the children 28 days after effective antimalarial therapy. Histidine rich protein 2 based malaria rapid diagnostic tests are not recommended for monitoring of antimalarial therapies.

Protocol and Researcher's Relationship with Institutional Review Board.

The document of ethical approval is an important official requirement for research involving human participants worldwide. It is the process whereby an investigator submits the full research proposal and related documents including detailed informed consent process to an independent Institutional Review Board (IRB) for scrutiny. The process of seeking review and approval is necessary to ensure adequate measure are in place to safeguard and protect research participants as entrenched in the principles of The Declaration of Helsinki and The Belmont Report. It is the responsibility of every clinical researcher to obtain ethical approval, therefore, their obligation to understand the process of review and establish relationship with local IRB in order to enhance smooth review and approval. This article, therefore, explains clinical research and distinguishes between research and clinical care, clarifies briefly what constitutes a study protocol and describes the researchers' relationship with IRB.

The economic burden of preterm/very low birth weight care in Nigeria.

The care of very low birth weight (VLBW) neonates may impose an enormous burden on professional resources and finances of caregivers. This study seeks to evaluate the immediate cost of care of VLBW babies in a developing economy. Twenty-four hospital case records VLBW babies who survived till discharge over a 1 year period at the University College Hospital, Ibadan, Nigeria were reviewed. Estimates of the out of pocket costs of managing these babies were calculated. The overall cost of hospital care ranged from US$211.1 to US$1573.9. The direct (median) and indirect (median) cost of care ranged from US$80 to US$1055 (US$247.3) and US$101.0 to US$1128.1 (US$257.2), respectively. These constituted 22.8% and 3966.3% (median 133.4%) of the combined family income. In conclusion, the cost of care of the VLBW deliveries in Nigeria is very high for the level of the economy and constitutes a major financial burden on the family.

Non-traumatic paraplegia in Nigerian children presenting at the University College Hospital, Ibadan.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.

Genetic diversity of the msp-1 locus and symptomatic malaria in south-west Nigeria.

Genetic characteristics of Plasmodium falciparum may play a role in the clinical severity of malaria infection. We have studied the association between diversity at the merozoite surface protein-1 (msp-1) locus and the severity of disease in childhood malaria in Ibadan, south-west Nigeria. Two hundred and twenty-three children (median age of 34.5 months) presenting with malaria were enrolled into the study. They comprised 53 children with asymptomatic malaria (ASM), 101 with acute uncomplicated malaria (UM) and 69 with severe malaria (SM). Genotyping of the msp-1 locus was by polymerase chain reaction. The distribution of msp-1 alleles was significantly different between the three groups. Asymptomatic malaria samples had a higher median number of alleles than the other two groups. The type of msp-1 allele detected was significantly associated with the clinical category of malaria. The absence of K1 alleles was associated with a three-fold increase risk of UM and a four-fold increased risk of SM when compared with asymptomatic malaria. The absence of MAD20 alleles was associated with a five-fold increase risk of UM and an eight-fold increase of SM. We have found an association between the msp-1 locus of P. falciparum and clinical severity of malaria in a sample of Nigerian children. Our findings show that the presence of the K1 and MAD20 alleles was significantly associated with ASM and consequently a reduced risk of developing the symptomatic disease.

Plasmodium falciparum malaria in south-west Nigerian children: is the polymorphism of ICAM-1 and E-selectin genes contributing to the clinical severity of malaria?

Plasmodium falciparum malaria remains a major public health hazard in sub-Saharan African children. While the factors that determine the variations in clinical outcome of a malaria have not been completely defined, both host and parasite factors, as well as the complex molecular interactions between them have been implicated. The cyto-adherent properties of the P. falciparum-infected red blood cells are considered as key properties in the pathogenesis of malaria and the polymorphisms of the host adhesion molecules could contribute to the severity of malaria. Clinical information and blood samples were collected from 223 children from Ibadan (south-west Nigeria), median age of 34.5 months, presenting with different clinical manifestations of malaria--clinically asymptomatic parasitism (ACP), acute uncomplicated malaria (UM) and severe malaria (SM)--as defined by WHO criteria. The polymorphisms of genes coding for four human adhesion molecules at six different loci (ICAM-1 exons 2, 4 and 6, E-selectin exon 2, CD36 exon 10, and PECAM exon 3) were studied. DNA samples were prepared for further genotyping of the six exons mentioned above by PCR-RFLPs using the appropriate restriction digests for each loci. The ICAM-1 exon 4 locus was monomorphic. All the other loci were at Hardy-Weinberg equilibrium (HWE). The E-selectin locus had very low heterozygosity (approximately 0.06) in contrast to the other loci under study (0.23-0.44). Once the data was further processed for covariates (age and parasite density) and taking as the reference category the ACP group, results show that in the presence of the G allele at the ICAM-1 exon 6 there is an increased risk (3.6 times) of severe malaria. As far as the T allele in the E-selectin exon is concerned, the number of sampled DNAs with the T allele within both the UM and SM categories is too low for drawing any relevant conclusion at this stage. In conclusion, these results suggest that genetic polymorphisms at host adhesion molecules loci are an important variable in the susceptibility to severe malaria. Further studies of host loci are needed to further delineate which polymorphisms are associated with severe malaria and increase our knowledge of the biology of host-parasite interactions.

A five-year review of childhood mortality at the University College Hospital, Ibadan.

INTRODUCTION: The present study sought to provide a comprehensive description of causes of mortality in a local Nigerian children population as a measure of their health status. METHODS AND PATIENTS: A retrospective study of the pattern of mortality among 12,522 children admitted into all the six wards of the department of Paediatrics, University College Hospital, Ibadan during a five-year period (January 1996 - December 2000) was done. RESULTS: There were 1,185 deaths with an overall mortality rate of 9.5 per cent. There was no significant change in childhood mortality rate over the five years reviewed. Of the 1185 deaths, 48.8 % occurred within 24 hours and neonatal deaths accounted for 50.8 % of the total number of deaths. The leading causes of death were neonatal tetanus, Prematurity/low birth weight, neonatal septicaemia, severe birth asphyxia, meningitis, severe malaria, pneumonia, septicaemia, severe malnutrition, and measles. Deaths from sickle cell anaemia were found only among children above 5 years of age. CONCLUSIONS: Majority of deaths occurred in neonates and were preventable.

Measles in Ibadan: a continuous scourge.

Measles remains one of the leading causes of childhood mortality in the world, despite the availability of a safe, effective, relatively inexpensive vaccine. It is also one of the leading causes of childhood blindness in the developing world. We reviewed the records of cases of measles admitted into Oni Memorial Children's Hospital, Ibadan over a 5-year period, January 2000 to December 2004; to evaluate any changes in the pattern of the disease. A total of 666 cases of measles were admitted comprising of 347 males and 319 females, giving a male to female ratio of 1.1:1. The yearly incidence of measles remained fairly the same from January 2000 to December 2002. There was a marked increase in yearly incidence in the year 2003. The majority of the affected children (74.1%) were 2 years and below. One hundred and thirty-six (20.4%) cases developed measles before the age of 9 months, the recommended age for measles vaccination in Nigeria. The peak incidence occurred in the months February and March. The commonest complication was bronchopneumonia, seen in 45.2% of cases. Other complications include protein-energy malnutrition, tuberculosis, croup, keratopathy, otitis media, heart failure and tension pneumothorax. Fifty-six patients died giving a case fatality rate of 8.4%. Factors associated with increased mortality were young age (<2years) and malnutrition. Measles remains a major threat to the health of the Nigerian child. A significant number of children developed measles before receiving the required vaccination at the recommended age of 9 months. There is a need to review the current immunisation policy, strengthen immunisation practices and improve the living standards in order to make the eradication of measles a reality.