Need for a clinical decision rule for the management of pharyngitis in Nigeria

Pharyngitis is a common reason for presentation in the hospital by children. Although viral aetiology is the commonest, Group AStreptococcus is the most important cause of and reason for antibiotictreatment of pharyngitis. The fact that GAS causes the non suppurativesequalae of rheumatic fever and acute glomerulonephritis perhapsdrives the empirical antibiotic treatment of most cases of pharyngitis.The unnecessary antibiotic treatment contributes to antibiotic resistance,a major public health problem. While it is desirable to do throat culture to guide the physician’s management of each case, the required laboratory skill is unavailable in most clinical settings in Nigeria. A clinical decision rule (CDR) which is a clinical tool that helps guide physicians in the management of conditions such as pharyngitis, have been shown to behelpful in managing pharyngitis in other countries. It reduces the numberof unnecessary antibiotic prescriptions and has a high sensitivity and specificity in distinguishing GAS from non GAS pharyngitis. Currently there are no guidelines or CDR for the management of pharyngitis in Nigeria, there is an urgent need to derive, validate and implement a CDR to guide the treatment of pharyngits

Does Nigeria need the birth dose of the hepatitis B vaccine?

The control of hepatitis B infection involves several strategies of which the most effective is vaccination. Schedules which include a birth dose (which can prevent vertical transmission when administered within 24 hours of birth) are recommended for use in countries with a high rate of vertical transmission. Nigeria is highly endemic for hepatitis B infection. Nigeria had hitherto utilized the monovalent HBV vaccine in the three dose schedule that includes a birth dose, the recent introduction of an HBV containing pentavalent vaccine (which cannot be administered at birth) calls to question whether there should be continued use of the birth dose of HBV (using the monovalent vaccine) in addition to three doses of the pentavalent vaccine given subsequently. This is given the fact that most infections in Nigeria are reportedly acquired in childhood through horizontal rather than vertical transmission. There is also the question of cost- effectiveness of the four dose schedule compared to the three dose schedule in the setting of Nigeria’s hepatitis B epidemiologic profile.A review of the available evidence indicates that a significant proportion of Nigerian women of child bearing age and pregnant women are seropositive for HBsAg and HBeAg. Maternal to child transmission rates of HBsAg of 47-53.3% have been documented while a significant proportion of newborns were noted to have serological markers for HBV infection before receiving their first immunization. These data indicate that there is a significant potential for vertical transmission of HBV in Nigerian infants providing a compelling reason for the continued use of the birth dose of the HBV vaccine. Cost-effectiveness was not examined in this review.There are, however, challenges to the universal delivery of the birth dose in a timely fashion. Encouraging institutional delivery, routine screening of pregnant women (with the administration of HBV within 24 hours of birth to infants of seropositive mothers), retraining of health care workers on ensuring the timely receipt of the birth dose of HBV vaccine and health education of mothers and the community on the need for immunization within 24 hours of birth are suggested strategies to improve the timely uptake of the birth dose of HBVKeywords: Birth dose, Hepatitis Bvaccine, Nigeria, Infant

Serum zinc values in children with congenital heart disease

Background: Some children with congenital heart diseases (CHD) may have increased pulmonary blood flow that causes recurrent  bronchopneumonia and congestive heart failure. Serum zinc is reduced in children with pneumonia and patients on diuretics.Objective: To evaluate the serum zinc level of children with CHD and their controls without CHD.Method: The subjects were 41 children with CHD confirmed on  echocardiography recruited from a paediatric cardiology clinic in a tertiary centre in Nigeria. The controls were 41 children without CHD. Biodata and anthropometric measurements were taken. The serum zinc was  determined using atomic absorption spectrophotometer method.Result: The mean difference in the serum zinc of the subjects 101.3 ± 21.6ìg/dl and controls 106.5 ± 18.3ìg/dl, was not significant, p = 0.351.The subjects with pneumonia had a lower mean serum zinc value 89.5 ± 15.0ìg/dl compared to those without pneumonia 103.9 ± 22.2ìg/dl, p = 0.006. The mean serum zinc values of the subjects on diuretic was notstatistically different from those not on diuretic, p = 0.599.Conclusion: The serum zinc levels of the subjects and controls were not significantly different. Children with CHD and pneumonia had significantly lower zinc level compared to those without pneumonia.Keywords: congenital heart disease, diuretic, pneumonia, zinc

Serological markers of hepatitis B infection in infants presenting for their first immunization

Introduction: Hepatitis B vaccine can prevent perinatal transmission if administered within 24 hours of birth. Nigerian infants are known to present late for their first immunizations and may acquire the virus either vertically or horizontally before receipt of the first dose of hepatitisB immunization. This study evaluated serological markers for hepatitis B virus infection in Nigerian infants prior to receipt of the first dose of hepatitis B immunization.Method: Blood samples obtained prior to the receipt of hepatitis B vaccine from infants presenting for their first immunization were analysed for HBsAg, antiHBc and antiHBe..Results: The mean age at presentation of the 153 infants studiedwas 14.3±15.6 days while only two infants presented on the first day of life. The prevalences of HBsAg and antiHBc were 16.3% and 15.7% respectively. Of those positive for either HBsAg or antiHBc 20(47.6%) were positive for antiHBe. The presence of HBsAg was not significantly associated with sex, age, circumcision, ear piercing and blood transfusion.Conclusion: Majority of the infants did not receive hepatitis B vaccine within 24 hours of birth. Institutional delivery should be encouraged while emphasizing to mothers and health care workers that hepatitis B  vaccination must commence within 24 hours of birth.Key words: Serological markers, hepatitis B. first infant immunizatio

Cardiovascular responses to blood transfusion in children with anemic heart failure

Introduction: This study evaluated the cardiovascular responses to blood transfusion in children with anemic heart failure using mostly clinical parameters.Materials and Methods: Consecutive patients with anemic heart failure presenting to a childrenfs emergency room and requiring blood transfusion were assessed for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), liver size, and oxygen saturation (O2 sat) pre.transfusion, 1.2 h into transfusion (intra.transfusion), immediate post.transfusion, and at late post.transfusion (24 h later).Results: A total of 75 patients were recruited of which 46 (61.3%) were males. Their mean age was 43.8 } 40.3 months while their mean PCV at presentation was 15.0 } 4.5%. There was a significant mean net reduction of 10 beat per minute (bpm) between the pre (139.7 } 25.2 bpm) and intra.transfusion (129.6 } 22.0 bpm) HR, P = 0.0004. The mean net reduction of 4 cycles/ min between the pre and intra.transfusion RR was also significant, P = 0.0033. The two parameters declined in values subsequently.Conclusion: The HR and RR are two easily measurable indices with reduction in HR and RR by 10 bpm and 4 cycles/min, respectively, from pre.transfusion to intra.transfusion observations

Parental contribution to over prescription of antibiotics for sore throat in children

Introduction: Antibiotics are often prescribed by physicians for sore throat in children because of the danger of post streptococcal complications. The role of the parents in over prescription of antibiotics is less well known.Objective: To evaluate the knowledge, attitudes and practice of parents to antibiotic prescription for childhood sore throat.Methods: The subjects were parents who brought their children to the out-patient clinics of a tertiary hospital. Their knowledge, attitude and practice of antibiotics prescription for sore throat in children were evaluated with the aid of a questionnaire. Responses were analyzed with IBM-SPSS version 20.0. The responses were presented in simple percentages while differences in proportions were tested with χ2 test.Results: There were 309 respondents studied, of which 264 (85.4%) were mothers. Respondents were aged 20 to 64 years. While 54.0% of respondents believed sore throat may resolve without antibiotics, 69.4% also felt that every child with sore throat should receive antibiotics. Some 57.2% of respondents will request for antibiotic. More respondents with secondary (59.0%) and tertiary (56.6%) levels of education compared to primary (20.6%) level would not request for antibiotics, P = <0.001. 42% will not be satisfied with a physician who does not prescribe antibiotics.Conclusion: This study demonstrated parental irrational demand for antibiotic for sore throat in children. This attitude was more in less educated parents. Education of the parents about the aetiology and rational antibiotic use of sore throat in children will mitigate this behavior.Keywords: Sore throat; antibiotic over prescription; knowledge; attitude, parent

Hepatitis B infection among Nigerian children admitted to a children’s emergency room

Background: Nigeria commenced her hepatitis B immunization programme in 2004 but there have been few evaluations of the programme in different parts of the country given the fact that prevalence in different regions of the country varies. The objective of this study was to determine the prevalence of HBsAg and the hepatitis B immunization status among children admitted to the children’s emergency room (CHER) in Benin Teaching Hospital.Methods: A descriptive cross-sectional study carried out in 150 consecutively recruited children aged 2 months to 15 years admitted to the CHER of the University of Benin Teaching Hospital. HBsAg was assayed for in blood.Results: HBsAg seroprevalence was 13.9%. Majority (83%) of the children were age appropriately immunized for hepatitis B. Mean age at receipt of the birth dose of hepatitis B (28.0±20.4 days) was significantly delayed (p<0.0001). Mean age at completion of the schedule(110±18.6 days) was significantly delayed compared to the recommended age of 98 days p<0.0002). Age, sex and socioeconomic status were not significantly associated with being seropositive(p>0,05).Conclusion: HBsAg seroprevalence was high despite high immunization coverage. Lack of timeliness in the receipt of the birth dose and in completion of the schedule may have contributed to the seeming lack of effectiveness of the immunization programme,Key words: Hepatitis B, Nigerian children, Emergency Roo

Risk Factors and Clinical Correlates of Hepatitits B Seroprevalence in Nigerian Children

Introduction: Establishing risk factors for a disease enables early identification of those with the disease (through screening) as well as targeted prevention and control measures. The significance and relative importance of such risk factors may differ based on geographic location and they may change over time with the institution of control measures. In this study we examined the association between HBsAg seropositivity, some risk factors and clinical features.Methodology: Consecutive children aged 2 months to 16 years who were admitted to a Children’s Emergency Room were recruited. Data on the presence / absence of risk factors such as previous blood transfusion, scarifications, receipt of unsafe injections and previous surgery were obtained. History to ascertain previous or present history of jaundice and pale coloured stool was obtained. Examination to detect hepatomegaly and spenomegaly was carried out. Blood samples were assayed for HBsAg.Results: Of the 150 children recruited 84(56%) were male. The mean (SD) age of the children was 33.0(39.1) months. HBsAg seropositivity was 13.9%. Circumcision, scarification, ear piercing, history of blood transfusion, receipt of unsafe injections, present/ past history of jaundice and malnutrition were not significantly associated with being seropositive (p>0.05).Conclusion: This study did not identify any pathognomonic clinical feature of hepatitis b seroprevalence. The lack of association between HBsAg seropositivity and the studied risk factors may represent a real improvement in infection control measures. Further research is required to ascertain if there are still some unidentified risk factors for hepatitis B transmission in Nigerian children.Keywords: Hepatitis B Virus, Infection, Risk Factor

Nigerian mothers opinion of reminder/recall for immunization

Introduction: Reminder/recall interventions have been shown to improve immunization coverage. The perception of mothers/caregivers may influence the outcome of such interventions. The attitude of Nigerian mothers to reminders/ recalls using cell phones was evaluated.Methods: This was a crosssectional observational study carried out (August to October 2012) on mothers attending the child welfare clinic of the Institute of Child Health, University of Benin, Benin City. The instrument was an interviewer administered questionnaire which sought information on respondents’ access to phones, their ability to read, perception and preference with regard to reminders/ recalls.Results: All 203 mothers had access to a phone although 188 (92.6%) currently owned a phone. Majority of the mothers 163 (80.3%) could read. Of the 203 mothers 127(62.6%) agreed that mothers should be reminded about immunization appointments of their children. Of those who disagreed, most agreed that mothers who forget/did not keep appointments could be reminded. More mothers 126(70.8%) favoured reminders compared to recalls 52 (29.2%) There was no significant difference in the proportion of mothers who preferred telephone calls and those who preferred text messages. Those with post secondary education were more likely to prefer text messages.Conclusion: The mothers studied are favourably disposed to receipt of reminder/ recalls for their children’s immunization appointments. There is good access to telephones among the study population enough to support the use of this technology for a reminder / recall intervention but the use of text messages may be limited by literacy.Key words: Reminder, Recall,Nigerian, Mother

Multiple fractures and iatrogenic burns in a newborn due to unskilled delivery: A case report

High neonatal mortality is the hallmark of developing countries. Most of the deaths are preventable by good antenatal care with risk identification and access to safe delivery. However, only about a third of births are attended by skilled personnel in Nigeria. The case of a newborn (one of a set of twins) delivered by breech in a church maternity, who sustained multiple fractures and thermal burns from resuscitation is presented. The mother had received antenatal care in an orthodox health facility but opted to deliver in the church maternity. We discuss the problems associated with delivery by unskilled birth attendants while reviewing the literature to highlight the roles and mechanisms of church birth attendants. Reproductive health education for women, their families and communities is advocated to enable birth preparedness. Training, supervision, monitoring and regulation of practice of church birth attendants will also be required to improve outcomes (Afr J Reprod Health 2008; 12[3]:197-206)