Effects of supplemental measles immunization on cases of measles admitted at the Wesley guild hospital, Ilesa, Nigeria

Background: Measles is a highly contagious vaccine-preventable infection which continues to be a significant cause of childhood morbidity and mortality in developing countries particularly those with poor routine immunisation coverage. Supplemental immunisation activities (SIAs) were thus introduced to improve vaccine coverage. Objective: This study was carried out to assess the impact of the supplemental measles vaccinations on the cases of measles admitted at a tertiary health facility in South west Nigeria. Methods: Weretrospectivelylooked at therecords of cases of measles in children admitted to the Wesley Guild Hospital, Ilesa over a ten year period (2001 - 2010); five years before and five years after the nationwide commencement of supplemental measles immunisation activities (SIAs) in the region in 2006. Measles cases were defined using the WHO case definition. Results: Over the ten year study period, a total of 12,139 children were admitted andmanaged; out of which 302 (2.5%) were cases of complicated measles. There was no difference in the mean (SD) of children admitted in the years before and after the introduction of the SIAs {6040 (122.7) vs.6099 (120.2); t-test 0.02, p =0.988.} There was however a remarkable reduction in the proportion of the cases of measles admitted after the introduction of SIAs compared to the period before SIAs (4.3% vs. 0.6% x2=169.580; p < 0.001) Conclusion:SIAs have remarkably reduced morbidity and mortality associated with measles in the region. We advocate for sustenance of these efforts as well as improvement in routine immunisation coverage to avoid a backlash which can lead to devastating measles outbreak.Keywords: Measles, Supplemental immunisation, MorbidityAfrican Health sciences Vol 14 No. 1 March 201

Characterization of bacterial isolates cultured from the nasopharynx of children with sickle cell disease (SCD)

Background: We characterized bacterial isolates from the nasopharynx of 84 Sickle cell disease patients 78 of whom were HbSS and 6 HbSC aged 4 four months to 15 years at Wesley Guild Hospital, Ilesa, southwestern Nigeria between February – September, 2014.Method:  Sterile cotton-tipped initially dipped into sterile saline thereafter was  introduced into nasopharynx of each patient and  thereafter  applied onto sterile thioglycolate medium and  incubated at 370 C for 24 hr, When growth was noticed,  samples were inoculated onto  enriched, selective and differential bacteriologic media. Bacterial colonies that grew on such media were picked and characterized by gram reaction, cultural, morphologic and biochemical methods.  Antibiotic sensitivity tests were determined by the disc diffusion method. Demographic data relating to severity of SCD were provided.Results: Altogether, 119 isolates were cultured from the nasopharynx. Gram positive bacteria predominated (65.54%)   and Corynebacterium spp (44.53%) dominated comprising of 19 (35.84%)  Corynebacterium xerosis 11 (20.75%) Corynebacterium diphtheriae, 10(18.86) Corynebacterium pseudodiphtheriticum, 8(15.09%) Corynebacterium ulcerans, 3(6.66%) Corynebacterium spp and 2(3.77%) Corynebacterium jeikeium. Other Gram positive rods cultured were Arcanobacterium haemolyticum 6(5%).  Bacillus subtilis was   3 (2.5%), Actinomyces isrealli 3 (2.5%) and Norcadia asteroids 1 (0.84%).  Low frequency of nasopharyngeal colonization recorded for Haemophilus influenzae 4.2%, and S. pneumoniae 2.5% and S. aureus 4(3.36%) and multiresistance was widespread for most isolates.Conclusion:  Indigenous microflora Corynebacterium spp predominated and low rate of nasopharyngeal colonization with H. influenzae, and S. pneumoniae recorded attributable to prophylactic use of penicillin and vaccines administration probably suppressed growth of organisms   and inevitably increased resistance to many antibiotics

Growth, upper arm anthropometry and serum 25-hydroxyvitamin d status of brazilian and nigerian school-aged children with sickle cell disease

BACKGROUND: Sickle cell disease (SCD) phenotype is very variable and many genetic and environmental modulating factors including nutritional status have been implicated. Comparative studies of patients in different socio-geographic and ecological zones afford an opportunity to investigate potential environmental and other factors that influence the phenotype. OBJECTIVES: To assess the growth parameters, upper arm anthropometry, and serum 25-hydroxyvitamin D (25-OHD) of two cohorts of children with SCD at the University Teaching Hospitals in Ile-Ife/Ilesa, Southwest, Nigeria, and Sao Paulo, Brazil. In addition, the study also sought to determine the influence of hydroxyurea (HU) on growth and nutritional status. Relationship between serum 25-OHD and disease phenotypes (rates of pain episodes, biomarkers of intravascular haemolysis and inflammatory cytokines) was also determined. METHODS: Sociodemographic, clinical, growth and upper arm anthropometry of school-aged Brazilian and Nigerian children with SCD as well as age- and sex-matched haemoglobin AA Nigerian controls were assessed. Haematological and biochemical parameters (serum 25-OHD inclusive); and inflammatory cytokines were determined by standard techniques. Relationships between serum 25-OHD, pain rates and cytokines were determined by statistical tests. Nigerian SCA children with suboptimal 25-OHD were given 2,000 IU of vitamin D3 supplemetation daily for three months and its infuence on cytokine profiles was evaluated. RESULTS: A relatively high proportion of the children in both centers (23.5 percent) were underweight. Weight, BMI-Z score, height for age-Z score, upper arm fat area and fat percentage were significantly lower in the Nigerian than Brazilian cohorts. A higher proportion of Nigerian patients (29.5% against 19.3%) were underweight, and of short stature (12.6% vs. 3.7%), while a higher proportion of Brazilian patients were overweight or obese, (9.2% vs. 4.3%) and taller for age, (16.5% vs. 8.4%). None of the Nigerian patients had severe vitamin D deficiency and only 12.6% had suboptimal vitamin D levels, however, 3.7% of the Brazilian patients had severe deficiency and majority, 79.8% had either vitamin D deficiency or insufficiency. Underweight and severe vitamin D deficiency were more prevalent among Brazilian children who were hydroxyurea-naive than those who had used HU for at least 12 months (30.6% vs. 13.7%, p = 0.036; and 11.4% vs 0%, p = 0.008 respectively). Their mean serum 25-OHD was also lower than the HU group, 20.80 ± 7.48 ng/ ml vs. 24.52 ± 8.26 ng/ml, p = 0.021. All Nigerian children with suboptimal vitamin D compared to 69.7% of those with normal vitamin D experienced vasoocclusive pain episodes in the preceding 12 months, p = 0.037, 95% CI = 0.7 ? 0.9. The mean serum vitamin D of those with at least one pain episode (41.25 ± 10.09 ng/mL), was significantly lower than 45.22 ± 7.71 ng/mL for those without pain episode, p = 0.043, 95% CI = 1.3 ? 7.8. After excluding the potential influence of HU, among Brazilian patients, hemoglobin and hematocrit had significant positive correlations with serum 25-OHD (r = 0.40, p = 0.017 and r = 0.45, 0.006 respectively), while reticulocyte percentage, absolute reticulocyte count and serum lactate dehydrogenase (LDH) had significant inverse correlation (r = -0.44, p = 0.008; r = -0.47, p = 0.007 and r = -0.45, p = 0.007 respectively). Also, the mean hemoglobin of those with suboptimal vitamin D was lower (8.1 ± 0.9g/dl vs. 9.4 ± 1.8g/dl, p = 0.014), while the mean reticulocyte count and serum lactate dehydrogenase were significantly higher, p = 0.047 and 0.003 respectively.Compared to those with normal level, Nigerian patients with suboptimal 25-OHD had significantly higher serum pro-inflammatory cytokines IL-6, 8 and 18 (p = 0.003, 0.010 and 0.002 respectively) and lower levels of anti-inflammatory cytokine IL-11 (p = 0.005). Proinflammatory cytokines IL-2, 6, 8, 17 and 18 were reduced significantly while antiinflammatory cytokines IL-11 was significantly higher at the end of 3 months of vitamin D3 supplementation. CONCLUSIONS: Nigerian children with SCD were lighter, shorter and had less fat than their Brazilian counterparts. On the contrary, more Brazilian children had overweight/ obesity, with majority having suboptimal serum 25-OHD levels. HU therapy tends to protect against growth retardation and vitamin D deficiency. A possible association between depressed serum vitamin D level and increased frequency of acute pain episodes supports the role of vitamin D in musculoskeletal health. Also the correlation between serum 25-OHD levels and biomarkers of intravascular haemolysis and inflammation suggest its role in the pathogenesis of haemolytic and inflammatory phenotypes in children with SCD.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

Total oxidant status of children with sickle cell anaemia: Correlation with rate of pain episodes and haematological indices

Background: Total oxidative status (TOS) measures cumulative oxidant levels. In sickle cell anaemia (SCA), oxidative stress plays a significant role in the pathophysiology of vasoocclusive and haemolytic phenotypes. In this study, we evaluated serum levels of TOS in children with SCA and matched healthy controls, and determined its relationship with the rates of vasoocclusive crisis (VOC) and haematological profile. Method: One hundred and sixty children, comprising of 80 with SCA aged 1–15 years and 80 age- and sex-matched haemoglobin (Hb) AA controls were studied. Serum TOS was determined by Human TOS Enzyme Linked Immunosorbent Assay. Result: The mean serum TOS of subjects with SCA (13.27 ± 4.62 U/mL) was significantly higher than 9.69 ± 2.74 U/mL for the matched controls, p < 0.001. Among the subjects, TOS had significant positive correlation with rates of VOC (r = 0.24, p = 0.036) and leucocyte counts (r = 0.25, p = 0.027), and significant inverse correlation with haematocrit (r = −0.46, p < 0.001). There was no significant correlation with other haematological indices. Conclusion: Children with SCA had higher TOS than matched controls. Markers of oxidative stress had significant correlation with rates of pain episodes and haematocrit levels. Efforts should be made to minimize altered oxidative milieu in SCA. Keywords: Children, Haematological profile, Sickle cell anaemia, Total oxidant status, Vasoocclusive crisi

Effects of supplemental measles immunization on cases of measles admitted at the Wesley guild hospital, Ilesa, Nigeria

Background: Measles is a highly contagious vaccine-preventable infection which continues to be a significant cause of childhood morbidity and mortality in developing countries particularly those with poor routine immunisation coverage. Supplemental immunisation activities (SIAs) were thus introduced to improve vaccine coverage. Objective: This study was carried out to assess the impact of the supplemental measles vaccinations on the cases of measles admitted at a tertiary health facility in South west Nigeria. Methods: Weretrospectivelylooked at therecords of cases of measles in children admitted to the Wesley Guild Hospital, Ilesa over a ten year period (2001 - 2010); five years before and five years after the nationwide commencement of supplemental measles immunisation activities (SIAs) in the region in 2006. Measles cases were defined using the WHO case definition. Results: Over the ten year study period, a total of 12,139 children were admitted andmanaged; out of which 302 (2.5%) were cases of complicated measles. There was no difference in the mean (SD) of children admitted in the years before and after the introduction of the SIAs {6040 (122.7) vs.6099 (120.2); t-test 0.02, p =0.988.} There was however a remarkable reduction in the proportion of the cases of measles admitted after the introduction of SIAs compared to the period before SIAs (4.3% vs. 0.6% x2=169.580; p < 0.001) Conclusion:SIAs have remarkably reduced morbidity and mortality associated with measles in the region. We advocate for sustenance of these efforts as well as improvement in routine immunisation coverage to avoid a backlash which can lead to devastating measles outbreak

Influence of serum 25-hydroxyvitamin D on the rate of pain episodes in Nigerian children with sickle cell anaemia

Background: In sickle cell disease (SCD), symptoms of vitamin D deficiency (VDD) and chronic pain can overlap. Aim: To examine the relationship between serum vitamin D levels and the frequency of acute pain episodes. Methods: In this cross-sectional study, serum 25-hydroxyvitamin D (25-OHD) was assayed by high-performance liquid chromatography, and its influence on the number of significant pain episodes was examined by bivariate and logistic regression analyses. Results: The mean (SD) serum 25-OHD level in 123 children with SCD (HbSS) was 105.8 (24.1) nmol/L (range 37.5-155.8). Fourteen patients (11.4%) either had a deficient (1.6%) or insufficient (9.8%) level. None had severe VDD. All the children with sub-optimal vitamin D experienced pain, as did 69.7% of those with normal vitamin D [14 (100%) vs 76 (69.7%), 95% CI 0.7-0.9, p=0.04]. The mean serum vitamin D level in the 90 patients with at least one pain episode [103.1 (25.2) nmol/L] was significantly lower than the 113.1 (19.3) nmol/L in the 33 without a pain episode (95% CI 1.3-7.8, p=0.04). The frequency of pain correlated inversely with the serum 25-OHD level. Serum levels of vitamin D (OR 1.2, 95% CI 1.3-1.7, p=0.04) and fetal haemoglobin concentration (OR 1.6, 95% CI 1.1-1.4, p=0.02) predicted significant pain episodes. Conclusion: In children with SCD, there is a possible association between depressed serum vitamin D levels and increased frequency of acute pain episodes. Vitamin D supplements should be considered in patients with low levels and frequent episodes of pain.Brazil National Council [CNPq- 159581/2014-1]Univ Fed Sao Paulo, Haematol & Blood Transfus Div, Escola Paulista Med, Sao Paulo, BrazilObafemi Awolowo Univ, Dept Pediat & Child Hlth, Ife, NigeriaKuwait Univ, Dept Paediat, Fac Med, Kuwait, KuwaitUniversidade Federal de São Paulo, Haematology & Blood Transfusion Division, Escola Paulista Medicina, Sao Paulo, BrazilWeb of Scienc

The Association of Serum 25-Hydroxyvitamin D With Biomarkers of Hemolysis in Pediatric Patients With Sickle Cell Disease

Although vitamin D deficiency (VDD) has been linked to anemia among sickle cell disease (SCD), its relationship with hemolysis is unclear. Serum 25-hydroxyvitamin D and biomarkers of hemolysis (hemoglobin [Hb]/hematocrit, reticulocyte percentage, absolute reticulocyte, and lactate dehydrogenase [LDH] levels) in 36 hydroxyurea-naive SCD children were quantified. Correlations were significantly positive with Hb/hematocrit (r=0.40, P=0.017r=0.45, P=0.006, respectively)inverse with reticulocyte percentage, absolute reticulocyte, and LDH (r=-0.44, P=0.008r=-0.47, P=0.007r=-0.45, P=0.007, respectively). In VDD groups, Hb was lower (P=0.014), reticulocyte counts and LDH were higher (P=0.047 and 0.003, respectively). Serum 25-hydroxyvitamin D correlated with biomarkers of hemolysis in SCD and VDD may play a role in SCD pathogenesis.CAPES/SUS (Coordination of Improvement of Higher Level Personnel)Brazil National Council for Research (CNPq)Escola Paulista Med, Haematol & Blood Transfus Div, Sao Paulo, SP, BrazilObafemi Awolowo Univ, Dept Pediat & Child Hlth, PMB 013, Ife, NigeriaUniv Fed Sao Paulo, Dept Pediat, Escola Paulista Med, Sao Paulo, BrazilKuwait Univ, Dept Paediat, Fac Med, Kuwait, KuwaitEscola Paulista Med, Haematol & Blood Transfus Div, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Pediat, Escola Paulista Med, Sao Paulo, BrazilWeb of Scienc