Detection of fever in children emergency care: comparisons of tactile and rectal temperatures in Nigerian children

<p>Abstract</p> <p>Background</p> <p>Clinical thermometry is the objective method for temperature measurements but tactile assessment of fever at home is usually the basis for seeking medical attention especially where the cost and level of literacy preclude the use of thermometers. This study was carried out to determine the reliability of tactile perception of fever by caregivers, nurses and house physicians in comparison to rectal thermometry and also the use of commonly practiced surface of the hand in the care of ill children. All caregivers of children aged 6 to 59 months who presented to the emergency department were approached consecutively at the triage stage but 182 children participated. Each child had tactile assessment of fever using palmar and dorsal surfaces of the hand by the caregivers, House Physicians and Nursing Officers. Rectal temperature was also measured and read independently by nurses and house physicians. Comparisons were made between tactile assessments and thermometer readings using a cut-off for fever, 38.0°C and above.</p> <p>Findings</p> <p>The caregivers' perception of fever had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 23%, 66% and 73%, respectively compared with 93%, 26%, 67% and 69%, respectively for nursing officers. Irrespective of the groups studied, 77.1% of 336 assessors opined that the dorsal surface of the hand was more sensitive in tactile assessment of temperature and the frequently used site for assessment of fever were the head (35.6%) and neck (33.3%). Tactile assessment of temperature over-detected fever in ≥ 24% of cases among the three groups of assessors.</p> <p>Conclusions</p> <p>The present study suggests that tactile assessment of temperature may over estimate the prevalence of fever, it does not detect some cases and the need for objective measurement of temperature is emphasised in paediatric emergency care.</p

Seroprevalence and determinants of Helicobacter pylori infection among asymptomatic under-five children at a Tertiary Hospital in the South-Western region of Nigeria

Background: The epidemiology of Helicobacter pylori (H. pylori) infection among under-five children in the South West Nigeria remains largely understudied. There is no data on the subject from the study area.Objectives: This study was conducted to assess the seroprevalence of H. pylori infection among under-five children at a tertiary hospital in the South Western, Nigeria and to determine its associated socio-demographic factors.Methods: Sera of 360 children were analyzed for anti H. pylori Ig G using enzyme linked immunosorbent assay test kit (BQ ELISA Ig G KIT) and H. pylori infection risk factors were determined. Determinants of H. pylori infection was determined using binary logistic regression analysis and p-values &lt; 0.05 were taken as statistically significant.Results: H. pylori infection seroprevalence rate was 32.8% and increased with age. Living in one room accommodation, large families, playing with soil, family history of dyspepsia, practice of premastication, sharing of plates and cutlery, and water closet toilet were associated with H. pylori Ig G seropositivity (p&lt;0.05) on binary regression analysis.Conclusion: The seroprevalence of H. pylori infection in under -five children is high, increasing as the age of the children increased. This may suggest that instituting preventive measures at young age, targeting identified factors may be effective in reducing the burden of H. pylori infection.Keywords: Helicobacter pylori, South-Western Nigeria

Seroprevalence and determinants of Helicobacter pylori infection among asymptomatic under-five children at a Tertiary Hospital in the South-Western region of Nigeria

Background: The epidemiology of Helicobacter pylori (H. pylori) infection among under-five children in the South West Nigeria remains largely understudied. There is no data on the subject from the study area. Objectives: This study was conducted to assess the seroprevalence of H. pylori infection among under-five children at a tertiary hospital in the South Western, Nigeria and to determine its associated socio-demographic factors. Methods: Sera of 360 children were analyzed for anti H. pylori Ig G using enzyme linked immunosorbent assay test kit (BQ ELISA Ig G KIT) and H. pylori infection risk factors were determined. Determinants of H. pylori infection was determined using binary logistic regression analysis and p-values &lt; 0.05 were taken as statistically significant. Results: H. pylori infection seroprevalence rate was 32.8% and increased with age. Living in one room accommodation, large families, playing with soil, family history of dyspepsia, practice of premastication, sharing of plates and cutlery, and water closet toilet were associated with H. pylori Ig G seropositivity (p&lt;0.05) on binary regression analysis. Conclusion: The seroprevalence of H. pylori infection in under -five children is high, increasing as the age of the children increased. This may suggest that instituting preventive measures at young age, targeting identified factors may be effective in reducing the burden of H. pylori infection. DOI: https://dx.doi.org/10.4314/ahs.v19i2.32 Cite as: Babatola AO, Akinbami FO, Adeodu OO, Ojo TO, Efere MO, Olatunya OS. Sero-prevalence and determinants of Helicobacter pylori infection among asymptomatic under-five children at a tertiary hospital in the South-Western region of Nigeria. Afri Health Sci.2019;19(2): 2082-2090. https://dx.doi.org/10.4314/ahs.v19i2.3

Affinity proteomics reveals elevated muscle proteins in plasma of children with cerebral malaria

Systemic inflammation and sequestration of parasitized erythrocytes are central processes in the pathophysiology of severe Plasmodium falciparum childhood malaria. However, it is still not understood why some children are more at risks to develop malaria complications than others. To identify human proteins in plasma related to childhood malaria syndromes, multiplex antibody suspension bead arrays were employed. Out of the 1,015 proteins analyzed in plasma from more than 700 children, 41 differed between malaria infected children and community controls, whereas 13 discriminated uncomplicated malaria from severe malaria syndromes. Markers of oxidative stress were found related to severe malaria anemia while markers of endothelial activation, platelet adhesion and muscular damage were identified in relation to children with cerebral malaria. These findings suggest the presence of generalized vascular inflammation, vascular wall modulations, activation of endothelium and unbalanced glucose metabolism in severe malaria. The increased levels of specific muscle proteins in plasma implicate potential muscle damage and microvasculature lesions during the course of cerebral malaria

Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

A comparison of tympanic and rectal temperatures in term NIGERIAN neonates

<p>Abstract</p> <p>Background</p> <p>Tympanic thermometry has come as a suitable alternative to traditional thermometry because of its safety and ease of use. However, it is still yet to gain wide acceptance in African settings due to conflicting results on its accuracy, thus rectal thermometry remains the gold standard in the newborn. The aim of this study was to compare tympanic and rectal temperatures in term Nigerian neonates.</p> <p>Methods</p> <p>Rectal and tympanic temperatures were measured simultaneously in 300 consecutive term neonates between the ages of 37 and 42 weeks gestation using mercury-in-glass and the Infrared tympanic thermometers respectively. Paired <it>t</it> test, Pearson correlation coefficient and the Bland-Altman plot were used to compute data. Using rectal thermometry as gold standard, the sensitivity, specificity and predictive values of tympanic thermometry at various rectal temperature cut-offs were determined. Receiver Operating Curves (ROC) were constructed and the Areas Under the Curves (AUC) were compared.</p> <p>Results</p> <p>The mean rectal temperature (37.34 ± 0.55°C) was significantly higher than the mean tympanic temperature (37.25 ± 0.56°C) (p < 0.001) with a mean difference of 0.09 °C ± 0.24 °C (95% CI: 0.06, 0.12). There was a strong positive correlation between the two measurements (r = 0.9; p < 0.001). Tympanic thermometry showed sensitivities ranging from 65% to 86% and specificities of 95% to 99% at rectal temperature cut-offs of 37.5°C to 38°C. The positive and negative predictive values of the tympanic temperatures at the various temperature cut-offs ranged from 82% to 93% and 80% to 98% respectively. Accuracy was noted to increase with higher temperatures as shown by the Receiver Operating Curves with the highest accuracy at the temperature cut-off of 38°C and AUC of 0.91.</p> <p>Conclusions</p> <p>The sensitivity of tympanic thermometry was relatively low in detecting rectal temperatures despite the good correlation and agreement between them. The specificities and predictive values of tympanic temperatures in detecting rectal temperatures were high and accuracy increased with higher temperatures. Though using the tympanic route for measuring temperature in the newborn is relatively safe and non-invasive, its low sensitivity limits its use. Further studies would be required to further assess the accuracy of tympanic temperature measurements in the newborn.</p

Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology

Aim Paediatric gastroenterology remains an under-recognised sub-speciality in Africa. We determined the preferred sub-specialities among paediatric residents in Southwest Nigeria and what influenced whether they chose paediatric gastroenterology. Methods This was a cross-sectional survey of paediatric residents in seven teaching hospitals in Southwest Nigeria. A self-administered questionnaire was used to obtain information on their socio-demographics, educational attainment, choice of sub-speciality and the factors influencing that choice. Results Of 144 eligible paediatric residents, 124 (86.1%) completed the survey. Their mean age was 35.0 ± 1.7 years, and 83 (66.9%) were females. The majority (94.4%) had already chosen their sub-speciality, and nearly two-thirds (65.0%) made the decision during training. The most popular sub-speciality was neonatology (30.6%), and only three (2.4%) residents chose gastroenterology. Factors influencing the choice of sub-speciality were perceived ability (85.3%) and academic experience (83.8%). Financial reasons were less frequent (32.5%). Lack of diagnostic equipment (30.6%) and role models (21.0%) were the most frequent reasons for residents being disinterested in paediatric gastroenterology. Conclusion Few residents were interested in paediatric gastroenterology and there is a need to encourage interest in this subject at an early stage in their training and provide more diagnostic equipment and greater mentorship

Circulatory hepcidin is associated with the anti-inflammatory response but not with iron or anemic status in childhood malaria

Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore, it is important to understand the pathology underlying the development of CM and SMA as opposed to uncomplicated malaria (UM). Increased levels of hepcidin have been associated with UM, but its level and role in severe malarial disease remains to be investigated. Plasma and clinical data were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, Nigeria. Here, we report that hepcidin levels are lower in children with SMA or CM than in those with milder outcome (UM). While different profiles of pro- and anti-inflammatory cytokines were observed between the malaria syndromes, circulatory hepcidin levels remained associated with the levels of its regulatory cytokine interleukin-6 and of the anti-inflammatory cytokine inerleukin-10, irrespective of iron status, anemic status, and general acute-phase response. We propose a role for hepcidin in anti-inflammatory processes in childhood malaria