Post-neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Tetanus is a public health problem in Nigeria. This study examines the demographic and clinical profile of postneonatal tetanus (PNT) seen in University of Maiduguri Teaching Hospital (UMTH), North- eastern Nigeria.Methods: This is a hospital-based prospective study of PNT. All childrenbeyond the neonatal period to 14 years of age admitted into the Paediatrics unit of UMTH, Maiduguri from June 2009 to July2011 with the diagnosis of PNT were studied.Results: A total of 39 cases of PNT were admitted over the period underreview. The male: female ratio was 2.3:1.0. Their ages at presentationranged between 16 months and 14 years, with mean +SD of 6.9+3.87 years. Over 90 percent of the children were either not immunizedagainst tetanus or their immunization status was unknown and onlytwo of the children were fully immunized. No booster immunizationwas received by any of the eligible children. The portal of entry of the infection was injury to the lower limbs and otogenic route in 53.9% and 33.3% respectively. Majority of patients were of low socioeconomicstatus. The duration of hospital stay ranged between 1-50 days with mean + SD (18.68+ 11.51).The mortality rate was (7)18 %.Conclusion: Tetanus still remains a major cause of childhood morbidityand mortality in Nigeria. Severe disease and the first one week of admission are the main variables identified to influence outcome.Therefore, there is need to strengthen routine immunization and booster doses of tetanus toxoid (TT) should be mandatory at primary and secondary school entry. Close monitoring of patients with severe tetanus during the critical period is imperative for successful management

The Influence of Gestational Age on the Loss of Maternal Measles Antibodies in Newborn Infants in North-Eastern Nigeria: A Call for a Review of Measles Immunization Schedule

Background: Maternal measles antibodies (MMA) are actively transferred in mother-infant pairs during third trimester of pregnancy. Gestational age (GA) affects the levels of MMA such that longer GA may result in infants starting out with high levels of MMA.Objective: To determine the influence of GA on the loss of MMA in newborn infants in North-Eastern Nigeria.Method: A prospective study was conducted on newborn infants at Maiduguri; sera were collected at birth and at six months of age. Enzyme linked immunosorbent assay (ELISA) was used to measure MMA while GA was determined using the last menstrual period, ultrasound scan reports and the Dubowitz criteria.Results: Seventy eight newborn infants were enrolled. Seventeen (89.5 %) preterm, 43 (95.6 %) term and 14 (100 %) postterm had protective levels of MMA at birth. Two (10.5 %) preterm, nine (20.0%) term and two (14.3 %) postterm had protective MMA at six months of age. Comparison of mean MMA at birth and at six months of age was significant (p = 0.005), however, it was independent of GA of the newborn infants.Conclusion: Significant decline of mean MMA levels was seen in these infants at six months of age, which was independent of their GA. These infants may be prone to measles at an earlier age (less than six months). Therefore, the current recommendation of measles immunization to infants at nine months of age may require reconsideration

Renal diseases: caregivers' knowledge, attitude and practice in North Eastern Nigeria

Lack of awareness of renal diseases among the parents/ care givers of children can contribute to the development of childhood chronic kidney disease (CKD). Awareness of kidney disease by the care givers of children can improve their health seeking behaviour and reduce the significant economic and public health burden. We conducted a cross-sectional descriptive study to assess the knowledge, attitude and practice of renal diseases among the care givers of children attending University of Maiduguri Teaching Hospital. Management of CKD is very expensive especially in the third world where most care givers are poor and cannot afford the cost of renal replacement therapy like dialysis and renal transplant. This underscores the determination of knowledge, attitude and practice of parents/ care givers on childhood renal diseases. Objective: To assess the knowledge, attitude and practices on renal diseases among the care givers of children attending a tertiary hospital in north eastern Nigeria. Method: This cross-sectional study was conducted among mothers or caregivers of children receiving care in the department of Paediatrics of a Teaching Hospital, Borno state. Mothers/ caregivers were consecutively selected as they come to the hospital and 420 subjects were interviewed through a self-administered questionnaire. Each subject was interviewed on his or her knowledge, attitude and practice of childhood renal diseases and data was entered appropriately into the different sections of the study questionnaires. Data was analysed using Epi-info statistical software (version 7.0). Informed consent was obtained from the parents and confidentiality to any information disclosed by the mother was ensured. Results: The ages of the respondents ranged from 18 – 67 years with amean age of 37.2 (SD±13.6) years. Majority 140 (33.3%) of the respondents were aged 31 – 50 years; p<0.05. Among the respondents, were 255 (60.7%) females and 165 (39.3%) males with male to female ratio of 1: 1.5. The ages of the children ranged from 1 month to 15 years with 239 (56.9%) males and 181 (43.1%) females and male to female ratio of 1.3: 1. There were 267 (63.6%) Muslims and 153 (36.4%) Christians. There were 98 (23.3%) care givers from the upper social class, 120 (28.6%) from the middle social class and 202 (48.1%) from the lower social class. Most mothers (89.2%) had no factor preventing them from seeking medical care. Many (70.7%) of the caregivers took their children to health facilities once sick or developed any symptom of severe childhood disease. Conclusion: Although most of the care givers that participated in this study had knowledge of one form of kidney disease or the other, most had no knowledge of any treatment modality of these kidney diseases

Antimicrobial Susceptibility Profile of Bacterial Pathogens Isolated From Pregnant Women with Asymptomatic Bacteriuria at Tertiary Hospital in Northeastern Nigeria

Asymptomatic urinary tract infection among pregnant women is a common clinical episode that is frequently undiagnosed. A total of 200 clean-catch mid-stream urine (150 pregnant women and 50 non-pregnant women)were examined by microscopy and culture methods. Overall, the  prevalence of asymptomatic bacteriuria was 59.0% (118/200) and was significantly higher among pregnant (63.3%, 95/150) than non-pregnant (46.0%, 23/50) subjects (÷2 = 4.66, df = 1, p = 0.03). Tertiary education (72.6%, OR = 1.45, p = 0.014), third trimester (77.6%, OR = 1.39, p = 0.042), multi-gravidity (79.0%, OR = 1.41, p = 0.0017) and multiparity (75.9%, OR = 1.49, p = 0.03) were factors associated with asymptomatic bacteriuria in studied pregnant subjects. Of the 118 bacterial isolates, Klebsiella spp accounted for 39.8% (47/118), followed by S. aureus 22.9% (27/118), E.coli 19.5% (23/118), Proteus spp 9.3% (11/118) and P. aeruginosa 8.5% (10/118) (p < 0.0001). Antibacterial susceptibility test revealed that all bacterial isolates were susceptible to quinolones (ciprofloxacin, pefloxacin and ofloxacin). In addition to this, S. aureus was also susceptible to erythromycin. However, all bacterial isolates were resistant to readily available antibacterial drugs including augmentin®, cotrimoxazole, penicillin and cephalexin. In conclusion, prevalence of asymptomatic bacteriuria among pregnant women in this study isconsidered to be high and the bacterial isolates were quinolones sensitive and resistant to other commonly used antibacterial drugs. Considering the clinical implications of untreated urinary tract infection, it is therefore advisable that routine urine culture may be adopted as part of antenatal care.Keywords: Asymptomatic bacteriuria, urinary tract infection, antimicrobial susceptibility, tertiary hospita

Post-Neonatal Tetanus in Nguru, Yobe State, North-Eastern Nigeria

Eighteen cases of post-neonatal tetanus managed between January 2005 and December 2008 at the Federal Medical Centre, Nguru were retrospectively reviewed. The male female ratio was 3.5: 1, and mean ±SD age of 5.83 ±3.38years with range between 2 and 12 years. The immunization status was uncertain in 83.3% of the cases. Suppurative otitis media (SOM) and circumcision by the traditional ‘surgeon’ were important portals of entry of theinfection, accounting for 50% of cases. A mortality of 5.9% was recorded. It is therefore recommended that patronage of traditional surgeons should be discouraged and parents should be encouraged to seek for medical care from Orthodox Health Care facilities. The role of Government in these matters is also vital. Furthermore, there is need to improve on routine immunization activities at the Local Government Area levels.Keywords: Post-neonatal tetanus, Immunization status, SOM, Circumcision

Neural Tube Defects: Epidemiologic Factors, Clinical Presentation And Outcome In North Eastern Nigeria

Background: Neural tube defects (NTDs) are important factors in fetal and infant morbidity and mortality with variations in incidence and ethnic distribution. This study was carried out to determine the epidemiologic factors, clinical presentation, types and immediate neonatal outcome of neural tube defects. Methods: The clinical records of all babies admitted with NTDs into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital (UMTH) were prospectively reviewed over a 5-year period. Results: A total of 103 babies were admitted with NTDs. The overall incidence of NTDs in this study was 43/1000 admission with a yearly admission rate of between 2.3 – 8%. The age of the mothers ranged from 15 to 38 years. There were 56 (54.4%) males and 47 (45.6%) females. Of the 103 babies, 87 (84.5%) had spina bifida cystica, 15 (14.6%) had occipital encephalocele, while 1 (0.9%) had anencephaly and died within 8 hours of delivery. All the 87 patients with spina bifida cystica were ruptured and infected at presentation, with seven of them dying from overwhelming sepsis. Most of the babies (58.3%) were delivered at home. Only 2 of them were delivered at the University of Maiduguri Teaching Hospital, Maiduguri. Conclusion: The incidence of NTDs in this study was high and on the increase with many of the mothers booking late for antenatal care and delivering at home. There is the need for improvements in all factors that will encourage women attend antenatal clinic and deliver in the hospital. The need for folic acid supplementation in women of childbearing age and fortification of foodstuff with folic acid is highlighted. Keywords: Clinical presentation, Immediate neonatal outcome, NigeriaSahel Medical Journal Vol. 11 (1) 2008: pp. 34-3