Achieving polio eradication in Nigeria: Prospects and challenges

The Global polio eradication initiative was launched in 1988 by the international community. Since then, tremendous progress has been made (99%). However, the last 1% of the journey has experienced several setbacks and rate of progress has slowed down in the last few years. Nigeria is one of the remaining 3 endemic countries in the world that has never interrupted the transmission of the poliovirus compared to more than 125 countries in 1988.What are the prospects and challenges to polio eradication in Nigeria?This paper discusses these and other relevant issues regarding polioeradication in Nigeria

Mothers’ knowledge, perception and practice of childhood immunization in Enugu

Introduction: Immunization has been shown to be the most successful and cost-effective public health intervention in the 20th century. In the developing world, it does not only prevent about three million child deaths annually, but also has the potential to prevent additional two million deaths if coverage improves. However, immunization coverage has remained low in Nigeria although vaccines are provided relatively free by the government. Efforts have focused on the health worker, health system and logistics with little attention being paid to maternal factors like knowledge, perception, beliefs and practice.Objectives: To assess mothers’ knowledge, perception and practice of routine and campaign immunization in Enugu.Methods: A structured questionnaire was administered to 207 mothers who have at least one child less than 5 years of age, attending children outpatient and immunization clinics at the University of Nigeria Teaching Hospital, Enugu.Results: Forty-eight per cent of the mothers had tertiary education, 42% had secondary education, and 9% had primary education while 1% had no formal education. Eighty-two per cent knew that children are immunized to prevent major killer diseases, 14% and 3.4% believed it was to prevent all diseases, and to treat diseases respectively. Most mothers took their children to health facilities for routine immunization (95.2%) and also accepted immunization on immunization campaign days (75.4%). However, 23.6% had never immunized their children during campaigns. On the other hand, 13% (27) of mothers had out-rightly rejected immunization during campaign while 85% (177) had never rejected immunization. The remaining 2% were not immunized due to reasons other than rejection. More mothers significantly rejected campaign immunization than the number that did not go for routine immunization (p=0.000). Maternal highest educational level was significantly associated with knowledge of reason for immunization and acceptance of immunization (p=0.000). Religious denomination was not significantly associated with rejection of campaign immunization (p=0.056).Conclusion: Most mothers studied had good knowledge and positive perception and practice of immunization. However, the Campaign immunization rejection rate was relatively high for the south eastern Nigeria where it is often assumed that non-compliance is not a problem. Similarly, the proportions of mothers with wrong knowledge and poor perception of immunization require policy attention. Maternal education was significantly associated with knowledge and acceptance of immunization. These findings are important in the design and implementation of childhood immunization programmes

Etiology of Pediatric Meningitis in West Africa Using Molecular Methods in the Era of Conjugate Vaccines against Pneumococcus, Meningococcus, and Haemophilus influenzae Type b

Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pathogens in central nervous system infections is poorly characterized. Cerebrospinal fluid (CSF) specimens were collected from children younger than 5 years with suspected meningitis, presenting at pediatric teaching hospitals across West Africa in five countries including Senegal, Ghana, Togo, Nigeria, and Niger. Cerebrospinal fluid specimens were initially tested using bacteriologic culture and a triplex real-time polymerase chain reaction (PCR) assay for N. meningitidis, S. pneumoniae, and H. influenzae used in routine meningitis surveillance. A custom TaqMan Array Card (TAC) assay was later used to detect 35 pathogens including 15 bacteria, 17 viruses, one fungus, and two protozoans. Among 711 CSF specimens tested, the pathogen positivity rates were 2% and 20% by the triplex real-time PCR (three pathogens) and TAC (35 pathogens), respectively. TAC detected 10 bacterial pathogens, eight viral pathogens, and Plasmodium. Overall, Escherichia coli was the most prevalent (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%). Multiple pathogens were detected in 4.4% of the specimens. Children with human immunodeficiency virus (HIV) and Plasmodium detected in CSF had high mortality. Among 220 neonates, 17% had at least one pathogen detected, dominated by gram-negative bacteria. The meningitis TAC enhanced the detection of pathogens in children with meningitis and may be useful for case-based meningitis surveillance

Pediatric Bacterial Meningitis Surveillance in Nigeria From 2010 to 2016, Prior to and During the Phased Introduction of the 10-Valent Pneumococcal Conjugate Vaccine

Background: Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods: From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results: A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions: Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the countr

Predictive Value of Respiratory Rate Thresholds in Pneumonia among Preschool Children in Enugu, Nigeria

A study was carried out to determine the predictive value of respiratory rate in the clinical diagnosis of pneumonia in 101 children with respiratory symptoms o

Congenital hypothroidism - A delayed diagnosis in a neonate. A case reoport

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Knowledge and Utilization of Oral Rehydration Therapy (ORT) among Mothers in Enugu, Nigeria: A Health Facility Survey

Objectives A health-facility survey was done to determine the knowledge and utilization of oral rehydration therapy (ORT) among 400 mothers resident in Enugu. Methods A systematic sample from a list of mothers attending the immunization clinic of the Institute of Child Health (ICH) of the University of Nigeria Teaching Hospital, Enugu was interviewed using a pre-tested structured questionnaire. Results A pre-survey awareness of ORT was noted among 97.5% of the mothers. The beneficial effects of ORT were seen by 57.3% of the mothers as replenishment of lost energy and 37.5% as fluid and salt replacement. Although 77.0% of the respondents could not describe correctly the preparation of salt-sugar solution (SSS)/oral rehydration salt solution (ORS), a high ORT utilization rate of 74.6% was recorded. ORT as a modality of managing childhood diarrhoea remained totally acceptable to 89.5% of the mothers. Conclusion Many Mothers, although they accept and use ORT/SSS, could not accurately describe the methods of preparation of ORS/SSS. It is recommended that maternal perception of the role of ORT should be utilized by health personnel to promote its use, while routine training of caregivers on the preparation of SSS/ORS should be intensified during health education sessions. Key Words: Knowledge of ORT, utilization of ORT, mothers, routine training. Orient Journal of Medicine Vol.15(1&2) 2003: 45-4