Event characteristics and socio-demographic features of rape victims presenting for post exposure prophylasix at the Federal Medical Centre, Owerri Nigeria

Objectives: On account of increasing awareness of the need for Post exposure prophylaxis (PEP) and availability of requisite drugs, victims of rape are now presenting at health facilities including ours to access PEP for HIV. This study set to document the socio-demographic features of these victims and the event characteristic of the rape act.Methods: The medical records of patients who presented between January 2009 and December 2013 to the Paediatric infectious diseases clinic of Federal medical Owerri for PEP were reviewed.Results: One hundred and fifty three patients presented over reviewed period. 148(96.7%) presented for PEP on account of rape. They consisted of 147 females and 1male.61 (41.2%) of victims previously knew and could identify their assailants while 19(12.8%) of the victims had been previously raped. 32 (21.6%) victims presented on the day of the rape and weapons were used in 27% of the cases to ensure the victims cooperation. The most common place for the rape act was the assailant's home.None of the victims completed the schedule of follow up visits.Conclusion: Rape remains the commonest reason for presentation at our centre for PEP. Most victims still present late and are nearly always lost to follow-up after the initiation of PEP.Keywords: HIV, Rape, Post exposure prophylaxis, Criminal code

Post exposure prophylaxis against human immunodeficiency virus: Awareness knowledge and practice among Nigerian Paediatricians

Objective: To determine the level of awareness, knowledge and practice of human immunodeficiency virus post exposure prophylaxis (HIV PEP) among paediatricians in Nigeria.Methodology: The study was a cross sectional questionnairebased survey conducted among paediatrcians that attended the Paediatric association of Nigeria annual scientific conference in 2015.Results: Most of the respondents (96%) were aware of the concept HIV PEP. The scores on knowledge of PEP for all the respondents ranged from 18% to 91 % with a mean score of 46.5 ± 14.1%. There was no significant difference between the performance of those who had received training on HIV PEP (48.0 ± 13.2%) and those who had not (45.1 ± 14.8%), p = 0.21, t =1.26. Ninety one (60.7%) of the respondents had been exposed to percutaneous injury during work. Thirty (33%) of the exposed paediatricians did not know the patient’s HIV status and only 10 (11%) received PEP, with only 7 (7.7%) of them completing the PEP for 4 weeksConclusion: Despite the high level of HIV PEP awareness, there was an unacceptable high rate of occupational exposures and poor knowledge of HIV PEP among Paediatricians. Additionally, there was a low uptake of HIV PEP services amongst exposed Paediatricians in Nigeria. There is need for urgent action to curb this trend.Key Words: HIV PEP, Paediatrician, Nigeri

Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015)

Abstract Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences

Pattern of morbidity among pre-school children attending the children's outpatient clinic of Federal Medical Centre, Owerri, Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 14(4) December 2005: 378-38

Can Oral Zinc Supplementation Reduce Relapses in Childhood Steroid-Sensitive Nephrotic Syndrome? A Systematic Review

Ngozi R Mbanefo,1 Samuel N Uwaezuoke,1 Chizoma I Eneh,2 Chioma L Odimegwu,1 Ugo N Chikani,1 Uzoamaka V Muoneke,1 Charles E Nwolisa,3 Kenneth E Odo,1 Francis N Ogbuka,2 Anthony T Akwue4 1Department of Pediatrics, the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital Enugu, Enugu, Nigeria; 3Department of Pediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria; 4Emergency Department, ASEER Field Hospital, Al Rabwah, Kingdom of Saudi ArabiaCorrespondence: Samuel N Uwaezuoke, Tel +2348033248108, Email [email protected]: Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS.Aim: This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease.Methods: We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review’s objective.Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity.Conclusion: Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence.Keywords: acute respiratory infection, frequent relapses, nephrotic syndrome, childhood, zinc supplementatio

Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study.

BACKGROUND: Blood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT. METHODS: All 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT was observation before, during and after transfusion process. RESULTS: Malaria related anaemia accounted for 98% of the BTs. Ninety-two percent of the children were assessed for paleness. Clinical signs such as difficult breathing and symptoms of cardiac failure were only assessed in 67% and 15% of the children respectively, prior to the BT decision. Pre-transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours. The zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood, respectively. ABO and RhD typing and screening for HIV and syphilis were undertaken in all transfused blood. Evidence for hepatitis B or C infection was not checked except in the ZBB. CONCLUSION: Criteria for BT are not always fulfilled; time to initiate and complete the transfusion is often unacceptable long and monitoring of vital signs during BT is poor. Blood from the ZBB was often not available and BT often depended on local donors which implied lack of screening for hepatitis B and C. It is recommended that an external supervision system be established to monitor and evaluate the quality of BT performance in the laboratories as well as in wards