Prevalence of asymptomatic bacteriuria among pre-school children in Nnewi, South-East Nigeria

Background: Early diagnosis and management of urinary tract infection (UTI) in young children reduces the risk of renal scarring and chronic renalinsufficiency. We determined the prevalence of asymptomatic bacteriuria(ASB) among pre-school children in Nnewi, South-East Nigeria.Methodology: This was a crosssectional survey involving apparently healthy nursery school children aged 3-5 years. A pre-tested, care-giver administered questionnaire was used to obtain information about the participants including age, sex, history of fever and antibiotic administration in the two weeks preceding the study. Following a clinical examination, a sample of mid-stream urine was collected from each participant for dipstick urinalysis, and urine microscopy and culture. ASB was defined as the presence of .105CFU/ml of urine in a participantwho had no symptoms of UTI.Results: Out of 792 children, 417 (52.3%) were females and 375 (47.4%) were males. The mean age of the children was 4.0 } 0.7 years. ASB was found in 31 children (4%). The prevalence of ASB in females (7.2%) was significantly higher than in males (0.5%), p<0.001. The highest prevalenceof ASB of 5.6% occurred in the 4-year-olds and the lowest of 2.0 %occurred in 5 year olds, p=0.09. The commonest bacterial isolates among the ASB cases were Staphlococcus aureus, 13 (40.6%); Streptococcus faecalis, 9 (28.1%) and Escherichia coli, 5 (15.6%). Conclusion: Asymptomatic bacteriuria is commoner in female preschoolchildren and S. aureus is the commonest bacterial isolate. Routine evaluation of female preschool children for bacteriuria is recommended.Key words: Asymptomatic bacteriuria, Pre-school children, Prevalenc

The performance of an Histidine rich protein-2 rapid diagnostic test (RDT) against the standard microscopy in the diagnosis of malaria parasitaemia among febrile under-five children at Nnewi

Background: Malaria remains a major cause of morbidity and mortality, thus there is need for quick, reliable inexpensive diagnostic tool to facilitate its prompt treatment especially in resource poor settings.Objectives: To compare the sensitivity of a locally available Histidinerich protein-2 based rapid diagnostic test (RDT) with the standard microscopy.Methods: This study was carried out to test the performance of an histidine rich protein -2 rapid diagnostic test (RDT) against the standard microscopy in the diagnosis of malaria among febrile under-five children attending Paediatric Clinic of NAUTH Nnewi. A total of 200 children under the age of five years were recruited for the study. Data on socio-demographic characteristics and symptoms were collected through an interviewer administered questionnaire. Blood sample was collected in EDTA bottle after observing universal precautions. All of them were tested with both Giemsa stained blood smear and Histidine rich protein-2 (HRP-2) rapid diagnostic test (RDT).Results: There were 118 males and 82 females, giving a male: female ratio of 1.44:1. Their ages ranged from 3-59 months and the average age was 27+17.49 months. Average number of days the subjects had fever before presentation were 3.78+1.95 days with a range of 1- 14 days. Body temperature ranged from 35.9-40.40C with average of 37.7+0.80C. Forty (20%) were positive by microscopy while 42 (21%) were positive by rapid diagnostic test. Twenty-percent of those positive by microscopy (n=8) were negative by RDT while 23.8% of those positive by RDT (n=10) were negative by microscopy. Using microscopy as a gold standard, the sensitivity of the RDT was 80%, the specificity was 93.8%. The positive and negative predictive values were 76.2% and 94.9% respectively.Conclusion: Based on these findings, the RDT demonstrated reasonable concordance with microscopy and was recommended for use at every level of healthcare in the diagnosis of malaria.Keywords: Malaria, RDT, Microscopy, under- five

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

The prevalence of anaemia in rural primary school children in Ekwusigo Local Government Area, Anambra State, Nigeria

Background: Anaemia is a public health problem affecting children with potential consequences on physical and mental development. Children living in resource poor countries where micro-nutrient deficiency and infections are prevalent are mostly affected.Objective: To determine the prevalence of anaemia in a rural primary school population of Ekwusigo Local Government Area of Anambra State, Nigeria.Methodology: One hundred and fifty-six primary school children aged 5-17years (75males, 81females) were recruited into the study using multi-stage sampling technique. Information on sex, age and parents’ educational attainment were obtained by the use of a self-administered questionnaire. Haemoglobin concentration of each child was determined, and each child was classified as anaemic if the value is less than the World Health Organization cut-off for age. Ninety-one children had stool microscopy for hook worm ova.Result: The prevalence of anaemia was 66.7% (104 subjects), 69.3% and 64.2% for males and females respectively. Anaemia was significantly observed more in children of mothers with only primary school education (82%) than children of mothers with tertiary education (30%); p<0.001. Of the 91 children whose stool samples were examined, 30 (33.3%) had hookworm infection. Anaemia occurred in 70% of children with hookworm infection compared to 60% of children without hookworm infection (X2 =0.33, p>0.5).Conclusion: Anaemia is a severe public health concern in the rural primary school population of Ekwusigo Local Government Area. Improved maternal education and mass de-worming provided through a school-based program would be of benefit in improving the haemoglobin concentration of these rural school children.Keywords: Haemoglobin concentration, hookworm infection, iron deficiency, maternal educatio

Drug Treatment Of Common Childhood Symptoms In Nnewi South Eastern Nigeria: What Mothers Do?

Objectives: To determine how mothers treat common childhood symptoms before hospital attendance in Nnewi. Materials and methods&#58 Information was obtained from 211 consecutive mothers on their children\'s presenting symptoms, drugs administered, source of the drugs, persons who prescribed the drugs, number of drugs administered, prior to hospital attendance through a structured questionnaire administered by the authors. Results: A combination of fever, cough and catarrh topped the list of presenting symptoms in 87 (41%) of the patients while fever and diarrhea had the least frequency of 16 (7.6%). One hundred and five or 52% of the mothers decided on the drugs that were administered followed by patent medicine dealers who accounted for 59 or 29.2%. Trained health professionals whom mothers consulted before bringing their children to hospital were responsible for 28 (13.8%) of the prescriptions. Patent medicine stores were the sources of 90.6% of the drugs while health facilities accounted for 8.4%. The frequency chart of prescribed drugs were analgesics 166 (34.9%),hematinics 88 (18.5 %), antibiotics and antimalarials 81 (17.1%) and 74 (15.6%) respectively while antidiarrheals and ORT were least administered with 7 (1.5%) and (0.2%) respectively. The children received an average of 2.7 drugs per prescription. Conclusion: With the high prescription rate of mothers for sick children at home there is need for effective methods to educate mothers on the use and potential dangers of home medication. Key Words: Maternal drug response, Drug Acquisition, Home medication Nigerian Journal of Clinical Practice Vol 8(1) 2005: 1-

Cultural Influences on Hepatitis B Surface Antigen Seropositivity in Primary School

Objective: To determine the role of cultural influences, namely: circumcision, ear piercing and traditional scarification, on HbsAg seropositivity among primary school children in Nnewi. Subjects and Method: Two hundred and thirty seven randomly selected primary school children aged 5-12 years, were screened for HbsAg. Information on the subjects were collected by use of a pretested questionnaire and physical examination. Results: An HbsAg prevalence of 7.6 percent was observed. There was no significant difference in the prevalence of HbsAg between exposed children and those unexposed to the various traditional practices [P >05]. Conclusion: Culturally related exposure did not seem to be a significant mode of HBV spread in Nnewi childhood population. Key Words: Cultural influences, Hepatitis B surface antigen Nigerian Journal of Paediatrics Vol.30(4) 2003: 140-14

Risk Factors For Neonatal Mortality In A Regional Tertiary Hospital In Nigeria

Objective: To determine the causes of neonatal mortality in a referral centre in Nigeria with a view to developing strategies that will help in reducing it. Methods: This is a retrospective patient record review of the records of 166 infants that died in the newborn unit between 1998 when the unit was established and April 2001. Results: During the study period of 38 months, the mortality was 166 (19.4%) out of a total of 854 admissions. Prematurity, birth asphyxia and sepsis topped the list of causes of death with 30.7%, 24.1%, and 19.3% respectively while postmaturity and intrauterine growth restriction (IUGR) were least with 1.2% each respectively. Conclusions: To reduce this magnitude of mortality among this group of babies there is need to establish more centres with trained personnel that will offer optimal management for the high-risk pregnancies and strategies to reduce the incidence of prematurity and low birth weight babies must be instituted. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 50-5