Serum Levels of Pro-inflammatory Cytokines in relationship to outcomes in Children with P. falciparum malaria, in Nnewi-South east Nigeria

Background and Objective: In P. falciparum malaria (PFM) infestation there are marked changes in cytokine production as the body mounts an immune response to it. Hence we set out to study these changes.Methods: A total of 158 cases of PFM among children attending the paediatric unit of our hospital and 56 healthy controls were studied. Children with febrile illness were screened for malaria using 10% Giemsa stained blood smear. Patients with positive smears were recruited; co-infected patients – those infected by another organism in addition to plasmodium specie.- were excluded. Whole blood was collected, some into plain tubes for serum cytokine testing and some into EDTA bottles for complete blood count and parasite density (PD) determination. Controls with asymptomatic parasitaemia were excluded.Results: Using the World Health Organization criteria for defining severe malaria; we identified 15 cases of severe and 143 cases of uncomplicated PFM. Significantly elevated levels of interleukin-1 (IL-1), interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were seen in the uncomplicated and severe forms of PFM. It was observed that the elevated cytokine values correlated with PD (in uncomplicated PFM but not in the severe forms). The difference between PD/absolute monocyte count (AMC) ratio was not significant (p=0.13); while PD/platelet count (PC) and PC/ AMC ratios were significant (p=0.01, and 0.03 respectively) when compared between uncomplicated and severe disease.Conclusion: Our data seems to suggest that subjects with an adequate immune response to the parasite density, in terms of pro-inflammatory cytokine levels, presented with uncomplicated disease; while those who have an inadequate response presented with severe disease. The ratios of (PD/PC) and (PC/AMC), in the positive and negative directions respectively, may be predictors of increased disease severity. These observations may have implications for predicting disease outcome and PFM therapy.Key Words: plasmodium falciparum malaria, pro-inflammatory cytokines, Parasite density/Platelet count ratio, Platelet count/Absolute monocyt

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

Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city

Background: Undernutrition remains the largest contributor to the global disease burden. Different factors affecting the nutritional status of children need to be studied to determine those to be targeted in a country like Nigeria, characterized by widespread poverty and inequitable distribution of wealth.Objective: This study was aimed at ascertaining the relationship between prevailing socioeconomic and environmental factors, and the nutritional status of children residing in a typical urban slum.Materials and Methods: A cross.sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage random sampling method from public primary schools in slum and non.slum areas of Onitsha was carried out. Their nutritional status was determined using anthropometric measures. The socioeconomic and environmentalvariables of interest were analyzed to determine their relationship with undernutrition in the children.Results: Socioeconomic status was the major determinant of nutritional status in this study. Poor housing also affected the nutritional status of the slum children who were significantly from poorer families than those residing in non.slum areas (ƒÔ2 = 66.69, P = 0.000).Conclusion: This study highlights the need for an effective nutrition program targeted at school children in urban slums surrounded by factors predisposing them to undernutrition.Key words: Determinants, school.aged children, undernutritio

Child Abuse: Abused all the way but determined not to abuse.

The case of a 14-year old girl who was abused right from infancy through childhood, pregnancy labour and immediate post-partum period, and management of both the child mother and her baby is presented. Information was obtained both retrospectively and prospectively. Tender loving care to the child mother and her premature baby coupled with gainful employment greatly improved her socio-economic status and facilitated graduation of the premature baby from the precarious under- five group. The danger and occasional inevitability of child labour in our environment are highlighted, and solutions are proffered. Sahel Medical Journal Vol.7(3) 2004: 98-10

Sexual Abuse Among Adolescents

Background: Adolescence constitutes a vulnerable age group where the actual prevalence of sexual abuse may remain largely unknown due to lack of knowledge, delay in and lack of reporting of such incidences. Objectives: To determine the knowledge and history of sexual abuse in adolescents and the associated factors.  Methods: A self-administered pretested questionnaire was used to collect data from children aged 10 to 19 years at an adolescent summer camp.  Results: Two hundred and seventy-six adolescents participated in this research out of which 41.3% had correct knowledge of sexual abuse, and 12.0% claimed they had been sexually abused.  Among the 33 respondents with a history of sexual abuse, 39.4% (13/33) had correct knowledge of sexual abuse.  Gender had a significant association with a history of sexual abuse (p = 0.008). Layered by age group, gender had a significant association with being sexually abused in mid-adolescence (p = 0.029) but not in late adolescence (p = 0.445). Age category had no significant association with being sexually abused. Conclusion: The knowledge of sexual abuse was inadequate among adolescents. A high proportion claimed to have been previously sexually abused and interestingly, had insufficient knowledge of sexual abuse There is a need to educate adolescents on sexual abuse to empower them to protect themselves and get help as appropriate