Knowledge of fever in children and its management among health workers in a tertiary hospital in South-east Nigeria

Introduction: Fever is an adaptive response and a common symptom of diseases in children. Caregivers rely largely on the different cadre of health care workers (HCW) for the management of fever. This study sought to determine the knowledge and management of fever in children among HCWs in a tertiary health facility. Materials and methods: Self-administered questionnaires were used for this descriptive cross-sectional study carried out over 8 weeks. Results: A total number of 165 HCWs participated in the study with a median work experience of 8 years. One hundred and twenty- three (74.5%) had managed a febrile child, predominantly medical doctors (85.3%) and nurses (75%) (p=0.006). Almost all the HCWs (92.1%) used mercury thermometer to assess body temperature, but only 58.2% rightly placed the thermometer in the axilla for 3 to 5 minutes before reading it, (p<0.0001). Significant majority of the HCWs (93.3%) recommended antipyretics to a child they assessed to have fever, while less than half (45.5%) recommended tepid sponging. All the medical doctors recommended antipyretics but were least to recommend tepid sponging, (p<0.0001). Antipyretics were recommended at a low temperature threshold of <38.5℃, and oral acetaminophen alone (44.2%) and in combination with oral ibuprofen (44.8%) were most commonly recommended. The recommended dose of these antipyretics varied, being rightly prescribed by 66.2% (oral acetaminophen) and 35.1% (oral ibuprofen) of the HCWs. Conclusion: The knowledge of and management of fever in children among health care providers were inconsistent in this study. A positive outcome can be achieved through regular re-training programs and focused research

Malaria Prevalence and its Sociodemographic Determinants in Febrile Children- a Hospital-based Study in a Developing Community in South-east Nigeria.

Background: Malaria remains one of the major contributors of child mortality in many developing countries in Africa. Identifying its determinants will help prevention and prompt intervention in these settings. Methods: This cross-sectional descriptive study was conducted over an eight-month period on 382 children who presented with fever to the children outpatient and emergency units of a tertiary hospital in South-east Nigeria. A structured questionnaire was used to collect information on socio-demographic factors. Blood film microscopy for malaria and parasite density was done on all subjects that tested positive for malaria. Result: The malaria prevalence rate was 16.7%, 26.7%, 29.9% and 46.2% in children <5 years, 5 to < 10 years, 10 to < 15 years and 15-17 years respectively. Logistic regression analysis showed that malaria was more prevalent in older children but children under the age of 5 years were more prone to higher parasite density. Also, children of mother with lower educational attainment, children from families of lower socio-economic class and resident in rural settings had higher likelihood of getting malaria infection. Conclusion: Sustained improvement in strategies to prevent malaria infection is still very imperative in children of all ages, especially the under-fives who are prone to severe forms, children of mothers with low educational attainment, from families of low socio-economic class and residents in rural communities

Immunological study of cervical biopsy specimen for human papiloma virus

Background: Cervical cancer is one of the most common cancers among women worldwide and its rates are higher in low and middle income countries. India is one not exemplified from the developing countries. Aims: The main aim of the present work is a preliminary prospective screening study to observe the incidence of human papilloma virus (HPV) virus in the specimens of cervical biopsy taken from the patients of gynecology department of Visakha Steel General Hospital, RINL, Visakhapatnam district. Screening procedures like Pap smear, Colposcopy Immunohistochemistry (IHC) were done to identify the prevalence of HPV. It is an effort to assess and also improving the quality of cervical cancer prevention and treatment services in Visakhapatnam district of North coastal Andhra Pradesh. Settings and design: This prospective study was conducted at the department of obstetrics and gynaecology, Visakha Steel General Hospital, RINL, Visakhapatnam district from January 2010 to December 2010. Materials and methods: The Pap test and colposcopic examination were conducted on 161 patients and IHC was done on 24 cervical biopsy patients. Results: The 87.58% of women was observed with abnormal Pap smear among that the severe dysplasia is around 10%. The abnormal cervix was seen by colposcopy is 89.44%. The 24 squamous metaplasia cases were subjected to IHC and 8 cases were found to be positive. Conclusion: Pap smear, colposcopy along with cervical biopsy for HPV can provide enough information for an accurate diagnosis of cervical cancer and also from the future course of action for the treatment of the patients

Associations between extreme temperatures and cardiovascular cause-specific mortality: results from 27 countries

BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-speci fi c cardiovascular deaths. METHODS: We used uni fi ed data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of speci fi c cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-speci fi c daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fi t case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. RESULTS: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1-2.3) and 9.1 (95% eCI, 8.9-9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4-2.8) and 12.8 (95% eCI, 12.2-13.1) for every 1000 heart failure deaths, respectively. CONCLUSIONS: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day-and especially under a changing climate

Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND: Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. METHODS: We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). FINDINGS: Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1-16·5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3-44·9), from 5·46 million (4·62-6·45) in 2000 to 7·74 million (6·51-9·2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. INTERPRETATION: Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. FUNDING: Bill & Melinda Gates Foundation

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer