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 country

Regularity in Breakfast and Snacks Intake and Its Relationship with Weight Status in Elementary School Students: A Cross Sectional Study

Background: Childhood weight status is one of the important predictors of health status later in life. Some previous studies have postulated a relationship between the pattern of breakfast intake and weight status, but this relationship has not yet been clearly confirmed. This study aimed to assess the status of regularity in intake of breakfast and snacks and its relationship with weight status in elementary school students. Method: This study was done with a descriptive-analytic design. 362 children (Males: 192, Females: 170 child) were selected from elementary schools of Urmia by the use of stratified cluster sampling. A dietary 24-hour recall form was used for the assessment of intakes. Data about breakfast, snacks, height, weight, and waist circumferences were collected. Children's Physical Activity Questionnaire (PAQ-C) was used to assess the participants' physical activity level. Data were analyzed using the descriptive and inferential statistics in SPSS software. Results: Mean student age, weight and BMI were 10.57 +/- 1.17 years, 37.44 +/- 11.30 kg and 18.4 +/- 3.39, respectively. 53.2 of girls had a regular breakfast and 55 regular snack intake. Among the boys, 46.8 had regular breakfast and 45 regular snack intake. Results showed a significant relationship between BMI and snacks consumption (p = 0.02). There was a significant relationship between the frequency of irregular breakfast intake and weight (P=0.01), but the relationship was not significant for the body mass index (P = 0.11). 58.1 of the students in the irregular breakfast group and 64.4 of those in the irregular snacks group were lean. Conclusions: Regular intake of snacks was correlated with higher weight status and maintaining desirable BMI. Irregular breakfast intake was related to lower weight. Most students with irregular breakfast and snack intake were underweight and thin

The ML flow test as a point of care test for leprosy control programmes: potential effects on classification of leprosy patients

To evaluate the use of the ML Flow test as an additional, serological, tool for the classification of new leprosy patients. In Brazil, Nepal and Nigeria, 2632 leprosy patients were classified by three : (1) as multibacillary (MB) or paucibacillary (PB) according to the number of skin lesions (WHO classification), (2) by slit skin smear examination, and (3) by serology using the ML Flow test detecting IgM antibodies to Mycobacterium leprae-specific phenolic glycolipid-I. The proportion of MB leprosy patients was 39.5, 35.6 and 19.4% in Brazil, Nepal and Nigeria, respectively. The highest seropositivity in patients was observed in Nigeria (62.9%), followed by Brazil (50.8%) and Nepal (35.6%). ML Flow test results and smears were negative in 69.1 and 82.7% of PB patients, while smears were positive in 58.6% of MB patients in Brazil and 28.3% in Nepal. In MB patients, both smears and ML Flow tests were negative in 15.6% in Brazil and 38.3%, in Nepal. Testing all PB patients with the ML Flow test to prevent under-treatment would increase the MB group by 18, 11 and 46.2% for Brazil, Nepal and Nigeria, respectively. Using the ML Flow test as the sole criterion for classification would result in an increase of 11.3 and 43.5% of patients requiring treatment for MB leprosy in Brazil and Nigeria, respectively, and a decrease of 3.7% for Nepal. The ML Flow test could be used to strengthen classification, reduce the risk of under-treatment and minimize the need for slit skin smear