Congenital tuberculosis: a case report

Congenital tuberculosis is insufficiently understood and has been rarely reported even in areas endemic for the disease. Unless a high index of suspicion is maintained, the diagnosis can be missed. A case of congenital tuberculosis is herein reported to illustrate the difficulty in identifying such infants and also to sensitize the medical practionner in TB endemic areas of the need for etiologic diagnosis in congenital pneumonias as well as for antenatal screening for TB in mothers at risk

Glucose-6-phosphate dehydrogenase deficiency; the single most important cause of neonatal hyperbilirubinaemia in Kano, Nigeria

Introduction: Glucose- 6-phosphate dehydrogenase deficiency is the most common enzymatic disorder of the red cell and an important risk factor for neonatal jaundice.Methodology: The aim of the study was to determine the incidence of G-6-PD deficiency among jaundiced neonates, and describe the associated morbidity and mortality pattern in them. A prospective cross sectional study was conducted and we studied one hundred consecutive jaundiced neonates (55 males, 45 females) presenting at Aminu Kano Teaching Hospital from between 2004 and August 2005. G-6-PD activity was assayed by Quantitative spectrophotometric method of Kornberg; serum bilirubin and haemoglobin levels were estimated by standard techniques. Exposure to possible Icterogenic agents, clinical features of kernicterus and the outcome were noted.Results: The incidence of G-6-PD deficiency was found to be 46% with male to female ratio of 3:1 (Χ2 = 15, p = 0.001). A higher proportion (60.6%) of the inborn neonates had G-6-PD deficiency (X2 = 5.5, p = 0.06). Jaundice was noticed significantly earlier in the G-6-PD deficient neonates (mean = 2.0, SD = 1 days) compared to (mean = 2.7, SD = 1.6 days) in the sufficient neonates (t = 2.3, p = 0.02). Sixteen (16%) neonates developed kernicterus, of these 10 (63%) were G-6-PD deficient. The mortality rate among G-6-PD deficient neonates was 15% (7 of 46) twice as much as in the sufficient neonates 7% (4 of 54). Only six neonates 0.6% ware exposed to naphthalene of whom three were G -6PD deficient. Five babies were given traditional medicine two of which were G6-PD deficient.Conclusion: G-6-PD deficiency is an important risk factor for neonatal jaundice. Jaundice appeared early in the deficient neonates. There is high incidence of kernicterus and mortality among them. Low admission weight significantly contributed to the mortality.Key Words: G-6-PD deficiency; Neonatal Jaundice; Kernicteru

An evaluation of phototherapy services in newborn units in Kaduna State Nigeria

Background Phototherapy (PT) for unconjugated hyperbilirubinaemia remains an important and invaluable intervention in the management of neonatal jaundice when appropriately and optimally employed. The efficiency of PT greatly depends on the irradiance of the device, which is measured using an irradiance meter. Available optimal phototherapy is a key desirable newborn service that should be offered and accessible in secondary and tertiary health care facilities.Objective: The study aimed at determining the availability and irradiance measure of phototherapy devices in neonatal units in Kaduna state, Northwestern Nigeria.Materials and Methods: The study was an action research survey of all hospitals providing newborn care in Kaduna state including public and private profit and nonprofit faith based facilities. Phototherapy devices in use in the facilities were documented (types, brand and bulbs). The average irradiance of PT device was measured using model 22 Olympic Bili – MeterTM at facility traditional PT distance and distance of optimal irradiance was also determined and documented. Facilities were introduced to and educated on protocols on neonatal jaundice and how to ensure optimization of irradiance and management of neonatal jaundice.Results: None of the 31 public secondary health care facilities operated a newborn unit nor provided management for neonatal jaundice. Overall 15 facilities provided PT services of which 87% were non-government facilities made up of 15% faith based and 85% private for profit facilities. Only 13.3% facilities had PT devices which offered irradiance (> 10 μW/cm2/ nm) suitable for conventional PT at the facilities’ traditional PT distance this however, increased to 7 (46.7%) facilities with adjusted distances. Only 3 (20%) facilities had devices that co uld o ffer intensive PT (irradiance > 30 μW/cm2/ nm) at varying distances. None of the surveyed facilities had a radiometer nor knew irradiance of their PT devices and neither did any have a written protocol for the management of neonatal jaundice. Expertise for and availability of exchangeblood transfusion (EBT) services was available only in 26.7% of the facilities.Conclusions: Private health care facilities constitute a major provider of neonatal jaundice healthcare services however the services were grossly suboptimal and inadequate and will need significant and urgent improvement to enhance newborn health and indices.Keywords: phototherapy, neonatal jaundice, newborn care, kernicterus, action researc

Perinatal Presentation and Outcome of High Birthweight Infants in Zaria, Nigeria.

Background: Infants with high birth weight are candidates for birth trauma, birth asphyxia and sometimes, death. Perinatologists are therefore gradually beaming the search lights on the contribution of high birthweight delivery to perinatal morbidity and mortality. Objectives: To determine the prevalence presentation and outcome of high birthweight deliveries in Zaria. Methods: A retrospective review of records of babies delivered at Ahmadu Be l lo University Teaching Hospital , Zaria , weighing 4000 grams and above at birth, over a 4-year period was undertaken. Maternal and neonatal records were obtained from the delivery suite and neonatal unit respectively, between January, 2005 and December, 2008. Data were analyzed with EPI INFO version 3.5.1 and statistical significance was set at p<0.05. Results: Of the 3065 deliveries in the study period, 167 (5.5%) weighed 4000 grams and above, giving a prevalence of 54.5 per 1000 births. The male: female ratio was 1.2:1, mean birthweight was 4340±290 grams and 65.9% of them were delivered during the rainy season. High birthweight delivery was associated with high maternal age, high birth order and assisted delivery. Per inatal asphyxia , hypoglycaemia , hyperbilirubinaemia, sepsis and trauma were the common perinatal conditions in high birthweight babies. Perinatal mortality rate for high birthweight babies was 3.9 per 1000 total births and 71.9 per 1000 high birthweight deliveries. Conclusion: High birthweight deliveries in the present study had high perinatal morbidity and mortality. Antenatal prediction and generous use of Caesarian section could reduce the prevalent morbidity and mortality rates.Key Words: High birthweight, Presentation, Outcome

Paediatrician workforce in Nigeria and impact on child health

Objective: To determine the number and distribution of paediatricians in Nigeria. It also aims to determine the association between paediatrician workforce and under five mortality (U5MR) and immunization coverageacross the six geopolitical zones of the country.Methods: The part II fellowship examination pass list of the West African College of Physicians and the National Postgraduate Medical College and the register and financial records of the Paediatric Association of Nigeria were searched for the purpose of the study. Using a structured questionnaire, personal and professional data was obtained frommembers at the 2011 Annual Paediatric Association of Nigeria Conference or via the Association’s website, email network and phone calls to Departments of Paediatrics in institutions (private and public) across the Country. Data on the paediatricians residing within Nigeria was then extracted from the comprehensive database and subsequently analyzed.Population data, mortality and immunization rates were obtained from the National Population Commission census and their most recent National Demographic health survey in Nigeria. Correlations were drawn betweennumber of paediatricians and U5MR and diphtheria-pertussistetanus(DPT) vaccine coverage.Results: There were 492 practicing paediatricians in Nigeria at theend of year 2011, comprising 282 (57.3%) males and 210 (42.7%)females; 476 (96.7%). Majority (84.7%) worked for the governmentwith 97% of them in hospital settings, mostly tertiary centres (344=88%). Lagos State had the highest number (85; 17.9%) of practicing paediatricians followed by the Federal Capital Territory with 37 (7.8%) paediatricians. More than two thirds of the paediatricians (336; 70.6%) were practicing in the southern part of the country. The average child:p a e d i a t r i c i a n r a t i o wa s 157,878:1for the country. TheNorth East zone had the highest chi ld- to-pa ediat r ician rat io (718,412:1) while South West had the lowest ratio (95,682:1).Higher absolute numbers of paediatricians in each zone were associatedwi th lower U5MR (Spearman ñ=-0.94, p=0.0048), accounting for 84% of the variability among zones. Higher ratios of child-to-paediatrician were significantly associated with higher U5MR (Spearman ñ=0.82, p=0.04,linear R2=0.73) and marginally with lower DPT coverage by geopoliticalzone (Spearman ñ=-0.77, p=0.07, linear R2=0.59).Conclusion: The study reveals that the number of paediatricians inNigeria is grossly inadequate with a huge child-to-paediatrician ratio.There is also an uneven distribution of the paediatricians with higher numbers in the southern states. Zones of the country with lower child-to-paediatrician ratios also experienced lower U5MR. There is a need to train more paediatricians in Nigeria and promote an even distribution of the paediatrician workforceKey words: Paediatrician, workforce, child-to-paediatrician ratio, under-5 mortality, immunization, childhealth, Nigeri

Mothers and childhood pneumonia: What should the focus of public campaigns be?

Background: Prompt administration of antibiotics to children with pneumonia significantly reduces the probability of death. However this requires early identification of such children in the community.In a country such as Nigeria with one of the highest pneumoniarelateddeaths, what do mothers know about pneumonia, and what should be the content of public campaign messages?Methods: A structured questionnaire was administered to mothers  attending paediatric clinics of Lagos University Teaching Hospital seekingtheir knowledge about the definition, causes, risk factors and symptomsof childhood pneumonia.Results: One hundred and seven (107) consecutive mothers participatedin the study. The majority (97; 90.6%) had at least secondary education,were married (96; 89.7%) and professed to be either Christiansor Muslims (105; 98.1%). Prior to the study, 16 (15%) had notheard about pneumonia. About half of the participants correctly identifiedfast/difficult breathing as suggestive of pneumonia. Threequartersreported exposure to cold as the cause of childhood pneumonia. Minimizing exposure to cold and wearing warm clothes were thetwo commonest reported ways of preventing pneumonia (75.8% and49.5% of the mothers respectively); in contrast hand washing, exclusivebreastfeeding and limiting exposure to sick persons with cough and catarrhwere the least mentioned. The proportion of mothers who correctlyidentified fast/difficult breathing as suggestive of pneumoniawas similar irrespective of educational status or source of pneumoniainformation.Conclusion: Mothers’ knowledge of childhood pneumonia is low. Publiccampaigns on pneumonia should focus on raising awareness aboutgerms as cause of pneumonia, immunization, hand washing and exclusivebreastfeeding as potent preventive strategies and fast/difficult breathing as a feature of pneumonia

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge,attitude and practice of childhood immunization among community members in Ile-Ife.Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adultresidents who attended a town hall meeting with the PaediatricAssociation of Nigeria. Two focus group discussions were also conductedamong sub-samples of male and female respondents.Results: The mean age of respondents was 43.2 ± 11.9 years with amale to female ratio of 1:0.7. Most had secondary education (63.9%)and had children (91.7%). Most of the respondents understood whatimmunization was and knew the benefits but were unaware of severalof the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of therespondents had immunized their children, they identified laziness ofmothers, negative attitude of health workers and logistics problemsat facilities as barriers to patronage of immunization services.Conclusion: This study identified knowledge gaps and negative attitudestowards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement inimmunization service delivery.Key words: Community, knowledge, attitude, childhood immunization

Accidental sulphuric acid poisoning in a newborn

A six hour old baby girl presented with shortness of breath and haematemesis five hours after accidental ingestion of sulfuric acid. We report the clinical presentation of corrosive ingestion in a neonate a rare and sparsely reported occurrence at such tender age.Key words: Acid ingestion, corrosives injuries, caustic substances, chemical ingestion, newborn

Selected hematologic and biochemical measurements in African HIV-infected and uninfected pregnant women and their infants: the HIV Prevention Trials Network 024 protocol

Reference values for hematological and biochemical assays in pregnant women and in newborn infants are based primarily on Caucasian populations. Normative data are limited for populations in sub-Saharan Africa, especially comparing women with and without HIV infection, and comparing infants with and without HIV infection or HIV exposure. We determined HIV status and selected hematological and biochemical measurements in women at 20-24 weeks and at 36 weeks gestation, and in infants at birth and 4-6 weeks of age. All were recruited within a randomized clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV (HPTN024). We report nearly complete laboratory data on 2,292 HIV-infected and 367 HIV-uninfected pregnant African women who were representative of the public clinics from which the women were recruited. Nearly all the HIV-infected mothers received nevirapine prophylaxis at the time of labor, as did their infants after birth (always within 72 hours of birth, but typically within just a few hours at the four study sites in Malawi (2 sites), Tanzania, and Zambia. HIV-infected pregnant women had lower red blood cell counts, hemoglobin, hematocrit, and white blood cell counts than HIV-uninfected women. Platelet and monocyte counts were higher among HIV-infected women at both time points. At the 4-6-week visit, HIV-infected infants had lower hemoglobin, hematocrit and white blood cell counts than uninfected infants. Platelet counts were lower in HIV-infected infants than HIV-uninfected infants, both at birth and at 4-6 weeks of age. At 4-6 weeks, HIV-infected infants had higher alanine aminotransferase measures than uninfected infants. Normative data in pregnant African women and their newborn infants are needed to guide the large-scale HIV care and treatment programs being scaled up throughout the continent. These laboratory measures will help interpret clinical data and assist in patient monitoring in a sub-Saharan Africa context

Measurement of Serum Total Bilirubin in Jaundiced Newborns by Direct Spectrophotometric Micro-Technique and Diazo Method.

Background : Serum total billirubin (STB) concentrations are measured by Diazo Methods (DMs) in clinical laboratories in third world countries. However, several reports across the world suggest that these methods are associated with numerous problems. There is a need to search for an alternative method specific for neonatal bilirubin analysis. The aim of the present study was to assess a direct Spectrophotometric micro-technique (DSMT) with a view to recommending its application or otherwise for the routine estimation of serum bilirubin (SB).Materials and methods: SB concentrations were estimated by both DM and DSMT in 100 (50 males and 50 females), full – term (n±84) and pre-term (n=16) jaundiced newborns, admitted to the Special Care Baby Unit (SCBU) of ABUTH, Zaria. Capillary and venous blood specimens were obtained for the measurement of STB concentrations by DSMT and DM respectively. The data obtained were analyzed using SPSS 11.0 for Windows (SPSS, Chicago, IL). The results of STB concentrations obtained by DSMT were compared with those obtained by DM using Student’s t- test statistic method. Correlation of the two methods was carried out using Pearson’s linear correlation. A p-value of equal to or less than 0.05 (p< 0.05) was considered as statistically significant.Results: The mean values of STB concentrations obtained using DSMT and DM were 242 ± 85 and 215 ± 90 μmol/L respectively. The difference between these values was statistically significant (