Blackwater fever (BWF)? a case report from the semi-arid northeastern Nigeria

Black Water Fever is an uncommon complication of P. falciparum malaria in our environment. The overall incidence in Nigeria is unknown but the frequency may be more than is reported. It is commonly associated with administration of suboptimal doses of quinine and development of acute renal failure.We present a case of BWF having occurred after the administration of quinine,whichwe treated successfullywith artemether.

Responses of selected inflammatory, kidney and liver function markers in Serum of Nigerian Children with Severe Falciparum Malaria to treatment with artesunate/artemether-lumefantrine combination therapy

Malaria tolerance is a defence strategy that limits the damage caused by Plasmodium species irrespective of pathogen burden. The mechanisms responsible for this, responses of these mechanisms and their impact on organs to treatment have not been extensively studied. Thus, in this study, serum levels of selected pro- and anti-inflammatory markers, liver and kidney function indices with leucocytes indices in 100 children (1-10 years) with severe falciparum malaria were determined before treatment, at 48 hours during treatment and 48 hours after treatment with WHO recommended dosage of artesunate/artemether-lumefantrine combination therapy using standard methods. Data were analysed using SPSS, differences were considered significant at p<0.05. The results revealed that the serum levels of interleukin-12 (IL-12), interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), C-reactive protein (CRP), nitric oxide (NO), creatinine, albumin, total protein and conjugated bilirubin were not significantly changed at higher parasite densities before treatment. Only serum IL-4, CRP, total bilirubin, urea and creatinine levels and alanine aminotransferase activity were significantly reduced below the ranges of those with severe malaria. The results suggest a self-protective feed-back control, indicating tolerance, which reduced the adverse effects of the disease on kidney and liver functions at higher parasite densities. The results also suggest serum IL-12, IL-4, TNF-α, IFN-γ, CRP and NO levels as immune-protective markers for tolerance and serum IL-4 level as an effective marker for disease severity and recovery from the disease in children with severe malariaKeywords: Immunity, falciparum malaria, inflammatory markers, childrenAfr. J. Biomed. Res. Vol. 22 (May, 2019); 165-17

HIV Prevalence in Vulnerable Children Living in Jos, Plateau State, North-Central Nigeria

Background: The lack of Parental supervision, including psycho social problems and decrease access to basic needs  such as food, shelter, clothing, education and health care are examples of the enormous challenges faced by Vulnerable children (VC). These challenges pushes VC to adopt survival and coping strategies, of which some are exposure variables of sexually transmitted infection including HIV infection. In addition, some of these children were orphaned and made vulnerable by HIV. As such, VC should benefit from a health provider initiated counseling and testing for HIV as recommended by the Nigerian HIV policy. However, focus on screening VC for HIV infection has been abysmal; it is on this premise that this study set out to determine the HIV prevalence of vulnerable children in Jos, Nigeria. Methods: Vulnerable children were sampled from 3 different institutions and from households in 3 different communities in Jos, Plateau State with the assistance of Non-Governmental organizations involved in the care of VC. All VC enrolled were interviewed, clinically examined and screened for HIV based on national protocol and standard. Data generated were analyzed using CDC epi info version 7. A p value less than 0.05 was considered statistically significant. Results: Out of the 237 children enrolled 145 (61.2%) were male VC while 92(38.8%) were female vulnerable children, giving a male female ratio of 1.0: 0.6. HIV sero - positivity was identified in 9 of the 237 VC giving a prevalence of 3.8%, amongst the study subjects. Out of the 9 HIV positive VC, 7 VC (77.8%) were resident in institutions; only two household VC were HIV positive. There was no statistically significant association between place of residence, age of VC, gender and type of vulnerability and HIV status among the studied population. Conclusion: The HIV prevalence of 3.8% in vulnerable children is enormous and appears to be higher amongst children resident in orphanages than those in househol

Utilization of poultry waste as feed and supplementary feed for fish growth

This research work was carried out to evaluate poultry waste as a potential feed for fish growth. The poultry droppings were collected for analysis. The parameter determined to ascertain the potential of this poultry waste were proximate analysis (Moisture, dry matter, ash, crude protein, fat, crude fibre and carbohydrate contents) and mineral nutrient composition (calcium, potassium, magnesium, sodium, copper, zinc, iron and manganese). The proximate analysis determined estimated moisture content to be 9.62±0.02%, dry matter 90.38±0.03%, ash content: 28.83±0.29%, crude protein: 21.34±0.16%, fat content: 2.61±0.13%, crude fibre:16.09±0.04, and carbohydrate: 21.53±0.03. The minerals nutrient composition for metals analysed is as follows; calcium: 2349.9±56.57mg/kg, potassium: 6239±572.76mg/kg. Magnesium: 1075.0±141.42mg/kg, sodium: 292.3±10.61mg/kg, copper: 104.8±7.07mg/kg, zinc: 395.0±7.07mg/kg, iron: 519.7±7.07mg/kg and manganese: 257.5±10.61mg/kg. However, based on the result for proximate analysis of the poultry waste analysed and mineral nutrients estimated compared with the mineral nutrient requirement of fish the results were not adequate for direct use as feed for fish. Thus the poultry droppings could only serve as feed or supplement for the conventional fish feeds use for fish to give excellent growth rate.Keywords: Poultry Waste, Feed, Fish, Proximate, Minerals, Parameters, poultry dropping

Profile of hospital Admissions of childhood poisoning at a North-central Nigerian tertiary health care centre

Background: Childhood poisoning is an important but preventable cause of morbidity and mortality in the paediatric subpopulation. There is the continuous need to describe the pattern of childhood poisoning and to create public awareness on the common agents of poison in this environment.Objectives: To determine the pattern of childhood poisoning and to bridge the existing knowledge gap on childhood poisoning in North-Central Nigeria.Patients and methods: A retrospective study of case records of children admitted and treated for childhood poisoning at the Emergency Paediatrics Unit of the Jos University Teaching Hospital, Jos over a five year period (February 2008-February 2013) was undertaken. The data extracted from the case records included bio-data, date of admission, type and route of poison exposure, level of education and occupation of parents of affected children, treatment received and outcomes.Results: Twenty-six (0.94%) out of a total of 2,770 children were admitted and treated for poisoning. Their ages ranged from 5 months to 13 years. Children aged 0 to 2 years accounted for 12 (46.2%) cases with a mean age of 1.88 years. There were 10 (38.5%) male and 16 (61.5%) female with a male: female ratio of 0.62:1. Organophosphate and kerosene accounted for 9 (34.6%) and 6 (23.1%) of all cases respectively. Twenty-four (92.3%) of the poisoning were accidental while 2(7.7%) were intentional. Oral route was the commonest route of poison exposure in 20 (76.9%) and 24 (92.3%) of all cases which occurred in their home environment. gastrointestinal system symptoms were the most frequent clinical presentation 16 (61.5%). Thirteen (50.0%) of the affected victims presented to the hospital in 1-6 hours of poison exposure. Indications for hospital admissions in decreasing order of frequency were dehydration 7 (26.9%), seizures 6 (23.1%) and coma 6 (23.1%). Six (23.1%) of patients received palm oil/milk as home remedies prior to hospital presentation. There was a mortality rate of 3.8% from carbon monoxide poisoning. Mean duration of hospital stay was 1.87 days.Conclusions: Organophosphate is the commonest cause of childhood poisoning in North-Central Nigeria and children aged 0-2 years are the most vulnerable age group for accidental poisoning while older children aged 13 years and above for intentional poisoning. Therefore, there are needs to increase and sustain public health awareness on childhood poisoning and the government to provide poisoning centres and improve standards of living.Keywords: Pattern, admissions, poisoning, children, North-Central NigeriaJos Journal of Medicine, Volume 7 No.

Effect of HAART on growth parameters and absolute CD4 count among HIV-infected children in a rural community of central Nigeria

Background:Monitoring response to highly active antiretroviral therapy (HAART) in HIV infected children using both laboratory and physical growth parameter is important. But monitoring laboratory parameters could sometimes be challenging in resource-poor settings as the machines used for these measurements may not always be functional or the required technical expertise be available especially in rural areas. Hence, changes in weight-for-age (WAZ), height-for -age (HAZ) and body mass indexfor age (BAZ) Z scores during clinic follow-up visits with or without changes in absolute CD4 count, could be used instead of viral load measurements as indicators of response to HAART in children.Objectives: To determine the effect in children of treatment with HAART - on changes in physical growth using WAZ, HAZ and BAZ and on changes in CD4 count using absolute CD4 count.Methods: Data on demographic/ clinical variables, viral load, absolute CD4 count, and weight and height measurements done at enrolment and at follow-up visits for 72 eligible children < 15 years who were consecutively enrolled into HAART were analysedResults: After nine months of HAART, the median absolute CD4 count increased by 28.2% and median WAZ increased by 28.6%. The reduction in the proportion of children with moderate malnutrition (WAZ < -2) from time of HAART commencement to nine months after HAART, was by 61.5% in those without severe immune suppression (SIS) and by 50% in those with SISConclusion: This study showed that WAZ and absolute CD4 count changes could be useful for monitoring response to HAART in resource –limited settings.Key words: Growth, Absolute CD4 count, Z score, HAAR

Pattern and Trends of Respiratory Disease Admissions at the Emergency Paediatrics Unit of Jos University Teaching Hospital – A Four Year Review

Aims: Respiratory diseases contributes substantially to the number of Paediatric admissions and deaths especially in low income countries. Understanding the trends will help in health planning and resource distribution. This study is to describe the pattern and trend of respiratory diseases in children in a tertiary healthcare facility in north-central Nigeria. Study Design: This study was a retrospective study including all patients admitted and managed with respiratory diseases. The relevant clinical information was extracted from the hospital records. Place and Duration of Study: The Emergency Paediatric Unit (EPU) of the Jos University Teaching Hospital (JUTH), Jos Nigeria, between January 2012 and December 2015. Methodology: A total of 2277 children aged 6 weeks-18 years were admitted into the unit within the study period. Out of these, 498 (21.9%) were diagnosed with respiratory disease. Clinical records were retrieved and reviewed. Those with inconclusive diagnosis as well as those with associated co-morbidities such as cardiac anomalies were excluded. The data collected were entered and analyzed using Epi Info version 7.2. Student t-test and chi-square test were used to analyze categorical and continuous variables respectively. Results: Pneumonia accounted for 54.4% of total respiratory diseases. Cases of Pneumonia were mostly seen at the peak of the rainy and the harmattan seasons. (March, June/July and October/November). The highest number of cases of respiratory diseases were in the under-fives. The commonest complication was congestive cardiac failure and it was commoner in the younger age group. Conclusion: The prevalence of respiratory diseases remains high and contributes significantly to hospital admissions especially in the under five children. There is need to introduce new vaccines and re-enforce existing immunization against common organisms that cause pneumonia in children. There is also need to introduce policies that would ensure appropriate treatment for children to reduce the burden of these diseases

Sero-prevalenceof Plasmodium falciparum malaria in rural communities of Bassa, Plateau State, Nigeria

Background: Nigeria and Democratic Republic of Congo account for an estimated 40% of world malaria burden. Malaria parasite prevalence is one of the primary tools for estimating disease burden in a population.Aim: To estimate rural sero-prevalence of Plasmodium falciparum malaria.Method: This was a cross-sectional descriptive study of 564 children and adults; 312 (55.3%) and 252 (44.7%) from Kwall and Jengre communities respectively of Bassa Local Local Government Areas of Plateau Stateusing a multistage sampling technique between 1st and 4th May, 2017.Clinical evaluation, laboratory diagnosis and case management for malaria were carried out. Stata 14.1 software was used for data analysis. Results were presented in table and bar chart.Result: One hundred and five (34.6%), 289 (51.2%), and 80 (14.2%) were aged 0 – 5, 5 – 17 and 18 – 80 years respectively. Fever was the commonest presenting complaint in 34 (6%) while 472 (83.7%) had no symptoms. P. falciparum sero-prevalence rates were 24.2%, 41.4% and 34.3% among under-five children, 6 – 17 years and 18 – 80 years respectively.Conclusion. Plasmodium falciparum malaria transmission continues to occur with high sero- prevalence in rural communities of Bassa Local Government Areas of Plateau State. A slight decline was however, noted. Research on innovative models such as malaria vaccines, mosquito bionomics and environmental sanitation to compliment malaria therapeutics may need be employed in our rural communities so as to achieve the global goal for malaria eradication.Keywords: Malaria, sero-prevalence, Rapid diagnostic test, disease burde

Epidemiologic review of Zika virus disease

Zika virus disease has resonated great concern globally. The World Health Organization declared it “a public health emergency of International concern” on 1st February, 2016. The recent outbreaks have become a major challenge due to a drift from its earlier known benign exanthematous spectrum to a causal link to microcephaly. Historically, the name Zika virus comes from the Zika Forest of Uganda. It was first identified in 1947 among Rhesus Macaque sub-population. Two genetically distinct isolates have been well characterized; the Asian and African strains. This virus is spread by bites of day-time-active Aedes mosquitoes; the Aedes aegypti and Aedes albopictus. Zika Virus appears to spread along a narrow equatorial belt of Africa to Asia through the Pacific Ocean to French Polynesia, New Caledonia (southwest Pacific Ocean), the Cook Islands (south Pacific), and Easter Island (a Chilean territory in Polynesia), and most recently to Mexico, Central America, the Caribbean, and South America, where today has assumed a pandemic proportion.Up to eighty percent of infections are asymptomatic. Symptomatic infections are characterized by a self-limiting febrile illness and maculopapular rash, arthralgia, conjunctivitis, back pain and mild headaches. Maternal Zika viral load is thought to be a significant risk factor to fetal infection leading to invasion of either trophoblasts or placental cells or both through maternal decidua. Zika viral RNA proteins and associated extensive selective tissue injuries have been demonstrated in the brains and spinal cords of abortuses. Diagnosis of Zika virus is essentially based on viral RNA detection from clinical specimens. Currently, licensed preventive medicines or vaccines are unavailable. With the wide spate of recent outbreaks and consequent neurologic morbidity and mortality, there is need for deployment of point-of-care equipment for screening of pregnant women in our environment. This is an ambitious call for advocacy by all relevant health care providers.Keywords: Zika Virus, disease outbreaks, microcephaly, Aedes mosquitoe

Human immunodeficiency virus type-1 (HIV-1) genetic diversity and prevalence of antiretroviral drug resistance mutations in treatment-naïve adults in Jos, North Central Nigeria

The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine efficacy and drug resistance. It is important to know the circulating genetic variants and associated drug-resistance mutations in the context of scale up of antiretroviral therapy (ART) in Nigeria. The objective of this study was to determine the genetic diversity of HIV-1 and the prevalence of antiretroviral (ARV) drug resistance mutations among antiretroviral treatment-naïve HIV-1 infected patients in Jos, North Central Nigeria. Plasma samples were collected from 105 ARV drug-naïve patients enrolled for HIV care at the Jos University Teaching Hospital (JUTH) HIV Treatment Center between October 2010 and April 2011. One hundred (100) samples were successfully amplified. Viral subtyping was done using REGA subtyping tool and by phylogenetic analysis using PAUP software. The drug resistance mutations were determined using the Stanford University HIVdb sequence interpretation algorithm. HIV-1 subtypes identified were; CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). 8% of the patients’ isolates had at least one major resistance mutation in the RT gene: Nucleoside reverse transcriptase inhibitors: M41L (1%), K65KR (1%), M184IM (1%), M184V (2%) and T215ADNT (1%), non-nucleoside reverse transcriptase inhibitors: K103N (2%), K101E (1%), G190A (1%), P225HP (1%), Y181I (1%), Y188L (1%), and Y181C (1%). Among antiretroviral (ARV) naïve patients in Jos, North Central Nigeria, the common HIV-1 subtypes was CRF_02 and G. And the prevalence of drug resistance mutations was found to be high (8%). Further study and national surveillance will be critically important to understand the clinical impact of transmitted resistance mutations on ART naïve individuals in resource limited settings.Keywords: HIV-1 subtypes, antiretroviral (ARV), treatment-naïve, drug-resistance, mutation, accessory and polymorphisms, NigeriaAfrican Journal of Biotechnology Vol. 12(17), pp. 2279-228