Short-term Persistence of Protective Maternally Acquired Immunity in Neonates Delivered by Primiparous Women in Ibadan, Nigeria

BACKGROUND: Unresolved questions remain concerning the protective effect and duration of immunity acquired from mothers. This study investigated persistence of immunity against tetanus in the first two weeks of life among neonates in Nigeria.METHODS: In a longitudinal study, 244 primiparous mothers and their newborns were consecutively recruited at 16 selected Primary Healthcare Centres in Ibadan, Nigeria. All the newborns were tested for protection against tetanus using a validated rapid diagnostic, “Tetanos Quick Sticks” (TQS) on days 1, 7 and 14. Persistent immunity was defined as positive TQS result on day-14. Data were analysed using descriptive statistics, Chi-square and logistic regression at p = 0.05.RESULTS: There were 137(56.1%) male neonates; 87.7% were delivered at ≥37weeks of gestation. The prevalence of protective immunity against tetanus (PIaT) among neonates on day-1 was 63.5%; 119 out of 153 neonates remained positive to TQS test by day-14, giving a persistence rate of 77.8%. Independent predictors of persistent PIaT were residence in urban area (OR = 9.66; 95% CI = 2.42-38.45), maternal age (OR = 2.06; 95% CI = 1.49-2.85) and gestational age (OR = 1.84; 95% CI = 1.23-2.74).CONCLUSION: Protective immunity against tetanus waned in some neonates over the first two weeks of life, and this decline was inversely related to maternal and gestational ages

Protocol and Researcher’s Relationship with Institutional Review Board

The document of ethical approval is an important official requirement for research involving human participants worldwide. It is the process whereby an investigator submits the full research proposal and related documents including detailed informed consent process to an independent Institutional Review Board (IRB) for scrutiny. The process of seeking review and approval is necessary to ensure adequate measure are in place to safeguard and protect research participants as entrenched in the principles of The Declaration of Helsinki and The Belmont Report. It is the responsibility of every clinical researcher to obtain ethical approval, therefore, their obligation to understand the process of review and establish relationship with local IRB in order to enhance smooth review and approval. This article, therefore, explains clinical research and distinguishes between research and clinical care, clarifies briefly what constitutes a study protocol and describes the researchers' relationship with IR

Accuracy of Nelson and best guess formulae in estimation of weights in Nigerian children population

Background: An alternative method of estimating children’s weights, when direct weighing is impracticable is the use of age-based formulae but these formulae have not been validated in Nigeria. This study compares estimated weights from two commonly used formulae against actual weights of healthy children.Methods: Children aged 1 month to 11 years (n= 2754) were randomlyselected in Ibadan, Nigeria using a two-stage sampling procedure. Weight of each child, measured using a standard calibrated scale and determined using Nelson and Best Guess formulae, were compared. Demographic characteristics were also obtained. Mean percentage error (MPE) was calculated and stratified by gender and age. Bland-Altman graphs were used for visual assessment of the agreement between estimated and measured weights. Clinically acceptable MPE was defined as ±5%.  Descriptive statistics and paired t test were used to examine the data. Statistical level of significance was set at p = 0.05.Results: There were 1349 males and 1405 females. Nelson and Best Guess formulae overestimated weight by 10.11% (95% CI: -20.44, 40.65) in infants. For 1-5 years group, Nelson formula marginally underestimated weight by -0.59% (95% CI: -5.16, 3.96) while it overestimated weight by 9.87% (95% CI: 24.89, 44.63) in 6-11 years. Best Guess formulae consistently overestimated weight in all age groups with the MPE ranging from 10.11 to 30.67%.Conclusion: Nelson and Best Guess formulae are inaccurate for weight estimations in infants and children aged 6-11 years. Development of new formulae or modifications should be considered for use in the Nigerian children population.Keywords: Measured weight, Best Guess formula, Nelson formula, Mean percentage erro

Accuracy of mid upper arm circumference in detection of obesity among school children in Yenagoa City, South-south region of Nigeria

Background: The search for alternative method that is easier and less cumbersome than body mass index (BMI), for identification of obese individuals has been controversially discussed in recent literature. This study was carried out to determine the accuracy of Mid Upper Arm Circumference (MUAC) compared to BMI. Method: We recruited 920 children aged 5–18 years from primary and secondary schools in Yenagoa in the Niger Delta region of Nigeria using a multistage random sampling technique. Weight, height and MUAC of the children were measured using standard methods. We calculated BMI, defined obesity as BMI-for-age z- scores >2 and the corresponding cut-off values of MUAC for defining obesity were determined. Sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV) of MUAC were determined using BMI as the gold standard. Area under the ROC (AUC) was also determined to assess MUAC’s ability to correctly identify obesity. Results: MUAC correlated positively with BMI and age, the cut-off values increased with age in both boys and girls. When compared with BMI, using sex and age group specific cut-off for MUAC, the estimated specificities were relatively higher than sensitivities in all age groups. However, the best performance of MUAC for detection of obesity was recorded for girls (AUC = 0.94, 96% CI = 0.89, 0.99) and boys (AUC = 0.89, 95% CI = 0.78, 0.99) in age group 10-14 years. Similarly, the NPV were higher than the PPV. Conclusion: The MUAC showed remarkably high accuracy for diagnostic and screening use among children aged 10-14 years but inconsistent results in other age groups

Adequacy of Bristol stool form scale in the assessment of stools by mothers of healthy infants in Ibadan, Nigeria

Background: An important complaint of mothers is the stool form of their infants. In the evaluation of stool forms, healthcare workers usually depend on mothers’ reports which are subjective and influenced by interpretation bias by health care personnel. There is therefore the need for an objective method of describing stool forms. In the present study, we evaluated the utility of the 7-point Bristol Stool Form Scale (BSFS) when used by mothers of healthy Nigerian infants. Materials and Methods: The mothers of 122 healthy infants delivered at term, with infants less than six months of age attending the Infant Welfare Clinics of two health facilities in Ibadan, South West, Nigeria for routine immunisation were enrolled. Mothers were requested to identify their child’s most recent stool form using the 7-point BSFS. Results: The mean ± SD age of the 122 study infants was 80 ±41.6 days (range 4-180 days). Eighty-eight (72.1%) infants were exclusively breastfed and 34 (27.9%) were on mixed feeding. Almost all (120; 98.4%) mothers felt that the BSFS adequately described their infants’ stools. The most commonly reported stool types were T ype 6 (56.7%) and T ype 7 (33.3%). There was no association between reported stool consistency and infant feeding type, level of maternal education and number of previous babies nursed. Conclusion: This study indicated that BSFS may be a reliable tool for mothers to describe stool consistency in healthy Nigerian infants

Dyslipidaemia in African Children and Adolescents

Dyslipidaemia tends to occur in children and adolescents and steadily worsens through to adulthood. The abnormal lipid profile in children with this disease is like what we see in adults with premature cardiovascular disease (CVD). Identifying children with dyslipidaemia and successfully improving their lipid profile may reduce their risk of accelerated atherosclerosis and premature CVD. In those children with severe dyslipidaemia due to a family history, treatment is used to decrease the risk of cardiogenic events. Screening for lipid disorders in children is based on the rationale that early identification and control of paediatric dyslipidaemia will reduce the risk and severity of cardiovascular complications in adulthood. Though lipid disorders and associated diseases are rare in children in Africa, there has been little research in this field. Emerging research indicates that obesity and cholesterol concerns is on the rise within children and adolescents of African descent. The definition of paediatric dyslipidaemia and the approach to screening, and diagnosis of lipid disorders in children are discussed in this chapter

Prevalence of dermatological lesions in hospitalized children at the University College Hospital, Ibadan, Nigeria

Objective: Skin disorders constitute a significant proportion of consultations in children’s clinics; however, there is a paucity of data on the prevalence of dermatological lesions in hospitalized children in Nigeria. This study determines the prevalence of dermatological lesions in hospitalized children.Materials and Methods: In this cross-sectional study, 402 children aged three months to twelve years admitted in the Pediatric wards of the University College Hospital, Ibadan, were enrolled over a six-month period. Examination of the skin and its appendages was done for each patient. Data on the socioeconomic status, hygiene, and health-related factors were also obtained using a structured questionnaire.Results: Over 96% of the children had at least one identifiable skin lesion. The five leading skin lesions were postinflammatory hyperpigmentation (49.5%), BCG scar (28.4%), Mongolian spots (27.1%), junctional melanocytic nevi (20.1%), and café-au-lait macules (18.4%). The leading infectious skin disease was pyoderma (13.4%), followed by tinea capitis (6.7%). Scarification marks (P=0.001), tinea capitis (P=0.014), plantar fissuring (P=0.001), and impetigo (P=0.016) were associated with low socioeconomic classes, while the presence of BCG scar (50.0%) was associated with the high socioeconomic class.Conclusions: This study shows that dermatologic lesions are common in hospitalized children. Identifying them will provide an opportunity for pediatricians to educate parents on the various causes as well as prevention of lesions

Physicochemical comsposition of Kenaf (Hibiscus cannabinus L.) seed under different storage temperature

Kenaf is an annual plant grown for its fibre which basically depend on the seed viability, for its maximum growth and production. The seed viability and vigor in turn depend on storage condition. There is insufficient information on physicochemical composition of kenaf seed in relation to seed viability. The present study was performed to know the physicochemical composition of the kenaf seed at different storage temperature in other to improve upon rapid loss of seed viability in kenaf. Four varieties of kenaf seed were obtained from I.A.R. & T seed unit. The seeds were stored at 00C (Unviable seed), 2.20C (Lower temperature), 350C (Ambient temperature), 280C (Cold room temperature which serve as control) for period of 8 months. Seed germination test and weight was performed  before and after the experiment.  Proximate analysis (Crude protein, Moisture, Carbohydrate, Ash, Crude fibre, Crude fat) and Phytochemicals (Total phenolics, Steroid and Total Flavonoids were also determined). The result shows that there is significant difference in all the parameters studied, for all the storage temperatures as compared with the control (280C) among the varieties except from ifeken 100 where the was no significant difference in Crude fibre and Ash  content for seed under ambient temperature as compared with the control. However, the level of tolerance to different storage temperature among the varieties following the order Ifeken 400 >Tianung 2 > Cuba 108>Ifeken 100.Keywords: Kenaf, Storage, Seed germination, Seed weight, Temparature, Seed viability, Proximate, Flavonoid, Phenolics

Physicians’ Knowledge of the Glasgow Coma Scale in a Nigerian University Hospital: Is the Simple GCS Still Too Complex?

Objective: The Glasgow Coma Scale, GCS, is a universal clinical means of quantifying the level of impaired consciousness. Although physicians usually receive undergraduate and postgraduate training in the use of this scale in our university hospital we are aware of studies suggesting that the working knowledge of the GCS among practising physicians might not be adequate. Methods: We carried out a questionnaire-based survey across all specialties and levels of training of physicians in active patient care in a Nigerian university hospital. Results: Of the 100 physicians sampled, 98 correctly spelled out what the three-letter abbreviation, GCS, stands for. Ninety-three percent also conceded it to be an important clinical rating scale. However, only 55–89% of the participants correctly identified the three respective clinical variables, (eye opening, verbal response, and motor response), of the GCS. More particularly, the participants’ ability to itemize and correctly score all the respective components of each of the three clinical variables ranged from 0 to 35% across specialties and levels of training. Performance was best for the four-item eye opening variable and, worst for the six-item motor response variable. Conclusion: In our university hospital, practising physicians’ working knowledge of the GCS is inadequate and is dependent on the degree of the complexity of each of the three clinical variables of the scale

Early home treatment of childhood fevers with ineffective antimalarials is deleterious in the outcome of severe malaria

<p>Abstract</p> <p>Background</p> <p>Early diagnosis and prompt treatment including appropriate home-based treatment of malaria is a major strategy for malaria control. A major determinant of clinical outcome in case management is compliance and adherence to effective antimalarial regimen. Home-based malaria treatment with inappropriate medicines is ineffective and there is insufficient evidence on how this contributes to the outcome of severe malaria. This study evaluated the effects of pre-hospital antimalarial drugs use on the presentation and outcome of severe malaria in children in Ibadan, Nigeria.</p> <p>Methods</p> <p>Two hundred and sixty-eight children with a median age of 30 months comprising 114 children with cerebral malaria and 154 with severe malarial anaemia (as defined by WHO) were prospectively enrolled. Data on socio-demographic data, treatments given at home, clinical course and outcome of admission were collected and analysed.</p> <p>Results</p> <p>A total of 168 children had treatment with an antimalarial treatment at home before presenting at the hospital when there was no improvement. There were no significant differences in the haematocrit levels, parasite counts and nutritional status of the pre-hospital treated and untreated groups. The most commonly used antimalarial medicine was chloroquine. Treatment policy was revised to Artemesinin-based Combination Therapy (ACT) in 2005 as a response to unacceptable levels of therapeutic failures with chloroquine, however chloroquine use remains high. The risk of presenting as cerebral malaria was 1.63 times higher with pre-hospital use of chloroquine for treatment of malaria, with a four-fold increase in the risk of mortality. Controlling for other confounding factors including age and clinical severity, pre-hospital treatment with chloroquine was an independent predictor of mortality.</p> <p>Conclusion</p> <p>This study showed that, home treatment with chloroquine significantly impacts on the outcome of severe malaria. This finding underscores the need for wide-scale monitoring to withdraw chloroquine from circulation in Nigeria and efforts intensified at promoting prompt treatment with effective medicines in the community.</p