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

Immunity against tetanus infection, risk factors for non-protection and validation of a rapid immunotest kit among hospitalised children in Nigeria

Seroepidemiological studies of tetanus in Africans have focused mainly on adults especially pregnant women and data on children are scarcely reported. We investigated the seroprevalence of protective immunity level, determined risk factors for non-protection against tetanus and evaluated the performance of Tetanos Quick Stick® (TQS) among hospitalised children aged 1 to 9 years in Nigeria. Blood IgG antibody levels to tetanus was determined using enzyme-linked immunosorbent assay (ELISA) in the laboratory and TQS (an immunochromatogrphic test) at the bedside for 304 children admitted into emergency unit of a tertiary hospital in Ibadan Nigeria. Demographic information and vaccination history were also collected. TQS results were compared with anti-tetanus antibody measured by ELISA using seroprotection cut-off of 0.1 IU/ml. Seroprevalence of protective level of immunity against tetanus using ELISA and TQS methods was 44.7% and 45.4% respectively. Protective level of immunity increased as age increases. Of the seven potential factors assessed, male gender and being second or more position among mother’s children were independent predictors of non-protective level of immunity. Absence of history of recent tetanus toxoid injection was significantly associated with non-protective level of immunity in univariate analysis but not logistic regression model. The agreement between the ELISA and the TQS results was good with a k coefficient of 0.931. TQS sensitivity was, 95.7%, specificity 97.6%, positive predictive value 98.0% and negative predictive values 96.0%. This study showed that lack of protective immunity against tetanus is common; few demographic characteristics correctly predict non-protection and IgG antibody levels to tetanus was accurately detected by TQS

Mothers′ understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control

Introduction: Regular evaluations of communities′ understanding of malaria-related practices are essential for control of the disease in endemic areas. This study was aimed at investigating the perceptions, prevention and treatments practices for childhood malaria by mothers in rural communities. Materials and Methods: We conducted a community-based cross-sectional study at rural communities of Ise-Orun local Government area, Nigeria. We randomly sampled 422 mothers of children less than 5 years and administered a validated questionnaire to assess their perceptions and practices relating to childhood malaria. We used a 10-point scale to assess perception and classified it as good (≥5) or poor (<5). Predictive factors for poor perceptions were identified using logistic regression. Results: Approximately 51% of the mothers had poor perception and 14.2% ascribed malaria illness to mosquito bite only. Majority (85.8%) of the mothers practiced malaria preventive measures, including: Insecticide treated nets (70.0%), chemoprophylaxis (20.1%) and environmental sanitation (44.8%). Of the 200 mothers whose children had malaria fever within the 3 months prior to the study visits, home treatment was adopted by 87.5%. Local herbal remedies were combined with orthodox medicine in the treatments of malaria for 91.5% of the children. The main reasons for not seeking medical treatment at existing formal health facilities were "high cost", "challenges of access to facilities" and "mothers′ preference for herbal remedies". Lack of formal education was the only independent predictor of poor malaria perceptions among mothers (OR = 1.91, 95% CI = 1.18, 3.12). Conclusions: Considerable misconceptions about malaria exist among mothers in the rural communities. The implications for malaria control in holoendemic areas are highlighted

Prevalence of Non-Nutritive Sucking Habits and Potential Influencing Factors among Children in Urban Communities in Nigeria

Background: The use of non-nutritive sucking materials like pacifiers and fingers poses health challenges to children in resource-limited settings, where hygiene practices and provision of clean water are poor. This study was designed to determine the prevalence of non-nutritive sucking habits and its association with acute diarrhoea in children aged 6 to 23 months in urban communities of Nigeria.Methods: In this cross-sectional study, 12 communities from four out of 12 geopolitical wards in Ibadan North Local Government Area and 427 mothers of children aged 6-24 months were randomly selected. A pre-tested, interviewer-administered questionnaire was used to obtain information on socio-demographic characteristics, recent history of diarrhoea (three months prior to visit) and use of non-nutritive sucking materials. Descriptive statistics, Chi square and logistic regression were used for data analysis at p=0.05. Results: Mean age of the children was 13.9±5.3 months and 50.6% were males. Prevalence of non-nutritive sucking was 45.2%. Prevalence of non-nutritive sucking was not significantly different between males (45.8%) and females (44.5%). The odds of engaging in non-nutritive sucking increases by 6.0% with increasing age (OR = 1.06; 1.02; 1.10). More children who were not exclusively breastfed (53.5%) than exclusively breastfed (26.2%) were likely to engage in non-nutritive sucking (OR = 3.25; 95% CI = 2.07, 5.12). Acute diarrhoea was more frequently reported in non-nutritive sucking group than the other (OR = 1.51; 95% CI = 1.03, 2.22). Conclusion: Non-nutritive sucking was linked with failure to practice exclusive breastfeeding, worse with increasing age and predisposes to acute diarrhoea. Further studies are necessary to verify the nature of these associations

Trends of infant vaccination timeliness and completion in selected urban slum communities in Ibadan, Southwestern Nigeria: A four-year review.

BackgroundSuboptimal infant vaccination is common in Nigeria and multiple interventions have been deployed to address the situation. Child health indicators are reported to be worse in urban slums compared with other urban areas, but urban data are usually not disaggregated to show these disparities. Examining the timeliness and completion of infant vaccination in urban slums is important to determine the effectiveness of existing interventions in improving infant vaccination among this vulnerable population. This study explored the trends of infant vaccination in selected urban slum communities in Ibadan, Southwest Nigeria between November 2014 and October 2018.MethodsThis was a cross sectional study where infant vaccination data were extracted from the immunization clinic records of six primary health care centers that were providing infant vaccination services for seven urban slum communities. Data was analyzed using descriptive statistics and Chi square test at α = 05.ResultsA total of 5,934 infants vaccination records were reviewed, 2,895 (48.8%) were for female infants and 3,002(50.6%) were from Muslim families. Overall, only 0.6% infants had both timely and complete vaccination during the four years under study. The highest number of infants with timely and complete vaccination were seen in 2015(12.2%) and least in 2018(2.9%). Regarding timeliness of the vaccines, BCG, was the least timely among the vaccines given at birth and the pentavalent and oral polio vaccines' timeliness reduced as the age of the infants increased. Both yellow fever and measles vaccines were timelier than the pentavalent vaccines. Vaccines were most timely in 2016(31.3%) and least timely in 2018(12.1%). Those from Muslim families significantly had delayed and incomplete vaccinations compared with those from Chrisitan families (p = 0.026).ConclusionInfant vaccinations were significantly delayed and incomplete in the study communities during the years reviewed. More focused interventions are required to ensure optimal vaccination of the infants

Adolescent girls’ understanding of tetanus infection and prevention: implications for the disease control in western Nigeria

Tetanus is a major cause of morbidity and mortality in developing countries. Nigeria is aiming to eliminate tetanus by maintaining coverage of routine vaccinations for infants and pregnant women, but little attention is given to the adolescents’ needs. This study assessed the understanding of adolescent girls about tetanus infection and prevention in order to provide information that may foster better policy. In this cross-sectional analytical study, 851 female adolescents were selected from eight secondary schools in Ibadan, south-west of Nigeria using a three-stage random sampling technique. A pre-tested structured questionnaire was used to obtain information on demographic and socio-economic characteristics, history of tetanus vaccination and adolescents’ knowledge of tetanus infection. Mean age of respondents was 14.3±1.9 years. Only 3.1% had received tetanus toxoid injection one year prior to the study, most frequently following a wound or injury (65.4%). Though, 344 (40.4%) respondents claimed they knew tetanus as a serious neurological disease, only 46.5% correctly defined tetanus. Overall, the mean knowledge score was 4.8±3.1 and 64.7% of the respondents had poor knowledge. Academic class was significantly associated with knowledge; higher mean score among the senior (5.3±5.3) than junior classes (4.4±3.2); p< 0.001. Over half (56.2%) of the adolescents disagreed with the statement that tetanus immunisation can be given to students in the school premises. There is the need to improve immunisation campaigns against tetanus among adolescent girls and consider the introduction of school-based immunisation programmes if the elimination of maternal and neonatal tetanus is to be achieved

The use of intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnancy in Ibadan, Nigeria: Implications for policy

Malaria in pregnancy (MIP) remains a major public health concern, inspite of the adoption of WHO recommended intermittent preventive treatment (IPTp) with sulphadoxine-pyrimethamine (SP) for its control in Nigeria. Using interviewer administered questionnaires, information on knowledge of the burden, consequences and the use of SP for malaria control in pregnancy was obtained from 800 mothers within 24 h after delivery at two health centres in Ibadan. Women who attended antenatal care (ANC) at the secondary facility were less likely to demonstrate poor knowledge of causes (OR = 0.18, 95 % CI = 0.08, 0.38), consequences (OR = 0.37, 95 % CI = 0.24, 0.55) and control strategies (OR = 0.32, 95 % = 0.18, 0.59) compared with tertiary facility. Only 56.4 % of all the mothers were aware of IPTp SP as government policy for prevention of MIP out of which 16.9 % used IPTp SP in index pregnancy. Overall, only 18.4 % of all mothers used IPTp SP. Being unaware of the existing government policy and educational attainment of 9 years independently predicted non-usage of IPTp SP. This study revealed that the uptake of IPTp SP in pregnancy is poor in spite of good knowledge of burden of malaria in pregnancy and underscores the need to scale up awareness campaign and monitor implementation at all levels of health care. Key words: Malaria in pregnancy, intermittent preventive treatment, sulphadoxine-pyrimethamine

Neonatal transport practices in Ibadan, Nigeria

Introduction: Neonatal transport involves moving sick neonates in optimal conditions to ensure good outcomes. It is well organized in most developed countries but receives little attention in developing countries where the highest burden of neonatal mortality exists and a large number of newborns require referrals daily for better medical care. This study sought to evaluate the modes of transport, pre- and intra-transport care of neonates referred to the University College Hospital (UCH), Ibadan, Nigeria. Methods: The methods of transporting 401 neonates presenting to the children’s emergency room of the hospital were evaluated as well as the care the babies received during transport. Categorical variables were compared using the Chi square test while continuous variables were compared by the student t-test. Results: About a third presented in the first 12hours and 85% in the first week of life, all from within 80km radius. There were 67.1% term, 31.4% preterm and 1.5% post-term neonates, all without prior communication. The modes of transport included private vehicles (43.9%), commercial vehicles (40.6%), motorcycles (9.0%), ambulance (4.0%) and on foot (2.5%). Only 3 (0.7%) were transported in incubators and none in KMC position. Only 42.0% had referral letters and 7.0% were accompanied by medical personnel. Materials available during transport included Ambubags (3.7%), oxygen (3.5%) and some drugs (3.5%). Events during transport were apnoea, 4.7%, vomiting 1.0%, reduced activity 16.2% and seizures 13.7%. 19 (4.7%) neonates were dead on arrival. Pre-transport care included resuscitation (18.2%), intravenous fluid/feeding (24.4%) and supplemental oxygen (14.0%). Conclusion: Neonatal transport practices in Ibadan, Nigeria are abysmal with associated high mortality.Pan African Medical Journal 2016; 2