Successes and challenges of under-five child mortality reduction in West Africa

Background: Under-five mortality rate is an important index for assessing achievements by countries and thus its targeted reduction is adopted as benchmark towards realizing the Millennium Development Goal number4 by 2015. With less than 24 months to the deadline, West Africa still contributes significantly to the global burden of child mortality, with over half of the deaths caused by infections.Objective: To review the successes and challenges of reducingunder-five mortality in West Africa.Sources: A search was made in Pub Med and Google Scholar using the key words: Under-five, Children, Mortality, West Africa, Successes, Progress, Achievements and Challenges. Relevant publications and reports availableat WHO, UNICEF and UN websites were also consulted. Tables and charts were drawn from relevant data for West African Countries obtained from these sources using Microsoft® Excel® for Mac 2011 Version 14.1.0(110310).Results: Although significant under-five death reductions have been  recorded in countries of West Africa between 1990 and 2012, the reduction falls far short of the expected targets and infections still remain the leading causes of death. In spite of a fivefold rise of average annual rate of reduction of under-five deaths compared to a 3-fold rise of the global average and a 49.7% reduction in under-five mortality rate, the sub-region trails behind other parts of Africa. While only Liberia achieved the MDG 4 target, Niger, Cape Verde, Gambia, Guinea and Burkina Faso are on track. Nigeria’s huge child population, high under-five mortality burden and slow reduction, weighs down the sub-region’s averages. Neonatal death  proportions are rising, with four countries ranking amongst the world’s top ten. With less than 24 months left, the likelihood of achieving the reduction targets for under-five mortality in most of the countries in the sub-region by the end of 2015 remains a mirage.Conclusion: Numerous daunting challenges have contributed to slow the pace of under-five death reduction in West Africa. Countries in the sub-region need to address their challenges while scaling up proven interventions to accelerate progress towards further reductions of under-five deaths.Key words: Children, under-five, mortality, West Africa, progress, successes, achievements, challenge

Situation Analysis Of The Existing Infant Feeding Pattern At The commencement Of The Prevention Of Mother To Child Transmission (PMTCT) of HIV Programme In Ibadan

To evaluate breastfeeding and weaning practices associated socio-demographic factors and knowledge aboutmother- to- child transmission ofHIVamongmothers in Ibadan. A cross sectional survey was conducted among 513 mothers of children aged 6- 24 months, attending infant welfare clinics. Data collection was by a structured questionnaire, which was supplemented by focus group discussions to further explore some of the issues covered in the survey. Breast-feeding rate was 99.4%, the duration of which ranged from 1-22 months with a median of 14 months among those who had stopped breastfeeding. Only 145 (28.3%) mothers breastfed their babies exclusively for six months and 259(50.8%) initiated breastfeeding within one hour of birth; both were associated with at least secondary level of education. The main obstacle to exclusive breastfeeding was the belief that water is required to quench thirst in babies. Expression of breast milk was not favoured by majority of the mothers (68%) most of whom felt that the milk would get contaminated. Wet nursing was rarely practiced (0.4%). Most of the mothers, 436 (85%) were aware that HIV could be transmitted through breast milk but the attitude towards amotherwho did not breast feedwas negative in 96.8%of respondents.Adherence to recommended infant feeding options for HIV-exposed infants are likely to be faced with challenges in a culture where breastfeeding is the norm and exclusive breastfeeding rate is low. There is need for counseling and health education on prevention ofmother- to- child transmission of HIV.Keywords: Exclusive breastfeeding, situation analysis, infant feeding patterns, Ibada

HIV infection in orphanages in South Western Nigeria

Background: As a result of the expanding HIV epidemic, affected children may end up in institutionalized care. Objectives: To determine the prevalence of HIV infection among children into orphanages in South Western Nigeria . Admission policies, knowledge and attitude of caregivers with respect to HIVwere also assessed Design: This was a cross sectional study in which interviewer administered questionnaires were used to collect information on consecutive children, heads of the orphanages and caregivers. Rapid HIV antibody testing was carried out. Results: A total of 190 children were enrolled from 7 homes with males accounting for 89 (46.8%). The main reasons for admission into the orphanages were; orphaned 85 (44.7%), abandoned 79 (41.6%) and mental illness in mother 11(5.8%). Two children were HIV positive, giving a prevalence rate of 1.05%. All the homes (100%) had a policy which excluded admission of HIV positive children but seldom carried out HIV testing at entry. Fear of disease transmission to others was the reason given for not admitting such children. Conclusion: The policy which excluded admission of HIV infected children may have contributed to the low prevalence of the infection in the orphanages. There needs to be a reform on the current policies in order to reduce discr iminat ion against HIV orphans.Keywords: HIV; Prevalence; Children; Orphanages; Admission policies; Caregiver

Pre-Hospital Management of Febrile Seizures in Children Seen at the University College Hospital, Ibadan, Nigeria

Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome.Objectives: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria.Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded.Results: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socioeconomic class of the caregivers (P=0.008).Conclusions: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortalityassociated with febrile seizures in the locality.Keywords: seizures, febrile, cow’s urine, socio-economic statu

Contraceptive self-injection knowledge, attitude and practices among female students of a tertiary health institution in south west Nigeria

Background: Contraception is one of the key strategies to achieving sustainable developments but access has been low among youths in developing countries. It is thus imperative to contextually understand the uptake of one of the newly developed contraceptive methods among undergraduate Nigerian students.  This study assessed knowledge, attitude and practices of students in Bowen University Teaching Hospital Ogbomoso on contraceptive self-injection (DMPA-SC).Methods: Descriptive cross-sectional design was employed among 167 consenting students who were recruited using stratified sampling method. Validated semi-structured, self-administered questionnaire was used for data collection. Both descriptive and inferential statistics were carried out.Results: Mean age (SD) of the respondents was 21.9±2.2. More than a quarter (32.0%) of the respondents were not aware of contraceptive self-injection. Attitude to contraceptive self-injection was positive in 91% of those who were aware of it. However, just 2.4% of the contraceptive users ever used contraceptive self-injection. Cost considerations (25%), fear of side effects (17%), feeling of being not at risk of pregnancy (33.3%) and lack of awareness (25%) were the major barriers to uptakes of contraceptive self-injection among our respondents. Almost three-quarter (71.0%) of the respondents had good knowledge of self-injection contraception. Age, (AOR=5.038, 95% CI=1.846-1.274) and attitude (AOR=3.286, 96% CI=2.253-4.794) were the determinants of good knowledge on contraceptive self-injection.Conclusions: In spite of the predominant positive attitude and good knowledge on contraceptive self-injection, uptake was low in the study population. Authors recommend increased awareness campaign regarding this method of contraception among health-related students who can be vanguards of information dissemination on the product

Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN)

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Severe childhood malaria syndromes defined by plasma proteome profiles

BACKGROUND Cerebral malaria (CM) and severe malarial anemia (SMA) are the most serious life-threatening clinical syndromes of Plasmodium falciparum infection in childhood. Therefore it is important to understand the pathology underlying the development of CM and SMA, as opposed to uncomplicated malaria (UM). Different host responses to infection are likely to be reflected in plasma proteome-patterns that associate with clinical status and therefore provide indicators of the pathogenesis of these syndromes. METHODS AND FINDINGS Plasma and comprehensive clinical data for discovery and validation cohorts were obtained as part of a prospective case-control study of severe childhood malaria at the main tertiary hospital of the city of Ibadan, an urban and densely populated holoendemic malaria area in Nigeria. A total of 946 children participated in this study. Plasma was subjected to high-throughput proteomic profiling. Statistical pattern-recognition methods were used to find proteome-patterns that defined disease groups. Plasma proteome-patterns accurately distinguished children with CM and with SMA from those with UM, and from healthy or severely ill malaria-negative children. CONCLUSIONS We report that an accurate definition of the major childhood malaria syndromes can be achieved using plasma proteome-patterns. Our proteomic data can be exploited to understand the pathogenesis of the different childhood severe malaria syndromes

Consistent Effects of Early Remdesivir on Symptoms and Disease Progression Across At-Risk Outpatient Subgroups: Treatment Effect Heterogeneity in PINETREE Study

INTRODUCTION: In the PINETREE study, early remdesivir treatment reduced risk of coronavirus disease 2019 (COVID-19)-related hospitalizations or all-cause death versus placebo by 87% by day 28 in high-risk, non-hospitalized patients. Here we report results of assessment of heterogeneity of treatment effect (HTE) of early outpatient remdesivir, focusing on time from symptom onset and number of baseline risk factors (RFs). METHODS: PINETREE was a double-blind, placebo-controlled trial of non-hospitalized patients with COVID-19 who were randomized within 7 days of symptom onset and had ≥ 1 RF for disease progression (age ≥ 60 years, obesity [body mass index ≥ 30], or certain coexisting medical conditions). Patients received remdesivir intravenously (200 mg on day 1 and 100 mg on days 2 and 3) or placebo. RESULTS: In this subgroup analysis, HTE of remdesivir by time from symptom onset at treatment initiation and number of baseline RFs was not detected. Treatment with remdesivir reduced COVID-19-related hospitalizations independent of stratification by time from symptom onset to randomization. Of patients enrolled ≤ 5 days from symptom onset, 1/201 (0.5%) receiving remdesivir and 9/194 (4.6%) receiving placebo were hospitalized (hazard ratio [HR] 0.10; 95% confidence interval [CI] 0.01-0.82). Of those enrolled at > 5 days from symptom onset, 1/78 (1.3%) receiving remdesivir and 6/89 (6.7%) receiving placebo were hospitalized (HR 0.19; 95% CI 0.02-1.61). Remdesivir was also effective in reducing COVID-19-related hospitalizations when stratified by number of baseline RFs for severe disease. Of patients with ≤ 2 RFs, 0/159 (0.0%) receiving remdesivir and 4/164 (2.4%) receiving placebo were hospitalized; of those with ≥ 3 RFs, 2/120 (1.7%) receiving remdesivir and 11/119 (9.2%) receiving placebo were hospitalized (HR 0.16; 95% CI 0.04-0.73). CONCLUSIONS: In the outpatient setting, benefit of remdesivir initiated within 7 days of symptoms appeared to be consistent across patients with RFs. Therefore, it may be reasonable to broadly treat patients with remdesivir regardless of comorbidities. TRIAL REGISTRATION: ClinicalTrials.gov number NCT04501952

Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection

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