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

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

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

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

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

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Data-driven malaria prevalence prediction in large densely populated urban holoendemic sub-Saharan West Africa

Over 200 million malaria cases globally lead to half-million deaths annually. The development of malaria prevalence prediction systems to support malaria care pathways has been hindered by lack of data, a tendency towards universal "monolithic" models (one-size-fits-all-regions) and a focus on long lead time predictions. Current systems do not provide short-term local predictions at an accuracy suitable for deployment in clinical practice. Here we show a data-driven approach that reliably produces one-month-ahead prevalence prediction within a densely populated all-year-round malaria metropolis of over 3.5 million inhabitants situated in Nigeria which has one of the largest global burdens of P. falciparum malaria. We estimate one-month-ahead prevalence in a unique 22-years prospective regional dataset of > 9 × 10^{4} participants attending our healthcare services. Our system agrees with both magnitude and direction of the prediction on validation data achieving MAE ≤ 6 × 10^{-2}, MSE ≤ 7 × 10^{-3}, PCC (median 0.63, IQR 0.3) and with more than 80% of estimates within a (+ 0.1 to - 0.05) error-tolerance range which is clinically relevant for decision-support in our holoendemic setting. Our data-driven approach could facilitate healthcare systems to harness their own data to support local malaria care pathways

Remdesivir Versus Standard-of-Care for Severe Coronavirus Disease 2019 Infection: An Analysis of 28-Day Mortality

BACKGROUND: Remdesivir is FDA approved for the treatment of hospitalized patients with COVID-19 and has been shown to shorten time to recovery and improve clinical outcomes in randomized trials. METHODS: This was the final day 28 comparative analysis of data from a phase 3, randomized, open-label study comparing 2 remdesivir regimens (5 vs 10 days, combined for this analysis [remdesivir cohort]) and a real-world retrospective longitudinal cohort study of patients receiving standard-of-care treatment (non-remdesivir cohort). Eligible patients, aged ≥18 years, had confirmed SARSCoV-2, oxygen saturation ≤94% on room air or required supplemental oxygen, with pulmonary infiltrates. Propensity score matching (up to 1:10 ratio) was used to ensure comparable populations. We assessed day 14 clinical recovery (determined using a 7-point ordinal scale) and day 28 all-cause mortality (coprimary endpoints). RESULTS: Altogether, 368 (remdesivir) and 1399 (non-remdesivir) patients were included in the matched analysis. The day 14 clinical recovery rate was significantly higher among the remdesivir versus the non-remdesivir cohort (65.2% vs 57.1%; OR 1.49, 95% CI 1.16–1.90; P = .002). The day 28 mortality rate was significantly lower in the remdesivir cohort versus the non-remdesivir cohort (12.0% vs 16.2%; OR 0.67, 95% CI 0.47–0.95; P = .03). CONCLUSIONS: Remdesivir was associated with significantly higher rates of day 14 clinical recovery, and lower day 28 mortality, compared with standard-of-care treatment in hospitalized patients with COVID-19. Collectively, these data support the use of remdesivir to improve clinical recovery and decrease mortality from SARS-CoV-2 infection