Urinary tract infection in febrile children in Maiduguri North Eastern Nigeria

No Abstract

Typhoid fever in children: Clinical presentation and risk factors

Objective: The diagnosis of typhoid fever based on widal test is on the rise despite its set back. We prospectively reviewed over one year period, cases of typhoid fever admitted in our centre to document the pattern of clinical presentation, risk factors and the reliability of Widal test in its diagnosis.Methods: This was a prospective study carried out in a NigerianTeaching Hospital. All children, whose parents consented, admittedwith a diagnosis of typhoid fever using the Centre for Disease Controland prevention (CDC) case definition for typhoid fever, between 1stJanuary and 31st December 2010, were consecutively reviewed using astructured questionnaire.Results: A total of 42 patients were admitted out of which 35 were analysed, the remaining 7 were excluded because consent was notobtained. The disease was more common in males than females withM: F ratio of 3:2. The study gives the incidence of suspected typhoidof 30.5 per 1000 admission. The age range of the study population was 6months to 15 years with cases being common among the age group fiveto nine years 13(37.1%). It has a bimodal peak of occurrence as itoccurs commonly in April/May and in August/September. The diseasewas common in the low socioeconomic classes. All the 35 patientshad fever (100%), vomiting 25 (71.4%), typhoid psychosis 3 (8.6%) and 4 (11.4%) had intestinal perforation. Culture was positive in 8 (22.9%) of the patients. Widal test were significant in 20 (57.1%) with a sensitivity of 62.5%, specificity 44.4%, positive predictive value 25%, negative predictive value 80% and the efficiency of the test was 48.6%.Conclusion: The incidence of typhoid fever in this study is 30.5 per 1000 admission, it is common during rainy and harmattan period. The use of Widal test is not too helpful in diagnosis of typhoid fever. Therefore, culture samples should be done in all cases of suspected typhoid fever

Co-morbidities in children hospitalized for community acquired pneumonia in Maiduguri, Nigeria

Background: Pneumonia is one of the commonest causes of morbidity and mortality in children, especially in developing countries. These children are also at risk of other morbidities, thus, increasing the morbidity and mortality.Objective: This study was conducted to examine the prevalence and pattern of co-morbidities in children admitted for community acquired pneumonia (CAP) in Maiduguri.Methodology: All children admitted into the Emergency Paediatric Unit (EPU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011, with CAP were prospectively followed until discharge or death. The children were evaluated for co-morbidities clinically and by examination of appropriate specimen where necessary.Result: A total of 115 children aged one month to 14 years were admitted for CAP during the study period. While majority of the children studied were underfive; 107 (93%), 65(56.5%) were males, 101 (87.8%) had one or multiple co morbidities, with about half of them 58 (50.4%) afflicted by malaria. Pre admission medication was commoner for orthodox than traditional medication. No significant difference in mortality outcome was however noticed between children with co-morbidity and those without comorbidity, p > 0.05.Conclusion: The occurrence of comorbid conditions among children hospitalized for CAP in Maiduguri is common; however, the presence of co-morbidity did not significantly affect the mortality outcome of their management. It is recommended that the presence of comorbidity be actively looked for in children hospitalized for pneumonia, so as to effect holistic treatment, and improve the outcome of management.Keywords: Pneumonia, Children. Co-morbidity, Maiduguri, Mortality outcom

Presentation, complications and management outcome of community acquired pneumonia in hospitalized children in Maiduguri, Nigeria

Background: Pneumonia remains a leading cause of U-5 morbidity and mortality in developing countries like Nigeria. This study was conducted to determine the clinical presentation, complications and factors contributing to mortality in the hospitalized children with community acquired pneumonia (CAP) in Maiduguri, Nigeria.Methods: Children younger than 14 years admitted into the EmergencyPaediatric Unit of the University of Maiduguri Teaching Hospital(UMTH), Maiduguri, in 2011 with the diagnosis of community acquiredpneumonia were followed up until discharge or death. Chest radiographswere read by radiologists.Results: Eighty nine children aged two months to 14 years were studied. The commonest clinical features were fever, cough, tachypnoea and dyspnoea. Radiographic evidence of pneumonia was found in 84 (94.4%) of cases. Dehydration and congestive cardiac failure (CCF) were the commonest complications encountered. Eight (9.0%) children died, seven of whom had complications of pneumonia. The rate of occurrence of complications, radiographic pattern of pneumonia and outcome of treatment did not significantly differ statistically in the different age groups; p = 0.135, 0.622 and 0.167 respectively.Conclusion: While dehydration and CCF were found to be commonestcomplications, mortality was commoner among the male infants hospitalized for pneumonia

Prevalence and Pattern of Malaria Parasitaemia among Under-Five Febrile Children Attending Paediatric Out-Patient Clinic at University of Maiduguri Teaching Hospital, Maiduguri

Background: Malaria has remained a major public health problem in Nigeria with the under-five aged children and pregnant women being the most affected. The local epidemiological profile of the disease is dynamic owing to the continuous variation in the various determinants and hence the need for periodic re-evaluation. We aim to determine the prevalence of malaria parasitaemia among the under -five aged children and the effect of various determinants.Material and Method: In this cross-sectional study, 433 outpatients aged below 5 years with fever or history of fever in the previous 72 hours were enrolled. Relevant information was obtained and recorded using a questionnaire. Thick and thin films were prepared from a finger or heel prick for each of the patients and subjected to microscopy.Result: The prevalence of malaria parasitaemia was 27.7%. Age, sex, nutritional status, socioeconomic class, temperature at presentation as well as ownership of insecticide treated nets had no significant effect on the prevalence of malaria (p>0.05). Only P. falciparum was seen in all the positive slides. The parasite density was generally low with 48.3% having parasite densities below 100/μl and only 7.5% had parasite density of ≥1000/μl. Parasite density increased significantly with increasing age (p=0041). Nutritional status as well as other studied factors had no significant effect on parasite density (p>0.05).Conclusion and Recommendation: Prevalence of malaria infection was high in the population studied. It is characterized by low density parasitaemia and hence the need to interpret negative results with caution. Age, gender, socio-economic and nutritional status, temperature at presentation as well as ownership of ITN had no significant effect on prevalence of malaria parasitaemia. There is need to strengthen and scale up various malaria control programs while ensuring proper implementations of programs and activities through effective monitoring and evaluation.Keywords: Prevalence, Pattern, Malaria, Parasitaemia, Under-five Febrile Children, Outpatient Clini

Risk factors in hospital deaths in severely malnourished children in Kampala, Uganda

BACKGROUND: Although the risk factors for increased fatality among severely malnourished children have been reported, recent information from Africa, during a period of HIV pandemic and constrained health services, remains sketchy. The aim of this study has been to establish the risk factors for excess deaths among hospitalized severely malnourished children of below five years of age. METHOD: In 2003, two hundred and twenty consecutively admitted, severely malnourished children were followed in the paediatric wards of Mulago, Uganda's national referral and teaching hospital. The children's baseline health conditions were established by physical examination, along with haematological, biochemical, microbiological and immunological indices. RESULTS: Of the 220 children, 52 (24%) died, with over 70% of the deaths occurring in the first week of admission. There was no significant difference by sex or age group. The presence of oedema increased the adjusted odds-ratio, but did not reach significance (OR = 2.0; 95% CI = 0.8 – 4.7), similarly for a positive HIV status (OR = 2.6, 95% CI = 0.8 – 8.6). Twenty four out of 52 children who received blood transfusion died (OR = 5.0, 95% CI = 2 – 12); while, 26 out of 62 children who received intravenous infusion died (OR = 4.8, 95% CI = 2 – 12). The outcome of children who received blood or intravenous fluids was less favourable than of children who did not receive them. Adjustment for severity of disease did not change this. CONCLUSION: The main risk factors for excess hospital deaths among severely malnourished children in Mulago hospital include blood transfusion and intravenous infusion. An intervention to reduce deaths needs to focus on guideline compliance with respect to blood transfusions/infusions

Should first-line empiric treatment strategies cover coagulase-negative staphylococcal infections in severely malnourished or HIV-infected children in Kenya?

BACKGROUND: Bloodstream infection is a common cause of morbidity in children aged andlt;5 years in developing countries. In studies reporting bacteremia in Africa, coagulase-negative Staphylococci (CoNS) are commonly isolated. However, it is currently unclear whether children who are highly susceptible to infection because of severe acute malnutrition (SAM) or HIV should be treated with antimicrobials specifically to cover CoNS. We aimed to determine the clinical significance of CoNS amongst children admitted to a rural hospital in Kenya in relation to nutritional and HIV status. METHODS: Systematically collected clinical and microbiological surveillance data from children aged 6-59 months admitted to Kilifi County Hospital (2007-2013) were analysed. Multivariable regression was used to test associations between CoNS isolation from blood cultures and SAM (MUAC andlt;11.5cm or nutritional oedema (kwashiorkor)), and HIV serostatus; and among children with SAM or HIV, associations between CoNS isolation and mortality, duration of hospitalization and clinical features. RESULTS: CoNS were isolated from blood culture in 906/13,315 (6.8%) children, of whom 135/906 (14.9%) had SAM and 54/906 (6.0%) were HIV antibody positive. CoNS isolation was not associated with SAM (MUACandlt;11.5cm (aOR 1.11, 95% CI 0.88-1.40) or kwashiorkor (aOR 0.84, 95% CI 0.48-1.49)), or a positive HIV antibody test (aOR 1.25, 95% CI 0.92-1.71). Among children with SAM or a positive HIV antibody test, CoNS isolation was not associated with mortality or prolonged hospitalization. CONCLUSION: In a large, systematic study, there was no evidence that antimicrobial therapy should specifically target CoNS amongst children with SAM or HIV-infection or exposure

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Oral Candidiasis: A Tool For The Detection Of Presence And Progression Of Hiv Infection In Children In Maiduguri, Nigeria

Oral cavity is an important and frequently undervalued source of diagnostic and prognostic information in patients with Human Immunodeficiency virus (HIV) infection. This objectives of the study were to determine the prevalence of HIV infection in children using oral thrush as a marker of disease presence and to find out the relationship of CD4 count with oral candidiasis in HIV-infected children. The study group consisted of 108 children aged 18 months to 5 years presenting with oral thrush as seen in the paediatric units of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Nigeria from July 2006 to June 2007. The diagnosis of HIV infection was made by double ELIZA technique and Dynal beads technique (Dynal Biotech, Oslo, Norway) for CD4 counting was used. Of the 108 children, 60 (55.5%) male and 48 (44.5%) were female with a male to female ratio of 1.25:1. Twenty children (18.5%) were found to be HIV sero-positive by double ELISA technique. Fifteen (75%) of positive children were less than 36 months, with 18 (90%) of the positive children coming from the lower socio-economic classes 4 and 5. Mother to child transmission (MTCT) was found to be responsible for 85% of infection in the present study (

Epidemiological Features And Outcome Of Meningococcal Meningitis Outbreak Inchildren In Maiduri Borno State, Nigeria

Meningococcal meningitis remains a major public health problem among children in Nigeria especially in the meningitis belt. Many epidemics of the disease have occurred in the past in Borno State, with little effort to control them. The last of such occurred in 1996 with devastating effects. This study presents the epidemiological features, treatment and outcome of the outbreak. All children who were admitted into the State Specialist Hospital with a clinical diagnosis of meningitis between January and May 1996 recruited into the study. Demographic information as well history of their Immunization was ascertained. In addition, lumbar puncture was done on all patients except where contraindicated A total of 285 children, 171 (66.7%) males and 114 (33.3%) females between the ages of one week and 14 year with a mean of 6.31 year were admitted during the study period, most of who were from the low socioeconomic background. Overall mortality rate was 21.4% with the highest among children below the age of 6 months (35.3%). Mortality decreased with increasing age. The highest number of cases was recorded in March; which is the beginning of the hot season. The sex of the child did not affect the outcome of the disease. Early immunization with the polyvalent group A and C polysaccharide vaccine is strongly recommended as well as improved living conditions. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 49-5