Neonatal malaria in Nigeria -a 2 year review

BACKGROUND: In view of the fact that a significant proportion of neonates with malaria may be missed on our wards on the assumption that the disease condition is rare, this study aims at documenting the prevalence of malaria in neonates admitted into our neonatal ward. Specifically, we hope to describe its clinical features and outcome of this illness. Knowledge of these may ensure early diagnosis and institution of prompt management. METHODS: Methods Hospital records of all patients (two hundred and thirty) admitted into the Neonatal ward of Olabisi Onabanjo University Teaching Hospital, Sagamu between 1st January 1998 and 31(st )December 1999 were reviewed. All neonates (fifty-seven) who had a positive blood smear for the malaria parasite were included in the study. Socio-demographic data as well as clinical correlates of each of the patients were reviewed. The Epi-Info 6 statistical software was used for data entry, validation and analysis. A frequency distribution was generated for categorical variables. To test for an association between categorical variables, the chi-square test was used. The level of significance was put at values less than 5%. RESULTS: Prevalence of neonatal malaria in this study was 24.8% and 17.4% for congenital malaria. While the mean duration of illness was 3.60 days, it varied from 5.14 days in those that died and and 3.55 in those that survived respectively. The duration of illness significantly affected the outcome (p value = 0.03). Fever alone was the clinical presentation in 44 (77.4%) of the patients. Maturity of the baby, sex and age did not significantly affect infestation. However, history of malaria/febrile illness within the 2 weeks preceding the delivery was present in 61.2% of the mothers. Maternal age, concurrent infection and duration of illness all significantly affected the outcome of illness. Forty-two (73.7%) of the babies were discharged home in satisfactory condition. CONCLUSION: It was concluded that taking a blood smear to check for the presence of the malaria parasite should be included as part of routine workup for all neonates with fever or those whose mothers have history of fever two weeks prior to delivery. In addition, health education of pregnant mothers in the antenatal clinic should include early care-seeking for newborns

Malaria resistance

Malaria has remained the leading cause of morbidity and mortality in children below the age of five years in Sub-Saharan Africa where the disease is endemic. Pregnant women and non-immune immigrants are among the vulnerable groups for this disease. It continues to be the leading cause of out-patient attendance in the region. The disease often results in loss of man-hours, school absenteeism etc. Its effect however, goes beyond the social life of the stricken individuals. The economy of the nation is also threatened. However, while some children readily die from the disease, others living in the same environment suffer minimally or no episode of malaria within the year. This article shall attempt to review what determines the number of episodes, and severity of disease in an apparently similar group of people. Some individuals with certain characteristic traits are protected form developing severe forms of the disease. Some of these traits are innate while others are acquired or even stimulated. The innate traits result from genetic mutations. They include sickle-cell trait, duffy –ve, α- thalassemia, Hb C. Others are acquired following prolonged periods of exposure. The period of exposure allows the individual to develop antibodies against the different antigens on the surface of the parasite. Smallpox vaccine has been found to offer protection against this deadly disease. Age and puberty have been found to contribute to malaria resistance. It is expected that knowledge of natural resistance to malaria may aid in developing Vaccines against this deadly disease. Keywords: malaria resistance, puberty, malaria economy, malaria vaccine Nigerian Medical Practitioner Vol. 49(5) 2006: 133-14

Massive Congenital Chylous Ascites in a Nigerian infant: A Case Report

Chyle leakage into peritoneal cavity is an uncommon disorder that may present at any age. It has been reported in many parts of the world particularly Europe, North America and Asia. However, reports from other parts like African and South America are virtually non-existent. We report a case of abdominal distension and bilateral giant inguinoscrotal hernia in a 2-day old neonate that presented at the Olabisi Onabanjo University Teaching Hospital, Sagamu. Physical examination and abdominal ultrasonography revealed a massive ascites, among other findings. Peritoneal tap yielded free-flowing fluid that was milky-white in appearance, thus confirming the diagnosis of chylous ascites. Key Words: Chyloperitoneum, Congenital chylous ascites, Neonatal ascites. Nig. Medical Practitioner Vol. 44(2) 2003: 26-2

Practice and percepton of biomass fuel use and its health effects among residents in a sub urban area of southern Nigeria. a qualitative study

Women and Children from developing countries are exposed to high levels of pollutants from biomass combustion with associated respiratory and other diseases .Many people are unaware of respiratory and other health risks of biomass fuel leading to extensive exposure to biomass smoke. Significant number of Chronic Obstructive Pulmonary Disease (COPD) patients in Africa are nonsmokers, main risk for COPD in rural areas in Asia, South America and Africa is smoke from biomass fuel used in cooking.1-4 The aim is to determine their practice of use of biomass fuel and their knowledge with regards to illness, respiratory and other diseases arising from its use. This study was a cross sectional descriptive qualitative study conducted between 6th and 31st July 2015. It consisted of 15 focus group discussion, open ended pre-determined questions were asked by moderators. What fuel do you use in cooking?, Which one is commonly use?, Do you know of any illness associated with the use of biomass fuel? Do we have substitute for use of biomass fuel? Out of 270 participants recruited by random sampling of clusters, 139 responded. Data analysis by systematic thematic analysis process. Bio data analysis was done using Epi-Info 3.5.1. The different groups commented on use of biomass fuel in form of wood as the commonest because it is cheap. They were aware of better and cleaner alternatives like gas and electric hot plates but for unaffordability and poor electricity supply, no mention of solar energy. Majority are of the opinion that biomass fuel use results in pain in eyes and dizziness. Most of the women mentioned cough, very few talked about asthma arising from use of biomass fuel. None mentioned COPD or cancers of the lungs or nasopharynx. Few people are aware of the relationship between smoke and respiratory diseases. No knowledge of chronic obstructive pulmonary diseases or cancers. There is urgent need creating awareness by stakeholders, about respiratory diseases among these people in order to sensitize towards seeking a cleaner fuel alternative. This may necessitate empowerment hence community leaders and policy makers as well health professionals will be involved in this health promotion.Keywords: Biomass fuel, Practice, Perception, Youth, Women, Sub-Urban, Nigeri

The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for children at 18 months

Objective: To assess the long-term effects of in utero exposure to magnesium sulphate for children whose mothers had pre-eclampsia. Design: Assessment at 18 months of age for children whose mothers were recruited to the Magpie Trial (recruitment 1998-2001 ISRCTN 86938761), which compared magnesium sulphate with placebo. Setting: Follow-up of children born at 125 centres in 19 countries across five continents. Population: A total of 6922 children were born to women randomised before delivery at follow-up centres. Of these, 2271 were not included for logistic reasons and 168 were excluded (101 at a centre where <20% were contacted, 40 whose death or disability was due to a problem at conception or embryogenesis and 27 whose parent/s opted out). Therefore, 4483 children were included in follow-up, of whom 3283 (73%) were contacted. Methods: Assessment by questionnaire, with interview and neurodevelopmental testing of selected children. Main outcome measures: Death or neurosensory disability at age of 18 months. Results: Of those allocated magnesium sulphate, 245/1635 (15.0%) were dead or had neurosensory disability at 18 months compared with 233/1648 (14.1%) allocated placebo (relative risk [RR] 1.06, 95% CI 0.90-1.25), and of survivors, 19/1409 (1.3%) had neurosensory disability at 18 months compared with 27/1442 (1.9%) (RR 0.72, 95% CI 0.40-1.29). There were no substantial differences in causes of death or in the risk of individual impairments or disabilities. Conclusions: The lower risk of eclampsia following prophylaxis with magnesium sulphate was not associated with a clear difference in the risk of death or disability for children at 18 months. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.Articl

The Magpie Trial: A randomised trial comparing magnesium sulphate with placebo for pre-eclampsia. Outcome for women at 2 years

Objective: The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia. Design: Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998-2001, ISRCTN 86938761), which compared magnesium sulphate with placebo for pre-eclampsia. Setting: Follow up after discharge from hospital at 125 centres in 19 countries across five continents. Population: A total of 7927 women were randomised at the follow-up centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced. Methods: Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed. Main outcome measures: Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources. Results: Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). Conclusions: The reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.Articl