Need for a clinical decision rule for the management of pharyngitis in Nigeria

Pharyngitis is a common reason for presentation in the hospital by children. Although viral aetiology is the commonest, Group AStreptococcus is the most important cause of and reason for antibiotictreatment of pharyngitis. The fact that GAS causes the non suppurativesequalae of rheumatic fever and acute glomerulonephritis perhapsdrives the empirical antibiotic treatment of most cases of pharyngitis.The unnecessary antibiotic treatment contributes to antibiotic resistance,a major public health problem. While it is desirable to do throat culture to guide the physician’s management of each case, the required laboratory skill is unavailable in most clinical settings in Nigeria. A clinical decision rule (CDR) which is a clinical tool that helps guide physicians in the management of conditions such as pharyngitis, have been shown to behelpful in managing pharyngitis in other countries. It reduces the numberof unnecessary antibiotic prescriptions and has a high sensitivity and specificity in distinguishing GAS from non GAS pharyngitis. Currently there are no guidelines or CDR for the management of pharyngitis in Nigeria, there is an urgent need to derive, validate and implement a CDR to guide the treatment of pharyngits

Does Nigeria need the birth dose of the hepatitis B vaccine?

The control of hepatitis B infection involves several strategies of which the most effective is vaccination. Schedules which include a birth dose (which can prevent vertical transmission when administered within 24 hours of birth) are recommended for use in countries with a high rate of vertical transmission. Nigeria is highly endemic for hepatitis B infection. Nigeria had hitherto utilized the monovalent HBV vaccine in the three dose schedule that includes a birth dose, the recent introduction of an HBV containing pentavalent vaccine (which cannot be administered at birth) calls to question whether there should be continued use of the birth dose of HBV (using the monovalent vaccine) in addition to three doses of the pentavalent vaccine given subsequently. This is given the fact that most infections in Nigeria are reportedly acquired in childhood through horizontal rather than vertical transmission. There is also the question of cost- effectiveness of the four dose schedule compared to the three dose schedule in the setting of Nigeria’s hepatitis B epidemiologic profile.A review of the available evidence indicates that a significant proportion of Nigerian women of child bearing age and pregnant women are seropositive for HBsAg and HBeAg. Maternal to child transmission rates of HBsAg of 47-53.3% have been documented while a significant proportion of newborns were noted to have serological markers for HBV infection before receiving their first immunization. These data indicate that there is a significant potential for vertical transmission of HBV in Nigerian infants providing a compelling reason for the continued use of the birth dose of the HBV vaccine. Cost-effectiveness was not examined in this review.There are, however, challenges to the universal delivery of the birth dose in a timely fashion. Encouraging institutional delivery, routine screening of pregnant women (with the administration of HBV within 24 hours of birth to infants of seropositive mothers), retraining of health care workers on ensuring the timely receipt of the birth dose of HBV vaccine and health education of mothers and the community on the need for immunization within 24 hours of birth are suggested strategies to improve the timely uptake of the birth dose of HBVKeywords: Birth dose, Hepatitis Bvaccine, Nigeria, Infant

Serum zinc values in children with congenital heart disease

Background: Some children with congenital heart diseases (CHD) may have increased pulmonary blood flow that causes recurrent  bronchopneumonia and congestive heart failure. Serum zinc is reduced in children with pneumonia and patients on diuretics.Objective: To evaluate the serum zinc level of children with CHD and their controls without CHD.Method: The subjects were 41 children with CHD confirmed on  echocardiography recruited from a paediatric cardiology clinic in a tertiary centre in Nigeria. The controls were 41 children without CHD. Biodata and anthropometric measurements were taken. The serum zinc was  determined using atomic absorption spectrophotometer method.Result: The mean difference in the serum zinc of the subjects 101.3 ± 21.6ìg/dl and controls 106.5 ± 18.3ìg/dl, was not significant, p = 0.351.The subjects with pneumonia had a lower mean serum zinc value 89.5 ± 15.0ìg/dl compared to those without pneumonia 103.9 ± 22.2ìg/dl, p = 0.006. The mean serum zinc values of the subjects on diuretic was notstatistically different from those not on diuretic, p = 0.599.Conclusion: The serum zinc levels of the subjects and controls were not significantly different. Children with CHD and pneumonia had significantly lower zinc level compared to those without pneumonia.Keywords: congenital heart disease, diuretic, pneumonia, zinc

Serological markers of hepatitis B infection in infants presenting for their first immunization

Introduction: Hepatitis B vaccine can prevent perinatal transmission if administered within 24 hours of birth. Nigerian infants are known to present late for their first immunizations and may acquire the virus either vertically or horizontally before receipt of the first dose of hepatitisB immunization. This study evaluated serological markers for hepatitis B virus infection in Nigerian infants prior to receipt of the first dose of hepatitis B immunization.Method: Blood samples obtained prior to the receipt of hepatitis B vaccine from infants presenting for their first immunization were analysed for HBsAg, antiHBc and antiHBe..Results: The mean age at presentation of the 153 infants studiedwas 14.3±15.6 days while only two infants presented on the first day of life. The prevalences of HBsAg and antiHBc were 16.3% and 15.7% respectively. Of those positive for either HBsAg or antiHBc 20(47.6%) were positive for antiHBe. The presence of HBsAg was not significantly associated with sex, age, circumcision, ear piercing and blood transfusion.Conclusion: Majority of the infants did not receive hepatitis B vaccine within 24 hours of birth. Institutional delivery should be encouraged while emphasizing to mothers and health care workers that hepatitis B  vaccination must commence within 24 hours of birth.Key words: Serological markers, hepatitis B. first infant immunizatio

Cardiovascular responses to blood transfusion in children with anemic heart failure

Introduction: This study evaluated the cardiovascular responses to blood transfusion in children with anemic heart failure using mostly clinical parameters.Materials and Methods: Consecutive patients with anemic heart failure presenting to a childrenfs emergency room and requiring blood transfusion were assessed for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), liver size, and oxygen saturation (O2 sat) pre.transfusion, 1.2 h into transfusion (intra.transfusion), immediate post.transfusion, and at late post.transfusion (24 h later).Results: A total of 75 patients were recruited of which 46 (61.3%) were males. Their mean age was 43.8 } 40.3 months while their mean PCV at presentation was 15.0 } 4.5%. There was a significant mean net reduction of 10 beat per minute (bpm) between the pre (139.7 } 25.2 bpm) and intra.transfusion (129.6 } 22.0 bpm) HR, P = 0.0004. The mean net reduction of 4 cycles/ min between the pre and intra.transfusion RR was also significant, P = 0.0033. The two parameters declined in values subsequently.Conclusion: The HR and RR are two easily measurable indices with reduction in HR and RR by 10 bpm and 4 cycles/min, respectively, from pre.transfusion to intra.transfusion observations

Parental contribution to over prescription of antibiotics for sore throat in children

Introduction: Antibiotics are often prescribed by physicians for sore throat in children because of the danger of post streptococcal complications. The role of the parents in over prescription of antibiotics is less well known.Objective: To evaluate the knowledge, attitudes and practice of parents to antibiotic prescription for childhood sore throat.Methods: The subjects were parents who brought their children to the out-patient clinics of a tertiary hospital. Their knowledge, attitude and practice of antibiotics prescription for sore throat in children were evaluated with the aid of a questionnaire. Responses were analyzed with IBM-SPSS version 20.0. The responses were presented in simple percentages while differences in proportions were tested with χ2 test.Results: There were 309 respondents studied, of which 264 (85.4%) were mothers. Respondents were aged 20 to 64 years. While 54.0% of respondents believed sore throat may resolve without antibiotics, 69.4% also felt that every child with sore throat should receive antibiotics. Some 57.2% of respondents will request for antibiotic. More respondents with secondary (59.0%) and tertiary (56.6%) levels of education compared to primary (20.6%) level would not request for antibiotics, P = <0.001. 42% will not be satisfied with a physician who does not prescribe antibiotics.Conclusion: This study demonstrated parental irrational demand for antibiotic for sore throat in children. This attitude was more in less educated parents. Education of the parents about the aetiology and rational antibiotic use of sore throat in children will mitigate this behavior.Keywords: Sore throat; antibiotic over prescription; knowledge; attitude, parent

Business Intelligence System For Logistics and Distribution, PETRONAS Chemicals Marketing

Business Intelligence system is specialized tools for data analysis, query , and reporting that support organizational decision-making which will enhance the performance of a range of business process. This project is developed for Logistic and Distribution Department of PCG. The objectives of developing this system are to find the appropriate tool to collect, store and analyze data that organization has, also to analyze those data. Other than that, is to increase confidence in making decisions in order to develop a business report. This project is using a technology of data warehousing, web-based in order to input data as well as technology of Business Intelligence dashboard as a tool to assist the user to analyze the data. The result consists of the findings from the literature review section, conclusion and recommendation conclude the whole chapter of the project and recommendation for future implementation of the project

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus

Discrimination against persons living with HIV/AIDS in hospital settings has been documented. This study examined the attitude of health care workers (HCWs) to nurses, doctors and patients infected with HIV. A total of 345 respondents selected by multistage sampling techniques were surveyed, using a semi-structured questionnaire, which explored respondents’ attitude to HIV-infected patients and colleagues with HIV/AIDS. HCWs were unwilling to accept that medical procedures be carried out on them by HIV-infected doctors and nurses, with almost 80% refusing surgery or assistance at surgery on them by an HIV-infected doctor or nurse. They were also significantly more unwilling to accept that medical procedures be carried out on them by an infected colleague, compared with their carrying out the same procedure on an HIV-infected patient. Thus, HCWs seemed to believe that the risk of contracting HIV was higher if an infected HCW were to perform medical procedures on them, and fear of contracting HIV seemed to be the driving force for their negative attitudes. Education on occupational risks of HIV, provision of a safe working environment with enforcement of universal precautions, as well as provision of post-exposure prophylaxis are suggested as ways to enable HCWs to change their attitudes

Assessment of facilities and best practices in orphanages in Benin City, south-south region, Nigeria

Aim: Increasing number of orphans will adversely affect the existing facilities and best practices in orphanages if there are no plans to accommodate the anticipated increase in demands. There is the need therefore, to assess the facilities and best practices in orphanages in view to obtain information necessary for provision and improvement of care of these vulnerable groups of children.Methods: Ten registered and functional orphanages were assessed between January and May 2011. A researcher administered questionnaire on the best practices such as adequacy of school enrolment, nutritional status, housing and security, the availability of potable water, playground/ playing materials and the adequacy of child-caregivers ratio was used to obtain information about the orphanages and the findings were compared with the standard practices.Results: Mean year of operation of the orphanages was 16.9 (95%CL 3.1, 30.7) years. Total number of children in all the 10 orphanages was 150 (males 62 [41.3%] and females 88 [58.7%]); mean age [SD] 7.0 [4.6] years. Although school enrolment in all the orphanages was good, however, there was poor child-caregiver ratio in 7 orphanages. Most of the children in the orphanages were stunted and was significantly observed in older children (p < 0.001) and in children who had stayed longer in the orphanages (p = 0.001). Over-crowding and inadequate toilet facilities were observed in 4 orphanages. Only one (10.0%) of the 10 orphanages, however, met all the best standard practices assessed.Conclusion: Adherence to best practices in most of the orphanages assessed in this study was poor.Keywords: best practices, caregiver, Nigeria, orphanage, orphans, overcrowding,standar

Perinatal mortality in a rural community

Objective: To determine the peri-natal mortality rate (PMR), still birth rate (SBR) and early neonatal death rate (ENDR) in Igueben Local Government Area (LGA) of Edo State.Design: A descriptive cross-sectional studySetting: Igueben LGA is a rural governmental unit in mid-western Nigeria.Subjects: All women of child-bearing age, resident in three randomly selected political wards in Igueben LGA were identified.Results: Of the 921 women of child-bearing age recruited, 258 deliveries with three perinatal deaths were recorded, giving a PMR, SBR and ENDR of 11.6/1000TB, 11.6/1000TB and 0/1000LB, respectively. Almost all the mothers studied (99.6%) received skilled obstetric care in delivery.Conclusion: The actual PMR, SBR and ENDR were considerably lower than the National estimated averages of 76/1000TB, 43/1000TB and 35/1000LB, respectively. While this may perhaps be related to the quality of obstetric care, it underscores the importance of community-based studies in the determination of vital statistics which are important in health planning including resource allocation