Timeliness and Completion Rate of Immunization among Nigerian Children Attending a Clinic-based Immunization Service

To achieve maximal protection against vaccine-preventable diseases, a child should receive all immunizations within recommended intervals. Clinic records of 512 Nigerian children were evaluated for timeliness in receiving vaccines and the completion rates of the schedule. About 30% of the children presented after four weeks of age for their first immunization; 18.9-65% of the children were delayed in receiving various vaccines compared to the recommended ages for receiving the vaccines. Only 227 (44.3%) children were fully immunized. Health education and mass mobilization of the community and health workers are recommended to improve the uptake of vaccines and to encourage timely receipt of vaccines

Physical activity, body mass index and blood pressure in primary school pupils attending private schools.

Background: Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. Objective: The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils attending private primary schools. Method: The intensity and duration of physical activity of the pupils selected by multiple stage sampling method were obtained with the aid of a questionnaire. The BMI and BP were measured. Analysis was by SPSS. Results: Of the 353 pupils, 132(37.4%) pupils were adequately physically active while overweight and obesity prevalences were 54(15.3%) and 65(18.4%) respectively. Hypertension prevalence in overweight/ obese children (6.5%) was significantly higher than in children with healthy weight 1.5%, P = 0.04. Conclusion: Only a third of pupils met the recommended level of physical activity. The prevalence of overweight and obesity was high while the overweight and obese pupils were more likely to have hypertension compared to those with healthy weight. Physical activity programmes for primary school pupils in school and at home are therefore recommended

Factors contributing to delay in commencement of immunization in Nigerian infants

Delay in receipt of immunization may result in a child being susceptible to vaccine preventable diseases for prolonged periods. Identification of factors which contribute to delay in receipt of immunization will help in developing targeted interventions. This study examined prospectively factors contributing to delay in the commencement of infant immunization in Benin City, Nigeria. This was a cross-sectional descriptive study of 153 consecutive mothers of infants presenting for their first immunization at the Institute of Child Health Child Welfare Clinic of the University of Benin, Benin City.  Reasons for not presenting in the first 24 hours were ascertained and associations between various factors and delay in commencement of immunization were examined. Of the 153 mothers only 2 (1.3%) brought their babies for immunization within 24 hours of birth while 66 (43.1%) brought their babies in the first week of life.  The most cited reason (30.3%) for not presenting within 24 hours of birth was that BCG, one of the immunizations that should be given at birth is given only on a specific day. Mothers who did not know that immunization should commence at birth (P=0.0054), those from low socioeconomic class (P=0.0056) and those with less than 12 years of schooling (P=0.0001) were significantly less likely to bring their babies for immunization in the first week of life. Delivery outside of health facilities was also associated with later presentation for immunization (P=0.0069). In conclusion, there is significant delay in the receipt of birth doses of immunization. Change in clinic practices to enable daily immunization as well as education of health care personnel on the importance of timely commencement of immunization will ensure timeliness of receipt of birth doses of vaccines

Infant-feeding Practices among HIV-infected Mothers in an HIV-treatment Programme

The transmission of HIV via breastmilk has led to various recommendations for HIV-infected mothers. In this study, the feeding practices of HIV-infected mothers in the first six months of their infants' lives were evaluated. In total, 103 consecutive mothers of children, aged 6-24 months, were evaluated for their feeding practices in the first six months of their infants' lives. The mothers were recruited in two cohorts based on their entry (PMTCT cohort) or non-entry (non-PMTCT cohort) to an HIV MTCT-prevention programme. Information obtained included maternal age, socioeconomic class, and the educational level attained. All the babies in the non-PMTCT cohort were breastfed compared to none in the PMTCT cohort. Infant formula was inadequately prepared for 77.42% of babies in the non-PMTCT cohort compared to 18.64% in the PMTCT cohort. The mixed-feeding rate was high (70.45 %) in the non-PMTCT cohort. Over 70% of babies in both the cohorts were bottle-fed. Voluntary counselling and testing services in the healthcare system should be strengthened. All mothers should receive infant-feeding counselling, with exclusive breastfeeding being encouraged in those with unknown HIV status

Les expériences des mères séropositives qui choisissent de ne pas allaiter leurs bébés au Nigéria

HIV positive mothers, who choose not to breastfeed their babies in a predominantly breastfeeding community would face a number of barriers. This study looked at the experiences of HIV positive mothers who chose the no breastfeeding option. Consecutive HIV positive mothers who opted not to breastfeed their infants after infant feeding counselling and whose infants were attending the HIV programme at the University of Benin Teaching Hospital, Benin City, Nigeria were recruited for the study. Disclosure of HIV serostatus and adherence to no breastfeeding options were evaluated using an interviewer administered structured questionnaire. Of the 62 mothers recruited for the study, 57 (91.94 %) had disclosed their serostatus to at least their partners. Most partners 42 (93.33%) were supportive while three mothers were divorced following disclosure. Thirteen (20.97%) mothers could not comply with no breastfeeding. Non disclosure of serostatus, pressure from extended family and token breastfeeding mitigate against adhering to no breastfeeding by HIV positive mothers (Afr J Reprod Health 2009; 13[1]:27-35).Les mères séropositives qui choisissent de ne pas allaiter leurs bébés dans une communauté qui pratique principalement l’allaitement rencontreraient des obstacles. Cette étude a examiné les expériences des mères séropositives qui ont choisi de ne pas allaiter. Les mères séropositives consécutives qui ont choisi de ne pas allaiter leurs bébés après l’orientation sur l’allaitement au sein et dont les enfants suivaient le programme sur le VIH au Centre Hospitalier Universitaire à Bénin City, Nigeria ont été recrutés pour l’étude. La révélation de la séropositivité et l’adhérence aux options de ne pas allaiter ont été évaluées à l’aide d’un questionnaire structuré administré par un interviewer. Sur les 63 mères qui ont été recrutées pour l’étude, 57(91,94%) avaient révélé leur séropositivité au moins à leurs partenaires. La plupart des partenaires 42 (93,33%) ont soutenu leurs femmes, alors que trois mères ont subi le divorce suite à la révélation. Treize (20,97%) mères ne pouvaient pas respecté le non-allaitement. La non-révélation de la séropositivité, la pression de la part de la famille étendue et l’allaitement symbolique font que les mères séropositives n’acceptent pas de ne pas allaiter (Afr J Reprod Health 2009; 13[1]:27-35)

Prevalence of renal disease in Nigerian children infected with the human immunodeficiency virus and on highly active anti-retroviral therapy

Access to highly active anti-retroviral therapy (HAART) has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV); thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each child′s urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR). Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR <60 mL/min/1.73 m 2 . Of the 99 children recruited, 60 were males and 39 were females. The mean age of the children was 6.6 ± 3.5 years. All the children were on HAART and 85% had acquired the HIV infection by vertical transmission. The overall prevalence of renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%); 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1%) with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 ). Renal disease was found to be significantly associated with advanced stage of HIV infection (P < 0.049). Our study showed that t he prevalence of renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection

Des fractures multiples et brûlures iatrogéniques chez un nouveau-né en raison de l’accouchement non qualifié : Un rapport de cas et documentation

High neonatal mortality is the hallmark of developing countries. Most of the deaths are preventable by good antenatal care with risk identification and access to safe delivery. However, only about a third of births are attended by skilled personnel in Nigeria. The case of a newborn (one of a set of twins) delivered by breech in a church maternity, who sustained multiple fractures and thermal burns from resuscitation is presented. The mother had received antenatal care in an orthodox health facility but opted to deliver in the church maternity. We discuss the problems associated with delivery by unskilled birth attendants while reviewing the literature to highlight the roles and mechanisms of church birth attendants. Reproductive health education for women, their families and communities is advocated to enable birth preparedness. Training, supervision, monitoring and regulation of practice of church birth attendants will also be required to improve outcomes (Afr J Reprod Health 2008; 12[3]:197-206).La haute mortalité néonatale est la marque des pays en voie de développement. La plupart des morts sont évitables par un bon soin prénatal avec de risque identification et accès à un accouchement sans danger. Pourtant, seulement un tiers de naissance s&apos;est occupé par des personnels qualifiés au Nigeria. Est présenté le cas d’un nouveau-né (l’un des jumeaux) accouché par le siège dans une clinique d’accouchement située dans une église, qui a eu des fractures multiples et des brûlures thermiques causées par la réanimation. La mère avait reçu des soins prénatals dans un établissement orthodoxe sanitaire mais avait choisi d’accoucher dans une clinique d’accouchement religieuse. Nous avons discuté les problèmes associés à l’accouchement par les accoucheurs non qualifiés en se documenter afin de mettre en relief les rôles et les mécanismes des accoucheurs religieux. L’éducation de la santé de reproduction pour des femmes, leurs familles et leurs communautés est recommandée afin de permettre la disposition de naissance. L’entrainement, la surveillance, le contrôle et le règlement de la pratique des accoucheurs religieux doivent aussi être requise d’améliorer les resultants (Afr J Reprod Health 2008; 12[3]:197-206)

The diagnostic value of both troponin T and creatinine kinase isoenzyme (CK-MB) in detecting combined renal and myocardial injuries in asphyxiated infants.

Troponin T (cTnT) and Creatinine Kinase Isoenzyme (CK-MB) are both markers of myocardial injuries. However, CK-MB is also elevated in acute kidney injury.The diagnostic value of both cTnT and cardiac CK-MB in combined myocardial and acute kidney injuries (AKI) in asphyxiated neonates was evaluated.40 asphyxiated infants and 40 non-asphyxiated controls were consecutively recruited. Serum levels of cTnT, CK-MB and creatinine were measured. Myocardial injury and AKI were defined as cTnT >95th percentile of the control and serum creatinine >1.0 mg/dl respectively.Of the 40 subjects, 9 (22.50%), 8 (20.00%) and 4 (10.00%) had myocardial injury, AKI and combined AKI and myocardial injuries respectively. The mean cTnT and CK-MB values were highest in infants with combined AKI and myocardial injuries. The Mean cTnT in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 0.010±0.0007 ng/ml, 0.067±0.040 ng/ml and 0.084±0.067 ng/ml respectively, p = 0.006. The mean CK-MB in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 2.78±0.22 ng/ml, 1.28±0.11 ng/ml and 4.58±0.52 ng/ml respectively, p = <0.0001.In severe perinatal asphyxia, renal and myocardial injuries could co-exist. Elevated cTnT signifies the presence of myocardial injury. Elevated CK-MB indicates either myocardial injury, AKI or both. Therefore renal injury should be excluded in asphyxiated infants with elevated CK-MB

Bacterial isolates of Tonsillitis and Pharyngitis in a Paediatric Casualty Setting

A prospective study was carried out to determine the pattern of bacterial isolates and their antibiotic sensitivity amongst children with tonsillopharyngitis. Consecutive children presenting with sorethroat, difficulty with swallowing, fever and/ or evidence of inflamed pharynx and/ or tonsils at the paediatric casualty of the University of Benin Teaching Hospital, Benin City, between February and October 2006 were recruited for the study. The patient's biodata were obtained and socioeconomic status was determined. Throat swabs were taken for microbiologic analysis. Seventy three throat swabs were analysed. Bacteria were isolated from 39 patients. Of which 19 (48.72%) were ß haemolytic Streptococcus (BHS). others were S. aureus five (12.83%), seven (17.95%) were Klebsiella mirabilis and three (7.69%) each of Pseudomonas aeroginosa and Proteus mirabilis . BHS and S. aureus showed 100% sensitivity to cefuroxine, azithromycin, ceftazidine and genticin. All the isolates had little or no sensitivity to ampicillin and cotrimoxazole. BHS is a significant cause of pharyngitis and tonsillitis in our environment and therefore poses a potential danger of rheumatic fever and rheumatic heart disease, a non-suppurative sequalae of BHS. Ampicillin and cotrimoxazole two affordable and commonly available drugs are ineffective in tonsillitis and pharygitis