Testing a method of sampling for entomological determination of transmission of Wuchereria bancrofti to inform lymphatic filariasis treatment strategy in urban settings

Background: There is on-going debate about scale-up of lymphatic filariasis treatment to include urban areas. Determining Wuchereria bancrofti transmission is more complex in these settings and entomological methodologies suggested as a solution as yet have no clear guidance. Methods: The study was conducted in six communities in Minna and Kaduna cities in Nigeria selected based on pre-disposing risk factors for mosquitoes and Transmission Assessment Survey (TAS) results in 2016 indicating need for treatment (> 1% prevalence). In each community, 4 gravid traps (GT), 15 exit traps (ET) and 21 pyrethrum spray catches (PSC) were used for 5 months targeting a sample size of 10,000 mosquitoes inclusive of at least 1500 Anopheles. Community researchers were selected and trained to facilitate community acceptability and carry out collection. We have evaluated the mosquito sampling and trapping methodology in terms of success at reaching targeted sample size, cost effectiveness, and applicability. Results: Community researchers were influential in enabling high acceptability of the methods of collection and were able to conduct collections independently. Overall, 12.1% of trapping events (one trapping event corresponds to one visit to one trap to collect mosquitoes) were affected by householder actions, weather conditions or trap malfunction leading to lower than optimal catches. Exit traps were the most cost-effective way to catch Anopheles (6.4 USD per trapping event and 12.8 USD per Anopheles caught). Sample size of 10,000 mosquitoes overall in each city was met though Anopheles catch was insufficient in one city. However, sample size was met only in one implementation unit out of the four. Conclusions: Methods need adapting to maximise Anopheles catch: we propose planning 250 gravid trap and 3724 exit trap trapping events in similar settings in West African urban areas where Culex is dominant, not using pyrethrum spray catches, and weighting trapping events later in the rainy season. Planning should increase involvement of community researchers, incorporate null catches and participants’ actions to predict catches. Importantly, evaluation units should be analogous with implementation units, the units at which treatment decisions will be made in the urban context

Adaptation of calcium absorption during treatment of nutritional rickets in Nigerian children

Nutritional rickets in Nigerian children has been effectively treated with Ca supplementation. High values of Ca absorption efficiency have been observed in untreated children, but whether Ca absorption efficiency changes during treatment with Ca is unknown. Our objective in conducting this study wits to identify the effect of Ca therapy on Ca absorptive efficiency in children with primary Ca-deficient nutritional rickets. Twelve children with radiographically active tickets, 2 to 14 years of age (median 39 months) participated in the study. We assessed dietary Ca intake via dietary recalls, and measured biochemical markers of Ca and vitamin D homeostasis. Fractional Ca absorption was measured using a dual tracer stable isotope method, before and after 2 weeks of treatment with 15.0 mmol elemental Ca daily. Ten children had adequate urine collection for inclusion in the analysis. Usual dietary Ca intake was 4.2 (SD 1.0) mmol/d. The median Ca absorption prior to treatment was 72% (range 52-97%) and decreased significantly to 57% (31-84%) (P=0.004) after 2 weeks Of Supplementation. We conclude that Nigerian children with rickets adapt to Ca Supplementation with a small decrease in Ca absorptive capacity, but retain very high absorptive levels during supplementation. Overall Ca absorption efficiency was comparable with that identified in other populations with low Ca intakes. These data demonstrate that although absorptive capacity is regulated by supplementation, recovery from rickets likely occurs through efficient use of both dietary and supplemental Ca

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

Background/Purpose : The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Methods : Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. Results : There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. Conclusion : While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors

Cytokine-associated neutrophil extracellular traps and antinuclear antibodies in Plasmodium falciparum infected children under six years of age

<p>Abstract</p> <p>Background</p> <p>In <it>Plasmodium falciparum</it>-infected children, the relationships between blood cell histopathology, blood plasma components, development of immunocompetence and disease severity remain poorly understood. Blood from Nigerian children with uncomplicated malaria was analysed to gain insight into these relationships. This investigation presents evidence for circulating neutrophil extracellular traps (NETs) and antinuclear IgG antibodies (ANA). The presence of NETs and ANA to double-stranded DNA along with the cytokine profiles found suggests autoimmune mechanisms that could produce pathogenesis in children, but immunoprotection in adults.</p> <p>Methods</p> <p>Peripheral blood smear slides and blood samples obtained from 21 Nigerian children under six years of age, presenting with uncomplicated malaria before and seven days after initiation of sulphadoxine-pyrimethamine (SP) treatment were analysed. The slides were stained with Giemsa and with DAPI. Levels of the pro-inflammatory cytokines IFN-γ, IL-2, TNF, CRP, and IL-6, select anti-inflammatory cytokines TGF-β and IL-10, and ANA were determined by immunoassay.</p> <p>Results</p> <p>The children exhibited circulating NETs with adherent parasites and erythrocytes, elevated ANA levels, a Th2 dominated cytokine profile, and left-shifted leukocyte differential counts. Nonspecific ANA levels were significant in 86% of the children pretreatment and in 100% of the children seven days after SP treatment, but in only 33% of age-matched control samples collected during the season of low parasite transmission. Levels of ANA specific for dsDNA were significant in 81% of the children both pre-treatment and post treatment.</p> <p>Conclusion</p> <p>The results of this investigation suggest that NET formation and ANA to dsDNA may induce pathology in falciparum-infected children, but activate a protective mechanism against falciparum malaria in adults. The significance of in vivo circulating chromatin in NETs and dsDNA ANA as a causative factor in the hyporesponsiveness of CpG oligonucleotide-based malaria vaccines is discussed.</p

Oral manifestations of HIV infection in 36 Nigerian children

Oral manifestations of HIV/AIDS are early and common clinical indicators of HIV infection. There has been no report on the clinical prevalence of oral lesions associated with HIV infection in children in sub-Saharan Africa.We report the findings of a cross sectional study of 36 Nigerian children seen at the Pediatrics Infectious Disease Clinic of the AIDS Prevention Initiative in Nigeria (APIN), Jos University Teaching Hospital (JUTH) Jos, Nigeria

Can neonatal pneumothorax be successfully managed in regional Australia?

INTRODUCTION: There is a lack of data reflecting the trend of neonatal pneumothorax in regional Australia. The aim of this study is to review the incidence and characteristics of neonates diagnosed with pneumothorax in Central Queensland, analyse outcomes in terms of the ability of local hospitals to manage this condition, and describe predictors for severe disease requiring transfer to a tertiary centre. Thus the role of regional health services in managing this condition will be reviewed. METHODS: This was a retrospective observational study of all neonates born between 1 January 2008 and 31 December 2015 coded by hospital records with a diagnosis of neonatal pneumothorax in Central Queensland. Data for sex and birth gestation for all Central Queensland births of the same period were also obtained. Descriptive statistics were calculated for birth weight and gestation, and Apgar scores. Frequencies were calculated for sex, length of admission, age of diagnosis and risk factors including meconium aspiration syndrome (MAS), prolonged rupture of membranes (PROM) and positive pressure ventilation (PPV). The primary outcome measure was successful treatment at a Central Queensland hospital versus requirement for transfer to tertiary hospital or death prior to transfer. Statistical significance was calculated for binary and continuous variables. RESULTS: During the study period, there were 31 cases of pneumothorax amongst 17 640 deliveries recorded by three Central Queensland hospitals, with a significant bias towards males (84%) amongst pneumothorax cases (

Hypoglycaemia in fasting low birth weight infants in Jos, Nigeria

Background/Objective: Low birth weight (LBW) infants are commonly at risk of hypoglycaemia. The prevalence of hypoglycaemia and its neurological features in fasting LBW infants below 24 hours of age was assessed. Methods: Low birth weight (LBW) infants seen within 24 hours of birth who had not fed or received glucose drinks were considered for recruitment. Blood sugar was assessed using Refloflux Glucometer at point of recruitment. Hypoglycaemic infants (defined as blood sugar below 2.2 mmol/l) were treated according to standard protocol. Blood sugar was repeated 2 hours later to ensure correction. Results: All forty eligible infants were recruited from 155 LBW infants in 31.57 weeks, giving a fasting incidence of 25.81%. Median age at presentation was 2.5 (range 0.33 to 19) hours. Mean birth weight was 1.413±0.3194 (range 0.904 to 2.200) kg. Incidence of hypoglycaemia was 65% overall, 67.9% in preterms, 60% in preterm SGA and 50% in term SGA infants. Maturity, place of birth, time of presentation, birth weight, parity and age of mother were not significant risk factors for hypoglycaemia. Hypoglycaemia was corrected within 2 hours of therapy in all infants. No infant demonstrated any neurological feature of hypoglycaemia. Mean PCV was 51.2±8.5% (range 33 to 65%). Conclusion: Hypoglycaemia is very common in fasting LBW infants, and was not shown to manifest with any neurological features in this population. Absence of neurological features of hypoglycaemia needs further investigation. Early feeding of LBW infants needs further emphasis

Which babies get blood in Jos, Nigeria?

Documentation of the transfusion needs of neonatal units is required to guide blood banks in meeting demands. A prospective observational study of newborn transfusions over 35 weeks was conducted. Eighty-four transfusions were conducted in 62 of 377 (16.45%) admitted infants in 35 weeks. Neonatal jaundice (57.2%) and anemia (38.1%) were main indications. In 85.7% cases, blood transfused wa

Intestinal parasites and human immunodeficiency virus (HIV) status of children in Jos, Nigeria

Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals. However, human immunodeficiency virus (HIV)-infected individuals with depleted immunity have an abnormally high susceptibility to infections. This study therefore, examines children with intestinal parasites according to HIV status and degree of immunosuppression. Consecutively consenting patients aged 1 to 15 years attending the Paediatric Clinic of acquired immune deficiency syndrome (AIDS) Prevention Initiative, Nigeria, were recruited as cases, while age and sex matched HIV negative controls were recruited from Out Patient Department of Jos University Teaching Hospital. Stool samples were examined for parasites by direct wet mount, formol-ether and modified Ziehl-Neelsen technique. Levels of immunosuppression were assessed amongst HIV-positive subjects. Five hundred and ten children aged 1 to 15 years equally divided between the two cohorts were enrolled for the study. Seventy-nine had IPI, giving a prevalence rate of 15.5%; 44 (8.6%) HIV positive and 35 (6.9%) HIV-negative children. The most prevalent extracellular parasite was Giardia lamblia, however HIV positives had significantly higher rate of G. lamblia infestation. Among the intracellular parasites, the infection rate in HIV-positive subjects (5.9%) was three times that in HIV-negative subjects (2.0%). HIV positive children with advanced and severe immunosuppression had significantly higher intracellular parasites. HIV status did not significantly predict the overall risk of having extracellular intestinal parasites however, it was noted that G. lamblia infection was significantly higher in HIV positive children. HIV positive children had higher risk of having intracellular parasites especially if they have advanced or severe immunosuppression. Therefore, the policy of screening children for intestinal parasites should continue irrespective of their HIV status. Those that are HIV positive children should specifically be screened for intracellular parasites