Inter-pregnancy interval and pregnancy outcomes among HIV positive mothers in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria

Background: Both short and long inter-pregnancy intervals have been associated with higher risk of adverse pregnancy outcomes. More so, short interpregnancy interval among HIVpositive women implies higher birth rate and subsequently a higher number of neonates exposed to HIV and potentially at r i s k o f mo t h e r - t o - c h i l d transmission.Aims: To study the influence of inter-pregnancy interval on pregnancy outcomes among booked HIV-positive mothers with singleton live-births atNauth, Nnewi.Methods: A cross-sectional study was carried out with the aid of s t r uc tur ed q ue s t io nnai r es , maternal clinical records and relevant anthropometry, between May and December 2011, among booked multiparous HIV-positive mother/singleton newborn pairs at NAUTH, Nnewi.Results: More than half (56.5%) of the 175 multiparous HIVpositive women studied had short inter-pregnancy interval (<18 months). Short inter-pregnancy interval was signi ficantly associated with adverse maternaland perinatal outcomes like maternal anaemia (X2 =14.95, p=0.021) and low values of m a t e r n a l o r n e o n a t a l anthropomet r ic parameter s. However only adverse maternal outcomes and MAC/OFC ratio of t h e n e o n a t e s r e ma i n e d significantly associated with short Inter-pregnancy interval after logistic regression analysis. Long inter-pregnancy interval was significantly associated with low values of neonatal  anthropometric parameters and maternal MAC less than 25cm (X2=15.10, p=0.019) as well as third trimester weight gain rate less than 250g/week (X2 =31.20, p= 0.000). The proportion of mothers with long interpregnancythat had anaemia or intra-partum BMI less than 25kg/m2 differed only slightly from that of those with inter-pregnancy interval of 18-59 months.Conclusion: Inter-pregnancy interval of 18 to 59 months is significantly associated with the lowest risk of both adverse maternal and fetal  outcomes among HIV-positive women

Socio - demographic characteristics of child street vendors in Nnewi, Nigeria

Background: Involvement of children in street trading is inimical, contrary to the Rights of the Child, and threatens holistic child development. Objective: To describe the sociodemographic characteristics of child street vendors in Nnewi. Method: A cross-sectional questionnaire survey of children selling wares on the streets of Nnewi, southeast Nigeria. Results: 147 children (90 boys and 57 girls) aged 8 – 19 years were interviewed: 57 (38.8%) lived with their parents, 63 (42.9%) with relations and friends, while 27 (18.3%) lived alone. Also, 27 (18.4%) were Anambra state indigenes, others hailing from surrounding states. The parents of all the subjects were of low socioeconomic status. Trading was taking place during school hours for financial gains of the family. As many as 42.9% of the subjects had completed primary education: 89 (60.5%) had completely dropped out of school for varying periods. Nine girls (6.1%) had been sexually abused and 46 children (32.7%) had at sometime lost their earnings to robbers. Majority (79.6%) aspired to higher education if given the opportunity. Conclusion: Many parents in the low socioeconomic groups still keep their children out of school to work and help boost the family income. It is recommended that legislation be made against children trading during school hours.Key Words: child labour, street children, child vendors, Nigeria

Adherence to infant-feeding choices by HIV-infected mothers at a Nigerian tertiary hospital: the pre-“rapid advice” experience

Objectives: The study examined adherence to infant-feeding choices made by human immunodeficiency virus (HIV)-infected mothers at a Nigerian tertiary hospital prior to implementation of the “rapid advice” guideline, i.e. the revised World Health Organisation principles and recommendations on infant feeding in the context of HIV.Design: This was a longitudinal descriptive study.Subjects and settings: The study was conducted on mother-infant pairs recruited from the prevention of mother-to-child transmission (PMTCT) of HIV programme of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Final analyses included 142 mother-infant pairs.Outcome measures: Adherence to a prenatal infant-feeding choice and the infant’s HIV status at six months of age were determined.Results: On enrolment, 73% (n = 103) of the mothers chose exclusive formula feeding (EFF), and 28% (n = 39) exclusive breastfeeding (EBF) for the first six months of life. Of the mothers who chose EBF, the actual practice of EBF declined from 88% at two weeks to 21% at six months, while EFF with correctly reconstituted infant formula decreased from 55% to 8% over the same period. The proportion of mothers who switched over to early complementary feeding increased from 8% at six weeks to 80% at six months in the EBF group, and 2% at two weeks to 92% at six months in the EFF group. Major reasons for nonadherence to their initial choice were fear of the mother-to-child transmission (MTCT) of HIV (65%) and non-affordability of the formula (97%) in the EBF and EFF groups, respectively. Factors significantly associated with adherence to their initial choice included having individual prenatal infant-feeding counselling sessions, being married, having a small number of children, being of higher socio-economic status and the mother’s educational status. However, only socio-economic status remained significant after logistic regression analysis was applied. The total MTCT of HIV rate was 1% at six months.Conclusion: Adherence to either EFF or EBF in this study was low, owing to early breastfeeding cessation and the inability to sustain EFF.Keywords: HIV-infected mothers, infant-feeding choice, infant-feeding practices, PMTCT, adherenc

Prediction of low birth weight from other anthropometric parameters in Nnewi, south eastern Nigeria

Background: Low birth weight is a global problem but presents a major burden on the neonatal services in developing countries such as Nigeria, and brings to bear a greater strain on the meagre resources available for health care delivery and family financing. In a resourceconstrained setting as ours, proper weighing of all newborn infants and medical surveillance of low birth weight infants, although highly desirable, are often not achieved due to unavailability of suitable, functional weighing scales. There are serial cut-off points for the various anthropometric indices for the normal birth weight babies below which any baby is termed low birth weight. This study assessed the predictive values of anthropometric measurements in the detection of low birth weight newborn babies and also determined the local specific cut-off points for these measurements in Nnewi, Southeast Nigeria.Methods: This was a crosssectional study in which length, occipitofrontal circumference, mid-arm circumference and maximum thigh circumference of 428 singleton babies were ascertained within 24 hours of delivery. Data were analysed using the Statistical Package for Social Sciences (SPSS) software. Correlation and linear regression analyses were done to examine the linear relationship between the predictors and birth weight. The sensitivity, specificity and predictive values were calculated at serial cut–off points and the points of best discrimination determined.Results: The low birth weight prevalence was 15.2%. Maximum thigh circumference attained the highest correlation with birth weight (r = 0.904), greatest coefficient of determination (r2=0.817), and least measure of dispersion around the actual birth weight. Thus maximum thigh circumference, which has a cut-off point of 16.75cm, was the best predictor of low birth weight, with 98.5% sensitivity, 92.3% specificity and diagnostic accuracy of 93.2% (P<0.001).Conclusion: Routine measurements of maximum thigh circumference in resource-poor countries is an effective proxy for weight at birth in prenatal assessments and epidemiologic surveys.Key words: anthropometric parameters,low birth weight, newborn, Nigeri

The performance of an Histidine rich protein-2 rapid diagnostic test (RDT) against the standard microscopy in the diagnosis of malaria parasitaemia among febrile under-five children at Nnewi

Background: Malaria remains a major cause of morbidity and mortality, thus there is need for quick, reliable inexpensive diagnostic tool to facilitate its prompt treatment especially in resource poor settings.Objectives: To compare the sensitivity of a locally available Histidinerich protein-2 based rapid diagnostic test (RDT) with the standard microscopy.Methods: This study was carried out to test the performance of an histidine rich protein -2 rapid diagnostic test (RDT) against the standard microscopy in the diagnosis of malaria among febrile under-five children attending Paediatric Clinic of NAUTH Nnewi. A total of 200 children under the age of five years were recruited for the study. Data on socio-demographic characteristics and symptoms were collected through an interviewer administered questionnaire. Blood sample was collected in EDTA bottle after observing universal precautions. All of them were tested with both Giemsa stained blood smear and Histidine rich protein-2 (HRP-2) rapid diagnostic test (RDT).Results: There were 118 males and 82 females, giving a male: female ratio of 1.44:1. Their ages ranged from 3-59 months and the average age was 27+17.49 months. Average number of days the subjects had fever before presentation were 3.78+1.95 days with a range of 1- 14 days. Body temperature ranged from 35.9-40.40C with average of 37.7+0.80C. Forty (20%) were positive by microscopy while 42 (21%) were positive by rapid diagnostic test. Twenty-percent of those positive by microscopy (n=8) were negative by RDT while 23.8% of those positive by RDT (n=10) were negative by microscopy. Using microscopy as a gold standard, the sensitivity of the RDT was 80%, the specificity was 93.8%. The positive and negative predictive values were 76.2% and 94.9% respectively.Conclusion: Based on these findings, the RDT demonstrated reasonable concordance with microscopy and was recommended for use at every level of healthcare in the diagnosis of malaria.Keywords: Malaria, RDT, Microscopy, under- five

Ranking of diagnostic features of childhood pulmonary tuberculosis by medical doctors in southeastern Nigeria

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. Conclusions: The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and radiographic abnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.KEY WORDS: Childhood pulmonary tuberculosis, Doctors, Ranking, Diagnostic features, Directly observed treatment short course (DOTS)

Awareness Of HIV / AIDS Among Hospital Workers

Objective: To determine the knowledge of a) HIV /AIDS among workers in a teaching Hospital, b) risk of HIV infection among hospital workers and c) precautionary measures against HIV infection in the hospital setting. Methods: 159 randomly selected workers of the Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria were interviewed using an open –ended questionnaire on aetiology, pathogenesis, prevention, spread and risk of occupational transmission of HIV infection. Data analysis was done with EPI- INFO 2000. The chi – square test was used for statistical analysis and the 0.05 level of significance was adopted Result: There were 68 males and 91 females aged between 20 and 60 years drawn from 10 departments, Administration, Security, Domestic services, Nursing services, Laboratory, Laundry, Tailoring ,Pharmacy Mortuary and Works .Their level of education varied from no formal education to above senior school certificate. Respondents exhibited a fair understanding of HIV/AIDS. Awareness was more in workers below 40 years and those with higher education. There was no significant gender difference in knowledge. Certain misconceptions were noted. There was knowledge deficit in etiopathogenesis of HIV infection and of exposure to and prevention of infection in the health care worker. Nurses, pharmacists and laboratory technologists showed superior knowledge of HIV /AIDS than others. Conclusion: There is a need for health education lectures for all cadres of health care workers so as to reduce occupational transmission of HIV infection KEY WORDS: Awareness, Hospital workers, HIV AIDS Nigerian Journal of Clinical Practice Vol.6(2) 2003: 102-10

Severe Anogenital Warts in a Child with HIV Infection: A Case Report

Objective: To highlight the possibility of nonsexual transmission of anogenital warts in children. Materials and Methods: An illustration using a case that presented to the author. Results: A five year old HIV-positive girl (vertically transmitted) with anogenital warts of 19 months duration is presented. She had never been sexually exposed. She responded well to treatment with Podophyllin solution applied topically twice weekly for a duration of two months. She is presently on highly active antiretroviral therapy. Conclusion: A good history and physical examination are of essence in the evaluation of anogenital warts in children. The likelihood of sexual abuse should be entertained but nonsexual modes of transmission can occur. Keywords: Anogenital warts, HIV, childNigerian Medical Journal Vol. 48 (2) 2007: pp. 49-5

Care seeking for illness in young children in Onitsha South East Nigeria

Objectives: To determine (a) the duration of symptoms before a child is taken to hospital (b) the treatment options utilized before presentation to hospital, if any, (c) the reasons for (a) and (b). Subjects and methods: 476 mother and child pairs presenting to a private children's hospital in Onitsha, South east Nigeria were interviewed. Results: Out of 476 sick children aged 5 years and below, there were 272 males and 204 females, with 70% aged 2 years and below. There was a significant preponderance of boys over girls brought for treatment. Boys were brought to hospital earlier than girls. There severity of symptoms rather than the age of the child affected time of presentation. Majority of the mothers could recognize the signs of common childhood diseases. Half of the mothers came straight to hospital at the onset of illness in their children. Several forms of care were sought including home remedies, drug peddlers, traditional medications and treatment by a nurse or laboratory technician. There was a tendency for mothers to try various forms of care at the same time, without really sticking to any and getting the desired benefit. Finance, proximity, easy accessibility and beliefs determined mothers' therapeutic decisions. Conclusion: Maternal knowledge and care- seeking practices need to be modified by appropriate health education. This would go a long way in reducing morbidity and mortality in young children. Tropical Journal of Medical Research 2004;8(2): 53-5