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

Serum vitamin A and other nutritional parameters in children with congenital heart disease

Objective: To compare the weight for age, the serum albumin and vitamin A of children with congenital heart disease (CHD) with those of age and sex matched controls without CHD.Methods: Consecutive children diagnosed to have CHD by echocardiography who were afebrile two weeks prior were recruited. Subjects who had bronchopneumonia were noted. Their weights, haematocrit, serum albumin and vitamin A were measured. Variables were compared betweensubjects and controls. Vitamin A was measured by high performancechromatography.Results: Thirty eight subjects with mean age of 3.6 ± 4.3 years and 40 controls with mean age of 3.6 ± 4.8 years were recruited. Fifteen (39.5 %) subjects had bronchopneumonia while 14/38 (36.8 %) and 4/36(11.1 %) subjects and controls respectively were undernourished, p = 0.014. The mean serum vitamin A values in subjects 0.86 ± 0.13 mmol/l and controls 0.87 ± 0.16 mmol/l was not significantly different, P = 0.76. Serum albumin of subjects and controls were 3.5 ± 0.5 and 3.6 ± 0.43  respectively, p = 0.60 Conclusion: There was no significant difference in serum vitamin A and albumin in subjects and controls. However, significantly more children with CHD than controls were undernourished.Keywords: congenital heart disease; vitamin A; serum albumin

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

Guideline defined asthma management in children: how compliant are general practitioners

Asthma is a chronic debilitating illness in children. The management of this condition varies from place to place depending on the accepted guideline used in such areas. However, there is a global initiative on asthma management (GINA) that has unified all the local guidelines such that the management is almost the same worldwide. Objective: To determine the awareness of and adherence to the GINA Guideline in the management of asthma by private practitioners. Methods: Semi-structured self-administered questionnaires were given to general practitioners during one of their continuous medical education (CME) meetings on asthma facilitated by the authors of the study. The data so generated were entered in EXCEL and transferred to SPSS and analysed. Results: Out of the 50 respondents, 48 reported that they managed asthma. Six of the 50 respondents were aware of the existence and content of the GINA Guideline. However, only 2 doctors could correctly state how to treat children under-5 years according to the GINA guideline. In the case of children above-5 years, only those who could correctly treat children under-5 years also could treat children above-5 years with the GINA guidelines. No participant could correctly state the Guideline-Defined long-term management of asthma. Conclusion: Management of asthma by general practitioners does not follow the GINA Guidelines. There was also poor awareness by the doctors of the existence of the GINA guideline. There is need for frequent update programmes for general practitioners

Streptococcal throat carriage in a population of nursery and primary school pupils in Benin City, Nigeria

Background: Group A streptococcus (GAS) is a major cause of mortality in man. Regular disease surveillance can be achieved through evaluation ofthroat carriage.Objectives: To evaluate GAS throat carriage amongst nursery and primary schools pupils in Benin City, Nigeria.Method: This cross sectional study was carried out between September and November 2011. A multistage random sampling method was used to recruit the pupils. Throat swabs were obtained for microscopy and Lancefied grouping.Results: 426 pupils were recruited of which 363(85.2) were in primary and 63(14.8%) in nursery schools. The subjects were aged 2 to 15years and 203(47.7%) were males. Of the 426 pupils, 123 (28.9%) had positive throat swabs for â haemolytic streptococcus (âHS). None of the isolate wasGAS. The isolates were groups C (50.4%), D (38.2%) and G (11.4%).Conclusion: Although âHS throat carriage rate in this study is high, there was no GAS isolate. This may suggest low prevalence of GAS related diseases in the community.Keywords: group A Streptococcus; throat carriage; school childre