Neonatal Tetanus: A Continuing Menace

Background: Tetanus especially that affecting the newborn has continued to contribute to morbidity and mortality in developing countries such as Nigeria despite the availability, for over 30 years of an effective vaccine. Its contributing factors include low immunization coverage, poor obstetric services and illiteracy. This study aims at reviewing the status of neonatal tetanus in UPTH with its characteristics and outcome while highlighting the need for instituting sustainable control measures.Methods: This is a retrospective analysis, involving the review of hospital records on neonatal tetanus cases treated at the University of Port Harcourt Teaching Hospital from 1995 to 2009. The case notes of all neonatal tetanus patients in the department of paediatrics from 1995-2009 were retrieved and reviewed for age, sex, presenting complaint, immunization status, examination finding, duration of hospitalization and outcome of illness.Results: Two hundred and ninety six neonates, comprising 174 (58.8%) males and 121(40.9%) females were treated 1(0.3%) of them did not have any record of his or her sex. Most of the mothers did not receive any doses of Tetanus Toxoid [TT] vaccine and delivered outside health facilities. Fifty percent of the cases died. The number and characteristics of the cases and deaths did not change significantly over the period.Conclusion: Essential obstetric care, strengthening of routine immunization, compulsory immunization of all women of childbearing age and school-age children should be adopted to reduce the incidence of neonatal tetanus in the country, while improved health care will reduce the associated high case fatality rate.Key Words: Neonatal tetanus, Outcome and trends; Port Harcourt; Nigeria

Microalbuminuria: It's Significance, risk factors and methods of detection

Background: Microalbuminuria, though a relevant screening tool world wide, is scarcely reported with very sparse literature in our setting. Microalbuminuria is a marker of early renal involvement, compare to routine serum creatinine and electrolytes changes in hypertension and diabetes mellitus. This article attempts to review the significance, risk factors and methods of detection of Microalbuminuria.Methods: Available publications from local and international journals in addition to Medline and Google search, particularly for local references were utilized. Other sources of our data included dissertations from the library of National post graduate medical college and text books of paediatric nephrology.Results: Microalbuminuria is used extensively in diabetes mellitus as a sensitive test for the detection of preclinical kidney dysfunction prior to the development of overt proteinuria, and as a predictor of subsequent  diabetic nephropathy. It has been found to be an important prognostic indicator in meningitis, malignancy and hypertension. It has been found to be useful in the monitoring of patients with renal scarring, unilateral nephrectomy and diabetes mellitus. It is also an important marker of glomerular injury, particularly in patients with sickle cell anaemia.Conclusion: Microalbuminuria is an early maker of glomerular injury. It is important as a screening tool in a variety of disease conditions. Screening may be performed with a semiquantitative assay. If the screen is positive, UAE should be evaluated by a quantitative assay.Key words: Microalbuminuria; Screening; Risk factors; Methods of detection

Childhood Pneumonia and under-five morbidity and mortality at the University of Port Harcourt Teaching Hospital- a situational analysis

Background: Childhood mortality which remains high in children under the age of 5years is largely due to infectious and other preventable causes such as Human immunodeficiency virus/ Acquired Immunodeficiency Syndrome ((HIV/AIDS), pneumonia and malaria1 . The prevention of pneumonia deaths is therefore an important th approach if the 4th Millennium Development Goal (MDG4) is to be attained.Aim: The aim of this study was to describe the pattern, clinical features, management and complications of pneumonia in under-five children admitted in the University of Port Harcourt Teaching Hospital (UPTH) and to highlight their morbidity and mortality.Methods: This was a retrospective cross sectional descriptive study of children diagnosed with pneumonia who were admitted into the children's wards between January 2007 and December 2009. The case notes of all children diagnosed of pneumonia who were admitted into the paediatric wards as recorded in the ward register, were reviewed.Results: Five hundred and ninety-two children met the inclusion criteria. The yearly number ranged from 107 in 2007 to 213 in 2009. The quarterly distribution showed a peak during the north east wind (harmattan) season. Their ages ranged from <1-168 months (mean age 13.2 months, SD=19.84). Neonates accounted for 24.5% of all cases, while 66.9% were Infants and Under-fives were 97.1%. They were 333(56.3%) males and 251(42.4%) females, with a M: F ratio of 1.3:1. Pneumonia alone was the diagnosis in 127(54 .7%) while 106(45.7 %) had pneumonia plus other associated conditions, the commonest being malaria. Heart failure was the commonest complication 69(29.7%). The children who completed their immunization in infancy according to the National program on immunization schedule were 61.2% of cases, those who were exclusively breast feeding for the first six months of life - 31.9%, while HIV/AIDS was observed in 9.1%. The case fatality rate was 9.0% with 79.2% of them as infants.Conclusion: Pneumonia which is still prevalent in underfives in this environment is associated with significant morbidity and mortality especially among infants. Efforts to address this contributor to under-five morbidity and mortality is required if MDG4 is to be attained.Keywords: Pneumonia, under-five mortality, morbidity, MDG4

Vulva cellulitis and abscess with extension to anterior abdominal wall

Background: Abscesses occur commonly in our environment. However abscesses of the vulva in children are not often seen but they do occur periodically, and there is a paucity of data on its prevalence in our environment.Aim: To present a case of vulva cellulitis and abscess with extension to anterior abdominal wall occurring in a 17- month-old female.Case report: A 17-month-old female presented with fever of one week duration and vulval swelling of four days duration. Her parents were of middle socioeconomic class. An initial diagnosis of a right inguino-labial hernia with a differential diagnosis of Bartholin's cyst was made but was changed to anterior abdominal wall abscess(vulva cellulites and abscess with extension to anterior abdominal wall) when an obviously tender, erythematous, warm swelling appeared in the right iliac region. She received antibiotics and had an incision and drainage of the abscess. She was thereafter discharged in good clinical condition.Conclusion: Cases of vulva cellulitis and abscess are not common in children. A high index of suspicion would be needed to make an early diagnosis. Keywords: Abscess, Vulva cellulitis, Anterior abdominal wall, Childre

prevalence of microalbuminuria in paediatric patients with sickle cell anaemia

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