Clinical profile and outcome of pediatrics tetanus: the experience of a tertiary hospital in Ethiopia

Background: Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction due to a potent exotoxin, tetanospasmin produced by Clostridium tetani. It is a common health problem in developing countries like Ethiopia. The aim of this study was to assess clinical profile and outcome of Pediatrics tetanus in a referral hospital, South Ethiopia.Methods: This is a retrospective cross-sectional study of medical records of 24 Pediatric tetanus patients who were admitted from July 2014 to June 2016 to the Pediatrics Department of Hawassa University Comprehensive Specialized Hospital, Hawassa-Ethiopia. Tetanus was diagnosed clinically. Data were entered and analyzed using SPSS statistical software.Results: The median age at diagnosis was 8 years with 19 (79.2%)of the study subjects being males. There were 3 male neonatal tetanus cases with 2 deaths. From post-neonatal cases, only 8(38.1%) were fully vaccinated for infant Expanded Period of Immunization (EPI). Booster vaccination with TT (tetanus toxoid) was only given to 5(29.4%) of discharged patients. Trauma was common in above 5 years of age and documented in 19(79.2%) of patients. All tetanus cases were generalized type with mild, moderate and severe grades comprising 7(29.2%), 8(33.3%), 7(29.2%) and 2(8.3%) respectively. Case fatality rate was 29.2% (7) with more deaths in higher grades. Respiratory failure 6(85.7%), and aspiration pneumonia 1(14.3%) were causes of death.Conclusion: In this study, case fatality rate was high. Hence, health promotion with scale-up of EPI for infant tetanus immunization and large scale studies to provide support for booster vaccination schedules are recommended.Keywords: Profile, outcome, tetanus, children, Ethiopi

Heart Failure in Ethiopian Children: Mirroring the Unmet Cardiac Services

BACKGROUND: HeartFailure (HF) is a progressive clinical and pathophysiological syndrome caused by cardiovascular and noncardiovascular abnormalities. Childhood HF has not been well studied in Sub-Sharan Africa, particularly in Ethiopia. Hence, this study aimed at describing the pattern and outcome of pediatrics HF at a referral-teaching hospital.METHODS: Medical records of 216 HFchildren aged 2months to 14 years, and admitted between January 2014 and January 2016 were reviewed. Clinical information was collected, analyzed and presented in tables and pie charts.RESULTS: A total of 2000 children were admitted to Hawassa University Hospital during the study period. HF accounted for 10.8% (216) of pediatrics admissions, 51.9% males. The median age of the study subjects was 6years. Functionally, NYHA/Ross class III and IV consisted 65(30.1%) and 139(64.4%) of HF. Structural heart diseasewas the commonest cause of HF, 144(66.7%): Rheumatic heart disease (RHD),75(52%), and congenital heart disease (CHD),64(44.5%). Anemia and renal cases contributed to 50(23.1) and 12(5.6%) of HF.CHD was predominantly documented in <5years. Pneumonia 66(42.9%), and infective endocarditis 29(18.8%) were the common precipitating/comorbid conditions with HF.Thecase fatality rate of HF was 13.9 %( 30).CONCLUSION: In this study, HF accounted for a tenth of pediatrics admissions. Structural heart disease was the commonest cause of heart failure. CHD and RHD affected predominantly children of <5years of age and >5 years of age. Echocardiographic screening of HF cases for structural heart disease and optimal care for patients with underlying structural heart disease are recommended

Right Pulmonary Artery Absence or Discontinuity in Ethiopian Toddler

BACKGROUND፡ Unilateral pulmonary artery absence or discontinuity is a rare congenital abnormality. Its reported prevalence is 1 in 150,000 adults.CASE PRESENTATION: A 22-month-toddler girl was referred from a general hospital for cardiac follow-up to our hospital after diagnosis of severe pulmonary hypertension was made. She presented with generalized body swelling, cough, fast breathing and high-grade fever of four days duration. She had repeated severe chest infections. Echocardiography and chest computed tomography revealed right pulmonary artery discontinuity. Acute care was given and chronic care was established.CONCLUSION:Pulmonary artery discontinuity is a rare anomaly. It should be considered in any child presenting with recurrent chest infections/pulmonary hypertension. Appropriate and timely diagnostic work up will avoid misdiagnosis

Severe Acute Malnutrition among Unoperated Ethiopian Children with Congenital Heart Disease: A Wake-up Call to Reverse the Situation, A Retrospective Cross-Sectional Study

BACKGROUND፡ Children with Congenital Heart Disease (CHD) are at increased risk for severe acute malnutrition (SAM). We aimed to determine the magnitude and determinants of SAM among children with CHD in a tertiary hospital.METHODS: Retrospective cross-sectional study was conducted among children with CHD between 2016 and 2019. Clinical and anthropometric data were retrieved from medical records. Anthropometric assessment was done by using WHO standard growth curves. Data analysis was done using Statistical Package for Social Sciences V22. Statistical significance was set at p-value<0.05, and multivariable logistic regression was used to determin predictors.RESULTS: There were 2400 pediatric admissions during the study period,CHD accounted for 6.5%(156) of admissions. For review, 141 records were eligible. The gender distribution was comparable, males 51.1% (72). Infants (<12 months) and older children (>12 months) accounted for 57.4% (81) and 42.6% (60) of study subjects, respectively. SAM was documented in 51.8% (73) of the study subjects, [95% CI: 44.7-60.2]. Infants had higher odds of SAM compared to children aged >12 months[adjusted odds ratio (AOR)= 4.48, 95%CI:2.07-9.70]. Anemic children had higher odds for SAM[AOR =3.76, 95% CI:1.54-9.18]. Children without acyanotic CHD with heart failure(HF) were 58% less likely to develop SAM[AOR= 0.42, 95% CI:0.19-0.96].CONCLUSION: The burden of SAM among children with CHD is high. Younger age,anemia and acyanotic CHD with HF predicted SAM.Screening for anemia and targeted anthropometric assessment are recommended for early SAM detection

Thoracic ectopia cordis in an Ethiopian neonate

Background: Ectopia Cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect with failure of fusion of the sternum with extra thoracic location of the heart. The estimated prevalence of this case is 5.5 to 7.9 per million live births.Case Presentation: We had a case of a 16-hour-old male neonate weighing 2.9kg with externally visible, beating heart over the chest wall. Initial treatment included covering the heart with sterile-saline soaked dressing, starting systemic antibiotics and supportive care. A staged surgical approach to this defect with the initial aim of replacement of the heart to the thoracic cavity was opted. The neonate died twenty minutes after the surgical intervention due to cardiogenic shock despite adequate resuscitative measures.Conclusion: This case report underscores the missed opportunity of antenatal ultra-sonographic diagnosis and the challenge of Ectopia Cordis treatment in Ethiopia.Keywords: Ectopia Cordis, case report, antenatal ultrasound, Ethiopia, treatment challeng

Incidence and Predictors of Tuberculosis Among Adult PLWHA at Public Health Facilities of Hawassa City

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important

Hydrometrocolpos presenting as a huge abdominal swelling and obstructive uropathy in a 4 day old newborn: A diagnostic challenge

BACKGROUND: Abdominal swelling is an uncommon presentation in newborn babies. A combination of huge abdominal swelling, obstructive uropathy and imperforate hymen in newborns has not been reported in the medical literature.CASE DETAILS: We report a 4 days old newborn with a rare presentation of hydrometrocolpos which posed a diagnostic challenge and consequently resulted in delays in diagnosis and treatment.CONCLUSION: Hydrometrocolpos should be considered as a differential diagnosis in neonates who present with huge abdominal swelling.KEYWORDs: Neonate, Abdominal Swelling, Hydrometrocolpos, Imperforate Hyme

Empiric treatment of acute meningitis syndrome in a resource-limited setting: Clinical outcomes and predictors of survival or death

Background: Bacterial meningitis is a significant cause of morbidity and mortality in the developing world. However, limited research has focused on the diagnosis and management of meningitis in resource-limited settings.Methods: We designed a prospective case series of children admitted to a large, academic referral hospital with acute meningitis syndrome. Data were collected on age, time of presentation, prior antibiotics, cerebrospinal fluid (CSF) parameters, antibiotic and steroid prescription, and clinical outcome.Results: Data on 99 patients were collected and analyzed. Most of the patients were males, n=69 (70%), and were from a rural area, n=83 (84%). Incomplete  vaccination was common, n=36 (36%) and many have evidence of malnutrition, n=25 (38%). Most patients, n=64 (72%), had received antibiotics prior to admission with a mean duration of symptoms of 4.9 days prior to admission. The CSF white blood cell (WBC) count was higher in those who had not received prior antibiotics though it was elevated in both groups. The CSF WBC count was not associated with survival; malnutrition and length of symptoms prior to admission were both associated with decreased survival.Conclusions: While use of antibiotics prior to obtaining CSF in patients with acute meningitis syndrome may decrease their CSF WBC count, it is not clinically significant. Many patients had a significant delay in presentation that had an effect on survival, This is a potentially modifiable risk factor despite the resource-limited setting.Keywords: bacterial meningitis, children, antibiotics, glucocorticoid