Profile of hospital Admissions of childhood poisoning at a North-central Nigerian tertiary health care centre

Background: Childhood poisoning is an important but preventable cause of morbidity and mortality in the paediatric subpopulation. There is the continuous need to describe the pattern of childhood poisoning and to create public awareness on the common agents of poison in this environment.Objectives: To determine the pattern of childhood poisoning and to bridge the existing knowledge gap on childhood poisoning in North-Central Nigeria.Patients and methods: A retrospective study of case records of children admitted and treated for childhood poisoning at the Emergency Paediatrics Unit of the Jos University Teaching Hospital, Jos over a five year period (February 2008-February 2013) was undertaken. The data extracted from the case records included bio-data, date of admission, type and route of poison exposure, level of education and occupation of parents of affected children, treatment received and outcomes.Results: Twenty-six (0.94%) out of a total of 2,770 children were admitted and treated for poisoning. Their ages ranged from 5 months to 13 years. Children aged 0 to 2 years accounted for 12 (46.2%) cases with a mean age of 1.88 years. There were 10 (38.5%) male and 16 (61.5%) female with a male: female ratio of 0.62:1. Organophosphate and kerosene accounted for 9 (34.6%) and 6 (23.1%) of all cases respectively. Twenty-four (92.3%) of the poisoning were accidental while 2(7.7%) were intentional. Oral route was the commonest route of poison exposure in 20 (76.9%) and 24 (92.3%) of all cases which occurred in their home environment. gastrointestinal system symptoms were the most frequent clinical presentation 16 (61.5%). Thirteen (50.0%) of the affected victims presented to the hospital in 1-6 hours of poison exposure. Indications for hospital admissions in decreasing order of frequency were dehydration 7 (26.9%), seizures 6 (23.1%) and coma 6 (23.1%). Six (23.1%) of patients received palm oil/milk as home remedies prior to hospital presentation. There was a mortality rate of 3.8% from carbon monoxide poisoning. Mean duration of hospital stay was 1.87 days.Conclusions: Organophosphate is the commonest cause of childhood poisoning in North-Central Nigeria and children aged 0-2 years are the most vulnerable age group for accidental poisoning while older children aged 13 years and above for intentional poisoning. Therefore, there are needs to increase and sustain public health awareness on childhood poisoning and the government to provide poisoning centres and improve standards of living.Keywords: Pattern, admissions, poisoning, children, North-Central NigeriaJos Journal of Medicine, Volume 7 No.

Methylated spirit versus 4% chlorhexidine gel in neonatal umbilical cord infection: A short report of a randomized, openlabelled, parallel-group trial

Background: Neonatal sepsis is a known leading cause of neonatal morbidity and mortality.Aim: To compare the efficacies of 96% methylated spirit and 4% chlorhexidine (CHX) gel in the treatment of umbilical stump of neonates.Method: This was a randomized, open labelled, parallel group trial of CHX gel and Methylated spirit for neonatal umbilical cord care in Jos, between 2/6/17 and 16/7/17. Inclusion criteria were term, newly born 0 to 6 hours old, with no known risk for sepsis and written informed parental consent. Eligible subjects were randomized to receive methylated spirit or 4% CHX gel. Outcome measures were cord separation time, omphalitis, neonatal sepsis and neonatal mortality by day 28.Results: A total sample of 51 of 58 met enrolment criteria. Thirtytwo (62.7%) where delivered in JUTH, 33(64.7%) were males with a mean birth weight of 3.7kg (CI 3.04 – 3.30). Mean cord separation times were 7.96 ± 4.07)days in the methylated spirit group vs 6.43 ± 3.13days in the CHX comparator group, (p=0.078). Omphalitis was0% vs2(8.3%) and NNS 2 (7.4%)vs2(8.3%) in methylated spirit and CHX treatment groups respectively. There was 1(3.7%) mortality in the methylated spirit treatment group.Conclusion: Methylated spirit and 4% CHX gel have comparable umbilical stump treatment efficacy. Methylated spirit may be a safe alternative in clinical settings where topical 4% CHX gel is unavailable or unsafe.Key words: Methylated spirit, 4% Chlorhexidine gel, mortality, Cord separation time, Neonatal sepsis, Omphaliti

Comparative Haematologic Parameters of Paediatric Uncomplicated Plasmodium falciparum Malaria in Children Treated with Artemether-Lumefantrine and Artesunate-amodiaquine in Jos, North-Central Nigeria.

Background: Malaria is still threatening the lives of millions of children particularly the under five years living in malaria endemic countries of the world. Acute malarial episodes cause many pathophysiological changes in the haematological system of man including alterations in erythrocytes, leucocytes and thromobocytes in the peripheral blood. These changes occur before and after treatment with antimalarial drugs and could also be influenced by the type of antimalarial drugs used.Aim: To determine and compare the changes in haematologic parameters before and after treatment of uncomplicated P. falciparum malaria with artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) in under-five children using 28 day study protocol.Method: Data on 111 children aged 6 to 60 months who were enrolled into a drug therapeutic efficacy testing (DTET) comparing the efficacy, safety and tolerability of AL (20/120mg) with AA (25mg/67.5mg or 50/135mg) in the treatment of uncomplicated falciparum malaria, were analyzed. This study was over a period of 10 weeks (27/06/2010 - 16/11/2010) at the General Hospital Brakin Ladi,Plateau State, Nigeria. Inclusion criteria were: history of fever in the last 24hrs and /or measured axillary temeperature 37.5 °C, P. falciparum infection with parasitaemia ≥ 1000 to ≤ 250,000 parasites/μL, HIV seronegative status, and a written informed consent from parents/guardians including readiness to comply with the follow-up visits by the parents. The children who met the inclusion criteria were randomized into the two treatment arms and their haematological parameters (haemoglobin(HB)) levels, platelet, neutrophil, lymphocyte counts, and total white cell count (WBC) measured.Results: Of 649 subjects screened for parasitaemia in the study, 282 (43.5%) were febrile (temperature 37.5°C). Out of 649 subjects, 252 (38.8%) had parasitaemia. Only P.falciparum was identified. Parasite count varied from 1000-200,000 asexual forms/μL. The mean age (months) of study population in the AL and AA arms were 38.9 16.90 and 37.7 16.76 respectively, (p=0.72). Thirty one (55.4%) and 25 (44.6%) were males and females in the AL study arm respectively while 32 (58.2%) and 23 (41.8%) were males and females respectively in the AA study arm, (p=0.77). The mean Packed cell volume (PCV) % pre-treatment (D0) rose from 32.14.7 to 35.7 7 in AL treatment arm and from 32. 5.5 to 35.14.4 in AA treatment levels of 9.83.5 and 10.04.7 to 7.82.2 and 7.72.4, in the AL and AA treatment arms D28 post-treatment (D0) levels of 36.912.5 to 32.88 in the AL treatment arm and from 37.517.0 to 35.0 10.6 in the AA treatment arm respectively, p=0.356. The mean monocytes counts (%) similarly dropped from pre-treatment levels of 11.14.8 to 8.63.4 in the AL treatment arm and from 10.7 4.2 to 8.2 3.7 in the AA treatment arm respectively, p=0.0404. Mean platelete counts also showed a decreasing trends from 545.3215.4 and 280.2151.8 to 268.2106.3 and 258.898.7 in the AL and AA treatment arms respectively at D28, post-treatment, p=0.394. Compared to the PCV, WBC, neutrophil, monocytes and platelete subpopulations of cells, the mean lymphocyte counts demonstrated a progressive increasefrom nadir of 51.415.7 to 58.711.6 in the AL treatment arm and 52.016.6 to 56.611.4 in the AA treatment arm at D28 post-treatment respectively, p=0.630.Conclusion: Uncomplicated paediatric Plasmodium falciparum malaria induces transient alterations in haematologic parameters before and after antimalarial treatment in Jos, North Central Nigeria. Therefore, malaria infection should be considered as a differential diagnosis in febrile children with alterations in haemologic parameters

COmparative heamatologic parameters of paediatric uncomplicated plasmodium falciparum malaria in children treated with artemether-lumerantrine and artesunate-amodiaguine in Jos, North-Central Nigeria

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