Cohort event monitoring of patients treated for uncomplicated malaria with artemisinin-based combination therapies in selected hospitals and community pharmacies in Nigeria

AIMS AND OBJECTIVES

The study was designed with the broad objective of determining the safety profile of artemisinin-based combination therapies amongst Nigerian population.

PATIENTS AND METHODS

This was a cohort event monitoring (CEM) programme involving monitoring adverse events (AEs) in malaria patients treated with either artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) in healthcare facilities in Nigeria. The study involved continuous enrolment of patients with malaria and treated with either AL or AA at the various sites until a total cohort of 600 patients were enrolled at each site. Patients were monitored from the onset of therapy, and on days 3 and 7 from the first day of treatment to identify AEs that may occur.

RESULTS

A total of 6102 AEs were recorded in 10,259 patients monitored during the programme. Of 4896 patients who received AA, 4233 (86.5%) patients reported at least one AE while 1869 (34.8%) AEs out of 5363 patients who received AL were reported (P = 0.010). The predominant incidence of each specific AE reported in each group among the patients who received AA and AL includes body weakness 30.8%/7.5%, dizziness 10.3%/3.9%, restlessness 5.02/1.12%, vomiting 3.5/1.03% and drowsiness 3.1/1.5% for AA and AL, respectively. There were more AEs among patients with co-morbid conditions and patients in the younger age groups (9-<15 years), P = 0.000.

CONCLUSIONS

Various types of AEs were seen and documented during the CEM programme. The findings suggested that the AA/AL monitored during this programme was generally safe and remarkably well tolerated among the Nigerian populations.

The mantoux test: should we change the site?

Recent studies have shown that sunlight-induced immunosuppression negatively alters the skin response to mantoux test. This study aimed to compare the response of the skin to mantoux test over the volar forearm surface, the traditional site, which is exposed to sunlight and the inner thigh, an area which is not. In all, 45 children had the mantoux test administered using 0.1 mL of 5TU purified protein derivative. Reactive induration to the mantoux test was recorded in five of these children. The average induration of the volar surface was 8.2 mm, while that at the inner thigh was 11.6 mm. The results have highlighted the potential of an enhanced mantoux test result, if parts of the body that are not exposed to high doses of ultraviolet light are used as the site for mantoux test.

Aniridia associated with ptosis in three generations of the same family

Aniridia is a spectrum of abnormalities of the iris anatomy, which range from a total absence of the iris to a mild stromal hypoplasia with normal pupil. Aniridia associated with ptosis in three generations of the same family is described. The cases fit the autosomal dominant familial aniridia (AN1) type, a genetic form of congenital aniridia characterised by isolated ocular defects.

A comparative assessment of motor function using the expanded and revised gross motor function classification system and the manual ability classification system in the same children with cerebral palsy in Shika, Zaria, Northwestern Nigeria

BACKGROUND

Assessment of motor function in children with Cerebral Palsy (CP) is vital to the identification and management of their mobility needs.

OBJECTIVE

To compare the Expanded and Revised Gross Motor Function Classification System (GMFCS-E&R) and Manual Ability Classification System (MACS) in the assessment of motor function in children with CP.

METHODS

A review of motor activity in children with CP documented at the Departments of Paediatrics and Physiotherapy, Ahmadu Bello University Teaching Hospital, Shika, Zaria, between January 2005 and December 2009.

RESULTS

A total of 28 children (16M: 12 F, 1.3:1) with an age range of 4 to 12 years (mean 6.2 ± 2.4 years) were studied. Birth asphyxia (46.43%) and Spastic Hemiplegia (71.43%) were the main identified predisposing factor and clinical type of CP respectively. The GMFCS-E&R identified 13 (46.43%) children with higher levels (I & II) of gross motor function against 4 (14.29%) children identified in the MACS higher levels (p=0.02). Also 6 (21.43%) of the children were identified as being in the GMFCS-E&R lower levels (IV & V) against 16 (57.14%) in MACS lower levels (p=0.00). The difference in the number of children identified as being in level III for GMFCS-E&R 9 (32.14%) and MACS 8 (28.57%) was not significant (p=0.77). Overall correlation between GMFCS-E&R and MACS levels was poor using Kappa statistics (Kappa=0.00).

CONCLUSION

The GMFCS-E&R and MACS significantly identified higher and lower levels of motor functions respectively in the same children. The disparity underscores the complexity in assessing the motor function of children with CP.

Ability of mothers to assess the presence of fever in their children: implication for the treatment of fever under the IMCI guidelines

BACKGROUND

Fever is a common reason for seeking medical attention, with febrile illnesses accounting for 10% to 20% of pediatric visits to emergency departments. A history of fever or presence of fever by palpation or measured temperature is required on the Integrated Management of Childhood Illnesses (IMCI) algorithms as a reason for the assessment of fever, which will lead to specific classifications that are linked to treatment protocols. Therefore, the WHO and its partners assume that mothers are able to assess their children for the presence of fever.

OBJECTIVES

To evaluate the ability of mothers to determine the presence of fever in their children by tactile examination of their children.

METHODS

We prospectively studied 126 mother-child pairs attending the pediatric outpatient clinic of Ahmadu Bello University Teaching Hospital (ABUTH). Mothers of children 2 months to 5 years of age who mentioned fever as part of the presenting complaints were studied using a structured questionnaire regarding their children's illness, temperature status and their educational level.

RESULTS

A total of 126 mother-child pairs were studied, of which 44 (34.9%) of the mothers had had their education extended to secondary school level and only 15 (11.9%) had their education extended to a tertiary level. Fever was present in 82 (65.1%) of the children when their temperatures were determined by thermometer. The mothers correctly identified 79 (sensitivity of 96.3%) of the children who were truly febrile and 19 (specificity of 43.2%) of those who were truly nonfebrile. The predictive value of a positive test was 76.0%, and the predictive value of a negative test was 86.4%.

CONCLUSION

The results showed that mothers in our environment, as has been observed in other parts of the world, are able to correctly assess the presence or absence of fever in their children.

Computerized tomography of children with seizure disorders

BACKGROUND

Neuro-imaging is generally considered as part of the evaluation of seizures and epilepsy. There is limited information about its usefulness in our environment. We describe the pattern of CT findings in children with seizures in our environment.

METHOD

We carried out a retrospective review of the computerized tomography findings in children with recurrent seizures over a one year period, November 2005 to October 2006.

RESULTS

During the study period, 49 infants and children had computerized tomography performed on them out of which 19 had CT done for recurrent seizures. They ranged in age from 4 months to 16 years with 13 of them being boys. Generalized tonic--clonic seizures was the most predominant seizure type, being present in 10 of the 19 (52.6%) children while simple partial seizure, myoclonic jerk and mixed seizure types were present in 2 cases each. Abnormal scan was demonstrated in 10 of the 19 children (52.6%) with 3 of them having double cerebral lesions, giving a total of 13 cerebral lesion demonstrated by the CT scan. Cerebral infarct was the most common lesion demonstrated, being present in 5 of the 13 lesions (38.5%). Others were cerebral atrophy in 4 cases (30.8%), moderate ventricular dilatation 2 (15.4%) and 1 each ofporencephalic cyst, hydrocephalus and linear skull fracture. Of the 10 children with abnormal scan, 90% of them had significant past medical history, with birth asphyxia (44.4%) and meningitis (33.3%) being the commonest significant past medical history in them. CCONCLUSION There is a high incidence of abnormal scan findings in children with seizure disorder in our environment compared to what is obtained from the developed countries. Cerebral infarct appears to be the most common abnormal CT findings in our children with seizures.

Pattern of neurological disorder presenting at a paediatric neurology clinic in Nigeria

BACKGROUND

Neurological diseases account for more than 20% of the world's disease burden with majority of affected people living in Africa. However there is a paucity of literature on neurological disease in Africa.

METHODS

A retrospective review of 114 children with neurological problem seen at a paediatric neurological clinic in a 2-year.

RESULTS

Delayed developmental milestone, convulsion and inability to walk were the 3 most common reasons for referral to our Paediatric neurology clinic. Cerebral palsy (55.3%), Seizure disorder (26.3%) and postmeningitic complications (6.2%) were the common neurological disorder seen at our neurology clinic. The Paediatric outpatient department (POPD) of our hospital was the main source of referral for most cases (83.2%) and 71.1% of all patients resides within Zaria metropolis. The default rate from follow-up was higher among children with cerebral palsy compared to children with seizure disorder (58.7% vs. 13.3%, P < 0.001).

CONCLUSION

Lack of adequate facilities for proper rehabilitation of children with cerebral palsy could have been the main reason for the high default rate from follow-up.

Burkitt's lymphoma presenting as obstructive jaundice

A 12-year-old boy presented with a 5-month history of yellowness of the eyes, progressive painless abdominal swelling and weight loss. Physical examination revealed a grossly wasted child with marked jaundice and non-tender hepatomegaly. Liver function tests and abdominal ultrasound suggested obstructive liver disease. Tissue biopsy at laparotomy showed histological findings consistent with Burkitt's lymphoma. He was commenced on cytotoxic chemotherapy and, after two courses, the jaundice disappeared and he remained well. Although ante-mortem presentation of Burkitt's lymphoma as hepatic disease is rare, this condition should be included in the differential diagnosis of a child with obstructive jaundice.

Bilateral pneumothorax complicating miliary tuberculosis in children: case report and review of the literature

An 11-year-old boy presented with a 4-week history of fever and 2 weeks later developed a cough with breathlessness. His chest X-ray showed bilateral miliary shadows with pneumothorax on the left side. While on antituberculous therapy which was started on admission, he developed right-sided pneumothorax with significant collapse of the left lung. He was managed by tube thoracotomy with underwater seal but died 4 hours after the procedure was completed.

Drug treatment costs: projected impact of using the integrated management of childhood illnesses

The strategy of integrated management of childhood illness (IMCI) aims at improving the skills of first level health workers and consequently, improving the survival chances of children. The guidelines have been shown to be cost-effective. We aimed to determine the potential impact of using IMCI guidelines on drug treatment cost. The cost of drugs prescribed for 129 sick children, by first level health workers, who were managed at three primary health facilities in Sabon Gari Local Government Area of Kaduna State, was calculated. The corresponding cost using the IMCI guidelines was also calculated. There were 74 males and 55 females (M:F=1.3:1). An average of 4.5 drugs per patient were prescribed by the health workers compared to 2.3 drugs per patient when using the IMCI guidelines. The total cost of drugs prescribed by the health workers was N15,279.39 with an average of N118.44 per child. The corresponding costs had the IMCI guidelines been used were N3,062.53 and N23.73, respectively. Treatment cost using the traditional method was 4.98 times more expensive than using methods advocated by the IMCI guidelines. The projected cost savings related to drugs when using IMCI guidelines were based on the assumption that inappropriate drugs would not be prescribed by health workers once they are introduced to and started using the IMCI guidelines.

Use of nitrite dipstick test in the screening for urinary tract infection in children

A prospective study of one hundred and eighty five children attending the paediatric units of Ahmadu Bello University Teaching Hospital, Zaria were evaluated for urinary tract infection (UTI) by culture, microscopy and nitrite dipstick test. There were 118 males and 67 females (M:F = 1:1:1). Positive urine culture with significant bacteria was found in 45 samples (24.3%). Urine microscopy for leukocyturia was significant in 55 urine samples. Significant leukocyturia correctly identified 23 of the 45 culture positive urine samples, giving a sensitivity of 51.1%. Nitrite dipstick test correctly identified 13 of the 45 urine samples with proven UTI (28.9% sensitivity). The positive and negative values were 72.2% and 80.8% respectively. The nitrite dipstick test was found to be less sensitive than significant leukocyturia in detecting UTI. It is concluded that although the urinary nitrite dipstick test has an excellent specificity, it is not sensitive enough as a routine screening test for urinary tract infection in children.