Pneumonia hospitalizations and mortality in children 3 - 24-month-old in Nigeria from 2013 to 2020: Impact of pneumococcal conjugate vaccine ten valent (PHiD-CV-10)

Pneumococcal conjugate vaccine ten valent (PCV 10) was introduced into Nigeria in three phases. Phase 3 introduction started in August 2016. However, its impact on pneumonia admissions and mortality among vaccinated Nigerian children has not been determined. Data in the period before PCV-10 introduction (3 August 2013-2 August 2016), and after (3 August 2017-2 August 2020) were retrospectively extracted from the medical charts of eligible patients aged 3-24 months with hospitalized radiological pneumonia at the University College Hospital (UCH), Ibadan; National Hospital (NH), Abuja; and Federal Teaching Hospital (FTH), Gombe, allowing for an intervening period of 1 year. Proportions of the patients with hospitalized pneumonia and case fatality rates were determined during both periods. The results were compared using z-test, multiple logistic regression analysis and p < .05 was considered significant. Adjusted pneumonia hospitalization rates between the two periods increased at the NH Abuja (10.7% vs 14.6%); decreased at the UCH, Ibadan (8.7% vs 6.9%); and decreased at the FTH, Gombe (28.5% vs 18.9%). Case fatality rates decreased across all the sites during the post-PCV introduction period: NH Abuja, from 6.6% to 4.4% (p = .106); FTH, Gombe, 11.7% to 7.7% (p = .477); and UCH, Ibadan, 2.0% to 0% (p = .045); but only significant at Ibadan. Overall, proportion of hospitalized pneumonia cases decreased after 3 years of PCV 10 introduction into the National Immunization Programme in Nigeria. The case fatality rate during post-PCV 10 introduction decreased at all the three sites, but this difference was significant at the UCH, Ibadan.

Maternal Instruction About Jaundice and the Incidence of Acute Bilirubin Encephalopathy in Nigeria

OBJECTIVE

To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice.

STUDY DESIGN

This was a multicenter, before-after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice.

RESULTS

Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction.

CONCLUSIONS

Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission.

Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital

Background

Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates.

Design

The study was prospective cross-sectional in design.

Subjects and Methods

Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses.

Results

Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95-61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40-721.84] were retained as significant predictors of IVH in the multivariate logistic regression model.

Conclusion

The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.

Oral amoxicillin compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with fast breathing when referral is not possible: a randomised, open-label, equivalence trial

BACKGROUND

WHO recommends referral to hospital for possible serious bacterial infection in young infants aged 0-59 days. We aimed to assess whether oral amoxicillin treatment for fast breathing, in the absence of other signs, is as efficacious as the combination of injectable procaine benzylpenicillin-gentamicin.

METHODS

In a randomised, open-label, equivalence trial at five sites in DR Congo, Kenya, and Nigeria, community health workers followed up all births in the community, identified unwell young infants, and referred them to study nurses. We randomly assigned infants with fast breathing as a single sign of illness or possible serious bacterial infection, whose parents did not accept referral to hospital, to receive either injectable procaine benzylpenicillin-gentamicin once per day or oral amoxicillin treatment twice per day for 7 days. A person who was off-site generated randomisation lists using computer software. Trained health professionals gave injections, but outcome assessors were masked to group allocations. The primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death, persistence of fast breathing on day 4, or recurrence up to day 8. The primary analysis was per protocol and we used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000286044.

FINDINGS

From April 4, 2011, to March 29, 2013, we enrolled 2333 infants aged 0-59 days with fast breathing as the only sign of possible serious bacterial infection at the five study sites. We assigned 1170 infants to receive injectable procaine benzylpenicillin-gentamicin and 1163 infants to receive oral amoxicillin. In the per-protocol analysis, from which 137 infants were excluded, we included 1061 (91%) infants who fulfilled predefined criteria of adherence to treatment and adequate follow-up in the injectable procaine benzylpenicillin-gentamicin group and 1145 (98%) infants in the oral amoxicillin group. In the procaine benzylpenicillin-gentamicin group, 234 infants (22%) failed treatment, compared with 221 (19%) infants in the oral amoxicillin group (risk difference -2·6%, 95% CI -6·0 to 0·8). Four infants died within 15 days of follow-up in each group. We detected no drug-related serious adverse events.

INTERPRETATION

Young infants with fast breathing alone can be effectively treated with oral amoxicillin on an outpatient basis when referral to a hospital is not possible.

FUNDING

Bill & Melinda Gates Foundation grant to WHO.

Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: a randomised, open-label, equivalence trial

BACKGROUND

WHO recommends hospital-based treatment for young infants aged 0-59 days with clinical signs of possible serious bacterial infection, but most families in resource-poor settings cannot accept referral. We aimed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin-gentamicin combination for 7 days for situations in which hospital referral was not possible.

METHODS

In a multisite open-label equivalence trial in DR Congo, Kenya, and Nigeria, community health workers visited all newborn babies at home, identifying and referring unwell young infants to a study nurse. We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age (0-6 days and 7-59 days), and randomly assigned each individual within these strata to receive one of the four treatment regimens. Randomisation was stratified by age group of infants. An age-stratified randomisation scheme with block size of eight was computer-generated off-site at WHO. The outcome assessor was masked. We randomly allocated infants to receive injectable procaine benzylpenicillin-gentamicin for 7 days (group A, reference group); injectable gentamicin and oral amoxicillin for 7 days (group B); injectable procaine benzylpenicillin-gentamicin for 2 days, then oral amoxicillin for 5 days (group C); or injectable gentamicin for 2 days and oral amoxicillin for 7 days (group D). Trained health professionals gave daily injections and the first dose of oral amoxicillin. Our primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event (including death), no improvement by day 4, or not cured by day 8. Independent outcome assessors, who did not know the infant's treatment regimen, assessed study outcomes on days 4, 8, 11, and 15. Primary analysis was per protocol. We used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000286044.

FINDINGS

In Kenya and Nigeria, we started enrolment on April 4, 2011, and we enrolled the necessary number of young infants aged 7 days or older from Oct 17, 2011, to April 30, 2012. At these sites, we continued to enrol infants younger than 7 days until March 29, 2013. In DR Congo, we started enrolment on Sept 17, 2012, and continued until June 28, 2013. We randomly assigned 3564 young infants to either group A (n=894), group B (n=884), group C (n=896), or group D (n=890). We excluded 200 randomly assigned infants, who did not fulfil the predefined criteria of adherence to treatment and adequate follow-up. In the per-protocol analysis, 828 infants were included in group A, 826 in group B, 862 in group C, and 848 in group D. 67 (8%) infants failed treatment in group A compared with 51 (6%) infants in group B (risk difference -1·9%, 95% CI -4·4 to 0·1), 65 (8%) in group C (-0·6%, -3·1 to 2·0), and 46 (5%) in group D (-2·7%, -5·1 to 0·3). Treatment failure in groups B, C, and D was within the similarity margin compared with group A. During the 15 days after random allocation, 12 (1%) infants died in group A, compared with ten (1%) infants in group B, 20 (2%) infants in group C, and 11 (1%) infants in group D. An infant in group A had a serious adverse event other than death (injection abscess).

INTERPRETATION

The three simplified regimens were as effective as injectable procaine benzylpenicillin-gentamicin for 7 days on an outpatient basis in young infants with clinical signs of severe infection, without signs of critical illness, and whose caregivers did not accept referral for hospital admission.

FUNDING

Bill & Melinda Gates Foundation grant to WHO.

Nasal Bubble CPAP: One Year Experience in a Neonatal Unit of a Tertiary Health Facility in Northwestern Nigeria

AIMS AND OBJECTIVES

Nasal bubble continuous positive airway pressure (NBCPAP) respiratory support, though decades old, is beginning to gain popularity in developing countries including Nigeria. We reviewed neonates who benefitted from NBCPAP, to describe the demographics and outcome of NBCPAP respiratory support in newborns admitted to the neonatal unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a one year period.

MATERIALS AND METHODS

The study is a descriptive observational review of all neonates who required NBCPAP respiratory support in the neonatal unit of ABUTH Zaria. Data was extracted from a specifically designed proforma used to obtain information on each neonate throughout the period of admission.

RESULTS

Twenty babies received NBCPAP respiratory support during the period of study. Seventeen (85%) of the neonates were successfully weaned off CPAP while three (15%) failed CPAP. Three neonates developed complications with two having CPAP belly syndrome and the third had facial swelling which resolved spontaneously after 6 hours. Overall, seven (41%) of the neonates who were successfully weaned off CPAP were discharged home.

CONCLUSION

MajorityofnewbornswhorequirerespiratorysupportwillbenefitfromNBCPAP therefore, this method of respiratory support should be popularized and neonatal units in the country should be supported to efficiently offer the service.

Outcome of Extremely Low Birth Weight Babies in Zaria; A Ten-Year Review

BACKGROUND

Survival among extremely low birth weight (ELBW) babies (birth weight below 1000grams) in resource limited settings is still very low. The study aimed to determine the correlation between materno-foetal factors and outcome in this category of neonates.

STUDY DESIGN

A retrospective study in which patients' records admitted into the Neonatal Unit of Ahmadu Bello University Teaching Hospital between January 2005 and December 2014 were retrieved. Information on neonates weighing < 1000 g were extracted and analyzed. Survival at discharge was the primary outcome.

RESULTS

The overall survival rate of extremely low birth weight babies was 18%. Mortality in ELBW neonates weighing less than 750g was 100%. Factors that were significantly predictive of survival were birth weight, parity and duration of hospital stay with p-values of 0.014, 0.039 and 0.025 respectively

CONCLUSION

The survival rate of ELBW babies remains low in our resource constrained setting. Focus should be on preventing preterm deliveries and as well equipping newborn care providers and newborn units with the necessary skills and materials respectively to enable implementation of evidence based interventions to improve newborn survival.

Congenital gangrene of the extremities in a newborn

Gangrene of the extremities in the newborn is extremely rare at birth. Less than 100 cases have been reported worldwide. Its etiology is obscure in many cases; however, some factors have been associated with it in the newborn, which include vascular injury and embolism. We report a case of a baby with congenital bilateral lower limb gangrene caused by thromboembolic phenomenon from retroplacental hematoma following abruptio placentae and highlight the challenges of managing such condition in resource-poor setting.

Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria

OBJECTIVES

The study aimed at identifying the risk factors for neonatal septicaemia in Zaria.

PATIENTS AND METHODS

Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05.

RESULTS

A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078).

CONCLUSION

The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.

Relationship between age and serum lipids in malnourished and well-fed pre-school children in Zaria, Nigeria

OBJECTIVE

The objective of this study was to evaluate the relationship between age and serum total cholesterol (TC) and triglyceride (TG) in malnourished and well-fed pre-school Nigerian children in Zaria, northern Nigeria.

MATERIALS AND METHODS

Serum total cholesterol (TC) and TG concentrations were measured in 115 malnourished and 115 age- and gender-matched well-fed children aged one (1)-three (3) years. These consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight, respectively with their corresponding age- and gender-matched well-fed children. There were 60 males and 55 females each of malnourished and well-fed children. Concentrations of TC and TG were measured by enzymatic colorimetric method using reagent kits supplied by HUMAN, Gesel Für Biochemical Und Diagnostica mbH (Wiesbaden, Germany).

RESULTS

There was no correlation between age and serum TC in malnourished children (r = 0.0101, p = 0.9250), while the correlation was negative and significant in well-fed children (r = 0.3599, p = 0.3110). Similarly, there was no correlation between age and serum TG in malnourished chidren (r = 0.0605, p = 0.4623) but negative and significant correlation in well-fed children (r = 0.3210, p = 0.0001).

CONCLUSION

The findings of this study demonstrate that in well-fed pre-school children, serum lipids decrease with advancing age and that this pattern was abolished in malnourished children. This contribution should be noted and considered when interpreting serum lipid results in children.

Body mass index of healthy Nigerian children

BACKGROUND

To study the Body Mass Index of healthy Nigerian school children from different socio-economic backgrounds resident in Kaduna, northern Nigeria.

METHOD

A cross-sectional prospective study of Body Mass Index was carried out on 3,802 healthy Nigerian school children aged 5 to 13 years resident in Kaduna, northern Nigeria. The subjects consist of 1,871 children from private schools (privileged) and 1,931 children from public schools (less privileged). The schools and pupils were selected by multi-staged clustersampling method.

RESULT

Over 75% of the 'privileged' and the 'less privileged' children are from upper and lower socioeconomic classes respectively The mean Body Mass Index of the 'privileged' boys was 15.1 +/- 0.7 compared with 14.7 +/- 1.2 for the 'less privileged' boys. The corresponding mean Body Mass Index values for the 'privileged' and the 'less privileged' girls were 15.1 +/- 0.5 and 15.0 +/- 1.7 respectively. The difference in this index, between the boys as well as between the girls was statistically insignificant (p = 0.05 and 0.12 respectively).

CONCLUSION

There was no statistical significant difference between the BMI of the 'privileged' and the 'less privileged' groups of children.

Serum lipid profile in malnourished Nigerian children in Zaria

BACKGROUND/OBJECTIVE

There is paucity of data on the pattern of serum lipids in malnourished children in Zaria. Most of the reported studies were carried out in southern part of Nigeria. The overall objective of this study was therefore to measure serum lipids in children with PEM in Zaria with the view to recommending its use in them.

SUBJECTS, MATERIALS AND METHODS

Serum lipids were measured in 115 children presenting with PEM and 115 age- and sex-matched well nourished controls aged 6-36 months .The malnourished children consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight respectively. There were 60 males and 55 females. Serum total cholesterol(TC),high density lipoprotein cholesterol (HDL-C) and triglyceride(TG) were measured by enzymatic colorimetric methods of serum low density lipoprotein cholesterol(LDL-C) and very low density lipoprotein cholesterol(VLDL-C) were estimated using Friedewald formula.

RESULTS

Serum TC, LDL-C and HDL-C levels were significantly lower (p<0.01, p<0.05 and p<0.001 respectively), while the ratio TC/HDL-C was significantly higher (p<0.001) in children with PEM than in their well-nourished counterparts. Concentrations of serum TG and VLDL-C were apparently but not significantly lower in children with PEM than in well-fed children (p>0.05).Serum levels of TC, LDL-C and HDL-C were significantly higher (p<0.001, p<0.001 and p<0.01 respectively) in oedematous PEM patients than in their non-oedematous counterparts. Serum TG and VLDL-C values were apparently but not significantly higher in oedematous PEM patients than in non-oedematous ones.

CONCLUSION

There was a significant reduction in serum lipid concentrations in children with PEM. The study therefore suggests that measurement of serum lipids could be of importance in the assessment of childhood malnutrition.

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.

Necrotizing fasciitis of the scalp in a neonate

We report an 11-day-old baby who presented with necrotizing fasciitis of the scalp from which Escherichia coli was cultured. Treatment consisted of administration of parenteral broad-spectrum antibiotics and debridement. Skin grafting of the resulting scalp defect was not permitted by the parents. The wound healed with scar tissue over 3 months.

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.

Predicting conception and safe delivery of a macrosomic baby

Clinical data obtained prospectively from 98 neonates, 49 normal weight controls, and retrospectively from their mothers had revealed a low incidence of neonatal macrosomia and some important predictive indices of conception and safe delivery of such babies. All the macrosomic infants were singletons and above 37 weeks gestation. The incidence of macrosomia was 26 per 1,000 live births. Increasing maternal age (up to 28 years) parity (up to three) and height were positively correlated with the conception and safe delivery of a macrosomic baby. A maternal height of less than 1.64m was found to be associated with a higher risk of unsafe spontaneous vaginal delivery of a large infant. It is suggested that even in the developing countries all efforts should be made to confirm a diagnosis of foetal macrosomia before the onset of labour so that the mother can be properly assessed for the most appropriate method of delivery.

Efficacy of a 3-day oral regimen of quinine in an area of northern Nigeria with low-grade resistance of Plasmodium falciparum to chloroquine and sulphadoxine-pyrimethamine

The efficacy in vivo of a 3-day oral regimen of quinine (30 mg/kg/day) was assessed in 34 children with falciparum malaria in an area of northern Nigeria with previously documented low-grade parasite resistance to chloroquine and sulphadoxine-pyrimethamine (SDX/PYR). By day 4, all 34 children were free of parasites. Mean parasite clearance time and fever clearance time were 2.7 and 1.7 days, respectively. However, on day 14, 5 (14.7%) children were again parasitaemic and 4 of them were clinically ill. They were again treated successfully with a standard course of oral chloroquine. No adverse drug effects were recorded. Of the 34 children, 9 parasite isolates were successfully cultured in vitro. EC50 and EC99 were 14.0 and 126.0 pmol per well respectively, indicating decreased parasite sensitivity but no resistance in vitro. In conclusion, the 3-day course of quinine was found to be an effective alternative to standard chloroquine treatment in the study area.

Antimalarial drug response of Plasmodium falciparum from Zaria, Nigeria

The sensitivity of Zaria strains of Plasmodium falciparum to chloroquine, mefloquine, quinine and sulphadoxine/pyrimethamine was investigated 5 years after the appearance of in vivo/in vitro chloroquine resistance in urban Zaria. Infections in 36/43 children (83.7%) treated with chloroquine were sensitive while those in 7 (16.3%) were resistant. 8/13 isolates cultured (61.5%) were sensitive in vitro to chloroquine and 5 (38.5%) were resistant. Of the cultured isolates, 13/13 (100%), 12/13 (92.3%) and 5/7 (71.4%) showed mefloquine, quinine and sulphadoxine/pyrimethamine sensitivity, respectively. The results confirmed chloroquine and sulphadoxine/pyrimethamine resistance in urban Zaria and revealed emerging quinine resistance. Resistance to chloroquine and sulphadoxine/pyrimethamine is at RI level and chloroquine should continue to be the first-line drug for the treatment and prevention of P. falciparum infection in the Zaria area of northern Nigeria. We suggest that, while quinine serves as second-line drug, mefloquine should be reserved for infections resistant to chloroquine, quinine and sulphadoxine/pyrimethamine.

Dysuria in infancy and childhood: an analysis of 42 children presenting in the paediatrics outpatients department

Urinary tract infection (UTI) was the only pathology found among 42 children presenting at the paediatric outpatient department with pain or straining on micturition. 18 (42.9%) had cystourethritis proven bacteriologically. 3 of these had gonococcal urethritis and were all males aged less than 3 years. Four had vasical schistosomiasis. No definite diagnosis could be made in 24 (57.1%) cases. Only secondary symptoms of gross haematuria, urethral discharge and cloudy urine were of diagnostic value, others were not. Children without these specific secondary symptoms predominate and may or may not have urinary tract pathology. Urinary leucocyte count on native urine is a useful screening test to identify those to be further investigated.

Chloroquine-resistant Plasmodium falciparum with reduced sensitivity in vitro to mefloquine and quinine in Zaria, northern Nigeria

Thirty-six P. falciparum isolates collected from children with malaria were tested for their susceptibility to chloroquine, mefloquine and quinine in vitro using the WHO microtest system. 37% of the isolates grew in the presence of 1.6 mumol chloroquine 1(-1) blood, indicating resistance. The sensitivity to both mefloquine and quinine was markedly reduced. The inhibitory endpoints for quinine correlated with those for chloroquine and mefloquine, but no such correlation was found between chloroquine and mefloquine.

Resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine combination in semi-immune children in Zaria, northern Nigeria

The World Health Organization (WHO) extended field test was employed to assess the in vivo sensitivity of Plasmodium falciparum to sulfadoxine-pyrimethamine combination in 44 children in Zaria urban area. 36 children (82%) were fully sensitive to the drug and 8 (18%) were resistant at the RI level. 8 parasite isolates were obtained from the children and successfully cultured in vitro using the WHO microtest (mark II) system. The 8 isolates underwent schizogony at concentrations of 10,000 pmol sulfadoxine/125 pmol pyrimethamine per well, indicating in vitro resistance.

Burkitt's lymphoma presenting with blindness: a case report

A 10-year-old schoolboy was referred to the Ophthalmic Unit of Ahmadu Bello University Teaching Hospital because of sudden loss of sight following 5 days of severe frontal headache. The child had bilateral ptosis with internal and external ophthalmoplegia and fixed and dilated pupils. There was no papilloedema. Eight days later, a jaw tumour and a rapidly enlarging abdominal tumour appeared. A fine needle aspiration biopsy of the jaw tumour confirmed Burkitt's lymphoma. Combination chemotherapy with cyclophosphamide, vincristine and methotrexate (COM) led to a rapid resolution of the jaw and abdominal tumour but the child never regained his sight. Cerebrospinal fluid examination was not helpful in reaching a diagnosis.

Chloroquine resistance of Plasmodium falciparum in semi-immune children in Zaria, northern Nigeria

Fifty-nine children with Plasmodium falciparum malaria were subjected to the World Health Organization (WHO) extended field test to assess the in vivo sensitivity of the parasite to chloroquine in Zaria urban area, Nigeria. The parasites in 53 children (90%) were positive but those in 6 (10%) were resistant at the RI-RII level. 36 isolates from the patients were successfully cultured in vitro for the WHO standard microtest. 13 (37%) of the isolates underwent schizogony at chloroquine concentrations of 1.6 microM/litre and above. Probit analysis showed that the chloroquine concentrations producing 50% (EC50), 90% (EC90) and 99% (EC99) schizont inhibition were 0.4, 1.6 and 4.9 microM/litre, respectively. The results indicate a rapid decline in the sensitivity of P. falciparum to chloroquine in the study area during the past 3 years.

The time of passage of the first urine and stool by Nigerian neonates

One thousand consecutive full-term healthy Nigerian babies delivered at Ahmadu Bello University Teaching Hospital Zaria, were studied for the time of passage of the first urine and stool. By 6 hours of postnatal age 42%, 12 hours 76%, 24 hours 95% and 48 hours 99.8% of babies had passed their first urine. Similarly 56%, 81%, 96% and 99.8% of babies had passed meconium by 6, 12, 24 and 48 hours respectively. It is suggested that apparently healthy neonates who have not passed urine and meconium by the age of 12 hours should be closely observed and those who have not done so after 24 hours should be investigated for congenital abnormalities of the lower gastrointestinal and urinary tracts.

Haematological values in healthy Nigerian infants

Normal values for haemoglobin concentration, packed cell volume, red blood cell counts and mean cell volume were serially electronically determined in a cohort of 99 healthy, normal fullterm Nigerian babies and infants from age 1 day-6 months. Mean values of haemoglobin concentration, packed cell volume and red blood cell counts were lower at all ages than those established for caucasian infants at the corresponding ages although the pattern was similar in both races. Infant sex, method of delivery and the presence of haemoglobin S in the heterozygous form had no influence on the values of the red cell indices. Based on this study, it is recommended that separate levels of these haematological indices for the black neonates and infants should be adopted.

Renal masses in neonates: report of eight cases

Palpable renal masses presenting in eight newly born babies are described. Three of the masses were primary renal tumours, namely renal dysplasia in two and congenital mesoblastic nephroma in one, while in three neonates the masses were secondary to obstruction, in two in the 'prune belly' anomaly and in one caused by posterior urethral valves. In two of the babies the masses were thought to be renal because of their location and in one following an abnormal intravenous pyelogram. Firm diagnoses were not possible in all our patients because some parents defaulted before investigation was complete. While surgical exploration is often crucial in establishing the diagnosis of an abdominal mass it is possible in certain cases to make a correct diagnosis without surgery.