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.

Transplacental transfer of macromolecules: proving the efficiency of placental transfer of maternal measles antibodies in mother: infant pairs

Background:

Smaller substances <600 Daltons (Da) can transit human placenta while larger ones >1000 Da may not. This may not be consistent because maternal measles antibodies (MMA) are large immunoglobulin G molecules with molecular weight of 150,000 Da, could cross the placenta in mother-infant pairs.

Aim:

The objective was to assess the efficiency of placental transfer of MMA in mother-infant pairs at birth.

Subjects and Methods:

Sera collected from mother-infant pairs were analyzed for MMA using enzyme-linked immunosorbent assay. Gestational age (GA) of newborns was determined using the last menstrual period, ultrasound scan, and the Dubowitz criteria, whereas their birth weight (BW) was measured using the bassinet weighing scale.

Results:

Correlation coefficient (r) of MMA of mother-infant pairs at birth was significant (P < 0.01) and comparison of mean MMA for term and postterm deliveries were significant (P = 0.001) and (P = 0.007) respectively. Goodman and Kruskal's Gamma rank correlation of GA and BW was also significant (P< 0.001).

Conclusion:

Passage of MMA across placenta was efficient and newborn infants are protected from measles at birth.

Exstrophy anomalies: preliminary review of 18 cases in Maiduguri, North-Eastern Nigeria

BACKGROUND

Exstrophy anomalies, although rare, pose a tremendous challenge to both surgeons and surrogates. Management is intricate and experience with large members is restricted to a few centres worldwide. This report is a review of 18 cases of these anomalies managed in University of Maiduguri Teaching Hospital (UMTH) over 8 years, highlighting the intricacies of management, and contributes to the existing data bank on this subject matter in our environment.

MATERIALS AND METHODS

We reviewed the records of all cases of anomalies that were managed in the index hospital from December 2002 to December 2010.

RESULTS

Eighteen cases were studied. The youngest was a 2-day-old neonate and the oldest was 6 years at repair, with a median age of 4 months. There were 7 boys and 9 girls with bladder exstrophy, and the remaining two were girls with cloacal exstrophy, giving a male-female ratio of 7:11 for the exstrophy anomalies. Eight patients (33.5%) had associated congenital anomalies; 16.7% had undescended testes (UDT), anorectal malformation (ARM) and patent processus vaginalis (PPV); and duplicate bladder occurred in 5.6% of the patients. All but one patient had bilateral posterior iliac osteotomy at bladder closure. Out of the 17 patients that had osteotomy, 76.5% had satisfactory bladder closure (no complication), 5.9% had superficial wound dehiscence, 11.8% had bladder neck dehiscence and 5.9% had complete disruption. The lone patient that did not undergo osteotomy had complete bladder dehiscence. Postoperative immobilization was done for 3 weeks for 16 cases; one was discontinued after 1 week because of complication. The longest follow-up was for 2 years and the shortest for 2 weeks. Four patients (22.2%) did not turn up for follow-up.

CONCLUSION

Exstrophy anomalies although rare remain a major challenge in paediatric surgery. Iliac osteotomy, among other technical considerations, remains a cornerstone for successful bladder closure.

The effects of maternal haemoglobin as an indicator of maternal nutritional status on, maternal measles antibodies of mother-infant pairs at birth

BACKGROUND

Maternal measles antibodies (MMA) are actively transferred through the placenta from mother to foetus. A relationship could exist between MMA of mother-infant pairs and maternal nutritional indicator (haemoglobin).

OBJECTIVES

This study reviewed the effects of maternal haemoglobin (Hb) on MMA of mother-infant pairs at birth.

METHODS

One hundred and fifty three mother-infant pairs were enrolled in this study using the systematic random sampling method. Means of maternal Hb and MMA of mother-infant pairs were compared using the Student t test. Correlation coefficients of maternal Hb and MMA of mother-infant pairs were also determined. Multivariate analysis of variable (MANOVA) and covariates (MANCOVA) was used to investigate the effects of maternal Hb (fixed factor), gestational age, maternal age, birth weight (covariates) on combined MMA of mother-infant pairs (dependent factors). Benferroni adjusted Univariate linear regression was used to investigate the dependent variables separately.

RESULTS

There were 78 (51%) males and 75 (49%) females. The (mean ± SD) MMA of mother-infant pairs at birth were 134.66 ± 93.31 (95% CI, 119.76 - 149.56) U/ml, and 187.49 ± 85.01 (95% CI, 173.91 - 201.07) U/ml, and their correlation was significant (p = 0.025). Ninety one (59.5 %) mothers had low Hb, 62 (40.5 %) had acceptable Hb levels. The overall mean maternal Hb was 11.01 ± 1.00 (95% CI, 10.85 - 11.17) g/dl . A positive significant correlation was observed between maternal Hb and MMA of the newborn-infant (p = 0.031). The MANOVA showed a statistically significant difference between maternal Hb on the combined dependent variables (p =0.033); however, results for the dependent variables using the Benferroni adjusted Univariate analysis was significant for only MMA of the infants, (p = 0.009).

CONCLUSION

There was a significant association between aacceptable levels of maternal Hb and high MMA of the newborn-infants. Therefore, these newborn infants start out with higher MMA that could give them better protection against measles during infancy.

Retrospective study of childhood burkitts lymphoma in north eastern Nigeria

BACKGROUND

Burkitt's lymphoma (BL) is one of the leading childhood cancers in tropical Africa. Despite this, after extensive literature search most literature reviews on BL found were old. Therefore, it is useful to learn the trend in the epidemiology of BL in north eastern Nigeria especially now that changing ecology of the disease are being published.

OBJECTIVE

To determine the prevalence of BL, and the pattern of distribution of the tumour in relation to gender, sites and socio-demographic background of children.

METHODS

A retrospective study of cases of BL over a 20 year period in the Paediatric Department of University of Maiduguri Teaching Hospital (UMTH) was conducted. A structured questionnaire was used to document socio-demographic characteristics and clinical features for all cases. Data were analyzed using SPSS software version 16 Illinois, Chicago USA and a computer program for epidemiologist (PEPI version 3.01). Student t test was used to test for significance of means. Kendall's rank correlation coefficient (tau b) hand Jonckheere-Terpstra test of relationship of socio-demographic variables and presenting symptoms of BL were determined. Likely ratio Chi-square (c2) by William's criterion was used to investigate association between yearly prevalence and trends in time and also between anatomical sites and staging of BL.

RESULTS

During the period, 49 cases, 32 (65.3%) males and 17 (34.7%) females, were identified out of the 29,636 total paediatric admissions during the period under review. The prevalence of BL was 0.17%. , The 6-10-year age bracket were mostly affected by BL 31 (63.3%) and males had the disease more than females (p = 0.021). The majority of children affected by BL were the Fulani ethnic group 15 (30.6%), those from Borno state 18 (36.7%) and rural dwellers 20 (40.8%). Most patients presented with stage C disease 27 (42.9%), and the most common primary site was the maxilla 11 (40.7). There was no significant change in yearly prevalence of Burkitts lymphoma (P = 0.983). The association between anatomical sites and staging of BL was significant (p = 0.003).

CONCLUSIONS

Males were more prone to BL than females and most cases of BL presented late to the hospital. There is no significant change in the yearly occurrence of BL. Socio-demographic and clinical features did not contribute significantly to the epidemiology of BL.

Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anemia in Maiduguri, Nigeria

BACKGROUND

Patients with sickle cell disease have increased tendency to develop frequent and severe infections, especially of bones and urinary tract.

OBJECTIVE

The knowledge of antimicrobial sensitivity pattern of common etiological agents will serve as a guide to empiric treatment while results of urine culture and sensitivity are being awaited.

MATERIALS AND METHODS

Antimicrobial sensitivity test was carried out on bacterial isolates from the urine of febrile children with sickle cell anemia (SCA) and children with HbAA in Maiduguri. Urine specimens were collected and cultured by standard methods. Sensitivity to 15 antimicrobials (based on availability of sensitivity disc) was tested using the disc-diffusion technique of stokes.

RESULTS

Significant bacteriuria was obtained from 65 (26%) of the 250 children with SCA and 51 (20.4%) of the 250 controls. The isolates were E. coli, Klebsiella, Coliforms, Proteus, Staph aureus and Salmonella. Sensitivity was highest to 3 rd generation cephalosporins, followed by the quinolones: ciprofloxacin (86.2%), ofloxacin (83.1%), and peflacine (73.8%). Sensitivity of the organisms to some of the commonly used antibiotics like ampicillin, cotrimoxazole, and nalidixic acid was generally low. In general, the pattern of bacteriuria and their sensitivity in the SCA group was similar to the pattern in the control group.

CONCLUSION

Etiological agents of childhood urinary tract infections (UTI) in this environment are resistant to most of the drugs commonly recommended for its treatment. Amoxicillin/clavulanic acid, cefuroxime, and gentamicin, are recommended as first-line drugs for treatment of UTI while awaiting results of culture and sensitivity. Ceftriaxone and ceftazidime should be reserved for case of non response to first-line drugs and severe infections.

Urinary tract infection in febrile children with sickle cell anaemia

BACKGROUND

Sickle cell anaemia (SCA) is very common in Maiduguri, North-Eastern Nigeria. Children with this disease have increased tendency to develop frequent and severe infections especially of the urinary tract, bones and lungs. The prevalence of urinary tract infection (UTI) has however not been reported in this part of the Nigeria.

OBJECTIVE

To determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia.

METHODS

This was a prospective study carried out on 250 children with SCA and 250 controls with HbAA aged 6 months to 15 years. Following clinical assessment, midstream urine or urine obtained by suprapubic bladder aspiration was collected and subjected to microscopy and culture.

RESULTS

Bacteriuria was found in 65 (26%) of children with SCA and controls 514 (20.4%) of controls, p>0.05. Escherichia coli [16 (27.7%)] and Klebsiella species [16(24.6%)] were the predominant isolates in SCA group, while Escherichia coli [13(37.3%)] and Coliforms (25.4%) were predominant in the control group. Significant bacteruria occurred in patients with other clinical conditions such as pneumonia and septicaemia.

CONCLUSION

Urinary tract infection is common in children with SCA. Routine screening is therefore recommended during febrile illnesses.

Evaluation of the Nitrite Test in Screening for Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia in Maiduguri- Nigeria

BACKGROUND: Urinary tract infection is a significant cause of morbidity in children with sickle cell anaemia (SCA). Individuals with SCA have increased risk of urinary tract infection (UTI). Facilities for urine culture may not be available in most rural and even some urban areas in most developing countries like Nigeria. It will therefore be useful to have a simple means of screening such children for UTI with the intent of prompt treatment. MATERIALS AND METHODS: The study will evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. This study was carried out in the Department of Paediatrics University of Maiduguri Teaching Hospital and State Specialist Hospital Maiduguri. RESULTS: The study consisted of 250 children aged 6 months to 15 years with SCA presenting with fever (temperature ≥ 37. 5°C). Midstream urine specimen was collected from older children and suprapubic bladder aspiration of urine specimen was collected from infants. Samples were subjected to nitrite test, culture and sensitivity. There was significant bacteriuria in 65 (26+) children with SCA. A positive test for nitrite was obtained in 43 of the 65 (66.2+) children. The nitrite test has a specificity of 93.5+ in detecting bacteriuria, a sensitivity of 66.2+, a positive predictive value of 78.2+ and a negative predictive value of 93.5+. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. CONCLUSIONS: From this study, the nitrite test is useful as a screening test for UTI in SCA children. However in sick children with SCA, microscopy, culture and sensitivity should still be done in spite of a negative nitrite test.

Pattern and outcome of congenital malformations in newborn babies in a Nigerian teaching hospital

BACKGROUND

Several types of congenital malformations have been seen in our settings, but the frequencies and pattern are not known.

OBJECTIVES

To review the prevalence and pattern of congenital malformation in the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital, Maiduguri, over a 10-year period.

METHODS

This was a retrospective study carried out in a semi-urban Nigerian Teaching Hospital. All admissions into SCBU from 1991 to 2000 were reviewed, using both the admission and discharge records. The information extracted from the case note of each patient included sex, age and weight on presentation, maternal age and parity, gestational age, presence of associated neonatal illnesses such as jaundice, sepsis and the type of malformation on physical examination only.

RESULTS

Three hundred and ten (13.9%) of 2233 admissions had major congenital malformation. Thirty one (10%) gave a history of antenatal care while 279(90%) had no record of receiving antenatal care. Of the 310 babies, 140 (45.2%) abnormalities were of the gastro-intestinal system and 75 (24.2%) of central nervous system. Anterior abdominal wall defect 77(24.8%) was the commonest type of malformation seen followed by neural tube defect 63(20.3%) and imperforate anus 31(10.0%). Gastro-intestinal malformations were associated with a mortality rate of 60.9% as compared with 21.1% in those with central nervous system malformations.

CONCLUSION

The high prevalence of malformation seen in this study could be associated with the fact that majority (75.4%) of the mothers delivered their babies outside the teaching hospital, whose antenatal care are unknown. The occurrence of congenital malformations is very high in North Eastern Nigeria, Environmental factors may have a role.

Review of neonatal infections in University of Maiduguri Teaching Hospital: common bacterial pathogens seen

BACKGROUND

Bacterial infections are important causes of morbidity in the neonatal period. Therefore identification of infecting organisms and the risk factors for possible bacterial infection in the newborn is of great importance. Institution early appropriate therapy is an important step in combating morbidity and mortality in this age group.

METHODS

Medical records of patients admitted into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital (UMTH) were reviewed over a 5-yaer period (1995-1999)

RESULTS

Of the 1,304 newborn admissions over the study period, 813 (62.3%) had risk factors for neonatal infections. Staphyloccus aureus (46.2%) was the predominant organism isolated from blood culture, followed by Klebsiella spp (24.8%). Streptococcus pneumoniae and Pseudomonas are the least encountered in this series. Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pneumoniae were the predominant pathogens in pyogenic meningitis. Most of the delivery occurred outside the teaching hospital, even those that delivered in the hospital, some come in during labour.

CONCLUSION

Neonatal bacterial infections are still a cause of high morbidity and mortality of the newborn in our setting. To reduce the morbidity and mortality from neonatal bacterial infections, mothers need to attend antenatal clinic, so that those who at risk can be taken care off immediately.