Liver aminotransferases in under-five HIV-positive children on HAART

BACKGROUND

Higher mortality rates were reported in developing countries during early months of HAART initiation than in developed countries. The study aimed at assessing the effect of Highly Active Antiretroviral Therapy (HAART) on liver function of under-fives.

METHOD

Two hundred and thirty-eight under-fives children were enrolled from five hospitals in Southern Nigeria. Ethical permission and written consent were obtained. Group A involved 91 seropositive-children on HAART regimen while Group B1 involved 24 seronegative-infants who received nevirapine from birth till age 6-week. Group B2 (18) and B3 (48) involved seronegative-children who received co-trimoxazole and were 6-month and 18-month old respectively. Group C involved 11 seropositive-children who received co-trimoxazole only. Group D involved 46 seronegative-children who served as the control group. A 2ml blood sample was obtained from each participant during first phase of the study and was analysed for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) using kits manufactured by Randox. Group A children returned for second and third phases of the study after 3-month and 6-month respectively. Data were analysed by using ANOVA.

RESULTS

The results showed that ALT was highest in group A (12.8 ± 11.0 IU/L) suggesting hepatotoxicity while AST was highest in group B2 (35.4 ± 53.1 IU/L). Second phase, ALT and AST of group A were significantly reduced by 39.3% (p < 0.05), 29.9% (p < 0.05) respectively suggesting resolved hepatotoxicity. Third phase, ALT and AST were significantly reduced by .50.6% (p < 0.05) and 32.2% (p < 0.05) respectively suggesting resolved hepatotoxicity.

CONCLUSION

Hepatotoxicity observed among HIV-infected children on HAART was resolved after 6-month of monitoring.

An assessment of the rate, types and severity of prescribing errors in a tertiary hospital in southwestern Nigeria

BACKGROUND

Accurate medication prescribing is an important process in ensuring the best possible outcomes in patient care. Worldwide literature is replete with studies reporting high prevalence of prescribing error which are the most common type of avoidable medication errors and hence are an important target for improvement.

OBJECTIVES

This study assessed types and prevalence of prescribing errors, their clinical significance, when in the prescribing process they occurred and the medications commonly associated with prescribing errors.

METHODS

A retrospective review of 2010 in-patients' records from medical and paediatric specialties of a tertiary hospital in South West Nigeria was undertaken. Prescriptions that met the standard as enumerated in the Nigeria Standard Treatment Guideline (STG) were assessed. Prescription error rates for potentially clinically serious and total errors were determined.

RESULTS

The total prescribing error rate was 40.9% (95% CI 37.8 to 41.4) with 1.3% (95% CI -1.1 to 3.7) being clinically serious. Omitting to write an ending date or duration for therapy and unsafe abbreviations were the most common errors. Prescriptions involving antimicrobials produced the bulk of errant prescriptions.

CONCLUSION

Prescribing errors were found to be common. There was poor compliance with the Nigeria Standard Treatment Guidelines which outline the essential elements of a prescription. Continuing prescriber education on proper prescription writing and rational drug use is recommended as a way to reduce prescribing errors.

Mothers knowledge on the cause, prevention and symptoms of malaria in a university staff clinic in an urban setting in Southwestern Nigeria

This prospective study was carried out at Jaja Clinic, University of Ibadan, Nigeria. The study documented the knowledge of mothers of children about the cause, prevention and symptoms of malaria. These were mothers of children between ages 1 month to 12 years that presented with fever at the clinic for the first time during the current illness. Data was collected with structured questionnaires administered to the mothers of the enrolled children. The children were clinically examined by clinicians and blood films for malaria parasites were taken and examined in the laboratory using Giemsa stain. The haematocrit level of each child was also determined. 60.4% of the children were 1 month-5 years (mean age 33.0 +/- 15.2 months) while 39.6% of them were over 5-12 years (mean 8.1 +/- 2.1 years). Most of the mothers (58.3%) had above secondary school education. Blood films for malaria parasites were positive in 76% of the children that presented with fever. 74.2% of the mothers knew mosquito bite as the cause of malaria while 13.2% of them were ignorant of the cause of malaria. The main protective measures practiced by the mothers against mosquito bites were netted windows (86.2%), use of aerosol insecticides (76.1%), and mosquito coil (17.0%). Most mothers were not knowledgeable about the use of insecticide treated nets (ITN) which is the most recently introduced protective measure against mosquito bite. Ninety percent of the mothers knew fever as the major symptom of malaria. The degree of parasitaemia affected the PCV level. The greater the parasite count, the lower the PCV level.