Au Eneh

Factors influencing adherence to paediatric antiretroviral therapy in Portharcourt, South- South Nigeria

Introduction The efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patients adherence. Adherence in children poses peculiar challenges. The aim of the study was to determine the adherence level and factors influencing adherence among HIV-infected children and adolescents in University of Port Harcourt Teaching Hospital, Nigeria. Methods A cross-sectional survey of HIV-infected children and adolescents on ART using self-report by the caregiver/child in the past one month. Results A total of 213 caregivers and their children were interviewed. A hundred and sixty-two (76.1%) had adherence rates ≥95%. Only 126 (59.2%) were completely (100%) adherent. The commonest caregiver-related factors for missing doses were forgetfulness 48(55.2%), travelled 22(25.3%) and drugs finished 16(18.4%), while the child-related factors were refused drugs 10(11.5%), slept 8(9.2%), and vomited 8(9.2%). Sixty-eight (31.9%) caregivers reported missing clinic visit and reasons given were travelled 18(26.5%), caregiver ill 12(17.6%) and family problems 9(13.2%). Predictors of poor adherence include mother as the primary caregiver (OR 3.32; 95%CI, 1.33-8.67), younger than 5years (OR 2.62; 95%CI, 1.30-5.31) and presence of a co-morbidity (OR 3.97; 95%CI, 1.92-8.33). Having a medication reminder strategy (OR 6.34; 95%CI, 3.04-13.31), regular clinic visits (OR 8.55; 95%CI 4.01-18.45) and status disclosure (p = 0.008) predicted a better adherence. The caregivers age (p= 0.11), education (p = 0.86), socioeconomic status (p = 0.89), gender of the child (p = 0.84), type of ART (p = 0.2) and duration of ART (1.0) did not significantly affect adherence. Conclusion Adherence is still suboptimal. Since barriers to Paediatric ART adherence are largely caregiver-dependent, identifying and addressing these barriers in each caregiver-child pair will improve adherence and patient outcome.

Malaria Parasitaemia in Neonates in Port Harcourt, Nigeria

Malaria is thought to be rare among neonates in malaria-endemic regions. Consequently, blood film for malaria parasite is not routinely included in the sepsis screening protocol for neonates. We examined the role of malaria in perinatal morbidity among neonates admitted into our unit with a view to determining the need or otherwise of including malaria parasitaemia in the sepsis work-up in suspected neonatal septicaemia. Fourteen babies who met our preset criteria were screened for malaria parasitaemia out of which five (35.71 per cent) had positive blood smears for Plasmodium falciparum. Eighty per cent of the neonates presenting with fever had positive blood films (Yates corrected chi2 = 3.9822; p = 0.04). All the babies responded to an oral course of chloroquine. These data have further highlighted the importance of malaria in perinatal morbidity in our environment. We recommend a multi-centred study to define clearly the role of malaria in perinatal and neonatal morbidity and mortality in malaria endemic areas.

Prospective evaluation of the usefulness of C-reactive protein in the diagnosis of neonatal sepsis in a sub-Saharan African region

BackgroundSepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. The present study was therefore carried out to determine the usefulness of C-reactive protein (CRP) for evaluation of neonatal sepsis in Port Harcourt, Nigeria in Sub-Saharan Africa.MethodFour hundred and twenty neonates with clinical suspicion of sepsis were prospectively studied over a 6 month period. Blood was obtained from each subject recruited for the qualitative estimation of CRP. Blood culture was used as gold standard for diagnosis of NNS.ResultsOf 420 neonates studied, 196 (46.7%) had positive CRP while 181 (43.1%) had positive blood culture. The sensitivity, specificity, positive and negative predictive values of CRP were 74.0%, 74.1%, 68.4% and 79.0% respectively.ConclusionThe qualitative method of estimating CRP which is cheap and rapid has moderate sensitivity, specificity and negative predictive value.

Sirenomelia in a Nigerian triplet: a case report

IntroductionSirenomelia, also known as mermaid syndrome, is a very rare fatal congenital abnormality in which the legs are fused together, giving them the appearance of a mermaids tail. It is commonly associated with abnormal kidney development, genital and rectal abnormalities. A handful of cases have been reported in other parts of the world, however, no cases have previously been reported in a Nigerian neonate. To the best of our knowledge, we believe that this is the first case reported from West Africa and in a triplet.Case presentationA 16-hour-old baby boy, the second of a set of Nigerian triplets, presented to our facility with fusion of the entire lower limbs, imperforate anus, indiscernible genital structures, single umbilical artery and a neural tube defect. His parents were from the Hausa ethnic group and not related.ConclusionSirenomelia has not been previously described in a set of triplets, and it is hoped that this report from West Africa will give information about the non-racial predilection of this condition.

Retinopathy of Prematurity in Port Harcourt, Nigeria

Purpose. With many preterm babies now surviving as a result of improvement in neonatal care in Nigeria, the incidence of visual impairment/blindness as a result of retinopathy of prematurity (ROP) may rise. We describe our findings after screening starts for the first time in a 15-year-old special care baby unit so as to establish the incidence and risk factors for developing ROP. Methods. A prospective study carried out at the Special Care Baby Unit (SCBU) and Pediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital between January 1 and October 31, 2012. Fifty-three preterm babies (of 550 neonates admitted within the study period) delivered before 32 completed weeks and weighing less than 1500 g were included in the study following informed consent and the main outcome measure was the development of any stage of ROP. Results. Mean gestational age at birth was 28.98 ± 1.38 weeks. Mean birth weight was 1411 ± 128 g. Out of 550 babies admitted at SCBU, 87 of 100 preterms survived with 53 included in study. Twenty-five (47.2%) had different degrees of ROP with prevalence found to be 47.2%. Prevalence was higher (75%) in babies weighing <1300 g and those delivered before 30-week gestation (58%). Twenty-one (84%) had stage 1 no plus disease and 3 (12%) had stage 2 no plus disease. Only 1 (4%) had threshold disease in Zone 1. None had disease at stage 4 or 5 or AP-ROP. Receiving supplemental oxygen (χ 2 = 6.17; P = 0.01), presence of sepsis (χ 2 = 7.47; P = 0.006), multiple blood transfusions (χ 2 = 5.11; P = 0.02), and delivery by caesarian section (χ 2 = 4.22; P = 0.04) were significantly associated with development of ROP. There were no significant differences with gender, apneic spells, jaundice, or phototherapy. Conclusions and Relevance. All live infants with ROP were noted to regress spontaneously in this study. Though it may not be cost effective to acquire treatment facilities at the moment (the only child with treatable disease died), facilities for screening preterm infants displaying high risk features may be essential as smaller babies are saved.

The Predictive Value of Micro-Erythrocyte Sedimentation Rate in Neonatal Sepsis in a Low Resource Country

Background: Neonatal sepsis is a major cause of morbidity and mortality in developing countries. Blood culture which is the gold standard for confirmation of sepsis has a low yield and does not provide rapid diagnosis. In addition, it is relatively costly and requires skilled workers and laboratory equipments that are scarce and space in between low resource settings. Therefore, there is need for other rapid screening tests, so that prompt intervention can be instituted. There is therefore need for other rapid screening or diagnostic tests. This study was therefore carried out to determine the predictive value of micro-erythrocyte sedimentation rate (mini-ESR) in the diagnosis of neonatal sepsis. Methods: A prospective study was carried out from July to December 2007. Blood was obtained from 406 neonates with suspicion of sepsis for the estimation of mini-ESR, blood culture, full blood count and blood film. Blood culture was used as gold standard for the diagnosis of neonatal sepsis. Results: Two hundred and fifty one (61.8%) neonates had elevated mini-ESR while 169 (41.6%) had positive blood culture. The prevalence of neonatal sepsis was 33.1%. The sensitivity, specificity, positive and negative predictive values of mini-ESR using blood culture as gold standard were 75.7%, 48.1%, 51.0% and 73.5% respectively. Combination of mini-ESR with band forms had high sensitivity and negative predictive values of 95.9% and 94.2% respectively. Conclusion: Mini-ESR can be combined with band forms as screening tools for neonatal sepsis.

Serum zinc levels in HIV infected children attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Background: Zinc deficiency is common in the Paediatric age group but the extent of this disorder is unknown in HIV infected children in Nigeria prompting this study. Objective : To determine the prevalence of zinc deficiency in HIV seropositive children, and compare this with age and sex matched controls. Methods : A case control study of 70 HIV sero-positive and age and sex matched HIV sero-negative children was carried out in the University of Port Harcourt Teaching Hospital between 1st of June, 2009 and 31st of May, 2010. We collected demographic, clinical, haematological and biochemical parameters from cases and controls, and analysed these using SPSS 20. Results : Sixty percent of the subjects were zinc deficient as against 41.4% of the controls, p= 0.028. Subjects that were zinc deficient were more likely to be in higher HIV disease stages, p = 0.003, in lower socio-economic classes and aged less than 60 months. We conclude that there is a high prevalence of zinc deficiency in HIV sero-positive children and they should have zinc supplementation immediately they are diagnosed to reduce their morbidity and mortality. Key words : Zinc deficiency, HIV sero-positive, socio-economic status