Ayebo E. Sadoh

HIV co-infection with hepatitis B and C viruses among Nigerian children in an antiretroviral treatment programme

Background. Nigeria has one of the world’s largest burdens of children living with HIV and is highly endemic for hepatitis B. This study set out to determine the prevalence of hepatitis B and C infections among HIV-infected children and to identify the factors associated with these co-infections. Method. We studied 155 HIV-infected children. Information on socio-demographics and history of exposure to risk factors such as scarification, blood transfusion, unsafe injections and circumcision were obtained. All the children were tested for the presence of hepatitis B surface antigen and antibodies to hepatitis C. Result. The prevalence of HIV/HBV co-infection was 7.7%, while that of HIV/HCV co-infection was 5.2%. No child was co-infected with all three viruses. Children who were co-infected with HCV were more likely to be older than 5 years. There was no significant association between co-infection with either of the hepatitis viruses and socio-economic status, gender, number of persons living in the household, World Health Organization clinical stage, route of acquisition of HIV, scarification, blood transfusion, unsafe injection or circumcision. Conclusion. The rate of HIV co-infection with hepatitis B and C in children is significant. HIV-infected children should be screened for these viruses. Those found to be negative and not immunised for hepatitis B should be immunised. Since the natural history of these co-infections in children is not known, it is imperative that affected patients be followed up adequately.

Re-emergence of diphtheria and pertussis: implications for Nigeria.

In the prevaccine era pertussis and diphtheria were responsible for significant morbidity and mortality in children. In the United States of America more than 125,000 cases of diphtheria with 10,000 deaths were reported annually in the 1920s. In the same period about 1.7 million cases of pertussis with 73,000 deaths were also reported. Vaccination against these two diseases has caused remarkable reduction in the morbidity and mortality from these diseases both in developed and developing countries. The initial vaccines were the combined diphtheria toxoid and whole cell pertussis vaccine. The recent reported increases in the incidence of these two diseases in countries, which maintain high childhood vaccination coverage is a source of concern not only to these countries but also for developing countries with weak immunization programmes. Nigeria for example reported 11,281 cases of pertussis, the second highest number of cases worldwide in 2009. Waning immunity in adult and adolescent populations has been reported and epidemiologically, more cases are being reported in adults and adolescents. Also a high proportion of pertussis cases are being reported in infants and most of these infant cases are linked to adult/adolescent sources. Recent approaches to control of these diseases include booster doses of combined diphtheria, tetanus and acellular pertussis vaccine while the cocooning strategy (which is immunizing every person who is likely to have contact with a given infant such as mother, father, grandparents and health care workers) is being used in a number of countries. For developing countries including Nigeria where the capacity for making the diagnosis of both diseases is limited, strengthening of routine immunization as well as diagnostic capacity is imperative. Research to determine current levels of immunity in children, adolescents and adults is required. This will enable the determination of the need for booster doses and the age at which such boosters should be administered. Improved surveillance will be needed to delineate current epidemiological profiles of both diseases.

Prevalence of Renal Disease in Nigerian Children Infected with the Human Immunodeficiency Virus and on Highly Active Anti-retroviral Therapy

Access to highly active anti-retroviral therapy (HAART) has improved the prognosis of Nigerian children infected with the human immunodeficiency virus (HIV); thus, more children are surviving. Long-term exposure to HAART is potentially nephrotoxic. We therefore aimed at assessing the prevalence of renal disease in Nigerian children infected with HIV, who are on HAART. In this cross-sectional study, we studied children, aged ten months to 17 years, infected with HIV, attending the pediatric HIV clinics of the University of Benin Teaching Hospital. Demographic and clinical data were obtained by parental interview as well as from the medical records. Each childs urine was tested for albumin and microalbuminuria using multi test strips and mitral test strips, respectively. The serum creatinine level of each child was also estimated and used in calculating the glomerular filtration rate (GFR). Renal disease was defined as the presence of significant proteinuria of 1+ and above on dipstick or the presence of microalbuminuria of ≥20 mg and/or GFR <60 mL/min/1.73 m 2 . Of the 99 children recruited, 60 were males and 39 were females. The mean age of the children was 6.6 ± 3.5 years. All the children were on HAART and 85% had acquired the HIV infection by vertical transmission. The overall prevalence of renal disease was 16.2%. Microalbuminuria was seen in 11 children with renal disease (11.1%); 3 of them had significant proteinuria. GFR of less than 60 mL/min/1.73 m 2 was seen in five children (5.1%) with renal disease, but none had end-stage renal disease (GFR less than 15 mL/min/1.73 m 2 ). Renal disease was found to be significantly associated with advanced stage of HIV infection (P < 0.049). Our study showed that t he prevalence of renal disease in HAART-treated Nigerian children is high and majority of them are asymptomatic of renal disease, but in the advanced stages of HIV infection.

The Diagnostic Value of Both Troponin T and Creatinine Kinase Isoenzyme (CK-MB) in Detecting Combined Renal and Myocardial Injuries in Asphyxiated Infants

Background Troponin T (cTnT) and Creatinine Kinase Isoenzyme (CK-MB) are both markers of myocardial injuries. However, CK-MB is also elevated in acute kidney injury. Objective The diagnostic value of both cTnT and cardiac CK-MB in combined myocardial and acute kidney injuries (AKI) in asphyxiated neonates was evaluated. Method 40 asphyxiated infants and 40 non-asphyxiated controls were consecutively recruited. Serum levels of cTnT, CK-MB and creatinine were measured. Myocardial injury and AKI were defined as cTnT >95th percentile of the control and serum creatinine >1.0 mg/dl respectively. Results Of the 40 subjects, 9 (22.50%), 8 (20.00%) and 4 (10.00%) had myocardial injury, AKI and combined AKI and myocardial injuries respectively. The mean cTnT and CK-MB values were highest in infants with combined AKI and myocardial injuries. The Mean cTnT in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 0.010±0.0007 ng/ml, 0.067±0.040 ng/ml and 0.084±0.067 ng/ml respectively, p = 0.006. The mean CK-MB in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 2.78±0.22 ng/ml, 1.28±0.11 ng/ml and 4.58±0.52 ng/ml respectively, p = <0.0001. Conclusion In severe perinatal asphyxia, renal and myocardial injuries could co-exist. Elevated cTnT signifies the presence of myocardial injury. Elevated CK-MB indicates either myocardial injury, AKI or both. Therefore renal injury should be excluded in asphyxiated infants with elevated CK-MB.

Intestinal helminthiasis in children with chronic neurological disorders in Benin City, Nigeria: intensity and behavioral risk factors

BackgroundBehavioral aberrations such as nail biting, finger sucking, and pica have been postulated as risk factors that enhance helminths ova transmission. These aberrations may present commonly in children with chronic neurological disorders and predispose them to heavy intensity of intestinal helminthiasis. This comparative cross-sectional study was to determine the prevalence, intensity, and behavioral risk factors for intestinal helminthiasis in children with chronic neurological disorders and apparently healthy controls.MethodsFresh stool samples from 155 children (2–17 years) with chronic neurological disorders seen at the child neurology clinic and 155 age and sex matched controls from nursery and primary schools in Benin City were analyzed using the Kato-Katz technique for detection of ova of helminths from November 2008 to April 2009.ResultsThe prevalence of intestinal helminthiasis (31.0%) was significantly higher in children with chronic neurological disorders compared with the controls (19.4%) (P=0.03). The intensity of infections in both groups was light ranging 24–144 eggs per gram. Ascaris lumbricoides, Trichuris trichiura and hookworm were the intestinal helminths isolated in both groups. Behavioral aberrations were significantly more represented in the subjects than in the controls (P<0.0001, OR=2.8). Nail biting and encopresis were the most significant independent predictors of intestinal helminthiasis (P=0.025 and 0.001, respectively) in the subjects only. Hand washing with water and soap after defecation and frequent de-worming exercise were practices significantly associated with decreased prevalence of intestinal helminthiasis in the subjects and controls.ConclusionsBehavioral modification in children with chronic neurological disorders should be an integral part of the control program for intestinal helminthiasis.

Effect of introduction of pentavalent vaccine as replacement for Diphtheria-Tetanus-Pertussis and Hepatitis B vaccines on vaccination uptake in a health facility in Nigeria.

BACKGROUND The introduction of a new vaccine into an immunization programme may affect the immunization system negatively or positively. The aim of this study is to determine the effect of the introduction of the pentavalent vaccine as replacement for DTP and Hepatitis B vaccines on timeliness, completion of the schedule and dropout rates among children attending a health facility. METHODOLOGY This was a retrospective cohort study which involved extracting immunization records of children attending the Institute of Child Health Child Welfare Clinic between June 2011 and May 2013. Pentavalent vaccine was introduced as a replacement for DTP and Hepatitis B vaccines in June 2012. The uptake, timeliness and dropout rates of different vaccines in the immunization schedule were determined for children who commenced immunization in the pre, peri and post introduction phases. RESULTS A total of 1110 children were studied - 190, 410 and 510 who commenced vaccination in the pre, peri and post introduction phases of the pentavalent vaccine respectively. Uptake was significantly higher for all vaccines in the post introduction phase compared to pre and peri introduction phases (p<0.001). Completion of the immunization schedule by 60.2% of the children who commenced vaccination in the post introduction phase was higher than the 31.6% and 41.7% for the pre and peri introduction phases respectively (p<0.001). Significantly more visits were required to complete the schedule in the peri introduction phase compared to the pre and post introduction phases p<0.001. Delay in receipt of the three doses of DTP/PENTA was significantly longer in the peri introduction phase compared to pre and post introduction phases. CONCLUSION The introduction of pentavalent vaccine significantly improved uptake of vaccines and completion of the schedule but resulted in prolonged delay in receipt of vaccines during the introduction period.

Comparison of adverse events following pentavalent and diphtheria-tetanus-pertussis vaccines among Nigerian children

Adverse events following immunization (AEFI) may follow the use of any vaccine. There is thus a need for documentation of the types and prevalence of AEFIs for each vaccine and early identification of new events or those occurring at rates higher than expected. When one vaccine replaces another, it is important to document the safety of the new vaccine as well as compare to that of the old. In this study, we aimed to document the AEFIs following the use of pentavalent vaccine recently introduced into the National Programme on Immunization and compare with those of diphtheria‐tetanus‐pertussis (DTwP) vaccine which it replaced.

Physical activity, body mass index and blood pressure in primary school pupils attending private schools

BACKGROUND Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. OBJECTIVE The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils attending private primary schools. METHOD The intensity and duration of physical activity of the pupils selected by multiple stage sampling method were obtained with the aid of a questionnaire. The BMI and BP were measured. Analysis was by SPSS. RESULTS Of the 353 pupils, 132(37.4%) pupils were adequately physically active while overweight and obesity prevalences were 54(15.3%) and 65(18.4%) respectively. Hypertension prevalence in overweight/ obese children (6.5%) was significantly higher than in children with healthy weight 1.5%, P = 0.04. CONCLUSION Only a third of pupils met the recommended level of physical activity. The prevalence of overweight and obesity was high while the overweight and obese pupils were more likely to have hypertension compared to those with healthy weight. Physical activity programmes for primary school pupils in school and at home are therefore recommended.

Effect of Peer Education on Knowledge of Human Papilloma Virus and Cervical Cancer among Female Adolescent Students in Benin City, Nigeria

Introduction: It is well documented that Human Papilloma Virus (HPV) is the cause of cervical cancer which is a major cause of morbidity and mortality especially in low- and middle-income countries. Vaccines against HPV are available. In developed countries where the vaccines have been deployed, lack of information among the target population (adolescents) is a major contributor to suboptimal uptake. In Nigeria, the vaccine is yet to be provided in the national programme on immunization, which is free, but it is available for a fee. In this study we determined the effect of peer education on the knowledge of female adolescents about HPV, cervical cancer, its treatment and prevention. Methods: This was an intervention study. The knowledge and awareness of female students of four secondary schools were assessed using a pre-tested self-administered questionnaire prior to the training of some of the students (peers). The trained students delivered messages on cervical cancer and HPV using fliers containing key information (peer training) to their school mates in formal delivery in a class setting. The knowledge and awareness of students, post-peer training, was then assessed. Results: There were 1337 students who responded to the baseline questionnaire while 1201 responded to the post-peer training questionnaire. Awareness of cervical cancer, knowledge of risk factors and cause of cervical cancer was low prior to the peer training. There was statistically significant improvement in awareness about cervical cancer and in the knowledge domains following peer training. Mean knowledge score prior to training was 12.94 ± 9.23 and this increased significantly to 53.74 ± 10.69 following peer training p < 0.0001. Conclusion: Peer training is effective in improving knowledge and awareness of secondary school students about HPV and cervical cancer.

Prevalence of congenital malaria in newborns of mothers co-infected with HIV and malaria in Benin city

Abstract Background: HIV and Plasmodium falciparum malaria co-infection annually complicates about one million pregnancies in sub-Saharan Africa. Congenital malaria (CM) has deleterious effects on newborns. Little is known about the effect of co-infections on the prevalence of CM in infants born by these women. This study was carried out to determine the prevalence of CM in newborns of mothers co-infected with HIV and malaria compared to HIV-negative mothers with malaria in Benin-City. Methods: Subjects were 162 newborns of mothers co-infected with HIV and malaria. Controls were 162 newborns of HIV negative malaria infected mothers. Blood film for malaria parasites was done on cord blood and peripheral blood on days 1, 3 and 7 in the newborns. Maternal peripheral blood film for malaria parasite was done at delivery and placental tissue was obtained for confirmation of placental malaria by histology. Diagnosis of malaria in blood films was by light microscopy. Results: The prevalence of CM in subjects was significantly higher than in controls (34.6% and 22.2%, p=.014). Profound immunodepression (maternal CD4 cell count <200 cell/mm3) was significantly associated with CM (p=.006). The major predictors of CM in subjects were maternal CD4 cell count <200 cell/mm3 and placental malaria while in controls placental malaria was the only predictor. Conclusions: Babies born to mothers co-infected with HIV and malaria are at increased risk for CM. All babies born by HIV positive mothers should be screened for CM.