Ro Ugwu

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.

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.

Pattern and predictors of maternal care-seeking practices for severe neonatal jaundice in Nigeria: a multi-centre survey

BackgroundNigeria is frequently associated with disproportionately high rates of severe neonatal jaundice (NNJ) underpinned by widespread Glucose-6-phosphate dehydrogenase (G6PD) deficiency. Timely and appropriate treatment of NNJ is crucial for preventing the associated morbidity and neuro-developmental sequelae. Since mothers are likely to be the first mostly to observe the onset of severe illness in their newborns, we set out to identify the pattern and predictors of maternal care-seeking practices for NNJ in three culturally-distinct settings in Nigeria.MethodsA multi-centre study was conducted among women attending antenatal clinics in Abuja, Lagos and Port Harcourt from October 2011 to April 2012 using a pretested questionnaire. Predictors of awareness of NNJ, accurate recognition of NNJ, use of potentially harmful therapies and preference for future hospital treatment were determined with multivariate logistic regressions.ResultsOf the 488 participants drawn from the three locations, 431 (88.3%) reported awareness of NNJ, predominantly (57.8%) attributable to professional health workers. A total of 309 (63.3%) mothers with prior knowledge of NNJ claimed they could recognise NNJ, but 270 (87.4%) from this group accurately identified the features of NNJ. Multiparous mothers (Adjusted odds ratio, AOR:4.05; 95% CI:1.75-9.36), those with tertiary education (AOR:1.91; CI:1.01-3.61), and those residing in Lagos (AOR:2.96; CI:1.10-7.97) were more likely to have had prior knowledge of NNJ. Similarly, multiparous mothers (AOR:2.38; CI:1.27-4.46) and those with tertiary education (AOR:1.92; CI:1.21-3.05) were more likely to recognise an infant with jaundice accurately. Mothers educated by health workers were 40% less likely to resort to potentially harmful treatment for NNJ (AOR:0.60; CI:0.39-0.92) but more likely to seek hospital treatment in future for an infant suspected with jaundice (AOR:1.88; CI:1.20-2.95).ConclusionsWomen with tertiary education and multiparous mothers who attend routine antenatal clinics are more likely than less educated women, to be associated with appropriate care-seeking practices for infants with NNJ regardless of the socio-cultural setting. Systematic efforts by professional health workers are warranted, as part of routine antenatal care, to engage other groups of mothers especially those likely to indulge in self-use of potentially harmful therapies.

Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital.

Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.

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