Wilson 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.

The cost of out-patient management of chronic heart failure in children with congenital heart disease

OBJECTIVE To evaluated the economic burden to families of managing chronic heart failure in children with congenital heart disease. MATERIALS AND METHODS This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the familys monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed. RESULTS Thirty two families were recruited for the study. The children were 16(50%) each of males and females with a mean age of 2.2 ± 1.7 years. The mean monthly income was

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

314.93 ± 271.36 while the mean cost of total care was

Congenital heart disease in Nigerian children: a multicenter echocardiographic study.

17.61 ± 10.58. The mean percentage of income spent on total care was 16.3 ± 26.2 % with a range of 0.7 - 122%. Families from low socioeconomic class spent significantly higher percentage of income on medicines and total care compared to those in middle or high socioeconomic classes, P = 0.0095 and 0.041 respectively. Only three (0.09%) patients had surgery for their condition. CONCLUSION The mean percentage of income spent on care was significant and amounted to catastrophic health expenditure for a third of the families. Government input in strengthening the existing cardiac centres, establish new ones and subsidising the cost of surgery to meet the needs for open heart surgery for children with CHDs is recommended.

Immunologic outcomes of antiretroviral therapy among HIV-infected Nigerian children and its association with early infant feeding and nutritional status at treatment initiation.

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.

Rationale and design of the African group A streptococcal infection registry: the AFROStrep study

Background: Congenital heart disease (CHD) is among the leading causes of morbidity and mortality in childhood. We report on the spectrum of echocardiographically diagnosed CHD from three different centers across Nigeria. Methods: Over a period of 42 months, children who were referred for echocardiographic evaluation in the centers located in three large metropolitan cities were consecutively recruited if they were confirmed to have identifiable CHD. Data were collected on age, gender, and types of CHD and analyzed using SPSS 16 (Chicago, Illinois,). Results: A total of 605 children were recruited, their mean age was 2.1 ± 3.5 (range 0-17) years, and 296 (48.9%) were males. Nearly half (42.5%) had echocardiographic diagnosis of their CHD within the first year of life. Only 17% of the diagnoses were made in the neonatal age group. Acyanotic CHDs were more common than the cyanotic heart diseases (82.8% vs 17.2%). The most common CHD was ventricular septal defect (VSD; 46.6%) followed by patent ductus arteriosus (12.1%), atrial septal defect (8.7%), atrioventricular septal defect (8.2%), and tetralogy of Fallot (7.8%). More than half of the VSDs were perimembranous (55.1%) followed by outlet VSD (23.8%), muscular (10.7%), and inlet VSD (9.6%). Only 42 (6.9%) of the entire study population had definitive intervention. Conclusion: The VSD is the most prevalent CHD in Nigerian children. There is increasing awareness, availability, and use of diagnostic facilities as mirrored in the age distribution of the children. However, access to definitive surgery is poor and draws attention to the urgent need for affordable surgical facilities in the country.

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

Objectives: To evaluate immunologic response to antiretroviral treatment (ART) among HIV-infected Nigerian children (<36 months old) and to assess its association with early infant feeding pattern and nutritional status at treatment initiation. Design: Mixed prospective and retrospective cohort study. Methods: One hundred fifty HIV-infected children were followed for 12 months from initiation of ART. CD4 count/CD4% was assessed at baseline and every 4–6 months. Nutritional status was assessed by height-for-age, weight-for-age and weight-for-height Z scores using the 2006 World Health Organization growth reference. Children were classified into 4 feeding groups—exclusively breast-fed, predominantly breast-fed, mixed fed and exclusively formula fed. Logistic regression was used to model odds of failure to reach CD4% of ≥25% at the 12-month follow-up. Linear random effects models were used to model the longitudinal change in CD4%. Results: There was a significant increase in CD4% for all children from 13.8% at baseline to 28.5% after 12 months (&Dgr;CD4% = 14.7%, 95% confidence interval: 12.1%–17.4%). There was no association of feeding pattern with immunologic outcomes. In adjusted analyses, children who were underweight (weight-for-age < –2.0) or with CD4% <15% at baseline were 4.30 (95% confidence interval: 1.16, 15.87; P < 0.05) times and 3.41 (95% confidence interval: 1.10, 10.52; P < 0.05) times, respectively, more likely not to attain CD4% of ≥25% at 12 months. Conclusion: Baseline nutritional status and CD4% were independently associated with failure to reach CD4% ≥25% at 12 months among HIV-infected Nigerian children on ART. These results emphasize the importance of early screening and initiation of ART among children in resource-poor settings before malnutrition and severe immunosuppression sets in.

Natural history of ventricular septal defects in Nigerian children

Introduction Group A β-haemolytic Streptococcus (GAS), a Gram-positive bacterium, also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and morbidity worldwide. The burden of GAS infections is, however, unknown in Africa because of lack of surveillance systems. Methods and analysis The African group A streptococcal infection registry (the AFROStrep study) is a collaborative multicentre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS) and (2) passive surveillance of iGAS disease from microbiology laboratories. Isolates will also be subjected to DNA isolation to allow for characterisation by molecular methods and cryopreservation for long-term storage. The AFROStrep study seeks to collect comprehensive data on GAS isolates in Africa. The biorepository will serve as a platform for vaccine development in Africa. Ethics and dissemination Ethics approval for the AFROStrep registry has been obtained from the Human Research Ethics Committee at the University of Cape Town (HREC/REF: R006/2015). Each recruiting site will seek ethics approval from their local ethics’ committee. All participants will be required to provide consent for inclusion into the registry as well as for the storage of isolates and molecular investigations to be conducted thereon. Strict confidentiality will be applied throughout. Findings and updates will be disseminated to collaborators, researchers, health planners and colleagues through peer-reviewed journal articles, conference publications and proceedings.

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 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.

Effect of HIV-1 Serostatus on the Prevalence of Asymptomatic Plasmodium falciparum Parasitemia Among Children Less Than 5 Years of Age in Benin City, Nigeria

Introduction. Ventricular septal defect (VSD) is a common congenital heart disease (CHD). Spontaneous closure of the VSD may occur, depending on the type and size of defects. This study was conducted to determine the natural history of VSD in a group of Nigerian children. Subjects and methods. Sixty-one children diagnosed with VSD were prospectively studied at a tertiary centre in Nigeria until they were 2 years old. They had regular two-dimensional (2D) and Doppler echocardiography evaluations for the VSD size and closure. Results. Most (35 – 57.4%) of the patients were female, their mean age at presentation was 11.2±5.2 months, and the most common type of VSD was the perimembranous (39 – 63.9%). Almost half (28 – 45.9%) of the patients had spontaneous closure. The spontaneous closure rate was highest in muscular VSD (82.4%) and in small defects (95.0%). Incidental presence of a murmur, absence of heart failure and bronchopneumonia were good clinical predictors of closure. Only 3 (4.9%) patients had surgery abroad. There were 2 (3.3%) deaths from bronchopneumonia and bacterial endocarditis. Conclusion. Spontaneous closure readily occurs in small-sized defects and muscular VSDs. However, most patients with moderate to large VSDs are confined to long-term medical management, highlighting the need for indigenous surgical capacity in Nigeria.