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Summary : A prospective study of all newborn infants with normal birthweight admit ted to the newborn unit , University of Calabar Teaching Hospital, Calabar from April 1996 to March 1998, was carried out. The aims were to determine the causes of morbidity and mortality among these neonates as well as relate these to the place of delivery. Of the 286 babies admitted to the unit during this period, the major causes of morbidity were septicaemia in 35.9 percent, neonatal jaundice in 19 percent, tetanus in 13 percent and birth asphyxia in 10.9 percent. There were 52 deaths, an overall mortality of 18 percent. Neonatal tetanus was the leading cause of death in this series accounting for 42.3 percent of the deaths and a case fatality rate of 59.5 percent. Other causes were birth asphyxia, septicaemia, neonatal jaundice and congenital malformations. Most of the morbidity and mortality were in babies delivered in religious buildings and the homes of traditional birth attendants (TBAs). Health education and other strategies aimed at changing the attitude of our TBAs and spiritualists towards utilization of sterile procedures, immuni zation services and prompt referral of complicated obstetric cases to where modern health care facilities exist, are recommended.

Background: In an apparent desire to improve the routine immunization coverage in the country, the Nigerian Government in 1997, launched the National Programme on Immunization (NPI) in place of the existing Expanded Programme on Immunization (EPI). Aim: The aim of the present retrospective study was to determine whether the desired goal was achieved, by comparing the hospital incidences, morbidities and mortalities from measles infection during the EPI (January 1992 to December 1996) and NPI (January 1997 to December 2001) eras. Subjects and Methods: The subjects were children admitted with measles infection to the University of Calabar Teaching Hospital, Calabar, during the period. Data were extracted from the relevant case files. Results: One hundred and twenty cases (representing 24 cases per year), and 36 cases (representing 7.2 cases per year) were admitted during the NPI and EPI eras, respectively (P

Background: The clinical features of hypoglycaemia and severe dehydration are similar, and these two can occur in a child presenting with acute diarrhoea. Hypoglycaemia occurring in a growing brain is deleterious and must be detected and treated. Objective: To determine the prevalence of hypoglycaemia among under-five children presenting with acute diarrhoea in UCTH, Calabar. Method: This was a prospective study of 150 children aged six weeks to five years presenting with acute diarrhoea in UCTH, Calabar from June 1st to October 31st 2008. Consecutive children who met the inclusion criteria were recruited into the study. Blood samples were collected for random blood sugar and serum electrotype estimation using One Touch Ultra Test Strips 2006 model and Flame photometry respectively. Results: The overall prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea was 4%. There was no sex difference. It was commonest among children of the low socioeconomic class (83.3%). Risk factors to developing hypoglycaemia were longer duration of last feeds greater than five hours and severe dehydration, both reaching statistically significant differences (p=0.022 and 0.002; FET respectively). Forty percent of patients who died had hypoglycaemia constituting 33.3% of patients with hypoglycaemia. Conclusion: Children with diarrhoea complicated with severe dehydration are prone to developing hypoglycaemia. It causes high mortality and thus this parameter should be checked for and managed on time.

Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection. Aim: To determine the prevalence of neonatal malaria and the associated clinical features in newborn babies with fever. Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs. Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged ≤7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria parasitaemia with four (2.7%) being congenital malaria and two (1.3%) acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while those with malaria and bacterial co-infection had, in addition, poor suck. Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeutic intervention

Summary: Mother to child transmission of HIV infection (MTCT) is the commonest mode of infection in children especially in resource limited settings. Routine HIV screening during antenatal period is recommended to prioritize treatment of seropositive mothers according to standard protocol. Various infant feeding options have been recommended by the World Health Organization (WHO) to reduce MTCT of HIV infection. The use of a cross-nurse who is documented HIV-negative is one of such options though not widely practiced. We present a case of HIV infection in an infant acquired through wetnursed.

Neonatal intestinal obstruction is the most common surgical emergency in the newborn period. Prompt diagnosis and urgent management improve the chances of a favorable outcome. Aetiology and outcome may vary in different parts of the same country. Objective: To evaluate the aetiology and factors associated with mortality in neonates presenting with intestinal obstruction in University of Calabar Teaching Hospital, Calabar, Nigeria. Method: This was a retrospective study of clinical records of neonates presenting with features of intestinal obstruction over an eight year period. The biodata, diagnosis, management and outcome for the neonates were documented. Result: Forty neonates; 26(65%) males and 14(35.5%) females were studied. Imperforate anus was seen in 40% of subjects while Hirschsprung’s disease and intestinal atresia each were seen in 10%. Aetiology could not be determined in about a fifth of the cases. Ageless than one week at presentation was significantly associated with a poor outcome. No case had surgical intervention within twenty-four hours of presentation. The overall mortality was 30%, most of these 9 (75%) was due to anorectal alformations. Conclusion: The management and outcome of neonatal intestinal obstruction in our setting is poor. There is urgent need to upgrade our neonatal intensive care services to improve outcome in affected neonates. More Paediatric surgeons are required to reduce the gross inadequacy of expert as this would improve on the surgical intervention time as reported in this study.

Background : In Nigeria, neonatal jaundice is commonly treated by overhead phototherapy with neonates lying supine, often with effective exposure of less than one half of the body surface. Total body exposure in phototherapy has been in use for less than 2 years in Nigeria, but is available in only five neonatal centres. Aim : To compare the effectiveness of total body exposure (TBPE) with the conventional partial exposure (COPT) for treatment of hyperbilirubinaemia. Methods : Eleven datasets from 10 neonatal units across Nigeria were retrieved. They included neonates with severe hyperbilirubinaemia treated with TBPE using the Firefly® device (MTTS Asia) as a test group. The remainder of the patients, the controls, were treated with COPT. Any requirement for exchange blood transfusion (EBT) in either group was documented. Total serum bilirubin (TSB) >213.8 μmol/L (12.5 mg/dL) was treated as severe hyperbilirubinaemia. The efficiency of the intervention was determined according to the time taken for a severe case to be downgraded to mild at ≤213.8 μmol/L. Results : A total of 486 patients were studied, 343 controls and 143 cases. Mean (SD) postnatal age was 6 days (0.7) for cases and 5 (0.9) for controls, for gestational age (GA) in completed weeks was 36 (0.5) for cases and 37 (0.7) for controls and for birthweight was 2.7 kg (0.25) for cases and 2.7 (0.22) for controls. Mean (SD) pre-intervention TSB was 299.3 (35.7) μmol/L for cases and 327.3 (13.9) for controls. Severity downgrade day was Day 2 (0.4) for cases and Day 5 (1.1) for controls. Overall relative EBT rate was 6% for cases and 55% for controls ( p = 0.0001), and early preterm relative EBT rate was 0% for cases and 68% for controls ( p < 0.01). Conclusion : TBPE was quicker and safer for reduction of hyperbilirubinaemia and patients rarely required EBT. TBPE is recommended for rapid reduction of serum bilirubin levels and the reduction of treatment costs, morbidity and mortality in low- and middle-income countries. Abbreviations: EBT, exchange blood transfusion; TBPE, total body exposure technique; COPT, conventional partial exposure; TSB, total serum bilirubin; SB, serum bilirubin; NNJ, neonatal jaundice; SCNU, special care neonatal unit; LMIC, low- and middle-income countries; HIC, high-income countries; LED, light-emitting diode.

Background: Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis., Aim: To determine the hematological indices in febrile newborn with malaria parasitemia., Materials and Methods: One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14., Results: One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization., Conclusion: Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Introduction: Hepatitis A infection is prevalent in developing countries where sanitation is still a public health issue. In Nigeria, there is no epidemiological data on children for this infection. A community based study was carried out to establish the seroprevalence and predictors of this infection in children., Methods: A community based cross sectional study was carried out in Akpabuyo local Government Area of Cross River State in southern Nigeria. Multi-staged sampling technique was used to recruit 406 children aged 1-18 years. Blood samples were analysed for anti-HAV total antibody (IgM and IgG) using a commercial Enzyme-Linked Immunoassay Assay(ELISA). A multivariate logistic regression was used to identify factors that independently predicted the occurrence of anti-HAV total antibody. p value of < 0.05 was considered significant., Results: Two hundred and twenty four subjects tested positive for anti-HAV total antibody giving a prevalence rate of 55.2%. The median age for those positive was 9 years and for those without evidence of HAV infection was 4 years. One hundred and one (45.1%) males and 123 (54.9%) females were positive. The study population was mainly of the low social class with 94.1%. After multivariate analysis, predictors of HAV infection were age and social class., Conclusion: HAV infection was prevalent in the study population. Educational campaign is imperative and vaccine provision is advocated to further curb the spread of this infection.

Objective: To assess the predictors of C-reactive protein response in plasmodium falciparum malaria as seen in children in a malaria endemic region of Nigeria., Design: A prospective cross-sectional study., Setting: The Children Out-patient (CHOP) Clinic, Children Emergency Unit (CHEU), Child Welfare/Growth Monitoring Clinic, Immunisation Centre and Paediatric Ward of the University of Uyo Teaching Hospital (UUTH), Uyo in Akwa-Ibom State., Subjects: Three hundred and sixty children aged six to sixty months with microscopically confirmed P. falciparum malaria compared with 360 healthy children without malaria parasitaemia matched for age and gender., Results: The predictors of the C-reactive protein response in malaria (CRP ≥ 10mg/l) were fever (t = 6.867; p = 0.001), malaria parasite count (t = 5.387; p = 0.001), severe anaemia (t = -11.23; p = 0.001) and age. Younger children had a greater CRP response. The logistic regression curve showed a 66.9% sensitivity, 92.1% specificity, positive predictive value, 83.2% and negative predictive value of 82.2% of predicting C-reactive protein response in malaria., Conclusion: P. falciparum malaria induces significant CRP responses. Younger children who present with fever, hyperparasitaemia and severe anaemia are more likely to have C-reactive protein response with malaria.

Background. Establishing the pattern of infection and antimicrobial sensitivities in the local environment is critical to rational use of antibiotics and the development of management algorithms. Methods. Morbidity history and physical examination of 140 children with severe acute malnutrition were recorded. Their blood, stool, and urine samples were cultured and antibiotic sensitivity patterns determined for any bacterial pathogens isolated. Results. Thirty-eight children had a pathogen isolated from blood culture, 60% of which were considered contaminants. Coagulase negative staphylococcus was the predominant contaminant, while the major causes of bacteraemia were nontyphoidal Salmonella (13%), S. pneumoniae (10%), and E. coli (8%). E. coli accounted for 58% of the urinary isolates. No pathogen was isolated from stool. In vitro sensitivity by disk diffusion showed that 87.5% of the isolates were sensitive to ampicillin and/or gentamicin and 84.4% (27/32) to penicillin and/or gentamicin. Conclusions. A combination of ampicillin and gentamicin provides adequate antibiotic cover for severely malnourished children in The Gambia.

Introduction: Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case., Case Presentation: We present a case of 9-hour-old, female, Nigerian dicephalus parapagus conjoined twins discordant for anencephaly diagnosed only after the birth of the twins. The anencephalic twin was stillborn while the normal one died within 9 hours of birth from cardiopulmonary failure., Conclusion: Many congenital defects of interest can now be detected before birth. A severe lesion such as that found in our index case, which is incompatible with postnatal life, requires counselling. If detected early enough during a properly monitored antenatal care, it may indicate termination of pregnancy.

Background: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004., Results: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission., Conclusion: Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age.

We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

A three-year survey of neonatal septicaemia (363 bacteriologically proven cases) in the University of Calabar Teaching Hospital, Calabar, has demonstrated that the dominant blood isolate was Staphylococcus aureus (53%) followed by unclassified Coliforms (20%), an unexpected Chromobacterium violaceum (5%). The incidence of neonatal septicaemia was 54.9 per 1000 live births for inborn infants. The predominant organisms were largely susceptible to gentamicin, ceftriazone and cefuroxime with a mortality rate of 19% with most (60.9%) of the fatalities being due to Gram-negative organisms.

A survey of Paragonimus infection among primary school children aged 6-10 years in Oban village, Akamkpa Local Government Area of Cross River State, Nigeria, was conducted. A total of 198 children were examined:112 (56.6%) were boys while 86 (43.4%) were girls. Eleven of the subjects were sputum positive for paragonimus eggs, giving an overall prevalence rate of 5.5%. The findings show that paragonimiasis is a significant health problem in South Eastern Nigeria; the risk of infection could be minimized by the proper cooking of fresh water crabs and crayfish before consumption.

Nigerian newborns presenting with convulsion in University of Calabar Teaching Hospital, Calabar during the period January 1989 to December 1990 were prospectively studied to determine the aetiology and pattern of their seizures. There were 60 patients representing 4% of admissions into the Newborn Unit during the period. Birth asphyxia, infections and hypoglycaemia were the important identifiable aetiological factors which operated either singly (48% of cases) or in concert (in another 48%) of the infants. Detectable infections included meningitis and septicaemia caused predominantly by coliforms and Staphylococcus aureus. Hypocalcaemia and electrolyte imbalance did not feature. There was an unusually high prevalence (63% of cases) of the generalised type of seizures probably due to the high frequency of mixed aetiology. The mortality rate of 50% encountered appears to be related to the underlying aetiology and prematurity. Detectable caused of neonatal seizures in our environment appear to be potentially preventable by improved obstetric and neonatal care. There is dire need also to provide modern facilities for investigating newborn seizures in order to improve upon the diagnostic yield.

Following rumors of some persistence of abuse on twins, a survey was conducted from January through June, 1991 in the rural areas of Efik, Ibibio and Annang tribes of South-Eastern Nigeria to determine the current attitude of the people towards twins and their mothers. Of the 619 women interviewed, 56% cherished having twins; 35% would not desire largely because of the economic and other minor difficulties associated with their up-keep but none of these would abandon the infants. The remaining 9% hold a taboo against twins: as babies derived from the devil, non-human and punishment from the gods for sinfulness. Consequently, 2.3% and 2.6% of the mothers would have their twins rejected and killed respectively and 6% of the twin mothers would be cast out but none killed by their husbands' families. The intention to perpetuate this form of abuse was elicited in all the three tribes but seemed relatively to be most pronounced in Annang people. The information generated, though limited to rural population, suggests that the rejection of twin births has actually not yet disappeared from this part of the country. Health workers in South-Eastern Nigeria who encounter twins with failure to thrive should consider rejection as a possible contributing factor. It would need intensive moral education and religious teaching to stem this brutal culture.

In a study of 149 cases of neonatal tetanus (NNT) admitted into the University of Calabar Teaching Hospital, 49 (33 per cent) were also found to have septicaemia. The dominant organisms were coliforms and Staphylococcus aureus. A comparison of the clinical features of the septicaemic and non-septicaemic neonates showed umbilical cord infection to be an indicator of septicaemia. There was no significant difference in the case fatality rates of the two groups of patients and the overall case fatality was low (37 per cent). This is attributable to early diagnosis and treatment of the septicaemia cases. It is suggested that paediatricians should have a high index of suspicion of septicaemia among cases of NNT as a means of reducing case fatality.

In a twelve-month prospective study of 132 neonates suspected of having septicaemia in the Special Care Babies Unit (SCBU) of the University of Calabar Teaching Hospital (UCTH), Calabar, 79 were confirmed by positive blood cultures. Forty (50.6 pc) of these were preterm infants. The incidence was 19.3 per 1,000 hospital live births, while the mortality rate was 30.3 pc. The main predisposing factors were birth asphyxia, birth outside hospital, prolonged rupture of membranes, prolonged labour and poor water supply in hospital. The predominant pathogens were coliform organism and Staphylococcus aureus. The antibiotic sensitivity pattern of the pathogens suggest the use of gentamicin as a sole agent in the initial treatment of septicaemia while awaiting culture results. In view of the role of inadequate antenatal care, poor water supply and unhygienic delivery practices in the aetiology of newborn septicaemia, it is suggested that improved antenatal care, water supply and childbirth practices will reduce the incidence of septicaemia.

A study of paediatric deaths in the University of Calabar Teaching Hospital, Calabar, Nigeria during a 4-year period (January 1984-December 1987) showed an overall mortality of 80 per 1000 paediatric admissions. A majority (47%) of the deaths were the newborn with a decline (7%) in children aged 61 months to 14 years. Major causes of death were tetanus, low birthweight and birth asphyxia in the newborn; malnutrition, pneumonia and measles in the pre-school age, and anaemia in the older children. Neonatal tetanus and malnutrition played a leading role in the overall mortality.

Since chloroquine-resistant Plasmodium falciparum (CRPF) has emerged in Nigeria, we monitored the susceptibility of the parasite strain to a standard chloroquine (C25) dose in our Children's Emergency Unit. Chloroquine (CQ) is the drug of choice for malaria chemotherapy in Nigeria. The WHO 7-day in vivo evaluation and Rieckmann's microtitre technique (in vitro test) were used. 33 children of mean age 4.9 years were enrolled in the study. 27 (81.8%) of the in vitro cultures were successful. 16 (59.3%) of the successful isolates still showed schizogony at CQ concentration of 5.7 pmol/well and above. 28 (84.8%) of the children completed the in vivo study. 15 (53.6%) were parasitaemic on day 7 and/or day 14 and were regarded as parasitologic failures. The isolates from 14 of these children showed corresponding in vitro resistance of CQ concentrations equal to or above 5.7 pmol/well. The proportion of RIII (= 13.3%) appears to have increased as compared to 5.9% recorded in 1987. We conclude that there appears to be a good correlation between in vivo evaluation of parasitologic failures (53.6%) and in vitro resistance (59.3%). It thus appears that CRPF is definitely increasing in South-Eastern Nigeria. This can be expected not only to complicate malaria chemotherapy in the Children's Emergency Unit of the University of Calabar Teaching Hospital, but will contribute immensely to the deterioration of malaria therapy and control in Nigeria.