Open Access Case Study

Omphalitis in a Nigerian Neonate; Lessons to learn

V. I. Joel-Medewase, A. A. Adegoke, O. A. Oyedeji

International Journal of TROPICAL DISEASE & Health, Page 760-765
DOI: 10.9734/IJTDH/2014/9694

We present a four day old male neonate who presented at the special care baby unit of the University Teaching Hospital, Ado–Ekiti with features of peri-umbilical cellulitis. The factors that predisposed to the development of omphalitis in this neonate whose mother is a university graduate is discussed with a view of providing information on how to prevent future occurrences.

Open Access Original Research Article

Prevalent Components of Metabolic Syndrome and Their Correlates in Apparently Healthy Individuals in Sub-saharan Africa

M. A. Charles-Davies, A. A. Fasanmade, J. A. Olaniyi, O. E. Oyewole, M. O. Owolabi, J. R. Adebusuyi, O. Hassan, M. T. Ajobo, M. O. Ebesunun, K. Adigun, K. S. Akinlade, U. A. Fabian, O. O. Popoola, S. K. Rahamon, W. Okunbolade, M. A. Ogunlakin, O. G. Arinola, E. O. Agbedana

International Journal of TROPICAL DISEASE & Health, Page 740-752
DOI: 10.9734/IJTDH/2014/5864

Aim: To assess the prevalent components of metabolic syndrome (MSC) and their related determinants of lipid metabolism in the Nigerian for early diagnosis, prevention and management of the metabolic syndrome (MS) and its associated diseases.
Study Design: Cohort study.
Place and Duration of Study: Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan between March and August 2010.
Methodology: 534 apparently healthy Nigerian traders aged 18–105 years were participants of a cohort study. The IDF (2005) criteria was used for MS diagnosis. Anthropometric indices and blood pressure (BP) were obtained by standard methods. Fasting plasma glucose, total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDLC) were determined by enzymatic methods while low density lipoprotein cholesterol (LDLC) was calculated. Data analysed were statistically significant at P<0.05.
Results: 60.1% of traders had 2 and 3MSC. 0.6%, 1.1% and 9.6% of traders had all 5MSC, ≥3MSC without elevated waist circumference (WC) and zero MSC respectively. Elevated WC, reduced HDLC and high BP were more frequent MSC representing 70.2%, 63.1% and 47.9% while FPG and TG were less frequent representing 11.2% and 2.2% of traders respectively. This pattern was similar in MS and non-MS groups. 25.3% of males and only 2.2% of females had no MSC. Reduced HDLC and elevated WC were the most frequent MSC in males and females respectively. All metabolic risk factors (MRF) except TC were significantly different in comparison between MS and non-MS groups as well as among traders with 0-5 MSC. WHR was the only parameter that correlated significantly with all MRF.
Conclusion: Elevated waist circumference, reduced high density lipoprotein cholesterol, and high blood pressure may be prevalent metabolic syndrome components and important in managing metabolic syndrome in Nigeria. Regional specific cut-offs for these components for the African population is needed.

Open Access Original Research Article

Clinical and Laboratory Profile of ARV Naive HIV Infected Children in the Era of Highly Active Anti-retroviral Therapy in Enugu, South-East Nigeria

A. C. Ubesie, K. K. Iloh, C. U. Eze, O. Iloh, N. S. Ibeziako, C. Okoli, I. J. Emodi

International Journal of TROPICAL DISEASE & Health, Page 753-759
DOI: 10.9734/IJTDH/2014/9630

Background: HIV/AIDS is one of the most dynamic epidemic infectious diseases. An estimated 1000 children are newly infected with HIV every day, most of them in sub-Saharan Africa. They often present with various clinical and laboratory manifestations that complicates their management.
Objectives: To determine the baseline clinical and laboratory features of HIV-infected children presenting at the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla.
Methods: Clinical and laboratory data were collected from HIV infected children seen at the Pediatric HIV Clinic of UNTH between July 1st 2010 and June 30th 2012. Clinical and immunological staging of the patients were done using the WHO criteria and data analysis was with SPSS version19.
Results: Two hundred and ten children were enrolled into the study. The most common route of HIV infection was vertical transmission (95.2%). Common presenting clinical and laboratory data were: anaemia (92.9%), cough (76.2%), fever (63.3%), popular rash (62.9%) and poor weight gain (61.0%). Thirty-four children (16.2%) each had severe and moderate acute malnutrition while 92 children (43.8%) were stunted. Tuberculosis, hepatitis B and C co-infections were seen in 32.4%, 1.9% and 3.3% of the children respectively. Most of the patients had either a WHO clinical stage III (42.4%) or II (39.0%) disease. Severe immunosuppression based on CD4% or count was seen in more than half of the patients (59.1%).
Conclusions: Anaemia was the most common clinical/laboratory finding; followed by cough. Although our patients were likely to present with WHO clinical 2 or stage 3 disease, severe immunological suppression was common.

Open Access Original Research Article

Placental Malaria and Its Associations with Pregnancy Outcome

V. E. Okolie, N. J. Obiechina, Z. C. Okechukwu, C. F. Oguejiofor, L. Okor, A. O. Onyegbule, L. S. A. Nwajiaku

International Journal of TROPICAL DISEASE & Health, Page 766-772
DOI: 10.9734/IJTDH/2014/9911

Background: Placental malaria constitutes a risk for both the pregnant women and their unborn child hence there is need to demonstrate the adverse associations between placental malaria and pregnancy outcome.
Aim: To demonstrate the adverse maternal and fetal associations with placental malaria
Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013.
Result: Two hundred placentae were analyzed, 141(70.5%) were positive for malaria, Placental malaria was associated with lower maternal pcv (30.67±1.60 vs 32.51±2.82, p-value < 0.001), preterm delivery (OR=4.99, C.I=1.15 – 45.08, p- value=0.020), and low birth weight (OR = 4.71, C.I=1.08 – 42.71, p-value=0.027) but not associated with maternal anaemia (OR=2.27, C.I= 0.90-6.47, p-value=0.063) and perinatal deaths (OR=Infinity, C.I =0.38 – infinity, p-value = 0.143).
Conclusion: Placental malaria was associated with low birth weight, lower pcv and preterm delivery but associated neither with maternal anaemia nor perinatal deaths.

Open Access Original Research Article

Prevalence and Laboratory Profile of Hepatitis B Virus Co-infected Nigerian Children with Human Immunodeficiency Virus

E. U. Ejeliogu, S. Oguche, A. O. Ebonyi, E. S. Okpe, E. S. Yiltok, M. O. Ochoga, J. A. Anejo-Okopi, O. O. Agbaji, J. A. Idoko, P. Okonkwo, P. Kanki

International Journal of TROPICAL DISEASE & Health, Page 773-781
DOI: 10.9734/IJTDH/2014/10089




Aims: To determine the prevalence of HBV co-infection in HIV-infected children and compare the baseline laboratory profile of mono-infected and co-infected patients.
Study Design: This was a retrospective cohort study.
Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of Jos University Teaching Hospital, Jos, Nigeria between January 2008 and December 2012.
Methodology: We reviewed the clinical records of 452 treatment-naïve children aged 2 months to 15 years confirmed to be HIV positive with Polymerase Chain Reaction (PCR) for children <18 months or Western blot for children ≥18 months. The baseline laboratory tests included: HBsAg, plasma viral load and alanine transaminase (ALT), CD4+T cell count for children ≥5years or CD4+T cell % for children <5years.
Results: Three hundred and ninety-four (87.2%) were mono-infected with HIV while 58 (12.8%) were co-infected with HIV and HBV (HIV/HBV). At baseline, the median viral load was 4.6 log copies/mL for mono-infected compared to 4.7 log copies/mL for HIV/HBV (P=.48). The median CD4+T cell count was 366 cells/µL for mono-infected compared to 332 cells/µL for HIV/HBV (P=.64). The median CD4+T cell % was 19% for mono-infected compared to 17% for HIV/HBV (P =.29). The median ALT level for the whole cohort was 23 IU/L for mono-infected compared to 26 IU/L for HIV/HBV (P=.15). However the median ALT level for mono-infected children aged 11-15 years was 28IU/L compared to 43 IU/L for co-infected children of same age (P =.008).
Conclusion: A high rate of hepatitis B co-infection was observed in HIV-infected children at our centre; however more severe HIV disease was not observed. Older children co-infected with HBV had significantly higher ALT levels compared to their mono-infected counterparts. Early detection is therefore necessary in order to develop an appropriate treatment plan for children co-infected with HIV and HBV.

Open Access Original Research Article

Social Determinants of Malaria among Gold Miners in Shwekyin Township, Myanmar

Zin Zayar Win, Ichiro Kai

International Journal of TROPICAL DISEASE & Health, Page 782-792
DOI: 10.9734/IJTDH/2014/9777

Background: Myanmar is one of the countries with evidence of artemisinin resistance and the greatest burden of malaria in the Greater Mekong Subregion. At present, migrant/mobile populations are considered to play a major role in the potential spread of artemisinin-resistant malaria within countries and across borders. In this regard, we conducted a cross-sectional community-based survey in Shwekyin Township, Bago Division, of Myanmar from March to April of 2013 to investigate social determinants of malaria among gold miners.
Methodology: We conducted a total of nine Key Informant Interviews and five Focus Group Discussions in two gold mines and two villages with different accessibilities to health facilities. We asked key informants about local health services, people’s perception of malaria, and treatment-seeking behaviors. We performed Focus Group Discussions on knowledge, attitudes, and treatment-seeking behaviors of migrants regarding malaria.
Results: Most villagers and gold miners had a fair understanding of causes, transmission, and symptoms of malaria though somewhat mixed and confused. The villagers had better knowledge and practices of prevention than the gold miners. Though villagers close to rural health centre used to undergo treatment within 48 hours of fever, those living with malaria social workers and gold miners were still experiencing self-treatment. Drug retailers played a major role in their first and initial response to malaria. Artesunate and artemether were the most familiar anti-malarials among all respondents. All the respondents accepted the use of rapid diagnostic tests well but they understood negative test results poorly and sometimes this led to self-treatment using artemisinin-based monotherapies.
Conclusion: Limited knowledge and practice of malaria prevention might be social determinants of malaria among gold miners. Self-treatment using artemisinin-based monotherapies was still common, even after negative rapid diagnostic test results in the vicinity of a health facility.

Open Access Original Research Article

Helminthiasis in School Aged Children in a Select Population in the Niger Delta

B. O. Foghi, N. C. Eze, S. O. Nzeako

International Journal of TROPICAL DISEASE & Health, Page 793-801
DOI: 10.9734/IJTDH/2014/9484

Aim: Helminthiasis and its effects on the hematological parameters of school aged children in a select population in the Niger Delta.
Study Design: A cross sectional study (Descriptive study).
Place and Duration: The study was carried out in Emohua Local Government Area of Rivers State, between January–April 2011.
Methodology: Concentration Method (Sedimentation) was used to examine the stool samples, Packed cell volume (PCV) was obtained by the use of hematocrit centrifugation and reader method; differential white blood count (WBC) was done according to Cheesbrough (2000).
Results: Result of the study showed variability in the four gastrol-intestinal helminths among the 360 pupils investigated. Out of the 264(73.3%) positive samples, 142(53.7%) and 122(46.21%) were females and males respectively. Age specific gastroi intestinal worm load was relatively high in all age groups. This pattern of infection was attributed to favorable ecological factors that promote helminths transmission in the study area. However, the overall age related worm load showed that the 5-7 age group had relatively the highest parasite load in the study. The weight and height of infected pupils in relation to the uninfected varied statistically (p<0.05) across the age ranges but was not statistically different (p>0.05) within the age groups. A. lumbricoides (53.3%) was the most prevalent helminth amongst the infected.
Conclusion: Overall mixed infection was (23.4%) while the 8-9 age range recorded the highest prevalence (28.2%). Sex related prevalence varied greatly in terms of percentage infection within and across the sexes. However, gastrointestinal parasitism was not significantly different (p>0.05) within the age groups but was significantly different (p<0.05) between the sexes. PCV values were below the normal range in both the infected uninfected in the study group indicating poor nutritional status of the population.

Open Access Original Research Article

Knowledge, Attitude and Practice on Dengue among Rural Communities in Rembau and Bukit Pelanduk, Negeri Sembilan, Malaysia

Tan Kok Leong

International Journal of TROPICAL DISEASE & Health, Page 841-848
DOI: 10.9734/IJTDH/2014/10509

Aims: The aim of the study was to assess the level of knowledge, attitude and practices concerning dengue among rural communities of Rembau and Bukit Pelanduk district, Negeri Sembilan, Malaysia.
Study Design: This was a community based cross-sectional study.
Place and Duration of Study: The study was conducted among household members in two villages from Rembau and Bukit Pelanduk districts respectively in Negeri Sembilan, Malaysia in August 2010.
Methodology: A total of 400 respondents were included in the study with 100 respondents from each of the four villages. Data was collected by a face-to-face interview of all residents aged 18 years and above in the selected households using a pretested structured questionnaire. The questionnaire consist of three sections; the first section concerned with knowledge comprising of 10 questions, the second part related to attitude comprised of six questions and the third part concerned with practice with seven questions.
Results: It was found that knowledge among the respondent was only adequate. The main source of information on dengue was from the television or radio (88.5%). The respondents’ attitude was good and most was supportive of Aedes control measures. There was significant association between knowledge and attitude (P<0.001) with an Odds Ratio of 3.8 (95% CI:2.2, 6.7). Knowledge was associated with age, ethnicity and educational level; attitude was associated with ethnicity and educational level while practice was associated with ethnicity and marital status.
Conclusion: Attitude and practice among respondents were good but knowledge was poor. However, isolated knowledge on symptoms and prevention was adequate. The results are useful as a baseline data for future health education and promotion intervention programs for rural communities.

Open Access Original Research Article

Prescribing Practices for Uncomplicated Malaria in a Rural District in Ghana, 2012

Donne K. Ameme, Kofi M. Nyarko, Keziah L. Malm, Edwin A. Afari, Fred Wurapa, Samuel Sackey

International Journal of TROPICAL DISEASE & Health, Page 849-859
DOI: 10.9734/IJTDH/2014/10771

Background: The use of Artemisinin–based Combination Therapies (ACTs) for laboratory confirmed malaria, in conformity to recommended guidelines, remains critical to halting the emergence of drug resistance. We reviewed prescribing practices for malaria in Kwahu South District (KSD) and determined factors influencing conformity to guidelines.
Methods: We conducted a cross-sectional survey in seven health facilities from three randomly selected sub-districts in KSD. We reviewed patients’ records with a diagnosis of malaria from January to December 2012. Patients’ records were selected by systematic random sampling. Variables reviewed were demographics, clinical presentation and prescription patterns. Prescriptions were considered to conform to recommended guidelines if ACT was prescribed for confirmed uncomplicated malaria and not prescribed for test negative or presumptive malaria. Frequencies, relative frequencies, mean and median were calculated. Unadjusted odds ratios were used to determine associations at 5% significance level. Predictors of conformity were determined by logistic regression model, adjusting for potential confounders.
Results: Four hundred and four records were reviewed of which 247(61.1%) were females. Median age was 23 years (interquartile range 12-38). Overall, 202(50%) of prescriptions conformed to guidelines: 132 (65.3%) being Artesunate-Amodiaquine (AA). Temperature of ≥37.5°C [adjusted odds ratio (AOR)=1.8, (CI:1.11-2.92)] and being managed at the district hospital [AOR=8.7, (CI:5.41-14.12)] were independent predictors of conformity.
Conclusion: Conformity of prescribing practices to recommended guidelines was suboptimal. Determinants of conformity were fever and being managed at the hospital. We recommended targeted interventions to improve conformity of case management practices to guidelines.

Open Access Review Article

Understanding of Malaria and Its Therapeutic Regimens–The Way Forward

`Saganuwan Alhaji Saganuwan, Patrick Azubuike Onyeyili

International Journal of TROPICAL DISEASE & Health, Page 802-840
DOI: 10.9734/IJTDH/2014/8920

Aim: Malaria is a very serious deadly disease that has attracted the attention of many researchers all over the world. Because a lot of work has been done in the area of malariology, there is need to understand its advance pattern and therapeutic regimens.
Methods: Past and recent literatures on malaria were searched for information on history, global situation, classification, biology, pathology, pathogenesis, diagnosis, treatment and control of malaria to assess the progress made so far in the area of malariology.
Results: Malaria is an ancient disease recognized by Hippocrates over 2413 years ago, caused by Plasmodium species, first identified by Charles-laveran 123 years ago affect 300–500 millions human worldwide, responsible for 3 deaths in every 30 seconds. The knowledge of classification, biology, pathology, pathogenesis, diagnosis and treatment of malaria is a tremendous achievement towards the control of the disease.
Conclusion: But complete elimination of malaria perhaps will still take another time, since lots need to be known about the molecular biology of antigenic shift and drift, nature and mechanisms of action of the parasite toxin, in order to have basis for definite vaccine development. By so doing, radical cure and total eradication of malaria can be achieved.