Nigerian Journal of Paediatrics

The global point prevalence survey of antimicrobial consumption and resistance (Global-PPS): First results of antimicrobial prescribing in a children hospital in Nigeria

2023-11-02T08:11:11+00:00

Background: Antimicrobial stewardship is vital for our hospital practice but it requires a knowledge of antibiotic prescribing practices, which is currently lacking. This survey aimed to assess the antimicrobial prescribing practices in our hospital.

Method: To obtain baseline information on antimicrobial prescribing practices, a uniform and standardized method for surveillance of antibiotic use in hospitals was employed. A point prevalence survey (PPS) was conducted in all the wards of the Massey Street Children’s hospital in June 2019. The PPS included all in patients receiving an antimicrobial on the day of survey. Data collected included age, gender, antimicrobial agents, microbiological data, and compliance to guidelines, documentation of reasons and stop/ review date of prescription. The denominator was the number of eligible patients. A web-based application developed by the University of Antwerp was used for data- entry, validation and reporting.

Results: Sixty-seven children were eligible, of which 62 (92%) CC –BY 4.0 received 128 antimicrobials. Fifty- seven (85%) were on multiple antimicrobial therapies, and route of administration was parenteral in 86%. All prescriptions were empiric. Reasons for prescribing were documented in 121(94.5%) therapies in case notes; Stop/ review dates were not documented in 126(98.4%). The most frequently prescribed antibiotics we recefuroxime ( 1 8 % ) , Ampicillin-sulbactam (15%) and gentamicin (12%). Antibiotic guidelines were not available. Most common diagnoses were sepsis (42%), pneumonia (15%) and malaria (9%).

Conclusion: This survey revealed very high antimicrobial prescribing rates in the hospital and the need to assess its appropriateness. We disclosed areas to improve antibiotic prescribing: antibiotic prescribing according to guidelines and low reporting of a stop/review date. There is a need to create awareness for evidence based antibiotic guidelines.

Unique triage methods in the paediatric emergency roomof a low resource setting

2023-11-02T08:24:43+00:00

Introduction: Despite its importance in emergency medicine, the practice of triage in low- and middle-income countries remains rudimentary, due to dearth of human and material resources, among other reasons.

Subjects and methods: In the Children Emergency Room of a teaching hospital, some nonclinical staff were intermittently deployed to coordinate patient traffic and provide brief first- contact triage on arrival. For this, they were internally trained in triage. The present study was aimed at assessing the value and accuracy of first-contact triage provided by nonclinical staff in a children emergency department of a tertiary hospital.

Results: Data of 45 patients seen during the period were obtained from the records of the triage officers and included their age, gender, presenting complaints and the findings of the paediatric assessment triangle. There was a statistically significant relationship between the triage ratings of the nonCC –BY 4.0 clinical staff and the qSOFA / L- qSOFA scores obtained by the emergency room doctors, the time spent in CHER and the total duration of admission (R²= 0.36 - 0.44; p = 0.003), (R²= 0.23 - 0.28; p = 0.018) and (R²= 0.33 - 0.40; p = 0.007) respectively.

Conclusion: This study shows that to a high degree, the nonclinical staff correctly categorized the severity of illness in the Paediatric Emergency Department of a tertiary level hospital, thus limiting undue tertiary delay in treatment and potential harm from such delays. Hence, the study exposes a potential source of human resources for paediatric emergency triage in LMICs where there is a dearth of professional medical personnel.

Routine childhood immunization knowledge: Do fathers who accompany their children for immunization differ from those who accompany their children for circumcision?

2023-11-02T08:44:25+00:00

Background: Paternal involvement in child care activities especially immunization is being advocated as their involvement portend better outcomes. Compliance with circumcision another child care activity is much higher than for childhood immunization.

Method: Fathers who accompanied their children for immunization were recruited at the immunization centre while fathers who accompanied their male infants for circumcision were recruited at Accident and Emergency theatre where circumcisions are performed. Demographic information was obtained as well as information on the knowledge of fathers about immunization.

Results: There were 103 fathers accompanying children for immunization and circumcision respectively. Mean age of those who accompanied for immunization 34.47±5.68 years was significantly younger than 36.91±4.54 years for fathers who accompanied for cirCC –BY 4.0 cumcision p<0.0008. Fathers who accompanied for circumcision were significantly more educated p<0.0001 and were significantly more likely to know the names of the vaccines administered and potential side effect s / complications of vaccines. Fathers who accompanied for immunization were significantly more likely to know the age at commencement and completion of immunization although a significant proportion of both groups were not knowledgeable about these dates.

Conclusion: Majority of fathers were not knowledgeable about immunization. All opportunities for contact with fathers especially when they accompany their children for health care activities should be used to educate them about immunization and its importance.

Achalasia cardia: An uncommon cause of aspiration syndrome in infancy

2023-11-02T08:51:58+00:00

Achalasia is a primary oesophageal motility disorder characterized by the absence of Oesophageal peristalsis and impaired lower oesophageal sphincter (LES) relaxation in response to swallowing leading to functional obstruction at the gastroesophageal CC –BY 4.0 junction. It is unusual in childhood and extremely rare in infants. We report a case of Achalasia cardia in a twomonth bold infant treated with anterior oesophago-cardio- gastromyo to my ( Modified Heller’s procedure).

Lightning-strike induced acute injury: A case report

2023-11-02T09:09:41+00:00

Lightning strike injury is a rare but a devastating lifethreatening condition affecting virtually all tissues and solid organs of the body. This can be attributed to the various energy transmission mechanisms from lightning strikes. This include ground strike, contact voltage, side flash, wire-mediated lightning, direct strike and weak upper streamer. Acute lung injury following lightning strike is an uncommon presentation which can manifest as pulmonary oedema, alveolar haemorrhage, pulmonary contusion and acute respiratory distress syndrome. This is a case report of a 15-year-old female, who presented to the Emergency CC –BY 4.0 unit following a lightning strike injury. She presented in coma from the referral centre, markedly dyspnoeic, and eventually admitted into the intensive care unit on account of respiratory failure. Chest radiograph findings showed features in-keeping with non- cardiogenic pulmonary oedema. She was mechanically ventilated, placed on steroids, hydrated, and given antibiotics. Following treatment, respiratory distress resolved and she regained full consciousness. She was discharged home after 11 days of admission.

Meperfluthrin poisoning from mosquito repellent fumes in a 14-year-old Nigerian male adolescent- a case report

2023-11-02T09:38:08+00:00

Mosquito coils, common in resource-constraint countries where mosquito-borne diseases are endemic, are slow- burning sticks that emit smoke containing mosquito repellents, commonly pyrethroids like meperfluthrin. In humans, the documented side effects of inhaled meperfluthrin are few. We report a case of meperfluthrin toxicity following exposure to mosquito coil fumes. A 14-year-old male adolescent developed multiple episodes of vomiting, respiratory distress, and altered consciousness following exposure to mosquito- repellent fumes containing 0.25% meperfluthrin. He had slept on a floor mat CC –BY 4.0 with the burning coil 20cm from his face before the onset of symptoms. He received initial oxygen, steroids, and antibiotics care at a private hospital before being referred to the teaching hospital. At presentation, his Glasgow Coma Score was 12, otherwise normal CNS finding. He developed irrational talk, violent behaviour and insomnia three days later. He recovered fully with supportive care. Excessive inhalation of meperfluthrinfumes maylead to neurotoxicity and pulmonary toxicity.