Kingsley N. Ukwaja

Publications

• Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

  Kingsley Nnanna Ukwaja, Olufemi B Aina, Ademola A Talabi

  Journal of infection in developing countries. 01/2011; 5(3):199-203.

  Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African c... [more] Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African children, necessitating dual IMCI classifications at health centres and treatment with both antibiotics and antimalarials. This study determined the prevalence of malaria-pneumonia symptom overlap and confirmed the diagnosis of malaria in these cases using a rapid diagnostic test. Consecutive consultations of 1,216 children (two months to five years old) were documented over a three-month period in a comprehensive health centre. Malaria rapid diagnostic tests were conducted only for children who had symptom overlap. Of the 1,216 children enrolled, 1,090 (90%) reported cough or fever. Among the children fulfilling the malaria case definition, 284 (30%) also met the pneumonia case definition. Twenty-three percent (284) of all children enrolled met the criteria for both malaria and pneumonia. However, only 130 (46%) of them had a positive result for malaria using a malaria rapid diagnostic test. During a malaria-pneumonia overlap, female children (chi-square 5.9, P = 0.01) and children ≥ one year (chi-square 4.8, P = 0.003) were more likely to seek care within two days of fever. Dual treatment with antimalarials and antibiotics in children with malaria-pneumonia overlap may result in unnecessary over-prescription of antimalarial medications. Use of rapid diagnostic tests in their management can potentially avoid over-prescribing of malaria medications.

  Download

• From DOTS to the Stop TB Strategy: DOTS coverage and trend of tuberculosis notification in Ebonyi, southeastern Nigeria, 1998-2009.

  Kingsley Ukwaja, Isaac Alobu, Ngozi Ifebunandu, Chijioke Osakwe, Chika Igwenyi

  The Pan African medical journal. 01/2011; 9:12.

  Nigeria ranks fourth among the 22 high tuberculosis (TB) burden countries. The estimated incidence of all TB cases in 2009 was 311/100,000 population. Since the implementation of DOTS in Ebonyi state, southeast Nigeria, the epidemiology of TB in the region has not been documented. Therefore, the obj... [more] Nigeria ranks fourth among the 22 high tuberculosis (TB) burden countries. The estimated incidence of all TB cases in 2009 was 311/100,000 population. Since the implementation of DOTS in Ebonyi state, southeast Nigeria, the epidemiology of TB in the region has not been documented. Therefore, the objective of this study was to assess the type and case notification dynamics of TB following DOTS expansion and to examine age- and sex-specific trends in TB notification rate. A retrospective trend analysis of case notification data from the Ebonyi State Ministry of Health records from 1998 to 2009 was conducted. Patients were diagnosed according to the National TB and Leprosy Control Programme guidelines. Denominators for TB notifications were derived from population census data. Of the 24, 475 cases notified between 1998 and 2009, 66% were smear-positive, 31% smear-negative and 3% had extra-pulmonary tuberculosis. Overall, the proportion of new smear-positive cases notified decreased continuously from 67% to 48% in 2009 while that of smear-negative cases increased from 29% to 40% in 2009. In 2005, 13 (100%) of the local government areas were covered by DOTS. Despite initial increase in case notification with DOTS expansion, the case notification rate had a mean annual decline of 3.1% for all TB cases (falling from 123/100,000 to 77/100,000), and of 5% for smear-positive patients (falling from 80/100,000 to 32/100,000). Smear-positive notification rate in children <14 years was consistently low while 25-34-year-old persons were affected most. However, smear-positive rates among persons aged =65 years did not change. Overall, annual new smear-positive notification rates were persistently lower in females than males. TB notification rate shows a decreasing trend in our region with a pool of infectious cases in young-persons. Additional targeted, type and age-/sex- specific interventions for TB control are needed.

  Download

• Outcome of presumptive versus rapid diagnostic tests-based management of childhood malaria - pneumonia overlap in urban Nigeria: a pilot quasi-experimental study.

  Kingsley N Ukwaja, Olufemi B Aina, Ademola A Talabi

  Ethiopian journal of health sciences. 11/2010; 20(3):179-83.

  Symptoms of malaria and pneumonia overlap in African under-five children and the integrated management of childhood illness strategy require that such children be managed presumptively with both antibiotics and antimalarials. A 2003 WHO expert meeting recommended the evaluation of malaria rapid diag... [more] Symptoms of malaria and pneumonia overlap in African under-five children and the integrated management of childhood illness strategy require that such children be managed presumptively with both antibiotics and antimalarials. A 2003 WHO expert meeting recommended the evaluation of malaria rapid diagnostic test in the management of children with this overlap, but this has not been evaluated. Therefore, the objective of this study was to compare the clinical outcome of presumptive versus malaria rapid diagnostic test-based management of childhood malaria-pneumonia overlap in Nigeria. A pilot quasi-experimental study was conducted November 2009 through February 2010 in an urban comprehensive health centre in Ogun, South-Western Nigeria. First, 50 children with malaria-pneumonia symptom overlap were consecutively enrolled and treated presumptively with antibiotics and antimalarials irrespective of malaria test result (control arm).Then, another 50 eligible children were enrolled and treated with antibiotics with/out antimalarials based on rapid diagnostic test result (intervention arm). Primary endpoint: clinical cure at day-5. The data were analyzed using Epi Info version 3.4.1. The intervention and control arms did not differ significantly regarding patient demographic and clinical characteristics. Clinical cure rate was slightly higher in children managed presumptively 49 (98%) than those managed rapid diagnostic test -based 47 (94%) (P = 0.31). However, rapid diagnostic test -based treated children had lower risk of receiving antimalarials compared to those treated presumptively (48% vs. 100%), (P = <0.001; relative risk 2.08, CI 1.56 to 2.78). No death or severe complications were recorded in either group at day-5 follow-up. Outcome of rapid diagnostic test-based treatment is not inferior to presumptive management in children with malaria-pneumonia symptom overlap. More extensive studies with larger sample sizes are needed.

• Home management of acute respiratory infections in a Nigerian district.

  Ukwaja KN, Olufemi OA

  Afric J Resp Med. 01/2010; 6:18 - 22.

  Globally, over 2 million children die annually from acute respiratory infections (ARIs) especially pneumonia. ARI symptoms (cough and difficult/fast breathing) frequently overlap with those of malaria. In Nigeria, children with these pneumonia symptoms are frequently overlooked by the home managemen... [more] Globally, over 2 million children die annually from acute respiratory infections (ARIs) especially pneumonia. ARI symptoms (cough and difficult/fast breathing) frequently overlap with those of malaria. In Nigeria, children with these pneumonia symptoms are frequently overlooked by the home management strategy that seeks to treat all childhood fevers as malaria. The aim of the study was to determine the prevalence of overlap of fever and ARI symptoms, the timeliness of care-seeking and the type of care sought for ARI with or without fever at community level. From a district, 420 households with 420 children aged over 5 years who had been sick with cough within 2 weeks of the survey were selected through systematic random sampling and their carer interviewed about the child’s illness. Of the 413 children who had been sick with cough, 21% reported overlapping symptoms of fever, cough and difficult/fast breathing (DFB). Of these, 27% received antimalarials alone. Sixty percent of children with ARI received antibiotics and 59% received care within 24 hours of symptom recognition. Carers of infants and children with DFB were more likely to seek care within 24 hours of symptom recognition (both p <0.001). Most (45%) of the antibiotics used were obtained from patent medicine dealers. It was concluded that a large percentage of children have malaria and pneumonia symptom overlap; and a significant proportion of these cases are mismanaged as malaria in the community. The role of patent medicine dealers in recognising and appropriately treating ARI should be explored.

  Download

• Typhoid fever presenting as a depressive disorder--a case report.

  Kingsley N Ukwaja

  Rural and remote health. 10(2):1276.

  Neuropsychiatric complications associated with typhoid fever are relatively common in the tropics; however, typhoid fever with associated depression is rare and can present a diagnostic challenge to rural clinicians. This case report describes a 12 year old female with no documented psychiatric hist... [more] Neuropsychiatric complications associated with typhoid fever are relatively common in the tropics; however, typhoid fever with associated depression is rare and can present a diagnostic challenge to rural clinicians. This case report describes a 12 year old female with no documented psychiatric history who developed signs and symptoms of delirium with depressive elements while also infected with typhoid fever. At the time of presentation to a community health centre in Abeokuta, Nigeria, the patient had been misdiagnosed as suffering from primary psychiatric morbidity and therefore mismanaged. Following investigation and appropriate therapy she made a complete recovery. A rural physician working in an area with an inadequate safe water supply can expect to encounter several cases of typhoid fever with neuropsychiatric presentation. In order to make a correct diagnosis clinicians must maintain a high index of suspicion of primary medical morbidity in patients presenting with depressive features associated with a febrile illness.

  Download