Dr. Ibrahim Rasheed Olayinka

Background Despite recurrent outbreaks of diphtheria in Nigeria, there is a lack of in-depth analysis of hospitalization outcomes. Herein, we describe the sociodemographic, clinical, and laboratory features associated with hospitalization outcomes (defined as death or discharge) during the recent diphtheria outbreak in Nigeria. Methods This prospective observational study included 246 confirmed diphtheria cases managed in a dedicated isolation ward of a health facility in northwestern Nigeria from July 1, 2023, to April 30, 2024. We analyzed clinical and laboratory features, immunization status, and socio-demographics in relation to hospitalization deaths using SPSS version 29. Results The median age (interquartile range) was 7.00 (4–10) years and 49.6% (122) were aged 5–10 years. Common clinical features were fever (95.9%), sore throat (91.9%), painful swallowing (90.7%), pseudomembrane (93.1%), and cervical-submandibular lymphadenopathy (91.5%). Most children were unvaccinated (158; 64.2%), 199 (80.9%) received diphtheria antitoxin, and both were related to outcomes. Mortality rate was 23.5% (58/246). After adjusting for confounders, predictors of hospitalization deaths were neck swelling with an adjusted odds ratio (AOR) of 9.80 (95% CI 1.68–56.47), abnormal respiratory findings (AOR, 149.99 [95% CI, 15.60–1442.02] ), hypoxemia (AOR, 37.79 [95% CI, 4.26–331.96] ), and elevated serum creatinine above 1.5 mg/dL (AOR 107.78, 95% CI, 7.94–1462.38). Conclusions Diphtheria is a significant burden in Nigeria, particularly among children. Neck swelling, hypoxemia, abnormal respiratory findings, and impaired renal function were predictive of hospitalization death. Although antitoxin and vaccination were related to outcomes, they did not predict hospitalization death.

Background: Malaria is a major cause of mortality among children. Objective: This study determines the clinical profile, outcome (discharge and death), and factors associated with poor outcome in children with severe malaria in a tertiary health facility in Northern Nigeria. Methods: We conducted a descriptive retrospective study of all children (≤14 years) admitted with severe malaria based on positive malaria parasite on thick film and or rapid diagnostic test and the World Health Organization guideline for severe malaria. We extracted relevant data from patients’ case files and departmental records and analyzed with the Statistical Package for the Social Sciences (SPSS) for Windows, version 20.0. (IBM Corp, Armonk, NY). Results: A total of 483 children with severe malaria were admitted with median age interquartile range of 4.0 (2.5–8.0) years. Males were 261 (54.0%). Underfives were 258 (53.4%). Common forms of presentation were cerebral malaria 169 (35.0%), prostration (102; 21.1%), and multiple convulsion (86; 17.8%). Cerebral malaria and prostration were significantly higher among children aged 5 years and older. The mortality rate was 4.3% (21). Multivariate logistic regression analyses showed that impaired consciousness (adjusted odds ratio [aOR] 8.5, 95% confidence interval [CI]: 2.345, 30.484), hypoglycemia (aOR: 21.4, 95% CI: 2.766, 165.410), presence of two or more components (aOR: 4.5, 95% CI: 1.630, 12.522), and duration of hospitalization of 24 h or less (aOR: 4.6, 95% CI: 1.621, 12.782) were independent predictors of poor outcome. Conclusion: Our study showed that cerebral malaria was the most common form of severe malaria with a significant burden in children above 5 years. The presence of impaired consciousness, hypoglycemia, multiple components, and duration of <24 h on admission were predictive of death.