Summary: Six children with AIDS, aged between eight and 27 months, are reported. As these patients and their mothers were HIV-positive, the mode of transmisssion was considered to be vertical. In the seventh, well and asymptomatic, but HIV-positive infant, transmission of the infection was through transfusion of contaminated blood that was donated by an HIV-positive father. Of the three fathers screened, two tested positive for HIV. Four of the seven HIV positive infants originated from the Cameroon, while three were resident in Nigeria. The disease manifested within the first four months of life in five patients and at the age of 14 months in one patient. Marasmic features, chronic diarrhoea, pneumonia, generalized lymphadenopathy, oropharyngeal candidiasis and dermatoses were the main clinical features. Management of the patients and the families included symp tomatic treatment and counselling. Four of the patients died, three of these in the hospital and one at home.

Thhis study presents findings from a nationwide survey of Board-certified pediatric infectious disease specialists (PIDS). The purpose of the survey was to learn about PIDS' antibiotic-prescribing habits for children with upper respiratory tract infections, using clinical vignettes followed by multiple-choice questions. In addition, we compared the responses of PIDS to responses from our previously published survey of pediatricians (PD) and family practitioners (FP) that used a similar format and identical questions.'

OBJECTIVE:To document the frequency and severity of various types of rashes seen with commonly used oral antibiotics in the pediatric outpatient setting.DESIGN:A retrospective review of 5923 patient records at a pediatric office.SETTING:A private group pediatric practice in northern Virginia with about 12,000 registered active patients.PATIENTS AND METHODS:Approximately 50% of the clinic medical records were reviewed. All children (defined as those aged 0-18 years in this study) identified on their medical records as having developed a rash following treatment with 1 or more of the commonly used oral antibiotics were included in the study. For further validation, a questionnaire about parental recollection of description of rash, other associated symptoms, physician verification, and outcome was mailed to families with children designated as being allergic to an antibiotic.RESULTS:On a prescription basis, significantly more rashes were documented for cefaclor (4.79%) compared with penicillins (2.72%), sulfonamides (3. 46%), and other cephalosporins (1.04%). Based on the number of patients for whom each group of antibiotic was prescribed, the documented frequencies of rashes were 12.3%, 7.4%, 8.5%, and 2.6% for cefaclor, penicillins, sulfonamides, and other cephalosporins, respectively. None of the children had rashes severe enough to require hospitalization.CONCLUSIONS:In a review of almost 6000 records in a private pediatric primary care setting, rashes occurred in 7.3% of children who were given the commonly used oral antibiotics. Significantly more rashes were documented with cefaclor use than with use of any of the other oral antibiotics.

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.

From January through December 1988 the causative factor of each case of childhood seizure seen in the Children's Emergency Room of the University of Calabar Teaching Hospital, Calabar, Nigeria, was prospectively studied with a focus on the relative importance of malaria-related seizures. Of the 134 seizure cases seen, febrile convulsion (FC) formed the majority (55%) with cerebral malaria (CM) as the only major (33%) rival. Other conditions such as meningitis, epilepsy, hypoglycaemia and drug poisoning together (12%) played a minor role. Malaria was the dominant cause (73%) of FC; 81% of these cases did not respond to chloroquine. On comparing the number of cases of CM accumulated in the same unit from 1986, there was a significant increase (P < 0.001) in the proportion of yearly CM admissions from 1986 through 1988. The study confirms the premier position of malaria in the causation of childhood seizures and also suggests a possible upsurge in the prevalence of CM in the environment. This upsurge probably derives from the emergence of chloroquine-resistant Plasmodium falciparum (CRPF) reported in Nigeria which appeared to have been identified in the present study. While more studies are needed to confirm this hypothesis, clinicians in areas of CRPF are alerted about a possible upsurge in CM in their locality.

The knowledge of and attitude to acquired immunodeficiency syndrome (AIDS) of 738 secondary school youths in Calabar were studied by questionnaire in March 1991. Most (92%) of the adolescents had heard about AIDS, largely through the mass media (79-85%), with parents and teachers contributing in less than 40%. About 30% did not know that AIDS exists in Nigeria. Most of them knew that promiscuity, blood transfusion and sharing injection needles and syringes are the major modes of transmission, but a number still incriminate toilet seats, eating utensils, hand-shaking and kissing. Only 31% were aware that condoms provide protection. For self-protection the youths prefer abstinence (45%) and confinement to one sex partner (19%). Only 3.6% would adopt the use of condoms. To prevent the spread of AIDS, the youths prescribe isolation (37%), treatment (34%), and killing (14%) of diagnosed cases. Most youths (77%) will stop seeing friends and 63% will reject relatives who develop AIDS. The study reveals that while general awareness of AIDS is fairly good, detailed knowledge is riddled with misconceptions and confusion. It is recommended that physicians in the community should assist in disseminating accurate information, with the support of parents, teachers and the youths themselves.

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.

Children admitted with measles to the University of Calabar Teaching Hospital, Calabar, Nigeria, were studied to determine the influence of the Expanded Programme on Immunization (EPI), launched in Nigeria in 1984. The data suggest a downward trend in the overall incidence of measles in the first 4 years of the campaign. However, compared with a previous study period (June 1981 to May 1983) in the same institution, the proportion of measles victims aged below 9 months had increased from 15 to 21 percent and the overall death rate had increased sevenfold. Delay in administering the measles vaccine (9 instead of 6 months) and the deteriorating nutritional status of Nigerian children probably account for this negative impact. The advantages of altering the immunization age for measles from 6 to 9 months have not been fully established in Nigeria yet.