Prevalence and pattern of functional gastrointestinal disorders among secondary school adolescents in Lagos, Nigeria

BACKGROUND

Limited data exist on functional gastrointestinal disorders (FGIDs) among sub-Saharan African children. This study aimed to determine FGID prevalence and pattern among secondary school adolescents in Lagos, Nigeria.

METHODS

This descriptive cross-sectional study was conducted among adolescents aged 10-18 years in Isolo, Lagos, Nigeria from December 2020 to March 2021. A multi-stage sampling technique was used to select a total of 696 students from four secondary schools. Data were collected using a specifically designed questionnaire, the ROME IV questionnaire (QPGS-IV), and analyzed using the Statistical Package for the Social Sciences (SPSS) version 24.

RESULTS

The mean age of the adolescents was 13.6 ± 2.1. A total of 221 (31.8%) adolescents fulfilled the criteria for at least one of the FGIDs. The most common FGIDs were functional constipation (10.1%), functional dyspepsia (9.4%) and abdominal migraine (8.6%). There was no significant difference in the overall prevalence of FGIDs between age groups (p = 0.07) and genders (p = 0.949). However, the prevalence of FGID sub-types showed that abdominal migraine, irritable bowel syndrome and functional non-retentive fecal incontinence were significantly higher in the age group 10-12 years (p = 0.045, p = 0.029 and p = 0.027, respectively) while only functional vomiting was significantly higher in male compared to female (p = 0.038).

CONCLUSION

FGIDs are common among adolescents in Lagos, Nigeria. The pattern of FGIDs shows similarities and differences with reports from other parts of the world. Healthcare workers must be aware of these disorders to provide optimal care.

Effect of a Fortified Dairy-Based Drink on Micronutrient Status, Growth, and Cognitive Development of Nigerian Toddlers- A Dose-Response Study

Malnutrition results in a high prevalence of stunting, underweight, and micronutrient deficiencies. This study investigated the effect of a multi-nutrient fortified dairy-based drink on micronutrient status, growth, and cognitive development in malnourished [height-for-age z-score (HAZ) and/or weight-for-age z-score (WAZ) < -1 SD and >−3 SD] Nigerian toddlers (n = 184, 1–3 years). The product was provided in different daily amounts (200, 400, or 600 ml) for 6 months. At baseline and endline, venous blood and urine samples were collected to determine micronutrient status. Bodyweight, height, waist, and head circumference were measured, and corresponding Z-scores were calculated. The Bayley-III Screening Test was used to classify the cognitive development of the children. In a modified per-protocol (PP) population, the highest prevalence's of micronutrient deficiencies were found for vitamin A (35.5%) and selenium (17.9%). At endline, there were no significant improvements in iodine, zinc, vitamin B12, and folate status in any of the three groups. Regarding vitamin D status (25OHD), consumption of 600 and 400 ml resulted in an improved status as compared to baseline, and in a difference between the 600- and 200-ml groups. Consumption of 600 ml also increased vitamin A and selenium status as compared to baseline, but no differences were found between groups. Within the groups, WAZ, weight-for-height z-score (WHZ), and BMI-for-age z-score (BAZ) improved, but without differences between the groups. For HAZ, only the 600 ml group showed improvement within the group, but it was not different between groups. For the absolute weight, height, and head circumference only trends for differences between groups were indicated. Cognition results did not differ between the groups. Within groups, all showed a decline in the per cent of competent children for receptive language. To study the effects of a nutritional intervention on linear growth and cognition, a longer study duration might be necessary. Regarding the improvement of micronutrient status, 600 ml of fortified dairy-based drink seems most effective.

Congenital cytomegalovirus infection as an important cause of infantile cholestatic jaundice: a case report

Infantile cholestasis has numerous causes and diagnosis can be difficult, especially in low-income countries where essential laboratory facilities are not readily available. This is a report of a baby who had severe conjugated neonatal hyperbilirubinaemia and deranged liver function tests, which posed a diagnostic dilemma before a diagnosis of congenital cytomegalovirus (CMV) infection was made. He was treated with Ganciclovir and responded well to treatment. He had no obvious associated neurologic manifestation of the disease and is presently been followed-up. This report highlights the challenges encountered in the diagnosis and management of the baby, as well as the favourable outcome with Ganciclovir therapy. The aim of the report is to increase the awareness of paediatricians and other stakeholders on congenital CMV infection in order to ensure early diagnosis and appropriate treatment of affected babies, with the ultimate aim of improving their prognoses and preventing the associated audiologic and cognitive sequelae.

Off-label prescribing for children with chronic diseases in Nigeria; findings and implications

BACKGROUND

Prescribing medicines in an off-label manner for children with chronic conditions is sparsely documented, even more so among developing countries. This needs addressing. The objective of this research was to investigate the extent of off-label prescribing among children with epilepsy, asthma, and sickle cell anaemia in Nigeria.

METHODS

Prescriptions for children ≤16 years documented in their case files that attended paediatric clinics in Lagos, Nigeria, for these three conditions between January and October 2015, were reviewed retrospectively to extract data on the medicines prescribed. British National Formulary for children and American Hospital Formulary Service Drug information were used as references.

RESULTS

477 patients received 1746 prescriptions. Off-label prescriptions were seen in 7.7% of prescriptions, related to dose (93; 68.9%), indication (22; 16.3%), and age (20; 14.8%). Nervous system (525; 30.1%) and anti-infective (441; 25.2%) medicines were the most prescribed but only 9.5% and 8.2% of the respective prescriptions were off-label. Children with epilepsy received the most number (94; 69.6%) of off-label prescriptions. The three chronic conditions did not associate significantly with the category of off-label medicine prescribed (p = 0.925).

CONCLUSION

Off-label prescribing for children with epilepsy, asthma and sickle cell anaemia occurs. Encouragingly, the overall rate appears low in Nigeria.

Potential drug-drug interactions in paediatric outpatient prescriptions in Nigeria and implications for the future

BACKGROUND

Information regarding the incidence of drug-drug interactions (DDIs) and adverse drug events (ADEs) among paediatric patients in Nigeria is limited.

METHODS

Prospective clinical audit among paediatric outpatients in four general hospitals in Nigeria over a 3-month period. Details of ADEs documented in case files was extracted.

RESULTS

Among 1233 eligible patients, 208 (16.9%) received prescriptions with at least one potential DDI. Seven drug classes were implicated with antimalarial combination therapies predominating. Exposure mostly to a single potential DDI, commonly involved promethazine, artemether/lumefantrine, ciprofloxacin and artemether/lumefantrine. Exposure mostly to major and serious, and moderate and clinically significant, potential DDIs. Overall exposure similar across all age groups and across genders. A significant association was seen between severity of potential DDIs and age. Only 48 (23.1%) of these patients presented at follow-up clinics with only 15 reporting ADEs.

CONCLUSION

There was exposure to potential DDIs in this population. However, potential DDIs were associated with only a few reported ADEs.

Head circumference of children with sickle cell disease in Lagos, Nigeria

Introduction

Growth retardation and under-nutrition are common in children with sickle cell disease (SCD). The aim of this study was to compare the head circumference (HC) of SCD children and non-SCD children and to determine the effect of malnutrition on head circumference of children with SCD.

Methods

This was a prospective case-control study conducted at the Lagos State University Teaching Hospital, Nigeria, involving SCD children (subject, n = 118) and non-SCD children (control, n = 118) matched for age, sex, and socioeconomic status. Weight, height and HC were measured using standard techniques.

Results

The mean ages of children with and without SCD were 7.46 ± 3.69 years and 7.01 ± 3.58 years, respectively. The HC increased significantly with age in both males and females (r = 0.75, p = < 0.001; r = 0.70, p < 0.001 respectively). There was no significant difference in HC between males and females (p > 0.05). At all ages, the mean head circumference of SCD children was not significantly (p > 0.05) different from non-SCD children. The In the age group 11-15 years, the prevalence of stunting was significantly higher among SCD children than non-SCD children. The mean HC of SCD children with stunting was significantly lower than those not stunted (51.7 vs. 53.5; P= 0.006) in age group 11.15 years.

Conclusion

The head circumference of children with SCD is not significantly different from that of non-SCD children. Therefore, the HC chart for the general population is also applicable for monitoring head growth in children with SCD. The effect of malnutrition on head circumference of SCD children is most marked in age group 11-15 years.

Upper arm composition and nutritional status of school children and adolescents in Abeokuta, Southwest Nigeria

BACKGROUND

Upper arm composition is a reflection of body protein and calorie reserves. However, there is a paucity of data on upper arm composition of children from African countries, including Nigeria. This study aimed to determine the composition of upper arm and nutritional status of school children in Abeokuta, Nigeria and to compare with international reference standards. The sensitivity and specificity of upper arm muscle area by height (UAMAH) as a nutritional assessment tool was also determined.

METHODS

Five hundred and seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, mid-upper arm circumference (MUAC) and triceps skin fold thickness (TSF) were measured. Body mass index, upper arm muscle area (UAMA), upper arm fat area (UAFA), fat percentage and UAMAH were derived.

RESULTS

The TSF, UAFA and fat percentage were significantly higher in females than males at each age group. MUAC and UAMA were significantly higher in female children aged 10-14 years, whereas UAMA was significantly higher in male children aged 15-19 years. UAMA and UAFA of the children were lower than those of Americans but similar to those of Zimbabweans, and higher than those of Indians. The sensitivity and specificity of UAMAH for detecting wasting were 80.8% and 63.9%, respectively, whereas the corresponding values for stunting were 32.2% and 58.2%, respectively.

CONCLUSIONS

The school children studied have a combination of poor calorie and protein reserve. UAMAH may be a valuable tool for complete evaluation of the nutritional status of school children.

Use of complementary medicines among HIV-infected children in Lagos, Nigeria

BACKGROUND

Complementary medicine (CM) use is common among children with chronic illnesses such as epilepsy and asthma. Lack of data on the profile of CM use among children with human immunodeficiency virus (HIV) infection necessitated this study.

METHODS

Parents or caregivers of HIV-infected children attending the paediatric HIV-clinic in a teaching hospital in Lagos, Nigeria, were randomly selected and interviewed with a semi-structured (open- and close-ended) questionnaire. Clinical details of the patients were extracted from their case files.

RESULTS

A total of 187 parents/caregivers were interviewed. Most of the parents/caregivers (181; 96.8%) have used CMs for their children. Mind-body interventions (181; 36.6%) and biological products (179; 36.2%) were frequently used. Relatives, friends and neighbours influenced CM use in 37.1% of the children. CMs were used mostly to treat weight loss (79; 43.7%), cold (40; 22.1%), and fever (39; 21.6%).

CONCLUSION

CM use is common among HIV-infected children in Lagos.

Obesity and blood pressure levels of adolescents in Abeokuta, Nigeria

BACKGROUND

We determined the prevalence of general and central obesity and their relationship with blood pressure levels among adolescents in Abeokuta, Nigeria.

METHODS

We selected 423 adolescents from seven schools in Abeokuta, Nigeria, using a multistage random-sampling technique. Body mass index (BMI), waist circumference (WC) and blood pressures were measured.

RESULTS

Twenty-one (5%) children had general obesity and 109 (24.5%) had central obesity. Of those with general obesity, 20 (95.1%) children were centrally obese. With simple linear regression analysis, BMI and WC explained 10.7 and 8.4%, respectively of the variance in systolic blood pressure (SBP), and 3.6 and 2.7%, respectively of the variance in diastolic blood pressure (DBP). Following logistic regression analysis, BMI was the major factor determining SBP levels (OR 0.8, 95% CI: 0.65-0.99, p < 0.05).

CONCLUSION

BMI remains an important anthropometric screening tool for high blood pressure in Nigerian adolescents.

Changes in the nutritional status of school children and adolescents in Abeokuta, Nigeria between 1983 and 2006

BACKGROUND

The prevalence of overweight and obesity among children is increasing worldwide with significant health and social consequences.

OBJECTIVE

The aim of this study was to determine the current nutritional status and its changes between 1983 and 2006 among school children and adolescents in a south western Nigeria town.

METHODS

five hundred and seventy children aged 5 to 19 years from randomly selected primary and secondary schools in Abeokuta, Nigeria had their weights and height measured using standard techniques. The data obtained were compared with data obtained from a similar cross sectional survey carried out in 1983. The National Centre for Health Statistics/World Health Organisation guidelines and cut-off points were used to determine the degree of underweight and stunting. Obesity prevalence was assessed using weight for age greater than 120 % of expected.

RESULTS

The mean age of the participants was 12.2 + 3.41 years, 296 (51.5 %) were males. The mean Weight-for-Age Z -score and Height-for-Age Z-score were -1.2773 + 1.14 and -0.8569 + 1.19 respectively. The prevalence rates of underweight and stunting were 24.7 % and 17.4 % respectively. Using weight greater than 120 % of expected weight for age, five (1.7 %) male and 7 (2.6 %) female children were obese compared to 3.3 % male and 5.1 % female children who were obese in 1983.

CONCLUSIONS

The prevalence of overweight and obesity has remained relatively unchanged between 1983 and 2006. However,under-nutrition remains a major nutritional problem among school children and adolescents in Abeokuta, Nigeria.

Tumor lysis and acute renal failure in Burkitt's lymphoma: A review on pathophysiology and management

Morbidity and mortality in patients with hematologic malignancies are significantly increased by development of acute renal failure. This is more likely in the developing world where facilities for renal replacement therapy are scarce. This review discusses the pathophysiology of acute renal failure due to tumor lysis syndrome in patients with Burkitt's lymphoma, the commonest hematological malignancy in the pediatric age group in sub-Saharan Africa, and evaluates the possible management options. Tumor lysis can also develop in association with other hematologic malignancies, both spontaneously and following treatment, and these principles are applicable in all such cases.

Micturitional dryness and attitude of parents towards enuresis in children attending outpatient unit of a tertiary hospital in Abeokuta, Southwest Nigeria

BACKGROUND

There is significant variability of the age at which children achieve dryness.

OBJECTIVES

We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children.

METHOD

A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre, Abeokuta.

RESULTS

At age 36 months, 86 (51.8 %) and 34 (20.5 %) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p = 0.009). Twenty-four (26.7 %) children had nocturnal enuresis. Four (4.4 %) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8 % correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem, a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015).

CONCLUSIONS

The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore, health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class.

Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria

CONTEXT AND OBJECTIVES

Adverse drug reactions (ADRs) may cause prolonged hospital admissions with high treatment costs. The burden of ADRs in children has never been evaluated in Nigeria. The incidence of pediatric ADRs and the estimated cost of treatment over an 18-month period were determined in this study.

DESIGN AND SETTING

Prospective observational study on children admitted to the pediatric wards of the Lagos State University Teaching Hospital (LASUTH) in Nigeria, between July 2006 and December 2007.

METHODS

Each patient was assessed for ADRs throughout admission. Medical and non-medical costs to the hospital and patient were estimated for each ADR by reviewing the medical and pharmacy bills, medical charts and diagnostic request forms and by interviewing the parents. Cost estimates were performed in 2007 naira (Nigeria currency) from the perspectives of the hospital (government), service users (patients) and society (bearers of the total costs attributable to treating ADRs). The total estimated cost was expressed in 2007 United States dollars (USD).

RESULTS

Two thousand and four children were admitted during the study; 12 (0.6%) were admitted because of ADRs and 23 (1.2%) developed ADR(s) during admission. Forty ADRs were suspected in these 35 patients and involved 53 medicines. Antibiotics (50%) were the most suspected medicines. Approximately 1.83 million naira (USD 15,466.60) was expended to manage all the patients admitted due to ADRs.

CONCLUSIONS

Treating pediatric ADRs was very expensive. Pediatric drug use policies in Nigeria need to be reviewed so as to discourage self-medication, polypharmacy prescription and sales of prescription medicines without prescription.

Providing safe medicines for children in Nigeria: The impediments and remedies

Promoting safety of medicines for children is a global concern which has prompted the World Health Organization (WHO) to launch a campaign of "Making Medicines Child Size". Children in Nigeria were once victims of unethical clinical medicine trials and repeated victims of use of fake and adulterated medicines. Considering the magnitude of harms children had suffered in Nigeria from the use of medicines, there is a need for literature review to identify the factors preventing children from accessing safe medicines and to suggest remedies to the problems. Lack of access to up- to- date medicine information, lack of training and research in pediatric clinical pharmacology, deficiencies in undergraduate and postgraduate teaching of medicine risk management and clinical pharmacology and therapeutics, irrational medicine use due to lack of pediatric focus on essential medicine list and inappropriate home storage of medicines by parents, lack of evidence- based medicine (EBM) practice, lack of national adverse drug reaction surveillance among children, and weak national drug policies were the major problems identified. It is to be hoped that development and provision of a pediatric national drug formulary for health professionals in Nigeria, creating a comprehensive national pediatric drug research network in collaborations with developed countries, reviewing the undergraduate and postgraduate curriculum in pediatrics to include teaching of basic elements of rational prescribing, drug dose calculations, adverse drug reactions and pharmacovigilance, increasing access to essential medicines for children, postgraduate teaching of EBM, and strengthening of the national drug policies would improve children's access to safe medicines in Nigeria.

Parental reporting of suspected adverse drug reactions in children in Lagos, Nigeria

OBJECTIVES

To determine the feasibility of parental reporting of suspected adverse drug reactions (ADRs) to community pharmacies in Nigeria.

METHODS

Fifteen registered pharmacies were randomly selected in Lagos, Nigeria. Caregivers who procured antibiotics, antimalarials, paracetamol or ibuprofen for a child up to 12 years of age in these pharmacies between July and September 2007, were asked to report suspected ADRs in their child by filling in a questionnaire given to them by the pharmacist. If the caregivers suspected an ADR within 5 days of administering the medicine, they were asked to return the questionnaire within the following 7 days.

RESULTS

9023 drugs were procured for 2868 children (1807 (63%) of whom were male) and 689 (8%) of these drugs were administered by injection. Antibiotics (1975, 24%) were the most frequently procured type of drug of the four groups surveyed (antibiotics, antimalarials, paracetamol and ibuprofen) and chloroquine (445, 46%) was the most frequently procured antimalarial. 509 (18%) caregivers reported 575 suspected, mostly mild, ADRs (509 to antibiotics, 42 to antimalarials and 24 to analgesics). The two most frequently reported suspected ADRs were diarrhoea in 292/575 (51%) children and skin rashes in 103/575 (18%). The overall prevalence of ADRs in these children was 509/2868 (18%).

CONCLUSION

Parental reporting of suspected ADRs to antibiotics, antimalarial and analgesics in their children is feasible in Nigeria. This method of pharmacovigilance should be used more extensively.

Waist circumference values of Nigerian children and adolescents

AIMS

This study aimed to determine the waist circumference (WC) of apparently healthy Nigerian children and adolescents and to compare the obtained values with available data for children from other parts of the world.

METHODS

A representative sample of children from 7 schools in Abeokuta, a state capital in South West Nigeria, was selected using the multi-staged random sampling technique. The sample population consisted of 570 children with ages ranging from 5 to 19 years.

RESULTS

WC increased with age in both sexes. The mean value of WC of children aged 5-9 years was about the same in both sexes (p = 0.113). However, in children older than 9 years, females had higher WCs than males (p = 0.000). Comparison of the 50th percentile WC of Nigerian children with that of American and Spanish children showed that both Nigerian male and female children had the lowest WC values. However, the values were similar to British male children up to 9 years and female children up to 14 years.

CONCLUSION

The WC value varied with age, sex and race. These data are expected to serve as a baseline against which future data can be compared.

The pattern of malaria infection in under-fives in Ile-Ife, Nigeria

Over 90% of the burden of malaria occurs in sub-Saharan Africa. Children, especially under-fives, are the most vulnerable. In Nigeria, Africa's most populous nation, it accounts for 25 and 30% of infant and childhood deaths, respectively. One hundred and seventy-six children who fulfilled clinical and parasitological criteria for the diagnosis of malaria, 26.4% of all under-fives, who presented to the Seventh Day Adventist Hospital in Ile-Ife during the months of May to September 2005 were studied to identify the factors that were associated with severe malaria in the target population. The proportion of children with severe malaria in the study was 17%, while the case-fatality rate was 3.5%. Of the 17 variables examined, high malaria parasite density, non-use of mosquito-bite preventive measures and poverty remained independently and significantly associated with an increased risk for severe malaria. Progress in stemming the burden of malaria depends on accurate knowledge and understanding of the epidemiology and control of the disease in the affected populations.

Low prevalence of malnutrition in a rural Nigerian community

This study was carried out to determine the prevalence of malnutrition in a rural Nigerian community. Using the modified Wellcome Classification, the prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of underweight, wasting and stunting were 23.1%t, 9% and 26.7%, respectively. The low prevalence of PEM in this rural Nigerian community may be due to the services and intervention provided by a non-governmental organization in the community. This method of intervention is similarly achievable in any other community.

A-5 year review of cerebral malaria in nigerian children

BACKGROUND

Cerebral malaria is thought to be common in the under fives in a malaria holoendemic region like ours. But we are recently seeing cases of cerebral malaria in children older than 5 years. This study was carried out to determine the Morbidity And Mortality Pattern Of Cerebral Malaria.

MATERIALS AND METHODS

This was a retrospective review of cases of cerebral malaria seen over a five-year period (1999-2003) at the Paediatrics Department of the Obafemi Awolowo University Teaching Hospital Complex Ile-Ife. All case notes of patients admitted with a diagnosis of cerebral malaria were retrieved and relevant data extracted to a standard form.

RESULTS

One hundred and fifty four (154) patients were managed as cerebral malaria, out of a total of 5,456 admissions over this period. Eighteen were aged less than one year, 128 were aged 1-5 years while eight were aged >5 years. Eight of the 154 patients died (5.2%). However 16 (10.3%) had various neurological deficits at discharge.

CONCLUSION

Cerebral malaria is still a major complication of malaria in our practice and it is no longer a problem of under-five children alone.

Prevalence of overweight and obesity in Nigerian preschool children

The problem of obesity is taking a worldwide dimension. However, there is paucity of data on obesity in Nigerian children. This study was therefore conducted to determine the prevalence and factors associated with overweight and obesity among Nigerian preschool children. A total of 270 children were recruited from 216 households using multistage cluster sampling technique. The prevalence of overweight and obesity were 13.7% and 5.2% respectively while the prevalence of underweight was 8.5%. Although, there was no statistically significant relationship between exclusive breastfeeding for 6 months, duration of breastfeeding and the prevalence of overweight (P = 0.569, 0.669 respectively), the prevalence of overweight decreases with increase in the duration of breastfeeding. Ninety-nine (36.3%) children were given infant formula feeds with 92 (93.9%) children introduced to infant formula feeds before the age of 6 months. The use of infant formula feeds was significantly associated with reduction in the prevalence of overweight (P = 0.041). No linear relationship was detected in the association between overweight and socioeconomic class. The population shows heterogeneity in their nutritional problem by having mixture of obesity and underweight. There is need for trend of obesity to be monitored so that timely intervention will be taken and associated morbidity and mortality from obesity prevented.

The use of antimalaria drugs and insecticide treated nets in Ile-Ife, Nigeria

BACKGROUND

The Roll Back Malaria Initiative (RBMI) is aimed at halving the malaria mortality in the year 2010 using prompt diagnosis and treatment of malaria and the use of Insecticide Treated Nets (ITNs).

METHODS

This is a cross sectional study of children aged 1 month to 14 years with confirmed malaria to assess the burden of malaria and to evaluate the home use of anti-malarial drugs and ITNs among children with malaria in Ile Ife, Nigeria.

RESULTS

Of the total of 1047 children seen, 190 (18.1%) had malaria and were surveyed. Complications were present among 74 (38.9%) children and a significantly higher of the under-fives had complications (p by Fisher's exact test = 0.0018). Chloroquine was administered to 63 (67.0%) children within the first 24 hours of the illness although only 25 (26.6%) children had the correct dosage. One hundred and fifty three (80.5%) were aware of the use of untreated bed nets in preventing malaria while 38 (20.0%) and 4 (2.1%) were aware of ITNs and used ITNs respectively. The awareness of ITNs increased with increasing maternal education.

CONCLUSION

Awareness of the parents about ITNs and their use are poor. Health education on appropriate antimalarial drug use and ITN use should be intensified. ITNs should be made more widely available.

Management of pain in children: a review of the literature

BACKGROUND

Pain is a very common situation encountered in clinical practice. It is as common in children as in adults and often it is underevaluated and undertreated. The aim of this review is to stimulate and sensitize paediatricians and other child health care providers to the importance and necessity of adequate appreciation, evaluation, and management of pain in children.

METHODS

Review of the pertinent literature. Selected references to highlight the mechanism of pain, pain assessment tools and therapeutic approach to management, were included in this review.

RESULTS

Pain in children is underevaluated and undertreated. This is so even in developed countries. A study put the prevalence of pain among children at 26%, and that two out of every three patients with pain were not detected, and that one out of three patients detected received no treatment. Popular dogma held that the human child does not feel pain and that giving the child powerful analgesics may lead to addiction. Despite the availability of several pain assessment tools, they are under used in paediatric practice. Pain pathways develop in the second trimester, so the smallest neonate is able to respond to noxious stimulation.

CONCLUSION

Childhood pain is still underevaluated and under treated. The adequate management of pain in children is an important factor in better outcome of childhood illnesses.

Childhood poisoning at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria

A retrospective study of children admitted into the Children Emergency Room of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 1989 and 1998 was undertaken. There were 127 cases constituting 0.52% of the total paediatric admissions over the study period. Poisoning was commoner among the lower socioeconomic classes and in males than females. 102 (80.3%) of the children involved were below the age of five years and poisoning was unintentional in 98.4%. Kerosene was the commonest agent accounting for 40.9% of all cases; followed by caustic soda (20.4%) and traditional mixtures (19.7%). Oral administration of palm oil is the commonest home remedy. Morbidity was commonest with caustic soda while traditional mixture was responsible for 80% of the mortality. Fifteen (11.9%) patients died constituting 0.84% of total childhood mortality during the study period. We conclude that childhood poisoning is still a significant cause of morbidity and mortality in children seen at the Obafemi Awolowo University Teaching Hospital. Improvement in the socioeconomic status of parents and health education on proper storage of household chemicals will help in reducing the incidence and mortality from poisoning.