Sexual Maturation of Female Adolescent Patients with Sickle Cell Anaemia in Lagos, Nigeria

BACKGROUND

Sickle cell anaemia (SCA) has been shown to have adverse effects on growth and sexual development. Recent Nigerian studies have reported a declining trend in the age of sexual maturation and menarche in haemoglobin AA (HbAA) individuals.

OBJECTIVE

To evaluate the sexual maturation of female patients with SCA aged 10 to 19 years seen at Lagos University Teaching Hospital Idi-Araba, Lagos and Sickle Cell Foundation.

METHODS

It was a cross-sectional study involving 140 girls with SCA (subjects) and an equal number of girls with HbAA (controls) who were matched for age and socio-economic class over a fivemonth period. The evaluation involved anthropometry, calculation of BMI and determination of breast and pubic hair development using Tanner staging.

RESULTS

The mean BMI for the subjects was 17.2±2.39 kg/m2and 20.2±3.09 kg/m2 for the controls (p < 0.001). The mean age at onset of breast development (B2) was 13 ± 0.39 years in the subjects and 10.5 ± 0.51 years in the controls (p < 0.001). The corresponding mean age for pubic hair development (PH2) was also higher at 13.8 ± 0.59 years for the girls with SCA and 10.4 ± 0.51 years for the controls (p <0.001), while menarche was achieved in the subjects at 14.7 ± 1.68 years and in the controls at 12.3 ± 1.33 years (p < 0.001). Upper socioeconomic class was associated with earlier menarche and faster transition from pre-pubertal stage to pubertal stage of sexual maturation in the controls but was not observed in the SCA subjects.

CONCLUSION

Sexual maturity in patients with SCA lagged behind those of the HbAA controls.

Efficacy of Hexetidine, Thymol and Hydrogen Peroxide-Containing Oral Antiseptics in Reducing Sars-Cov-2 Virus in the Oral Cavity: A Pilot Study

BACKGROUND

Studies have demonstrated the role of sputum as a site of severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) transmission. However, there is limited literature on the virucidal efficacy of oral antiseptics against SARS-CoV-2 virus. This study investigated the virucidal efficacy of three oral-antiseptics compared to a placebo-control in the sputum of SARS-CoV-2 infected individuals.

METHODOLOGY

A pilot study of adults with SARS-CoV-2 positive results, as determined by reverse transcription-polymerase chain reaction (RT-PCR) of <7 days. The oral antiseptics investigated were: Hexetidine (0.1% w/v); Thymol (0.063% w/v) and H2O2(1.5%) compared to de-mineralized sterile water (Placebo-control). The primary outcome measure was the proportion of negative RT-PCR results at 15-mins, 30-mins, 1-hour, 2-hours and 4-hours After Oral antiseptics Interventions (AOI) compared to the placebo-control. Statistical analysis was done using STATA 15.0 software with p-values of <0.05 considered statistically significant.

RESULTS

Data from a total of 66 participants that were RT-PCR SARS-CoV-2 positive at baseline (0-min) was analysed. At 15-mins AOI, the highest proportion of negativation from sputum samples was observed in the Hexedine group, with 69.2% of the baseline PCR positive cases converting to negative compared to 46.7% in the placebo-control group. In addition, H2O2 demonstrated efficacy at 2-hours AOI compared to placebo-control (62.5% vs 37.5% respectively) and other oral-antiseptics. Across all time-points, the oral-antiseptic groups compared to the placebo-control group, there was no statistically significant difference in the proportion of sputum samples which converted to a negative status (p>0.05).

CONCLUSION

The findings in this study suggest there was no significant difference in the proportion of participants who converted to a negative sputum status across the treatment groups at various time points. Future studies could compare the cycle threshold (ct) viral titre values of sputum samples to determine quantitative differences.

Doppler echocardiographic assessment of pulmonary artery pressure in children with sickle cell anaemia

Background

Pulmonary artery hypertension (PAH) is a known complication of patients with sickle cell disease (SCD). The prevalence of PAH has been reported to be high in children with SCD in developed countries. The mortality rate of patients with SCD who develop PAH is said to be 40% at 24 to 40 months after diagnosis. In Sub-Saharan Africa, particularly Nigeria, where the prevalence of SCD is high, there is a dearth of data on the prevalence of PAH in children with SCD. PAH may be a likely contributor to the unacceptably high mortality rate of children with SCD in Africa. The present study aimed to determine the pattern of pulmonary artery pressure in children with sickle cell anaemia (SCA) aged 1 to 12 years in their steady state using Doppler echocardiography in our environment.

Methods

Analytical, comparative and cross-sectional study. It was carried out at Lagos State University Teaching Hospital (LASUTH) over a period of seven months (31st August 2015 through 31st March 2016). A total of 400 children, aged 1 to 12 years were recruited following parental consent and assent. Two hundred children with SCA in steady state and 200 age and sex matched children with haemoglobin genotype AA who served as controls were studied. All subjects and controls had Doppler echocardiography performed on them by the author. PAH was defined as a pulmonary artery systolic pressure (PASP) of ≥30 mmHg at rest derived from the tricuspid regurgitant velocity (TRV) measured from Doppler echocardiography. This corresponds with TRV value of ≥2.5 m/s.

Results

The prevalence of PAH in children with SCA was 8% (n=16). None of the controls had PAH. The youngest subject with PAH was aged 2 years. The overall mean pulmonary artery pressure of children with SCA was significantly higher than that of controls (18.54±5.81 vs. 13.76±5.71 mmHg, P=0.000). The prevalence of PAH in children with SCA demonstrated an increase in trend with age.

Conclusions

The prevalence of PAH in children with SCA in steady state is high. This complication was noticed as early as the second year of life. It is recommended that all children with SCA should have periodic Doppler echocardiography for early detection of PAH.

Pneumococcal-specific IgG levels after 13-valent pneumococcal conjugate vaccination in Nigerian children with sickle cell disease

BACKGROUND

Children with sickle cell disease (SCD) are particularly susceptible to pneumococcal infection. Administration of the 13-valent conjugate pneumococcal vaccine which is now available in Nigeria may help to reduce the incidence.

OBJECTIVES

To determine the serum level of pneumococcal-specific IgG (PIgG) in a cohort of patients with SCD after administration of a single-dose of a 13-valent pneumococcal conjugate vaccine.

METHODS

The study was conducted between December 2011 and March 2012 among children with SCD aged 5 months to 5 years attending the sickle cell clinic in five public hospitals in Lagos. Altogether, 151 children with SCD and 52 without it (controls) were recruited by convenience sampling from the sickle cell clinics and well-child clinics. Blood samples were collected for PIgG concentrations before and 2 months after a single dose of the Prevenar 13 vaccine. Seroconversion was defined as a fourfold or greater increase in antibody concentration after vaccination while those with PIgG concentrations ≥200 μU/ml were considered to have protective levels.

RESULTS

The age range of the total study group was 5-60 months with a mean (SD) of 39.04 (15.44) months and a median of 39 months. The mean (SD) ages of subjects with and without SCD were 38.91 (15.75) months and 16.39 (15.45) months, respectively. The PIgG concentration 2 months post-vaccination was significantly greater than the pre-vaccination levels in all age categories in both groups and almost all subjects had protective PIgG concentrations 2 months after vaccination. A four-fold increase in PIgG concentration was detected more commonly in the controls than in SCD patients.

CONCLUSION

Prevenar 13 provided protective immunity in all vaccinated children but those under 2 years of age who had non-protective levels pre-vaccination benefited the most.

Children With Tetralogy of Fallot in an Urban Centre in Africa

Introduction: There is a dearth of literature on tetralogy of fallot (TOF) in children in Sub-Saharan Africa. This study up aims to describe the prevalence, clinical profile and associated cardiac anomaly of children diagnosed with TOF documented over an eight year period in a tertiary hospital in South Western Nigeria.

Methods: A prospective review of all consecutive cases of TOF diagnosed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2014. Data were analyzed using SPSS version 20. Tables and charts were used to depict those variables. Descriptive statistic are presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the student t test and proportions using chi-square test. Skewed distribution were analyzed using appropriate non-parametric tests. Level of significance set at P < 0.05.

Result: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 10 000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance and most children presented within 1-5 years of age. Chromosomal abnormalities such as Down syndrome, Turners syndrome and CATCH 22 syndrome were documented in some subjects. Some of the subjects had atypical presentation.

Conclusion: TOF is as common in Nigeria as other parts of the world, there is a need to established cardiac centers to salvage these children. Collaboration from developed countries will be helpful in this resource limited region.

Profile and outcome of patients with post-neonatal tetanus in a tertiary centre in south west Nigeria: any remarkable reduction in the scourge?

INTRODUCTION

The incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja.

METHODS

A prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p<0.05.

RESULTS

A total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age±SD of 6.5±3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%.

CONCLUSION

Tetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.

National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report

BACKGROUND

Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth.

MATERIALS AND METHODS

Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities.

RESULTS

Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants.

CONCLUSION

The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.

Erythrocyte indices in Pre-school Nigerian Children with Sickle Cell Anaemia in Steady State

BACKGROUND

Sickle cell disease is a genetic haemoglobinopathy with consequent haemolysis and anaemia. It is of interest to study its effect on red cell indices beside haemoglobin concentration.

OBJECTIVES

The objective of the study is to determine the values of red cell indices in preschool-age children with sickle cell anaemia.

METHODS

we conducted a cross-sectional study including 97 children with sickle cell anaemia aged six months to five years and 97 age-and sex-matched healthy controls with haemoglobin genotype AA (Hb AA). The red cell indices such as packed cell volume, haemoglobin concentration, mean corpuscular volume, red blood cell count, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration were investigated, using an auto analyzer.

RESULTS

The mean PCV, haemoglobin concentration and red blood cell count were significantly higher in HbAA controls (p = 0.000 in each case). The mean MCV was higher among HbSS subjects but it was only among females and when the result was analyzed irrespective of gender that the difference was statistically significant (p < 0.05).

CONCLUSION

Children with sickle cell anaemia in steady state have lower values of all red cell parameters and higher values of MCV, compared to haemoglobin phenotype AA controls.

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.

Evaluation of arm span and sitting height as proxy for height in children with sickle cell anemia in Lagos, Nigeria

BACKGROUND

Sickle cell anemia may affect linear growth, and complications like avascular necrosis of femoral head may make direct measurement of height difficult.

OBJECTIVE

To determine the relationship between height and arm span as well as between height and sitting height among children with sickle cell anemia in Lagos, Nigeria.

METHODOLOGY

A random sample of 200 children aged 8 months to 15 years were studied-100 with hemoglobin genotype SS and 100 with hemoglobin genotype AA, matched for age and sex. Height/length, sitting height, and arm span were measured. Correlations and regression analysis were performed to test the relationship between height as a dependent variable and the sitting height and arm span as independent variables.

RESULTS

Height, arm span, and sitting height were slightly but not significantly lower in subjects with sickle cell anemia. Strong correlations (R ≥ 0.95) were observed between height and other measurements in both subgroups. Regression analysis with height as the independent variable showed that arm span had a higher coefficient of determination than sitting height in both subjects (R(2) = 0.94 vs 0.899) and controls (R(2) = 0.942 vs 0.940). On the other hand, sitting height had a lower mean difference between observed and predicted height (0.04 and -0.11, respectively).

CONCLUSION

Sitting height may be the preferred proxy for height in children with sickle cell anemia.

Assessment of overweight and obesity among Nigerian children and adolescents using triceps skin-fold thickness and body mass index

The prevalence of obesity is increasing in children and adolescents even in resource-poor countries. The study aimed to determine the prevalence of obesity in a group of Nigerian school children using triceps skin-fold thickness (SFT) and body mass index (BMI). The subjects were 1235 randomly selected primary and secondary Lagos school children aged 5-18 years, triceps SFT was measured with Harpenden® calipers and BMI calculated from weight and height. Using BMI, overweight and obesity were defined as values of 85th to 94th percentile for age and sex and ≥95th percentile, respectively. Using triceps SFT, obesity was defined as SFT > 85th percentile of the NHANES III study. Fifty-seven subjects (15 boys and 42 girls) had SFT > 85th percentile with a higher prevalence in girls than boys (6.4% vs. 2.6%, P = 0.001). The prevalence of BMI-defined overweight and obesity were also higher among girls (11.9% vs. 5.7%, P < 0.001 and 4.7% vs. 2.2%, P = 0.02, respectively). Females of upper socioeconomic class were more likely to be overweight (16.2% vs. 6.6%, P < 0.0001), obese (6.3% vs. 2.8%, P = 0.03) or have elevated SFT (8.2% vs. 4.2%, P = 0.03) than those of low socioeconomic status. Forty-seven of 57 subjects (82.5%) with elevated SFT also had high BMI. The prevalence of obesity is low in the study population but the much higher prevalence of overweight suggests that steps should be taken to control fatness before the figures worsen. In more than 80% of subjects, elevated SFT co-existed with elevated BMI.

Transcatheter closure of patent ductus arteriosus: report of the first case in Nigeria

BACKGROUND

Since the first report on device closure of patent ductus arteriosus (PDA) by Porstmann et al in 1967, the procedure has gained wide acceptance and has been used all over the world, including parts of Africa. The advantages when compared to surgical closure include shorter procedure time and hospital stay and no scar being left. This mode of treatment was not available in Nigeria prior to this with patients having to travel abroad to benefit.

PATIENT AND METHOD

Cardiac catheterisation laboratory became available in Lagos, Nigeria in 2009 and in October 2010, the laboratory collaborated with Lagos State University College of Medicine (LASUCOM) and Lagos State University Teaching Hospital (LASUTH), to perform a device closure on a 3-year old girl with PDA who had presented to LASUTH with heart failure at the age of 6 months. To the best of our knowledge, this is the first time the procedure has been performed in Nigeria

RESULTS

The patient made a successful recovery and is haemodynamically stable, on no medications.

CONCLUSION

Device closure of PDA is now safe and available in Nigeria.

International patients with congenital heart disease: what brings them to India?

BACKGROUND

Factors that have led to the increasing popularity of medical travel include the high cost of healthcare, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries.

AIM

The present study aims to elaborate the factors that attract international cardiac patients to India, to document the proportion of the admissions into the paediatric cardiac ward who are international patients, and to identify the sources of funding of the international patients.

METHODS

This was a prospective, cross-sectional, and analytical study carried out between May 2009 and October 2009 in the paediatric cardiac care unit of a large tertiary care cardiac centre in India paediatric wards. Structured questionnaires were administered.

RESULTS

A total of 1372 patients were admitted during the study period, of which 155 (11.3%) were patients from countries outside India. Majority of the patients were from Malaysia (45%), Nigeria (23%), and Tanzania (15%). The age ranged from 1 month to 39 years with an average of 61 months. The male to female ratio was 1:1.4 and the majority of subjects (72.5%) were in social classes 3 and 4. cheaper cost and better expertise was the prominent reason for choosing India. More than half of the respondents were either sponsored by the government or self-funded. For patients from Nigeria 53% (9) were sponsored by self (parent), 29% (5) by non-governmental organisations (NGO), 12% (2) by the parent employer, and 6% (1) by the government.

CONCLUSION

There is a need for local development of facilities and training of personnel in specialised areas of healthcare to provide succour for a significant number of nationals who might otherwise have suffered and possibly have even died of their ailment. There is also the added advantage that such facilities would save foreign currency and help boost our economy.

Obesity--does it occur in Nigerian children with sickle cell anemia

Children with sickle cell anemia are vulnerable to growth deficits; thus, it would be thought that obesity would be rare among them. The objective of the study is to examine the prevalence of obesity in a sickle cell anemia population in Lagos. A random sample of children with sickle cell anemia aged 2-15 years was interviewed and anthropometric measurements including weight and height were taken. Their body mass index (BMI) was calculated. Participants were classified as obese or not obese by their BMI or weight-for-height-for-age using World Health Organization standard definitions. The overall prevalence of obesity was 2.5% and 3.8% among hemoglobin genotype SS subjects and hemoglobin genotype AA controls, respectively. The age-specific prevalence for obesity was highest among the adolescent age category in hemoglobin genotype AA controls and the childhood age category in subjects with sickle cell anemia. All the obese subjects with sickle cell anemia were from upper socioeconomic strata, while two and one of the three subjects with hemoglobin genotype AA were from upper and middle socioeconomic strata, respectively. Obesity does exist among children with sickle cell anemia in Lagos, Nigeria. Public health programs aimed at prevention and control of obesity must include children with sickle cell anemia.

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.

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.

Relationship between bioelectrical impedance analysis and body mass index in adolescent urban Nigerians

BACKGROUND

Body mass index is often used to assess adiposity but it does not differentiate between fat and non-fat components of body mass. However, body fat composition may be assessed using bioelectrical impedance analysis.

OBJECTIVE

The study aimed to relate body mass index to fat in the assessment of overweight and obesity among adolescent Nigerians.

METHODS

Adolescent pupils aged 10 years to 18 years from randomly selected secondary schools in Lagos, Nigeria were studied. Body mass index was calculated while percentage body fat was measured using Tanita body® fat scale model BF 681. Overweight and obesity were defined using age and sex specific criteria for body mass index and for body fat.

RESULTS

There were 753 pupils {377(50.1%) males and 376(49.9%) females}. The overall mean values of body mass index for males and females were 18.1±2.72 and 18.9±3.41 (p < 0.05) respectively. The corresponding figures for body fat were 9.5±4.48 and 18.9±7.51 (p<0.05) respectively. About three quarters (76.2%) of the females who had body mass index in the overweight and obesity range had high body fat in comparison to 44.4% of males (p < 0.05).

CONCLUSION

Body mass index is more related to body fat in adolescent females than in their male counterparts.

Sickle cell anaemia: awareness among health professionals and medical students at the Lagos University Teaching Hospital, Lagos

BACKGROUND

Sickle cell anaemia (SCA) is a chronic haemolytic disorder caused by homozygous inheritance of abnormal haemoglobin called 'haemoglobin S' (HbS). The disease burden is enormous to the patient, family and community. One potential weapon in its prevention is health information and awareness among the populace.

OBJECTIVE

The study is to detrmine the awareness of sickle cell anaemia among health professionals and medical students at the Lagos University Teaching Hospital Idiaraba, Lagos.

METHODS

Part of a large study which was cross-sectional and descriptive study, carried out at the Lagos University Teaching Hospital (LUTH), between the months of August and September 2006. Data were collected from 403 health professionals and students using structured questionnaires.

RESULTS

Majority (98.7%) of the respondents had heard about SCA. Only 211 (55%) of the respondent felt genotype screening should be done at pre-school age. 128 (33.7%) felt it should be done during childhood. Doctors had a statistically significantly better knowledge of best time for detecting genotype. In all, 85% of the respondents had been involved in the management of sickle cell anaemia with the highest proportion among nurses (p = 0.02). Only 93 (24.3%) of the respondents knew most of the complications of sickle cell anaemia, 176 (46.3%) knew some of it, while 111 (29.2%) knew only a law complications. Nurses had a statistically significantly poorer knowledge of the complication of sickle cell anaemia. More nurses felt that engagement should be ended if there was a risk of having a child with sickle cell anaemia.

CONCLUSION

Continuing medical education for health professionals about sickle cell anaemia, its management and complication is necessary.

Echocardiographic findings among children with sickle cell anaemia at the Lagos University Teaching Hospital

BACKGROUND

Few studies documenting the echocardiographic findings of patients with sickle cell anaemia have been reported from Africa despite the high prevalence of the disease on the continent.

AIMS AND OBJECTIVES

The present study aimed to determine echocardiographic cardiac dimensions and haemodynamic parameters of children with homozygous sickle cell anaemia (SCA), in steady state at the Lagos University Teaching Hospital (LUTH).

MATERIALS AND METHODS

Sixty children with SCA and sixty age and sex matched controls with ages ranging from 1-15 years were studied. Their cardiovascular functions were determined by echocardiographic examination.

RESULTS

Mean age of SCA patients and controls were 95.41 ± 49.06 months and 95.45 ± 50.9 months respectively (p = 0.97). Mean left atrial dimension (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPW), Interventricular septal thickness (IVS) and left ventricular mass (LVM) in SCA patients were significantly larger than those of controls (p < 0.001 for each parameter). Left ventricular fractional shortening (FS) and ejection fraction (EF) were within acceptable normal limits although significantly lower in SCA patients (p < 0.001). The mean haemoglobin concentration in the subjects (77.23 ± 12.88) was significantly lower than in the controls (121 ± 16.09) (p < 0.001). Each direct echocardiographic parameter (LAD, AO, LVEDD, LVESD, IVS, LVPW and LVM) correlated significantly with age in both groups while left ventricular functional parameters (FS and EF) did not in both groups. Chamber dimensions, LVPW, FS and EF were inversely correlated with haemoglobin concentration in the subjects.

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.

Early postnatal growth of preterm low birth weight, appropriately-sized infants

BACKGROUND

Postnatal growth monitoring is useful in assessing the health ofpreterm babies but their growth patterns have not been sufficiently studied in Africans.

AIM

To describe the growth achievements ofpreterm, low birth weight, appropriately-sized, Nigerian infants.

STUDY DESIGN

The subjects were prospectively recruited from two centers Olabisi Onabanjo University Teaching Hospital (January 1994 to June 1995) and Havana Specialist Hospital (June 1995 to June 1997). The weight, length and occipito-frontal circumference of 89 preterm, low birth weight, appropriate-for-dates infants were monitored from birth until 53 post-conceptual weeks. Growth velocities were compared with 46 term infants.

RESULTS

Initial weight loss, age at regaining birth weight and growth rate in the early postnatal weeks were inversely related to gestational age. Subsequent weight gain was directly related to gestational age. Between birth and 40 weeks post conception, growth rates for different gestational age groups were 129 to 207 g/week (weight), 0.78 to 0.93 cm/week (length) and 0.62 to 0.65 cm/week (head circumference). After 40 weeks, the corresponding rates were 188 to 238 g/week, 0.86 to 0.96 cm week and 0.48 to 0.50 cm/week, respectively. Head growth demonstrated a faster catch-up than weight and body length in that order. The observed growth rates were slower in some respects than Caucasian figures but faster than reported for the Japanese.

CONCLUSION

Study subjects had growth patterns within previously defined ranges. The better profile of western babies is probably related to better infrastructure while the advantage over Asian babies is probably racial.

Prevalence of iron deficiency in children 6-24 months in Lagos

BACKGROUND

Iron deficiency is the commonest cause of nutritional anaemia in children worldwide particularly in developing countries. Infants and toddlers are prone to developing iron deficiency anaemia (IDA). This study was carried out to determine the prevalence of IDA and some factors associated with it in this group of children.

STUDY DESIGN

Haemoglobin concentration and mean corpuscular volume (MCV) estimations carried out in 282 apparently well children aged 6-24 months. Estimations of serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF) and transferrin saturation (TS) were also determined in children with anaemia (Hb concentration < 11.0 g/dl). Information on current diet was also obtained using a diet record.

RESULTS

Two hundred and twenty three (79.1%) children had anaemia. The mean Hb concentrations of all the age groups were less than 11.0 g/dl. Forty (14.9%) children had IDA (defined as aneamia plus 2 or more of the following--MCV < 70fl, Ts < 10% or SF < 10 microg/dL). The mean age of children with IDA (8.96 +/- 2.54 months) was statistically lower than for those without the condition 10.94 +/- 4.55 months (p = 0.016). Inclusion of vegetables and animal protein less than three times a week in the diet were both significantly associated with IDA.

CONCLUSION

The prevalence of IDA in this study is high especially before the age of 12 months and an average weekly intake less than 3 times a week or iron rich foods like animal protein and vegetables was significantly associated with IDA. Emphasis should be on the inclusion of iron rich foods in the diet following exclusive breastfeeding to reduce the prevalence of IDA in these children.

Do working children have worse academic performance?

OBJECTIVE

To examine the effect of child labor on school children's academic performance.

METHODS

Primary school children engaged in child labor were compared with age, sex and school-matched controls for absence from school and scores obtained at sessional examination in English language, Mathematics, Sciences and Social studies.

RESULTS

There was no significant difference in the mean rate of school absence (p = 0.80), mean aggregate examination scores (p = 0.1) and proportion of class repeaters (p = 0.16) among working school children and the controls. However, a significantly higher proportion of the controls had high (>75%) average examination scores compared with the working school children (p = 0.017). Similarly, the controls performed better than working school children in each of four core subjects but significant differences were observed only in Social Studies and Science (p = 0.006 and 0.001 respectively).

CONCLUSION

There is some undermining of academic performance among children who combine schooling with child labor despite comparable school absence with the controls.

Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital

This study was conducted to determine the incidence of meconium staining of the amniotic fluid (MSAF) and its associated factors in a Nigerian teaching hospital. Perinatal data on 80 consecutive live, singleton infants of booked mothers born through meconium-stained liquor from March - June 2003 were analysed and compared with babies born through clear liquor. The incidence of MSAF was 20.4% for 393 deliveries. The rate increased with gestational age: no case was found below 37 weeks (p = 0.001). Primiparity, prolonged rupture of fetal membranes and obstructed labour were more often associated with MSAF (p = 0.005, p = 0.0013 and p = 0.0000002, respectively) as were tachycardia or bradycardia and low Apgar scores (p = 0.0000001 and p = 0.046, respectively). It is concluded that meconium-staining is common. It is related to gestational maturity and stressful peripartum conditions and associated with adverse symptomatology in the fetus and newborn.

The effects of birth interval on the birthweights of consecutive, same-sex term siblings

OBJECTIVE

To investigate the effect of birth interval on the relationship between the birthweights of successive siblings.

METHODS

The records of women who had delivered two consecutive, same-sex, live, singletons babies (1983 through 1997) in a private hospital were analysed. The intervals between the birth dates of the siblings were calculated. The first of the siblings was coded Set A and the second, Set B. The ratios of the birthweights (Set B/Set A) were calculated. Comparison of findings was made between various ranges of birth interval.

RESULTS

The birth interval band 24-29 months was associated with the highest mean birthweight for Set B babies and the highest birthweight ratio (p=0.016). Set A babies weighing less than 3000 g were most likely to be outweighed by their Set B siblings (p=0.000001).

CONCLUSION

Birth intervals of 24 to 29 months and small size of Set A babies were associated with most significant advantages in birthweight for Set B siblings.

A study of neonatal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria

A two-year prospective study of neonatal deaths at a Nigerian University Teaching Hospital is presented. There were 55 deaths among 1081 inborn live deliveries (50.88/1000). Low birthweight babies accounted for 60% of deaths. There were 49 (45.33/1000) perinatal deaths, 61% of which occurred within 24 hours. The mortality rate of term small-for-gestational age neonates was higher than that of their appropriate-for-gestational age counterparts (chi 2 = 4.55, P < 0.05). The mortality rate for 315 referred admissions was 400/1000. Referred very low birthweight babies had a better outcome than inborn ones. Severe infections, severe birth asphyxia, respiratory distress syndrome and recurrent apnoea were among the leading causes of death in this study. There is a need for improved intensive care facilities for the high-risk newborn. Greater effort is required to improve early utilization of available maternity services.

Perinatal mortality at the Ogun State University Teaching Hospital, Sagamu, Nigeria

A study of perinatal mortality at the Ogun State University Teaching Hospital during the first 30 months (March 1989 to August, 1991) of the establishment of a separate neonatal unit was made. One-hundred-and-sixty-two (87.5/1000) of the 1852 deliveries were stillborn and 60 (35.5/1000) of the 1690 live births died in the early neonatal period. The overall perinatal mortality rate was 119.9/1000 deliveries. Of stillbirths, 82 per cent occurred in unbooked mothers and were diagnosed at presentation. The major causes of stillbirths were teenage pregnancy, elderly motherhood, high maternal parity, and prolonged, obstructed labour. The major causes of early neonatal death were low birth weight, breech delivery, and severe birth asphyxia. The need for increased utilization, improvement, and regionalization of antenatal and perinatal services is emphasized.