Empiric antibiotic prescription among febrile under-five Children in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Background: More than 97% of febrile infants and young children have self-limiting viral infection and therefore, would not require antibiotics. Over prescription of antibiotics increases antibiotics exposure and development of resistance among patients. There is need to evaluate empiric antibioticprescription in order to limit its use to only febrile children with bacterial infection.Aim and Objectives: The aim of this study was to determine the prevalence of empiric antibiotic prescription among febrile underfive, post neonatal children presenting in the children outpatient clinic of the  University of Port Harcourt teaching hospital. Method: Febrile Children aged 29 days to <60 months who presented in the outpatient clinic were recruited from September 2010 to January 2011. Their weight, biodata, symptoms, Physician’s diagnosis, and names of antibiotic prescribed were entered into a predetermined proforma and analysed.Result: A total of 362 children with male to female ratio of 1.03:1 werestudied. Two hundred and eighty three (78.2%) febrile children receivedempiric antibiotic prescriptions. The most frequent antibiotic prescribed was amoxicillin 80 (28.3%). Children aged 1-12months received the highestnumber of prescriptions 113 (80.7%). There was no significant relationship between age, temperature level, weight for age, number of symptoms and frequency of antibiotic prescription (p>0.05). Upper respiratory tract  infection (83.7 %) and diarrhea (55.9%) were significantly associated withempiric antibiotic prescription (P=0.05 and 0.002 respectively).Conclusion: Empiric antibiotic prescription for febrile under-five children is a common practice in UPTH. Physicians should therefore reduce the  frequency of antibiotics prescription in febrile children unless there is clinicalevidence of bacterial infection.Key words: Empiric Antibiotics, Fever, post neonatal under-five, Nigeri

Knowledge and Attitude of Healthcare Workers towards Kidney Transplantation in Nigeria

Background: The knowledge and attitude of healthcare workers towards kidney transplantation are fundamental in the development and sustainability of transplant programs. Healthcare workers caninfluence the willingness to donate kidneys.Objectives: To evaluate the knowledge and attitude of Nigerian healthcare workers regarding kidney transplantation.Methods: A prospective study of doctors and nurses at the 43rd Paediatric Association of Nigeria Conference in Ile-Ife, in January 2012 was carried out. Selfadministered questionnaires on the knowledge and attitude of healthcare workers towards kidney transplantation were given to participants practising in Nigeria to complete.Results: The questionnaire completion rate was 93.6% (n = 217). Majority (45.2%) of the respondents were aged 35 – 44 years; 59.0% had been in practice for more than 10 years and 83.9% were Christians. On the average, the healthcare workers responded correctly to 63.9% of the questions testing on knowledge and 50.7% were willing to donate kidneys. There was significant relationship between willingness to donate and profession (p = 0.001) but not with age, gender, tribe, religion or duration of practice.Conclusion: Nigerian healthcare workers have good knowledge and favourable attitude towards kidney transplantation. We recommend training of health workers to further improve their knowledge on renal transplantation.Key words: Kidney Transplantation, Healthcare workers, Nigeri

Adolescent blood pressure pattern in Rivers State, Nigeria: A rural - urban comparison

Background: Childhood and adolescent blood pressure pattern have been known to predict adult blood pressure levels and development of hypertension. Hypertension, once rare in traditional African societies, is now the commonest non-communicable disease in Nigeria. There are few studies on adolescent blood pressure pattern, especially in adolescents living in rural areas. It is therefore important to identify blood pressure differences, if any, between adolescents living in rural areas compared to their urban counterparts.Objective: To determine and compare the blood pressure pattern of apparently healthy adolescents in rural and urban areas, and to determine the association between blood pressure and body mass index in these children.Subjects and Methods: A cross sectional population based blood pressure survey was carried out on 2,136 Nigerian school adolescents (1080 were resident in rural areas and 1056 in urban areas) aged 10-18 years, selected from 26 secondary schools using a multi-stage stratified sampling technique. Blood pressure measurements were taken by auscultatory method. An average of three readings was taken as the actual blood pressure.Results: Systolic and diastolic blood pressure increased with age in both rural and urban subjects. The mean systolic blood pressure of the rural subjects (111.10 ± 14.72 mm Hg) was significantly (p= < 0.001) higher than that of the urban subjects (108.09 ±15.40 mm Hg), whilst the mean diastolic blood pressure of the urban subjects (66.88 ± 11.27 mmHg) was slightly higher than those of  the rural subjects (66.32±11.71 mmHg. Urban subjects had a higher mean body mass index (19.82± 3.57kg/m2) than their ruralcounterparts (19.59±2.78 kg/ m2).Systolic and diastolic blood pressure showed a positive significant (p= <0.001) correlation with BMI in subjects in rural and urban schools.Conclusion: Significant differences in blood pressure were observed between rural and urban adolescents in Rivers State, with a positive significant correlation between BMI and blood pressure. We recommend blood pressure surveillance as part of the School Health Programme.Keywords: adolescent, blood pressure, rural-urban, Nigeri

Evaluation of microalbuminuria in obese adolescents

Background: Obesity is a risk factor for metabolic syndrome with insulin resistance. Its effect on renal and cardiovascular diseases is reported in developed countries, but rarely established among adolescents in developing countries.Subjects and methods: A crosssectional study of 846 adolescents selected from 12 secondary schools in Port Harcourt, Nigeria. Obese subjects with Body Mass Index (BMI) equal to or greater than the 95th percentile for age and sex on the United States CDC growth chart were selected and studied. Urine samples of subjects without overt proteinuria were tested for microalbuminuria using the micral test strips.Results: Seventy-three of the subjects were obese giving the prevalence of obesity to be 8.6%. Microalbuminuria was present in 23 (35.4%) of the 65 obese subjects without overt proteinuria. The proportional prevalence was higher in females (42.9%), in age group 10-14years (42.2%), in subjects with hypertension (57.1%), and family history of hypertension (50.0%) and diabetes mellitus (37.5%) [p > 0.05].Conclusion: There is high prevalence of adolescent obesity, and a high prevalence of microalbuminuria among obese adolescents in Port Harcourt. We recommend efforts at reducing obesity as a means of preventing renal disease in adolescents

Prevalence of enuresis among primary school children in Port Harcourt

Background: Enuresis is a common problem among children and adolescents. It can lead to important psychosocial disturbances. Knowledge of the prevalence and types of enuresis in a community would guide early intervention. Objectives: To determine the prevalence of enuresis among primary school children aged 6-12years in Port Harcourt (PHC) and the types of enuresis among these children. Methods: A cross sectional study of enuresis among school children in 13 primary schools in three school districts in PHC was performed. Pretested questionnaires completed by parents/guardians and augmented by history obtained from the children were used to collect data from 922 school children. Descriptive statistics and chi-square test were used for data analysis. Results: A total of 922 school children, consisting of 463 (50.2%) males and 459 (49.8%) females were studied. The response rate was 82.2%. The overall prevalence of enuresis was 23.2%. Enuresis was notably more common in boys (male: female ratio 1.4:1), and the prevalence rates decreased with increasing age. Of all enuretic children, 92.1% had nocturnal enuresis, 0.9% had diurnal and 7.0% had nocturnal-diurnal enuresis. Conclusion: Enuresis is a common problem among school children in PHC, is more common in males. The predominant type is the primary nocturnal enuresis. Key Words:  Prevalence, Enuresis, Primary school-children, Port-Harcour

Central Diabetes insipidus in a Nigerian child : A case report

Background: Central diabetes insipidus (CDI) is rare in children. About 30 - 50% of cases are idiopathic. Early and accurate diagnosis are crucial for safe and effective treatment. This is the first report of Central diabetes insipidus in a child in Nigeria.Case report: We report a case of central diabetes insipidus in a female toddler who presented at the University of Port Harcourt Teaching Hospital with polydipsia and polyuria with a urine specific gravity of 1.000 and normal blood sugar. The diagnosis of CDI was confirmed by her inability toconcentrate urine after a water deprivation test followed by an increase in urine osmolality from 59mOsm/kg to 158mOsm/kg and serum osmolality from 286mOsm/kg to 321Osm/kg following intravenous administration of desmopressin. The patient responded well to oral desmopressin.Conclusion: Central diabetes insipidus occurs in Nigerian children and responds to oral desmopressin. We recommended high index of suspicion in children with polyuria and polydipsia.Key words: Central diabetes insipidus, polyuria, polydipsia, desmopressin, Nigerian chil

Factors associated with enuresis among primary school children in Port Harcourt

Background: Enuresis is a common childhood problem and can lead to important psychosocial disturbances.Objectives: To determine the risk factors to enuresis, its methods ofmanagement and relationship with academic performance among school children in Port Harcourt City (PHC)Methods: A cross sectional study of enuresis among school children in PHC was performed. Pretested questionnaires completed by parents/ guardians was used to collect data. Validation of their academic performances was made using their results in the past one year from the schools head teachers’ records. Descriptive statistics and chi-square test were used foranalysis.Results: A total of 922 children, consisting of 463 (50.2%) males and 459 (49.8%) females were studied. The response rate was 82.2%. The prevalence of enuresis was 23.2%. Arousal difficulty and positive family history of enuresis were significantly more frequent in the enuretic group (p<0.05). Enuresis was associated with family stressors in 45 (21.0%) of the children. The enuretic children had higher rates of poor school performance compared with nonenuretic children (p < 0.001) however;there was no statistical significant relationship between enuresis and social class. None of the enuretic children visited a physician for the management of enuresis. Prayers, punishment and herbal medication were the methodsof treatment in 89(41.6%), 42 (19.6%) and 6 (2.8%) children respectively.Conclusion: Arousal difficulty, positive family history of enuresis and family stress were common risk factors for enuresis. Also, enuretic children had higher rates of poor school performance compared with non-enuretic children. The inappropriate enuresis management methods requires healtheducation interventio

Evaluation of Teachers’ Performance of Vision Screening in Primary School Children in Port Harcourt

Objective: To evaluate the ability of primary school teachers toperform simple vision screening on their school pupils, so asto determine if they can provide the first level of school visionscreening services, and refer to the ophthalmologist for furtherevaluation when necessary.Methods: Using a multi-stage sampling technique, 130 teacherswere randomly selected from 13 schools in Port HarcourtLocal Government Area of Rivers State. They were trained forsix hours at a skills acquisition workshop on vision disordersin children and vision screening using Snellen visual acuitycharts. Subsequently, they screened 1,300 of their pupils, whowere all re-screened by the research team.Results: One hundred and ten female (84.6%) and 20 maleteachers (15.4%) participated in the study. Seventy (53.8%)were from public schools while 60 (46.2%) were from privateschools. The sensitivity of the teachers’ visual acuity test,compared to that of the research team, was 53.3%, with a highspecificity of 94.6%. The positive and negative predictivevalues of the teachers’ test were also high. The teachers’ visualacuity measurements showed moderate agreement with thatof the research team with a Kappa score of 0.604.Conclusion: The study concluded that trained primary schoolteachers can effectively perform vision screening in schoolchildren using Snellen visual acuity charts for early detectionand treatment of vision disorders in school pupils

Improvised Peritoneal Dialysis in an 18-month-old Child with Severe Acute Malnutrition (kwashiorkor) and Acute kidney Injury: A Case Report.

Severe acute malnutrition is common in developing countries. Children with severe acute malnutrition are prone to complications, including electrolyte imbalance and infections. Our patient was an 18-month-old boy who had severe acute malnutrition (kwashiorkor) and developed acute kidney injury, which was managed with peritoneal dialysis using improvised equipment. This case report illustrates the importance of improvisation in resource-limited settings in providing lifesaving treatment. To the best of our knowledge, this is the first case report on peritoneal dialysis in a child with severe acute malnutrition (kwashiorkor). We report a case of an 18-month-old Bantu-African Tanzanian boy who had severe malnutrition and developed anuric acute kidney injury. He had severe renal dysfunction and was managed with peritoneal dialysis using an improvised catheter and bedside constituted fluids (from intravenous fluids) and was diuretic after 7 days of peritoneal dialysis, with complete recovery of renal functions after 2 weeks. Children with severe acute malnutrition who develop acute kidney injury should be offered peritoneal dialysis, which may be provided using improvised equipment in resource-limited settings, as illustrated in this case report

Knowledge about safe motherhood and HIV/AIDS among school pupils in a rural area in Tanzania

\ud The majority of adolescents in Africa experience pregnancy, childbirth and enter motherhood without adequate information about maternal health issues. Information about these issues could help them reduce their pregnancy related health risks. Existing studies have concentrated on adolescents' knowledge of other areas of reproductive health, but little is known about their awareness and knowledge of safe motherhood issues. We sought to bridge this gap by assessing the knowledge of school pupils regarding safe motherhood in Mtwara Region, Tanzania. We used qualitative and quantitative descriptive methods to assess school pupils' knowledge of safe motherhood and HIV/AIDS in pregnancy. An anonymous questionnaire was used to assess the knowledge of 135 pupils ranging in age from 9 to 17 years. The pupils were randomly selected from 3 primary schools. Underlying beliefs and attitudes were assessed through focus group interviews with 35 school children. Key informant interviews were conducted with six school teachers, two community leaders, and two health staffs. Knowledge about safe motherhood and other related aspects was generally low. While 67% of pupils could not mention the age at which a girl may be able to conceive, 80% reported it is safe for a girl to be married before she reaches 18 years. Strikingly, many school pupils believed that complications during pregnancy and childbirth are due to non-observance of traditions and taboos during pregnancy. Birth preparedness, important risk factors, danger signs, postpartum care and vertical transmission of HIV/AIDS and its prevention measures were almost unknown to the pupils. Poor knowledge of safe motherhood issues among school pupils in rural Tanzania is related to lack of effective and coordinated interventions to address reproductive health and motherhood. For long-term and sustained impact, school children must be provided with appropriate safe motherhood information as early as possible through innovative school-based interventions.\u