Socio-demographic and clinical characteristics of asthmatic children seen at Aminu Kano Teaching Hospital, Kano, Nigeria

Introduction: Asthma is a chronic inflammatory disorder associated with variable air flow obstruction and bronchial hyperresponsiveness. It is characterised clinically by recurrent episodes of cough, difficulty in breathing and wheezing which resolves spontaneously or with treatment. Thesocio-demographic and clinical characteristics of asthmatic children in north western Nigeria have not been reported.Methods: This was a descriptive study in children with asthma aged 4-15 years carried out over a 3 month period Aminu Kano Teaching Hospital (AKTH), Kano. The aim was to determine the socio-demographic and clinical parameters of asthmatic children. Asthmatic children whoseparents or guardian consented to the study were recruited consecutively. Their bio-data, sociodemographic and physical examination were documented.Results: Seventy asthmatic children were recruited of which 50(71.4%) were males and 20(28.6%) were females, giving a male: female ratio of 2.5:1. Insecticide was the commonest asthma trigger (64.3%) and 26(37.1%)patients belonged to socio economic class III. Mild persistent asthma was the commonest form of asthma severity encountered. There was positive correlation between PEFR and height (r = 0.577, p< 0.0001).Conclusion: Most of the asthmatics children seen at AKTH, Kano were males with mild persistent asthma, had positive family history of atopy and belonged to the middle socio economic class.Key words: Asthma, Children, Socioeconomic class, Asthma severit

Incidental finding of dextrocardia with situs inversus totalis in a day old neonate: Case report and review of the literature

Dextrocardia with situs inversus are rare congenital anomalies which can be asymptomatic and compatible with normal life. They are characterized by mirror images of all intra-thoracic and intra-abdominal viscera. Our aim isto report an incidental finding of dextrocardia with situs inversus in a neonate with neonatal sepsis. A day-old male term neonate presented with features of infection. Physical examination revealed cardiac apex on the 4th right   intercostal space, along the mid-clavicular line. Chest radiograph and  abdominal ultrasound confirmed the diagnosis of dextrocardia with situs inversus. Bilateral cervical ribs were also seen on chest radiograph. He was managed with antibiotics  and  discharged . Newborn babies should have a thorough physical examination after delivery before discharge to enable early diagnosis of congenital anomalies for appropriate referral.Key words: Dextrocardia, neonate, neonatal sepsis

Antibiogram of pharyngeal isolates of children with pharyngotonsillitis in a specialist hospital in Gusau, North-Western Nigeria

Pharyngotonsillitis is one of the common childhood infections caused by bacteria in 30 to 40% of cases. Bacterial causes are important due to the non suppurative sequalae caused by Streptococcus pyogenes and also associated complications. These microorganisms undergo constant changes and antibiotic resistance have been reported. Objective: To document organisms isolated from throat swab microscopy and culture with their antibiotic susceptibility pattern in children diagnosed with pharyngotonsillitis. Methodology: This was a retrospective analysis of throat swabs microscopy, culture and sensitivity results of children aged 0-13 years with a diagnosis of pharyngotonsillitis over a four-year period. Results: Of the 144 results reviewed; 120 samples yielded 122 isolates, giving a culture positive yield of 83.3%. Males were 81 (56.2%) with a M:F ratio of 1.3:1. Majority of the children were under fives (58.3%). Gram positive organisms were 118 (96.7%), with Streptococcus pyogenes being the commonest organism isolated (79.5%), followed by Staphylococcus aureus (13.9%). Gentamicin (85.0%), Ofloxacin (64.2%) and Augmentin (51.7%) had the highest susceptibility rate, while the least was seen with Cefixime, Tetracycline, Levofloxacin and Netillin. Streptococcus pyogenes and Staphylococcus aureuswere susceptible to Gentamicin and Ofloxacin, while all the Streptococcus pneumoniae were susceptible to Gentamicin. Multi drug resistance was seen with Providencia spp and Serratia marcescens. Conclusion: Streptococcus pyogenes was the commonest organism and Gentamicin, Ofloxacin and Augmentin were the antibiotics with the highest susceptibility. Gram negative organisms display high rate of multidrug resistance. Gentamicin could be considered as an option or an adjunct in the treatment of pharyngotonsilliti

Evaluation of Antibiotic Prescription and Utilization amongst Hospitalized Children in a Tertiary Facility in Sokoto, North-Western Nigeria

Background: Antibiotics are the most widely utilized therapeutic agents. Inappropriate use causes increase cost and antibiotic resistance. The World Health Organization recommends assessment of antibiotics use to guide prescribing practices. Objective: To describe the pattern of antibiotic usage among paediatric inpatients aged > 1 month to 15 years in a tertiary hospital in Sokoto, Nigeria. Methods: Febrile children were recruited prospectively by systematic random sampling from January to October 2018. Socio-demographics, diagnosis, antibiotics administered were obtained from case notes. The WHO indicators of use of antibiotics were employed for evaluation. Data was analysed with SPSS version 23. Results: Out of 352 children, 318 (90.3%) received antibiotics; commonest being Ceftriaxone in 155/318 (48.7%), Cefuroxime in 74 (23.2%), and Metronidazole in 29 (9.1%). Average number of antibiotics per patient was 2.3±1.1 with treatment duration of 4.3±1.4days. Antibiotic consumption was 937.2 days of antibiotic therapy/1000 patient days (DOT/PD). Generic name was used in 92.3% while 100% of the drugs were on the essential medicine list. Frequent diagnoses were severe malaria 98/352 (27.8%), respiratory infections 39 (11.1%) and severe malnutrition in 38 (10.8%). Only 6 (1.7%) patients had microbiologic evidence of infection. Conclusion: Utilization of antibiotics is higher than recommended. There is need for improved diagnostic facilities to avoid antibiotic overuse and its consequences. Keywords: antibiotics, prescription, utilization, children, inpatients, DO

Hepatitis b, c and hiv serological markers in children with sickle cell anaemia in a tertiary hospital, Gusau, North-Western Nigeria

Sickle Cell Anaemia patients are considered to be among the high-risk groups for hepatitis B and C viral infections. These viruses and HIV share common routes of transmission and similar risk factors and their infections coexist. Objective: This study was aimed at determining the seroprevalence of hepatitis B, C and HIV viral markers of infections in children with SCA. Methodology: A cross sectional Hospital based study conducted on 89 confirmed SCA Children aged 6 months – 13 years in steady state attending Haematology Clinic in a Specialist Hospital Gusau from July 2017 to March 2018. Approval for the study was obtained from the Research and Ethics Committee of the Hospital. The age, gender, history of blood transfusion, traditional scarification, uvulectomy, circumcision and immunization of the subjects were recorded. Serological test was carried out to determine the prevalence of hepatitis B, C and HIV using the viral markers and HIV 1& 2 rapid test kits. Results: Eighty-nine subjects were recruited with 46(51.7%) males and 43(48.3%) females. The mean age was 5.06 ±3.4 years. The seroprevalence of HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, AntiHCV and HIV 1& 2 were 3(3.4%), 3(3.4%), 5(5.7%), 1(1.1%), 6(6.9%) and 0% respectively. No co-infection among the studied subjects. There is no significant difference in the age or gender distribution and seroprevalence of the viruses among SCA children. p = > 0.05 Conclusion: Hepatitis C infection is found to be high as opposed to Hepatitis B which is lower among SCA Children in this community

Interactions between Schistosoma haematobium group species and their Bulinus spp. intermediate hosts along the Niger River Valley

Background Urogenital schistosomiasis, caused by infection with Schistosoma haematobium, is endemic in Niger but complicated by the presence of Schistosoma bovis, Schistosoma curassoni and S. haematobium group hybrids along with various Bulinus snail intermediate host species. Establishing the schistosomes and snails involved in transmission aids disease surveillance whilst providing insights into snail-schistosome interactions/compatibilities and biology. Methods Infected Bulinus spp. were collected from 16 villages north and south of the Niamey region, Niger, between 2011 and 2015. From each Bulinus spp., 20–52 cercariae shed were analysed using microsatellite markers and a subset identified using the mitochondrial (mt) cox1 and nuclear ITS1 + 2 and 18S DNA regions. Infected Bulinus spp. were identified using both morphological and molecular analysis (partial mt cox1 region). Results A total of 87 infected Bulinus from 24 sites were found, 29 were molecularly confirmed as B. truncatus, three as B. forskalii and four as B. globosus. The remaining samples were morphologically identified as B. truncatus (n = 49) and B. forskalii (n = 2). The microsatellite analysis of 1124 cercariae revealed 186 cercarial multilocus genotypes (MLGs). Identical cercarial genotypes were frequently (60%) identified from the same snail (clonal populations from a single miracidia); however, several (40%) of the snails had cercariae of different genotypes (2–10 MLG’s) indicating multiple miracidial infections. Fifty-seven of the B. truncatus and all of the B. forskalii and B. globosus were shedding the Bovid schistosome S. bovis. The other B. truncatus were shedding the human schistosomes, S. haematobium (n = 6) and the S. haematobium group hybrids (n = 13). Two B. truncatus had co-infections with S. haematobium and S. haematobium group hybrids whilst no co-infections with S. bovis were observed. Conclusions This study has advanced our understanding of human and bovid schistosomiasis transmission in the Niger River Valley region. Human Schistosoma species/forms (S. haematobium and S. haematobium hybrids) were found transmitted only in five villages whereas those causing veterinary schistosomiasis (S. bovis), were found in most villages. Bulinus truncatus was most abundant, transmitting all Schistosoma species, while the less abundant B. forskalii and B. globosus, only transmitted S. bovis. Our data suggest that species-specific biological traits may exist in relation to co-infections, snail-schistosome compatibility and intramolluscan schistosome development

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit