The pattern of paediatric respiratory illnesses admitted in Ebonyi state university teaching hospital south east Nigeria

Background: Reports from the developed nations reveal respiratory tract infections as the leading cause of childhood hospital admissions. Children may be admitted for a variety of respiratory illnesses. Data on the spectrum of pediatric respiratory illnesses admitted in the hospital is scarce. Aim: To determine the pattern of pediatrics respiratory illness admissions, seasonal frequency, underlying risk factors and outcome. Subjects and Methods: A retrospective assessment of respiratory cases admitted in the pediatric ward from 2005 to 2010 was conducted using case notes. Parameters considered included month of presentation, age, sex, immunization and nutritional status, tools of diagnosis and patient outcome. Results were analyzed using the Statistical Package for the Social Sciences with the level of significance P ≤ 0.05. Results: Of the 239 cases admitted, there were more males than females (1.4:1). The commonest case was Bronchopneumonia, 71.6% (171/239 out of which 161 were uncomplicated, 5 had effusions and 6 were associated with measles). Other cases were Pulmonary Tuberculosis, 10.9% (26/239), Lobar pneumonia 8.8% (21/239), Bronchiolitis, 5% (12/239), Aspiration pneumonitis 2.1% (5/239) and Bronchial asthma, 0.8% (2/239). Mortality was 7.5% (18/239) mostly from Bronchopneumonia amongst the 1–5 years old. Mortality was significantly associated with malnutrition (P < 0.001) and poor immunization status (P < 0.01). Conclusion: Bronchopneumonia was found to be the commonest illness with significant mortality and peak occurrence in the rainy season. More emphasis must be laid on anticipatory guidance and prevention by encouraging the immunization, good nutrition and increased attention on children even after 1 year of age.Keywords: Admissions, Ebonyi, Nigeria, Pattern, Respiratory illnes

In Vivo Comparative Evaluation of Effects of Artemeter-Lumefantrine, Sulphadoxine-Pyrimetamine and Halofantrine on G6PD Activities, Haemoglobin Concentration and Malaria Parasite Clearance Rate in Malaria Infected Adults

Background: The use of antimalaria combination therapy especially regimens containing an artemisin-based compound has been recommended as a good first-line treatment for malaria by WHO. However, limited reports exist on the effects of the ACT and other antimalarial drugs on some vital biological parameters such as G6PD activity and haemoglobin concentration. In this study, we investigated the effects of Artemeter-Lumefantrine, sulphadoxine-pyrimetamine combination therapies and Halofantrine monotherapy on G6PD activity, Haemoglobin level and parasite clearance rate in malaria-infected adults treated with the drugs in Enugu, Nigeria. Methodology: Forty malaria-infected adults aged between 20 and 30 years were used. The subjects were divided into four groups (A, B, C and D). The groups A, B and C were given Artemeter-Lumefantrine, sulphadoxine-pyrimetamine and halofantrine respectively, while group D was a control group (malaria-positive control). Blood samples of the subjects were collected through venepuncture at baseline (Day 0) and after treatment on Day 4, for comparative analysis of G6PD activity, haemoglobin concentration and parasite clearance for each group. Results: The result of this study showed that sulphadoxine-pyrimetamine significantly (p<0.05) lowered haemoglobin concentration as compared with Halofantrine, Artemeter-lumefantrine and control. The haemoglobin concentration of the last three groups did not show any significant difference (p>0.05) between each other. The G6PD activity of the group treated with sulphadoxine-pyrimetamine was significantly (p<0.05) higher as compared with that treated with Artemeter-lumefantrine but non-significant (p>0.05) as compared with halofantrine and control. Parasite clearance rate was significantly (p<0.05) highest with the Halofantrine group (76%, p< 0.05) while Sulphadoxine-pyrimetamine had the lowest (52%) parasite clearance. Conclusion: This study therefore indicated that antimalaria drugs as well as malaria parasite could cause a reduction in haemoglobin concentration with sulphadoxine-pyrimetamine causing significant (p<0.05) increase in G-6-PD activity. Keywords: Antimalarials, Artemether-Lumefantrine, G6PD, sulphadoxine-pyrimetamine, Parasite clearance, Halofantrine, Haemoglobin concentratio

Evaluating School Health Appraisal scheme in Primary Schools within Abakaliki metropolis, Ebonyi State, Nigeria.

Background: Ill health constitutes a potential major limiting factor in the educational progress of any child. Some studies have noted a high prevalence of diseases and disability among apparently well school children. Appraisal of the health of school pupils/staff is necessary to optimise learning. Objectives: This study assessed school health appraisal implementation in primary schools within Abakaliki Metropolis. Materials and Methods: This was a cross sectional descriptive study of the forms of health appraisal in all 31 primary schools in Abakaliki metropolis. Relevant information was obtained from the head teacher in each school and scored using a validated evaluation scale. Data was analysed using the SPSS 13 with the level of significance set at p <0.05. Results: Out of the 31 primary schools, 16 were public while 15 were privately owned. All the schools did routine inspection of the pupils. Few (12.9%) requested pre-entry medical examination and those were exclusively private schools, none organised periodic medical examinations for their staff and/or pupils, seven (22.6%) schools practiced referral of pupils to health centers or hospitals, while only two schools supervised the health of the handicapped. The private schools performed relatively better than the public schools especially in pre-entry screening (p=0.027) and referral of cases (p=0.001) Conclusion: Generally, appraisal of the health of school children within the study area is poor and this needs intervention if children are to benefit from the Universal Basic Education.Keyword: School health services; Appraisal; Primary schools; Abakaliki, Nigeri

Culture and Biomedical Care in Africa: the influence of culture on biomedical care in a traditional African society, Nigeria, West Africa

BACKGROUND: Biomedical Care in Africa and the influence of culture on the health-seeking behaviour of Africans can not be underestimated; many African cultures have different understanding of the causes of disease which more often affect our public health system, policy, planning and implementations. The traditional African healer unlike a doctor trained in western biomedicine, looks for the cause of the patient's ailments as misfortune in relationship between the patient and the social, natural and spiritual environments. The complexity of African society with different cultural and religious practices also reflects on the people's attitude and understanding of their health matters. This paper is an overview of the cultural influence on biomedical care in a traditional African society, Nigeria, West Africa.METHODS: A research on the patients' health seeking behaviour and Primary Health Care service organization in 10 health centres in the five eastern states of the Federal Republic of Nigeria was carried out using a multistage cross-sectional study. A semi-structured questionnaire was administered to the health care providers and patients while an in-depth semi- structured interview was also conducted. RESULT: We observed there is underutilization of health care services at the primary level because most people do not accept the model of health care system provided for them. Most people believe diseases are caused by supernatural beings, the handiwork of neighbours or vengeance from an offended god as a result of transgressions committed in the past by an individual or parents. This group of people therefore prefers seeking traditional medicine to seeking orthodox medicine and often ends up in the hands of witch doctors who claim to have cure to almost all the diseases. CONCLUSION: Biomedical care in Africa is influence by culture because of different understanding of what ailment is and also due to limited knowledge of health matters, poverty and ignorance. There is a need therefore to focus on health out-reach programme, communication and enlightment campaign in Africa especially in the rural areas that are more vulnerable and are burdened with many of these diseases.KEYWORDS: Biomedical Care; influence of Culture; Africa; Nigeri

Health Seeking Behaviour and Access to Health Care Facilities at the Primary level in Nigeria: our experience.

Context: Health care at the primary level is accepted as the model for delivering basic health care to low income populations especially in developing countries such as Nigeria. Despite all the efforts and strategiesadapted in Nigeria, there is still high level of morbidity and mortality from the diseases primary health care (PHC) is expected to control. The aim of this study was to determine the effect of limited knowledge and accessto primary health care services on the health-seeking behaviour of NigeriansMethods: We carried out a multistage cross-sectional study in 10 health centres in Nigeria using qualitative and quantitative research methods. A semi-structured questionnaire was administered to the health care providers and patients while an in-depth interview was also conducted amongst the community members where the health centers were situated.Results: Out of the 166 questionnaires distributed, 161 (97%) were returned anonymously while 32 interviews were conducted giving a total of 193 response rate. One hundred and eleven (57%) seek health care at the health centres, 121 (62.7%) patent medicine stores, 87 (45%) medicine vendors, 100 (51.8%) private clinics, 56 (29%) prayer houses, 118 (61.1%) traditional healers. The commonest reason (79.8%) for preferred choice of visit was accessibility to health care services.Conclusion: Limited access to health care services and poor service organization of the primary health care (PHC) in Nigeria have been identified as reasons for seeking health care in an unothordox method, which often expose individual to the lure of witch doctors who claim to have cure to almost all the diseases Therefore, the PHC service organizations in Nigeria should among other things provide access to health care services and also appreciate the need for health outreach programme and communication in rural areas.Keywords: Health care services, Accessibility, Health-seeking behavour, Nigeria

Severe Malaria in Neonates Masquerading as Septicaemia

Background: Malaria was once thought to be rare in the neonatal period, especially in neonates of semi-immune mothers in holoendemic areas. As a result, ill neonates admitted to newborn special care units are often presumed to have neonatal sepsis. Consequently, blood films for malaria parasites are not routinely included in the sepsis screening protocol for such neonates. Objective: To highlight the manifestations of, and the significant morbidity associated with malaria in the newborn. Patients and Methods: In a prospective study, all consecutive term neonates admitted for presumed sepsis during a five-month rainy season period (April to August 2002) to the Ebonyi State University Teaching Hospital, Abakaliki period were investigated for septicaemia and malaria. Septicaemia was diagnosed by positive blood culture, while malaria parasitaemia was diagnosed on Giemsa stained blood smears. Results: Eighty four neonates were screened for sepsis and malaria parasitaemia during the study period. Out of this number, 28 (33.3 percent) had positive blood smears for malaria parasites alone, 10 (11.9 percent) had septicaemia alone, while four neonates (4.8 percent) had both malaria and septicaemia. Plasmodium falciparum was found in all positive blood smears. Twenty-four (75.0 percent) of the 32 neonates with positive malaria parasitaemia had congenital malaria, while the remaining eight (25 percent) most probably had acquired malaria. None of the neonates had transfusional malaria. Parasite densities were uniformly low. Infected neonates weighed 230g less than the non-infected (p< 0.005). Babies of primiparae were infected with malaria parasite in significantly greater proportion than those of the multiparae (p< 0.01). The presenting features in the 28 babies with neonatal malaria alone, included fever in 24 (85.7 percent), refusal of feeds in 23 (82.1 percent), respiratory distress in 19 (67.9 percent) and jaundice in 15 (53.6 percent). The features in the 10 babies with septicaemia alone, included refusal of feeds in 10 (100.0 percent), respiratory distress in 10 (100.0 percent), jaundice in 10 (100.0 percent) and fever in five (50.0 percent). Fever was significantly more prevalent in neonatal malaria than in septicaemia (

Prevalence of malnutrition in hospital children in federal teaching hospital Abakaliki, Ebonyi state south eastern Nigeria.

Background: Malnutrition is a state of excess or deficiency in energy, protein and or other nutrients which causes measurable adverse effects on body forms and function. A holistic approach is required in the management of hospitalized pediatric patients and includes the assessment and management of nutritional problems if present.Objectives: To assess the prevalence and factors associated with malnutrition amongst hospitalized pediatric patients.Methods: A cross sectional descriptive study carried out in the General Pediatric ward of Federal Teaching Hospital Abakaliki, Southern Nigeria where. Data on height, weight and mid arm circumference were taken and recorded in a questionnaireproforma Weight-for-height Z-Score’s were calculated using the WHO reference values 2007 and &lt;-2 Z-score used as definition of moderate and severe malnutrition. BMI was calculated and the BMI-for-age SD-scores calculated from the WHO reference values 2007.Undernutrition was defined as BMI-for-age SD-score&lt;-2.Variables were cross-tabulated and associations tested using the Fisher’s Exact test with a level of significance set at p&lt;0.05.Data analysis was done using SPSS version 20Results: Of the 150 subjects recruited, majority (60.7%) were males, of the lower socioeconomic class (56.7%) and admitted for various infectiousdiseases (80.6%).19.3% were wastedmalnourished using the weight-for-height while 37.3% were underweight using BMI-for-age percentiles. Diagnosis was significantly associated with malnutrition (p&lt;0.05)Conclusion: A high prevalence of malnutrition exists amongst hospitalized patients. Hence all inpatients should have anthropometric measurements taken and recorded so that their nutritional needs may be addressed with their primary diagnosis.KEYWORDS. Hospitalized children, malnutrition, and prevalence