Characteristics and Outcome of Paediatric Traumatic Brain Injuries: An Analysis of 163 Patients in Enugu

Background: As with most ailments common to adult and paediatric age groups, studies that describe and characterize paediatric traumatic brain injuries (TBIs) lag those of their adult counterparts. This is more so in the developing countries where national data are not well developed. The development of local clinical  guidelines has been shown to positively impact outcomes of paediatric TBI. Data on the characteristics and outcomes of TBI among paediatric age groups will provide a framework for the development of an  all‑encompassing management guideline. Methods: In this study, a retrospective review of demography, mechanism of injury, pattern of presentation, nature of treatment, duration of hospital admission, and outcome of children aged 0–17 years managed for traumatic TBI at the University of Nigeria Teaching Hospital, Enugu‑Nigeria was performed. Data were analyzed using SPSS version 21. Relevant test statistics were used to test for associations. AP = 0.05 was considered  statistically significant. Results: Atotal of 163 patients’ medical records were retrieved and analyzed. Of these, 117 (71.8%) were males and 46 (28.2%) were females. Their ages ranged from 6 weeks to 17 years with a mean age of 7.66 ± 5.1 years and peaked at 3–5 years. No difference in mean age between gender (P = 0.427). Pedestrian motor vehicular accident was the most common cause of injury. Fall from fruit trees and assault were peculiar to children from suburban/rural areas. TBI severity on admission was mild (44.2%), moderate (38.7%), and severe (17.2%). Other systemic injuries were present in 33.7%, of which long bone fractures were the most common (23/55). Abnormal brain computed tomography findings were seen in 83.2% with skull fracture being the most common finding. Operative procedures were carried out on 19.6% of patients. Conservative measures were the mainstay of management. The mean  duration of hospital admission was 14.01 ± 11.8 days was significantly associated with admission Glasgow Coma Scale (GCS) Score (P < 0.0001) and Glasgow Outcome Score (GOS) at discharge (P = 0.03). The overall outcome was good (GOS 4 and 5) in 92.0% and has a significant association with GCS on admission (P < 0.0001). Long‑term (Extended GOS) was 8 in 98.2% of those followed up. Conclusion: Paediatric TBI is mainly mild to moderate in severity with a male predilection. The main cause is road traffic accidents with most victims being pedestrians. Management is mainly non-operative and the outcome at discharge is good even in a middle‑income country and significantly determined by GCS on admission

Frequency and Predisposing Factors to Hypoglycaemic Events: Experiences at a Diabetes Youth Camp in Sub-Saharan Africa

Background: Early detection and management of hypoglycaemia is an integral part of care in diabetes camps. The objective of this report was to present the frequency of hypoglycaemic events and possible predisposing factors in a diabetes camp in Nigeria.Methodology: The blood glucose recordings for twenty one children and adolescent aged 6 years to 19 years who attended aweekend diabetescamp were analyzed. Further information about subjects was retrieved from completed pre camp documents.Results: Eight (38.1%) campers had hypoglycaemia and 7(43.8%) of the episodes occurred at 2am check. Hypoglycaemia was recorded in 17(7%) of 252 blood glucose recorded with a rate of 0.4 per camper/day. The mean insulin unit/kg/day was significantly higher in children with hypoglycaemia compared with those without (p= 0.03). 40% of campers with HBA1C less than 7.5 had hypoglycaemia and the mean HBA1C and BMI Z score of campers with hypoglycaemia was lower than in those without. This finding was however not statistically significant. Fifty percent of younger campers aged 6 to 12years had hypoglycaemia compared to 35% of older campers.There was no statistically significant relationship between age, sex, duration of diabetes and occurrence of hypoglycaemia.Conclusion: More than a quarter of campers had hypoglycaemia. Mean insulin dose was significantly higher in campers who experienced hypoglycaemi compared to those who did not. Frequency of hypoglycaemia was higher at 2 am check and following hiking before lunch

Haematological profile of anti-retroviral therapy (ART)-naive HIV positive children in Enugu, Nigeria

Background: Haematological complications such as anaemia, neutropenia and thrombocytopenia are associated with Human Immunoeficiency Virus (HIV) disease progression and reduced survival. These have been documented to be the second most common cause of morbidity and mortality in infected children. This study sought to assess the haematological parameters in HIV positive Anti-retroviral therapy (ART)-naïve children and compare with the HIV negative children in order to discover ways of maximizing outcomes and value from ART when eventually indicated.Methods: This was a prospective observational study done in 2016 at University of Nigeria Teaching Hospital, Enugu, involving a total of 200 children. Blood samples were collected for full blood count (FBC) and Cluster of Differentiation 4 (CD4) counts. Data generated were analyzed with Statistical Package for Social Sciences (SSPS) version 22.Results: The prevalence of anaemia was 60% among HIV-infected children. Hemoglobin levels unlike leucocyte and platelet counts were significantly associated with HIV-infection. CD4 count was inversely associated with anaemia. Similarly the incidence of anaemia but not neutropenia and thrombocytopenia was also inversely and significantly associated with the ages of the children.Conclusion: Anaemia was prevalent among HIV infected children and is inversely associated withCD4 count. Haemoglobin concentration estimations can therefore be considered as one of the criteria for commencement of antiretroviral medications especially in resource poor centers where CD4 count is not readily available.Keywords: HIV, Antiretroviral therapy naïve, Anaemia, Thrombocytopenia, CD4 count, Childre

Childhood diabetes: a myth or reality?- perception of the public from a low-income country: a cross-sectional study

Abstract Background The diagnosis of Type 1 diabetes is commonly missed in most health facilities in Nigeria. Adequate knowledge of childhood diabetes is necessary for the recognition and possible intervention for the control of the disease. However, research to assess knowledge deficiencies and their relationship to attitude is lacking in most developing countries including Nigeria. This study intends to survey the beliefs and perceptions of caregivers of children towards diabetes in childhood. It also aims at determining the caregivers’ depth of knowledge of diabetes in children, the relationship between knowledge and practices as well as the association between level of education and gender with practices and knowledge. The study outcome will help in the formulation of policy and education of the communities with regards to the preconceived myths and realities of childhood diabetes. Methods A descriptive study involving 500 respondents, population groups were selected by multi-staged sampling from different areas in Enugu metropolis, south-East of Nigeria. A validated structured interviewer-administered questionnaire was used. Ethical approval was obtained, and only consenting subjects were interviewed. Data was analyzed with Statistical Package for the Social Sciences (SPSS) version 20. Result Almost all the respondents (99.8%) had heard of diabetes in adults. However, a lower proportion of respondents 43.2% knew about diabetes in childhood. Only 24.8% had good knowledge of the different aspects of diabetes. Although females were more knowledgeable about the effects of healthy life style modifications on diabetes, there was no gender predisposition in knowledge about diabetes in childhood. A positive association existed between knowledge and education [p < 0.001] concerning childhood diabetes. Irrespective of this association 82.6% of the respondents with good knowledge of the disease still had a poor attitude towards healthy life style practices. Conclusion This study has shown that beliefs and perceptions of childhood diabetes among the adult caregivers in Enugu, south – East Nigeria is mostly erroneous and their knowledge deficient. Literacy did not improve both knowledge and attitude to healthy lifestyle practices