Adverse Drug Event From Artemether/lumefantrine Ingestion: Case Series

We present rare cases of three adverse drug events from artemeter-Lumefantrine(AL) ingestion. This is an antimalaria combination therapy used in the management of malaria. Adverse reaction is rarely reported when using this drug. We report these cases of our patients who developed urticaria and bullae. One had hypotension few hours after taking AL. We report these cases to show that though rare, adverse drug event can occur in AL.Conclusion: Artemesinin combination therapy though safe in children, is not without adverse reaction.Ke y Wo r d s : a r t eme t e r - Lumefantrine; Children; Adverse drug event

The practice of paediatric cardiology in Nigeria: A Review

Background: The practice of Paediatric cardiology in Nigeria is at its early phase and it is being choked in an environment overwhelmed with economic, ethnic and political issues. Paediatric cardiology covers a broad area of medicine. This includes diagnosis, medical treatment, interventional cardiology, prenatal diagnosis and surgery. It will also notthrive without a high level of infrastructure manned by personnel with advanced training and expertise. Regretably, the manpower and infrastructure that are needed is grossly inadequate in Nigeria. For the practice of paediatric cardiology to gain ground, a well knitted corroborative mechanism involving the government and hospital authorities must be endorsedMethods: A search for published works on practice of paediatrc cardiology in Nigeria was performed using Google and Pub Med. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were historical facts, burden of the problem, organization, factors militating Paediatric cardiology practice in Nigeria and the way forward.Results and Conclusions: Contrary to what is widely believed in many quarters, though erroneously, there is overwhelming evidence that the practice of paediatric cardiology has left much to be desired.Keywords: paediatric cardiology; Nigeria; manpower; infrastructur

Sleep practices among medical students in Pediatrics Department of University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Background: Medical students are a population who are at great risk of having bad sleep practice and hygiene due to demanding clinical and academic activities. Poor sleep practices are a disturbing and destabilizing phenomenon. It affects many people and can affect the quality of work, performance and education of medical students. Determining the sleep practices and behaviors could be useful to establish a systematic mental health curriculum in medical schools.Objectives: The objectives of this study is to describe sleep practices among undergraduate medical students in a Nigerian University.Materials and Methods: Sleep practices were investigated using a convenience sample of medical students from the University of Nigeria Teaching Hospital Ituku Ozalla, Enugu from October 2012 to February 2013.Results: A total number of participants enrolled were 241 consisting of 150 male and 90 female medical students. However, 222 (response rate: 92.1%) completed and returned the questionnaire. The median number of hours of night sleep on a weekday and weekend were 6 and 7 h respectively. There was a significant correlation between the number of hours of sleep and use of caffeine (Spearman r = −0.148, P < 0.0321). Ninety two (45.3%) had a sleep latency of 10-30 min while 157 (70.7%) woke up 1-2 times/night. Twenty five (11.3%) experience unusual sleep practices such as sleep walking, talking or night terrors.Conclusion: Medical students in our institution have varying degrees of sleeping practice and behavior and this may affect academic performance.Key words: Medical students, pediatrics, sleep practic

Impact of Parental Sex Education on Child Sexual Abuse among Adolescents

Background: Parental sex education of children is an often overlooked issue in pediatrics, especially in our society where talking about issues concerning sex is regarded as a taboo.Objectives: The objective of this study is to determine the impact of sex education on child sexual abuse among adolescents attending secondary schools in south east Nigeria.Methods: This is a cross-sectional study that was carried out among children in three secondary schools in Enugu and Ebonyi states of Nigeria. Five hundred and six adolescents who met inclusion criteria were consecutively recruited into our prospective study between June and October, 2014.Results: Eighty (80%) of respondents were educated by parents on sex abuse. Of those educated majority was by mother (46.2%) and both parents (45.2%). Most (72.1%) were not informed that family members or family friends can abuse children and 73.8% were not told to inform adults if it happens to them. A lower proportion (37.9%) of those educated by parents at home was abused. Those educated by parents were 1.23 times less likely to be abused than those not educated. There was significant difference in sex abuse between males and females (p=0.014) while there were no significant difference for age (p=0.157) and social class (p=0.233).Conclusion: Children educated by parents on sexual abuse were less likely to be sexually abused than those not educated. There is no link between socioeconomic class and child sexual abuse among adolescents.Keywords: Parental Sex Education, Adolescents, Nigeri

Health services utilization and costs of the insured and uninsured under the formal sector social health insurance scheme in Enugu metropolis South East Nigeria

Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious  utilization of financial resources, in order to provide financial risk  protections and cost burden sharing for people against high cost of  healthcare through various prepayment methods prior to falling ill. It is still unclear how the Federal Social Health insurance program for federal civil servants has affected the insured and uninsured civil servants in terms of health services cost and utilization in Enugu metropolis.Objectives: The aim of the study was to compare the health services  utilization and cost of insured with that of the non.insured federal civil servants with a view to generate information for policymaking on improving services of the National Health Insurance Scheme.Materials and Methods: A comparative, descriptive, cross.sectional survey  of both the insured and uninsured federal civil servants was conducted in Enugu metropolis. Respondents were purposively enrolled and were  grouped according to their insurance status after signing the informed consent form. Comparative analysis of health services utilization,satisfaction, and health services cost which include total cost, average cost, and catastrophic expenditures were done using SPSS version 17.0.Results: There were 809 respondents; this comprised 451 insured and 358 uninsured respondents. There were 420 males (51.9%) and 389 females (48.1%). It was found that 657 respondents had at least easy access to health; this comprised 369 (56.7%) insured and 288 (43.3%) non-insured respondents while 70 (46%) of the non-insured and 82 (54%) of the insured civil servant had difficult access to health care (P = 0.620).Conclusion: There are still federal civil servants yet to enroll into the formal sector social insurance program. The NHIS-insured civil servants have no appreciable advantage in terms of access to and cost of health services in Enugu metropolis.Key words: Health insurance, health services utilization, insure

Pattern and outcome of paediatric medical admissions at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu: a five year retrospective review (2007 – 2011)

Background: Most health information from Nigeria and other developing countries are based on hospital records which although may not be a true representative of the whole population, they serve as pointers. Such information has shown that infections and malnutrition remain the leadingcauses of morbidity and mortality , although non-communicable diseases also pose substantial threat to child health.Objective: To review the pattern, trend and outcome of paediatricadmissions at the University of Nigeria Teaching Hospital over afive year period.Methods: Patients admitted into the main pediatric wards of the hospital over a five year period were reviewed, through information obtained from their case notes. Neonates, surgical and trauma patients as well as patients admitted into the children’s emergency room were excluded.Results: Infections (44.5%) were the leading causes of hospital admissions while non-communicable diseases were the leading causes ofdeath in this study with an overall mortality rate of 9%.Conclusion: Despite all efforts over the years, infections continue to pose serious challenges to child health in developing countries. At the same time, non-communicable diseases are taking over as leading causes of mortality. Therefore, as we make stronger efforts to tackle infections and malnutrition, we should make provisions for improved diagnosis and management of non-communicable diseases.Key words: Outcome, Paediatric, medical admissions, Enugu

Pattern and clinical profile of children with complex cardiac anomaly at University of Nigeria Teaching Hospital, Ituku‑Ozalla, Enugu State, Nigeria

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross‑sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla, Enugu State over a 5‑year period (January 2007‑June 2012) was undertaken.Results: Thirty one thousand seven hundred and ninety‑five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio‑septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner’s syndrome and another with VACTERAL association.Conclusions: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.Keywords: Abnormalities, children, complex congenital cardiac, Enugu, presentationNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Coagulation profile of children with sickle cell anemia in steady state and crisis attending the university of Nigeria teaching hospital, Ituku-Ozalla, Enugu

Background: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome.Objectives: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype.Materials and Methods: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex.Results: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038).Conclusion: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.Key words: Children, coagulation profile, sickle cell anemi

Caroli disease in a 2 month old Nigerian-A case report

We present a rare and first case of Caroli Disease (CD) in a child who presents with abdominal distension, regurgitation of feeds, passage of greenish stools and fever, typical ultrasonographic and abdominal and x-ray findings. The purpose of presenting this case report is to highlight the distinctive manifestation of Caroli disease and to provide a concise report of this rare disease with the hope that such information will help identifypatients earlier in the course of their illness. This will add to medical literature by helping clinicians to know that this anomaly is treatable in a good setting and if detected early.Key words: Rare disease; childhood; polycystic disease; liver disease; Nigeria

Mortality among paediatric inpatients in Mile 4 Mission hospital Abakaliki, south-eastern Nigeria: A retrospective study

Background: In the sub-Saharan Africa, one in every five children dies before their 5th birthday, mostly from preventable causes. Recent data from Nigeria, show infant and under-5 mortality rates of 88 and 143 deaths per 1000 live births respectively. Although significant efforts havebeen made in the last two decades towards the reduction of childhoodmortality, the rate still remains unacceptably high.Objective: The aim of the current study was to evaluate the patternand causes of paediatric (childhood) mortality at Mile 4 Mission Hospital, Abakaliki. This will help us to know exactly what happens in a small mission hospital with few facilities and limited skilled medical personnel. In addition, this is the very first time this study was undertaken in thishospitalMaterials and Methods: The records of admissions and deaths ofchildren managed at the Mile 4 Mission Hospital from the 1st January 2009 to 31st December 2009 were retrieved from the Medical Records Department for analysis.Results: Of the 1110 patients admitted within this period, 72 diedgiving an overall mortality of 6.5%. There were 43 males and 29females, giving a male: female ratio of 1.5:1. Most of the deaths58 (80.6%) occurred among children aged younger than 2 years.Malaria was the most common presumed cause of death, followedby gastroenteritis and bronchopneumonia. Twelve and half percent (12.5%) of the children died within 24 hours of admission. The commonest causes of death within 24 hours were severe anaemia, pneumonia and gastroenteritis. The modal months for childhood mortality in this hospitalwere May and August.Conclusion: Mortality was commonest among children younger than 2 years of age. Malaria, gastroenteritis and pneumonia were the commonest causes of death. A proactive planning taking into account the seasonal variation of these diseases could reduce the childhood mortality in this centre