Some economic and socio-cultural factors associated with cerebral malaria among under-fives in Benin City, Nigeria.

Introduction: Risk factors associated with the occurrence of cerebral malaria in under fives are well documented. Outside these acknowledged factors of age, location, and nutrition, other socioeconomic/cultural factors could contribute to the maze of factors determining the occurrence of the morbidity. Methods: To unravel such factors a key informant interview was conducted among resident doctors in paediatrics at the University of Benin Teaching Hospital. Factors identified formed the basis of this cross-sectional, case control study involving 64 cases each of subjects and controls with uncomplicated malaria carried out at the Hospital. Such factors as delay in accessing competent intervention, prolonged use of anti-pyretics, material educational status, use of substandard medication and abdominal scarification as identified were evaluated in the two sets of patients. Others evaluated included mothers’ occupation and health seeking behaviours. Results: Factors found to be significantly associated with occurrence of cerebral malaria were initial treatment in clinics (X2 = 6.43, p = 0.011) presence of fresh abdominal scarification (X2 = 4.30, p=0.038) late presentation (X2 = 32.64; p=0.000) and non- use of mosquito nets (X2 = 9.14; p=0.002). Conclusion/Recommendations: Initial treatment either in clinics or non orthodox facilities contributed significantly to the occurrence of cerebral malaria. The implication of these is that pre- teaching hospital treatments were inadequate in managing the child meant to develop cerebral malaria. Attention should therefore be directed at these areas alongside use of mosquito nets if the objective is to minimise the occurrence of cerebral malaria.Key words: Cerebral malaria, Risk factors, Under fives, Economic factors & Socio-cultural factors

Sodium concentration in home made salt – sugar – solution (sss): influence and implications of changing solvent measures.

In a cohort of 210 young mothers, selected through cluster sampling technique from Ogida health district of Egor Local Government Area of Edo State, the electrolyte concentration of prepared salt-sugar-solutions (SSS) were evaluated. This was predicated on the need to determine the effects of introduction of various solvent measures on electrolyte concentration. About 85% of mothers used appropriate sized bottles. Of the 32 that used inappropriate sized bottles, 21 (65.5%), 9 (28.1%) and 2 (6.3%) respectively used two of the 350ml coke bottle, one of 350ml coke bottle and 2 of 250ml coke bottle. The choice of appropriate sized bottle was not significantly influenced by previous use of SSS, recent use of SSS, age, maternal education and social class. Mean sodium concentration of the 600ml beer bottle or two 300ml coke bottles varied significantly from those obtained with the use of multiples of 250ml (t = 6.76; p 120.0 and < 91.0. The preparation of solution with appropriate sodium concentration was uninfluenced by recent use of SSS, prior use of SSS, maternal age and maternal education. The multiplicity of various sizes of soft drink bottles in the Nigerian market has the potential of worsening the problem of inappropriate sodium concentration of homemade SSS. It is recommended that a standard measure of 600ml capacity, devoid of any relationship with sale and consumption of any commercial drink be introduced into the Nigerian market to enhance SSS promotion and standardization. Keywords: Sodium concentration, SSS, Solvent – measures. Annals of Biomedical Science Vol. 1 (2) 2002: pp. 124-13

Socio-demographic determinants and impact on academic performance of attention deficit/hyperactivity disorder in school children in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) affects children worldwide. In Nigeria, there is paucity of information on the socio-demographic associates of this important childhood condition. Methods: Across-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6 to 12 years, selected randomly among pupils drawn from Egor Local Government Area of Edo State. The subjects were screened using Disruptive Behaviour Disorder (DBD) Rating Scale to identify children with ADHD symptoms. Identified subjects were further evaluated with questionnaires to ensure that they met the other explicit non-symptom criteria contained in the DSM-IV manual, such as functional impairments. Children who were confirmed to have ADHD were compared with randomly selected controls to determine the association, if any, between the prevalence of the condition and some socio-demographic characteristics. Results: The prevalence of ADHD was 7.6%. There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. No significant association was found between the prevalence of ADHD and socioeconomic background, size of family, age of parents and characteristics of the child′s primary caregiver. The children with ADHD had significantly lower school aggregate than that of selected control (Mean aggregate score of 51.7+16.1% versus 63.7+ 16.5%, p<0.001). Conclusion: The prevalence of ADHD in this study is relatively high. Community screening under the umbrella of the School Health Programme is required. Appropriate medications, educational support and psychotherapy when incorporated in the national health system will go a long way in redirecting affected children′s developmental lives

Community survey of attention-deficit / hyperactivity disorder among primary school pupils in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neuro-developmental condition with early onset. ADHD affects children worldwide. However, there is a variation in the prevalence across different countries. In Nigeria, there is paucity of information on the prevalence. To provide the relevant information, a cross-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6-12 years selected systematically among pupils in Egor Local Government Area of Edo State. Materials and Methods: All the 1473 pupils were screened with the Disruptive Behavior Disorder (DBD) Rating Scale to identify children who had ADHD symptoms as contained in the DSM -IV. Such children were compared with randomly selected controls. The academic records of both the groups were also compared. Results: The prevalence of ADHD was 7.6%. The prevalence was higher in boys (9.4%) when compared to girls (5.5%) (P = 0.003). Of the three different subtypes of ADHD, the predominantly inattentive subtype (ADHD-I) was the most prevalent (47.3% of the ADHD population) followed by the combined type (ADHD-C; 31.3%), while the least prevalent was the hyperactive/impulsive subtype (ADHD-HI; 21.4%). There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. Conclusion: The prevalence of ADHD was relatively high when compared to the figures available for other countries. For this reason, there is a need to pay increased attention to this condition in Nigeria. Community screening under the umbrella of the School Health Program could be of assistance

Detection of SHV and TEM-type Extended spectrum β-lactamase in bacterial isolates recovered from clinical samples of patients attending military hospitals

Background Multi-drug resistant bacterial strains have been increasingly implicated in clinical infections worldwide and beta-lactamase production is one of the commonest mechanisms of resistance in these strains. This study investigated the prevalence of extended spectrum â-lactamase (ESBL)-producing isolates and determined the temoneira (TEM) and sulfhydryl variable (SHV) types implicated in two military hospitals in South-South Nigeria. Methods Three-hundred and eighty (380) consecutive non-duplicate bacterial isolates (Gram negative bacilli) recovered from clinical samples were identified following standard techniques. Antimicrobial susceptibility tests were performed for each isolate following the Clinical Laboratory Standards Institute guidelines. Bacterial isolates recovered which comprised Escherichia coli, Klebsiella spp, Proteus spp and Pseudomonas aeruginosa were screened for ESBL using a phenotypic method (double disc synergy test). All positive isolates were screened for TEM and SHV genes by PCR method. Results Sixty-five isolates (17.1%) were ESBL producing using phenotypic method, E. coli showed the highest ESBL prevalence (24.3%). One isolate was SHV positive (1.5%), 8 (12.3%) were TEM positive while 3 (4.6%) isolates harbored both SHV and TEM genes. Fluoroquinolone - ofloxacin showed marked activity against ESBL-producing isolates (90.8%) while the least active were ceftriaxone (9.2%), ceftazidime (3.1%) and ampicillin (1.5%). Conclusion This study demonstrated that 17.1% of Gram-negative bacilli were ESBL producers. Screening of clinical isolates for ESBL should be implemented. The findings of this study suggest the need for caution in the use of antimicrobial agents in order to curb the incidence of antimicrobial resistance

Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria

Abstract Background Home-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6–59 months). Methods A descriptive cross-sectional study carried out from June 2012–July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16. Results Of the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ2 = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (β = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (β = 1.87, OR 6.5, p = 0.02). Conclusions The expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality

Community survey of attention-deficit / hyperactivity disorder among primary school pupils in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neuro-developmental condition with early onset. ADHD affects children worldwide. However, there is a variation in the prevalence across different countries. In Nigeria, there is paucity of information on the prevalence. To provide the relevant information, a cross-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6-12 years selected systematically among pupils in Egor Local Government Area of Edo State. Materials and Methods: All the 1473 pupils were screened with the Disruptive Behavior Disorder (DBD) Rating Scale to identify children who had ADHD symptoms as contained in the DSM -IV. Such children were compared with randomly selected controls. The academic records of both the groups were also compared. Results: The prevalence of ADHD was 7.6%. The prevalence was higher in boys (9.4%) when compared to girls (5.5%) (P = 0.003). Of the three different subtypes of ADHD, the predominantly inattentive subtype (ADHD-I) was the most prevalent (47.3% of the ADHD population) followed by the combined type (ADHD-C; 31.3%), while the least prevalent was the hyperactive/impulsive subtype (ADHD-HI; 21.4%). There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. Conclusion: The prevalence of ADHD was relatively high when compared to the figures available for other countries. For this reason, there is a need to pay increased attention to this condition in Nigeria. Community screening under the umbrella of the School Health Program could be of assistance

Assessment of use of national guidelines for malaria case management among paediatric resident doctors attending an update course in Benin City, Nigeria

Introduction: The National Malaria Guideline is a veritable tool for appropriate case management of malaria. Whether the pediatric residents who are the primary caregivers of children know and make use of this guideline in their routine practice is not yet assessed. Aim: The aim of the study is to assess the awareness of the Nigerian pediatric residents of the national guidelines for malaria case management (including antimalarial prescription for uncomplicated and severe malaria). Settings and Design: The descriptive study carried out during the 2017 National Postgraduate Medical College of Nigeria, Faculty of Paediatrics Update Course in Benin City. Subjects and Methods: Data were obtained using a self‑administered questionnaire which was given to all pediatric residents who participated at the update course and who had given written informed consent. Statistical Analysis Used: The statistical analysis was done using the Statistical Package for the Social Sciences version 16.0 (Inc., Chicago, Illinois, USA). Results: Of the 108 participants whose questionnaires were analyzed, 75.0% were Part 1 candidates and 25.0% Part 2 candidates; mean age 34.0 ± 4.5 years (range 26–51 years) and 42 (39.0%) males while 66 (61.0%) were female. Ninety‑four (87.0%) were aware of the current national guidelines for management of malaria and 45 (41.7%) had read the guidelines. Correctness of prescription was obtained from 39 (36.0%) respondents in uncomplicated malaria cases and 44 (40.7%) in severe malaria cases.This finding did not significantly associate with the years of practice, level of practice, practicing institutions, awareness, and reading of the national guideline. Conclusions: Most pediatric residents have not read nor use the national guidelines for management of malaria which reflected in poor prescription pattern of antimalarial drugs in routine practice

Micro-Albuminuria In Adolescent/Young Adult Offsprings Of Hypertensive Nigerian Adults - A Preliminary Report

Objectives: To determine the prevalence of micro-albuminuria in adolescent/young adult offsprings of Nigeria hypertensive adults. Background: On the premise that micro-albuminuria is a predictor of early stage hypertensive disease and the fact that heredity plays an important role in the aetiology of essential hypertension, the prevalence of micro-albuminuria in children of hypertensive adults was assessed. Setting: Medical wards of the University of Benin Teaching Hospital, Benin City. Subjects: Normotensive, non-diabetic, non-obese adolescents/young adult offsprings of known adult hypertensives, receiving in-patient care. Controls had similar characteristics but born to normotensive adults. Design: Prospective, cross-sectional involving 42 subjects and 50 controls. Results: Mean age of the 42 study subjects (24 males and 18 females) was 17.95+0.52years (range 13 – 24 years). Eight (19.0-%) had microalbuminuria as compared to 4(8.0%) in controls. Five (62.5%) of the micro-albuminuric subjects had fathers who were hypertensive while none had maternal history of hypertension. The incidence of microalbuminuria in subjects with positive paternal history of hypertension was 21.1% as against 0.0% in those with positive maternal history of hypertension. Parental history of diabetes mellitus did not enhance the risk of micro-albuminuria. Similarly, combined morbidities of hypertension and diabetes mellitus in either parents or both were unassociated with increased incidence of micro-albuminuria. Mean duration of paternal hypertension of 9.20± 2.09 years did not vary from 8.90±1.13years in the parents of those who were micro-albuminuria negative. Conclusion: Microalbuminuria could be a predictor of early phase adolescent hypertensive disease and such may have more relevance in offsprings of Nigerians at risk of hypertensive fathers. Recommendation: Longitudinal and more detailed work employing timed urine sample is advocated to further examine these relationships. Key Words: Micro-albuminuria, Adolescents, Parental essential hypertension, Africans. Nigerian Journal of Clinical Practice Vol. 7(2) 2004: 60-6

HIV - sero Positivity and Intestinal Helminthiasis among Children in a Tertiary Health Facility in Benin-City, Nigeria.

To determine the effect of HIV sero - positivity on the prevalence of intestinal helminthiasis. Descriptive, crossectional study design was undertaken. A cross sectional study among 496 HIV sero- positive (cases) and 490 HIV sero- negative (controls) children 1 – 15 years attending paediatrics clinic were surveyed for intestinal helminthiasis. Faecal samples were collected and examined for the presence of characteristic helminth ova using formol ether concentration method while intensity of infection was determined using McMaster counting chamber. Overall prevalence of intestinal helminthiasis was 15.4%. Prevalence was higher among the cases, 21.4% than the control, 9.5% and the difference in rate of infection was found to be statistically significant (PÂ 0.0000). The prevalence of helminthiasis is significantly higher among the cases than the controls. It is likely that in the cases, HIV status could have accentuated their susceptibility to helminthiasis. Regular deworming of cases alongside improved personal hygiene should be practiced to reduce infection burden.Key words: HIV sero - positive, intestinal helminth, children, health facility