Challenges of childhood obesity in a developing economy: A review

Background: Obesity once considered a high income country’s malady is now on the rise in most developing countries particularly in urban settings. Most of these emerging economies have been reported to have different shades of under – nutrition coexisting side by side with over-nutrition. It is pertinent therefore that we determine the factors driving the increase in obesity rates in developing countries as they generally lack the infrastructure to adequately handle the associated complications.Objectives: This communication is aimed at reviewing the burden and risk factors for obesity in children in developing countries, double burden of malnutrition, challenges including medical as well as economic costs and sustainable preventive programmes of obesity in our environment with the hope of sensitizing both the health community and policy makers of this emerging epidemic.Methods: We searched relevant literature on the subject published only in English language or translated into English language manually and electronically. The Index Medicus, AJOL, Medline, PUBMED, and HINARI were specifically searched for the period between 1980 and 2014 and reviewed. The following key words were applied in the search: Obesity in childhood, its burden and associated risk factors, complications of obesity in childhood, double burden of malnutrition in developing countries, assessment of obesity, childhood challenges of obesity including its direct and indirect costs in developing countries as well as practical preventive models in developing economies.Results: Several relevant studies were identified. The health as well as economic costs of obesity is diverse. Obesity is the major risk factor for a variety of non – communicable diseases including cardiovascular diseases, type 2 diabetes and malignancies in later life. Also obese children have higher risk of orthopaedic problems and psychological disturbances like low -self esteem and bullying. This can also lead to poor social adjustments among our teeming youths who are the bedrock of our future economy. Most of these diseases cause premature deaths in addition to long term morbidities. Many of these obesity associated complications impose substantial burden on the health care system in developing countries with weak health systems, and if allowed unmitigated the implications are that the cost of its care may overwhelm not only the health budget but also affect the provisions of basic social amenities.Conclusions: Preventive programmes have been shown to reduce the burden of obesity in developed countries. Dearth of data on burden of obesity and its associated complications in children and adolescents still a challenge in most developing economies. Efforts should be made to prevent childhood obesity using multi- pronged approach at population level through targeted education, sustainable interventions related to healthy nutritional practices as well as physical activity promotion.Key words: Challenges; Obesity; Children; Developing Economie

Comparison of actual (measured) weights and heights with the standard formula methods of estimation among children in Enugu

Background: In paediatric practice, weight and height are required for therapeutic and diagnostic interventions. In some circumstances actual anthropometric measurements are not possible and estimates are used. Several formulae are in use for weight and height estimations. The adequacy of these estimates has not been tested for our children. The aim of the current study was to compare the adequacy of formula methods ofweight and height estimation with measured values in children.Materials and Methods: This was a comparative observational study.Children who met the inclusion criteria were selected consecutively and studied over a two month period using a semi-structured questionnaire.Weight and height of each child were measured and recorded to the nearest 0.1kg and 0.1cm respectively using standard protocols. Weight and height for age were also estimated using the universally accepted formulae. Data were analyzed using SPSS 19.0. Paired t- test was used to compare the means of actual and estimated weights and heights according to age. The level of significance was set at p<0.05.Results: A total of 370 children were studied. They were aged one year two months to 12years. Among children .2 years the measured weights and estimated values showed no significant difference. However, in children3-5years, the estimated weights were significantly lower than the measured weights. There was no consistent relationship for children 7.12 years where a different formula was used to estimate weight. For heights, the estimated values were significantly lower than the measured except for two year oldswhere both where almost similar. Scatter diagrams comparing actual and estimated plots showed linear relationship.Conclusion: The current methods of estimation are underestimating weights and heights of children in our environment. There is need for a multi-centre cohort study to test the various formulae in our children.Key words: Measured, Estimated, Weight, Height, Children

Prevention of mother to child transmission of hepatitis B virus infection in Nigeria: A call to action

Background: Sub- Sahara Africa including Nigeria has the second largest global burden of chronic carriers of hepatitis B virus (HBV) infection after Asia. Mother-to-child transmission (MTCT) of HBV is the most commonroute of transmission in high endemic areas .MTCT of hepatitis B virus infection continues to occur despite the interventions of hepatitis B vaccinations and immunoglobulins in settings where it is practiced. Infants most at risk are those whose mothers have high HBV DNA viral loads and produce the protein HBeAg. Various Nigerian studies have reported high HBV infection rates as well as HBeAg positivity among pregnant women. These HBV infections usually occur intrapartum and rarely inutero. Mothers with HBeAg positivity known to be associated with higher HBV DNA viral loads have been linked with higher chances of MTCT as HBeAg is the only structural HBV protein that can cross into the placental circulation. In the absence of post exposure prophylaxis about 40 percent of infants delivered by HBV infected mothers could develop HBV infections, and about 25% of them may come down with chronic hepatitis and resulting possible complications including liver cirrhosis and hepatocellular cancer later in life. The prevention of transmission of retroviral infection from motherto- child has been a success story of the 21st century and such feat could be replicated for HBV infection. The standard PMTCT of HBV currently will comprise: timely prenatal screening, starting anti-viral therapy for pregnant women with HBeAg positivity and high viral load, infant postexposure prophylaxis and followup of infants of HBsAg positive mothers. There is no co-ordinated PMTCT of HBV programme in place in our setting despite the huge burden of the disease in Nigeria. Hence the need therefore to develop a home grown PMTCT programme of HBV to help tackle the burden of the disease in our country. An evidence based review of current best practice guidelines for the prevention of mother-to-child transmission of HBV for use in low and medium resource income settings with hepatitis B hyperendemicity will be quiet apt in this circumstance. This document therefore will be useful as a quick guide to Paediatricians, Obstetricians, Family Physicians, General Practice Doctors and other allied health workers charged with the care of pregnant mothers and their young children.Methods: Relevant literatures published in English language or translated into English were searched manually and electronically in PUBMED and SCOPUS for the period between 1990 and 2016 on the subject. Keywords searched included: epidemiology of HBV infection, MTCT of HBV, and its preventive strategies including prenatal screening, antiviral agents in pregnancy, infant post exposure prophylaxis and follow-up of infected children.Results: Over 35 scholarly articles on HBV epidemiology, MTCT, and preventive measures as well as follow –up models were retrieved and analyzed.Conclusion: Universal screening of all pregnant women for HBV infection is the most effective strategy for the prevention of MTCT of HBV, as effective preventive measures could be applied starting from pregnancy to delivery while infants of HBsAg positive mothers should receive timely post exposure prophylaxis and followed up for possible development of chronic hepatitis B infection.Key words: Prevention of mother to child transmission; Hepatitis B virus infection; Resource limited settings

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

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

Perception of child adoption among parents/care‑givers of children attending pediatric outpatients’ clinics in Enugu, South East, Nigeria

Background: There has been an increasing interest by couples in child adoption due to its acceptability in recent times in our locale. The enactment of the Child’s Right Act in Nigeria has harmonized child adoption process across the nation. With the rising demand for babies from child care institutions by many Nigerian couples, there is need to ascertain their perception of child adoption.Objectives: To evaluate the perception of child adoption among parents/care‑givers of children attending Pediatric Clinics in Enugu.Materials and Methods: The parents and care‑givers of children attending pediatrics out‑patients clinics in Enugu, Enugu State, South East, Nigeria  served as the respondents. Two hundred and fifty nine of them were selected by convenience sampling method after obtaining their informed written consent. The data were obtained using semi ‑ structured questionnaire that was administered by an interviewer and subsequently analyzed using SPSS Version 15.0.Results: Many caregivers (respondents) (94.2.7%) had heard of child adoption and 79.2% of them understood the actual meaning of the term child adoption. About 1.9% of them had adopted previously. Majority of the respondents (73.87%) prefers to adopt a child during its neonatal age with a slight preference for adoption of male babies. 15.1% and 8.9% of the respondents gave private hospitals and middle men, respectively, as sources of child adoption. Knowledge of the Government adoption laws and process was generally below average (49.2%) among the respondents.Conclusion: Continued advocacy and public enlightenment campaigns should be strengthened in order to harmonize adoption process in our setting.Key words: Child adoption, parents/care‑givers, perceptio

Accidental Childhood Poisoning in Enugu, South‑East, Nigeria

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South‑East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. Results: Sixty‑five cases of childhood poisoning were recorded during the 10‑year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.Keywords: Accidental poisoning, Childhood, Kerosen

Mothers’ perception and management of abdominal colic in infants in Enugu, Nigeria

Background: Abdominal colic is common in infants but generally harmless. The exact aetiology is unknown but it has been associated with vicious cycle of crying and swallowing of air by the infant. The excessive crying associated with it can result in a lot of distress for family members creating unnecessary panics. We sought to find the perception and management of abdominal colic by mothers in Enugu.Objective: Objective of this study is to determine the perception and ‘home management’ of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them.Materials and Methods: A cross-sectional survey involving 177 mothers that presented with their infants at the pediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011. A pretested questionnaire was used after obtaining their consent.Results: A total of one hundred and seventy-seven mothers participated in this study. They were aged 20 to 60 years with mean age of 34 ± 7.3 years. Most of them (99.4%) believed that babies can have abdominal colic. While 41.3% attributed no problems to colic, the rest believed that it causes loose/greenish stools (12.4%), fever (16.4%) and vomiting (9.6%) etc. Most of the mothers (87.7%) do apply medications for colic which range from paracetamol (33.1%), Gbomoro (16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water (4.6%).Conclusions: Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. There is need for health education of mothers and potential mothers.Key words: Abdominal colics, enugu, infant

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

Factors affecting compliance to treatment among children with epilepsy attending at a paediatric neurology clinic of a tertiary hospital in Enugu

BACKGROUND:This study aimed to determine the factors affecting compliance to treatment among children with epilepsy in Enugu,Nigeria.METHODS: Children with diagnosis of epilepsy were consecutively recruited.Their 6 months retrospective and 1 month prospective data were collected;and analyzed using SPSS version 20.0 (p < 0.05).RESULTS: Fifty six children with epilepsy (mean age= 9.7 ± 4.1 years) were studied. Generalized tonic clonic epilepsy was noted in 41.1% (23/56) of them.Thirty six (64.3%) complied strictly with the treatment regimen. Polytherapy, high cost of drugs, multiple drug dosages and drug related side effects affected compliance. Majority (79.4%, 27/34) of patients on monotherapy and a few (27.2%, 6/22) on poly-therapy had good seizure control (p<0.001).CONCLUSION: Poor drug compliance is a major constraint to adequate seizure control in children with epilepsy in our setting.Addressing the problem of poor compliance will enable them to achieve optimal seizure control.KEY WORDS: Epilepsy, Treatment Compliance, Associated Factors;Childre