Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study

IntroductionFolic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. MethodThis study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. ResultsThe median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Conclusion Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state

Assessment of Physical Growth in Male Children Infected with Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy in Abakaliki

Background: Human immunodeficiency virus (HIV) infection causes a derangement in growth. Antiretrovirals promote immune function restoration and improvement in the quality of life. Variables such as poor adherence to drugs and unsuppressed viral load may negatively influence growth in HIV-infected children. The study aimed at determining the growth in HIV-infected males aged 8–17 years in Abakaliki who were on antiretrovirals. Methods: Acase–control hospital-based study, involving 80 HIV-infected males aged 8–17 years who were matched for age and socioeconomic class with 80 HIV‑uninfected controls. Growth parameters including the heights, weights, and body mass index (BMI) of subjects and controls were measured, and Z scores for age derived for height, weight, and BMI. Results: The mean height of subjects (1.420 ± 0.18 m) was significantly lower than that of controls (1.515 ± 0.17 m). The mean weight of subjects (35.09 ± 12.48 kg) was significantly low compared to controls (42.21 ± 12.95 kg). A significant difference was documented in the mean BMI for age among subjects (16.78 ± 2.12 kg/m2 ) and controls (17.93 ± 2.27 kg/m2 ). There was a significant relationship between CD4 count and growth (BMI) (P = 0.006) and between duration on highly active antiretroviral therapy and growth (P = 0.024). Conclusion: HIV‑infected males had significantly impaired growth despite the use of antiretroviral drugs. Keywords: Children, human immunodeficiency virus antiretroviral drugs, males, physical growt

Generalized lymphadenopathy: an unusual presentation of burkitt lymphoma in a Nigerian child: a case report

Intoduction: Burkitt Lymphoma is the fastest growing tumor in human and the commonest of the childhood malignancies. Generalized lymphadenopathy is a common feature of immunodeficiency associated Burkitt lymphoma but an uncommon presentation of the endemic type in Human Immunodeficiency Virus (HIV) negative children. Case presentation: The authors report a 6 year old HIV negative boy who presented with generalized lymphadenopathy, cough, weight loss, fever and drenching night sweat and had received native medication as well as treatment in private hospitals. His examination revealed hepatosplenomegaly, bull neck with generalized significant massive lymphadenopathy. Diagnosis was missed initially until a lymphnode biopsy for histology confirmed Burkitt lymphoma. He was managed on combination chemotherapy with complete resolution and now on follow up. Conclusion: To the best of our knowledge, this is the first documented report of its kind of endemic Burkitt lymphoma involving lymphnodes generally as the primary site. High index of suspicion and early biopsy are the key in this uncommon presentation

Association between HIV infection, sociodemographic characteristics and depression in caregivers of HIV infected children in Enugu, South-East, Nigeria.

Background: In the presence of certain factors, HIV infection in children increases the burden of depression in their caregivers. This necessitated the need for this study which aimed to determine the factors that are associated with depression in the caregivers of HIVinfected children.Methods: A comparative hospital-based study of 352 study participants comprising two groups. The first group was the subjects consisting of 176 caregivers of HIV-infected children and the second was the control consisting of 176 caregivers of HIV negative children. Having met the inclusion criteria, these study participants were screened for HIV infection, their sociodemographic characteristics were obtained and depression in them was assessed using Zung self-rating depression scale (SDS). The essence was to determine the factors that were significantly associated with depression in the subjects.Results: Forty-three (24.4%) and 133 (75.6%) of the subjects were males and females respectively while 47 (26.7%) and 129 (73.3%) of the control were males and females respectively. Seventy-six (43.2%) of the subjects and 12 (6.8%) of the control group had SDS scores in the depression range and this difference was significant (2 = 62.06, df = 1, p < 0.001). The factors that were significantly associated with depression in the subjects were the age of the HIV-infected children (p = 0.023, OR = 2.28), caregiver’s sex (p = 0.003, OR = 3.25), socioeconomic status (p < 0.001, OR = 4.00), marital status (p < 0.001, OR = 2.18), type of caregivers (p = 0.028, OR = 2.78), spouse support (p = 0.019, OR = 2.08).Conclusion: There is a high burden of depression among caregivers of HIV-infected children and depression in them is significantly associated with caring for a preadolescent HIVinfected child, female caregivers, lower socioeconomic status, death of a spouse, being a biologic caregiver and lack of spouse support

Determinants of academic performance in children with sickle cell anaemia

BACKGROUND: Some factors are known to influence the academic performance of children with Sickle Cell Anaemia (SCA). Information on their effects in these children is limited in Nigeria. The factors which influence academic performance of children with SCA in Enugu, Nigeria are determined in this study. METHODS: Consecutive children with SCA aged 5–11 years were recruited at the weekly sickle cell clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Their age- and sex- matched normal classmates were recruited as controls. The total number of days of school absence for 2009/2010 academic session was obtained for each pair of pupils from the class attendance register. Academic performance was assessed using the average of the overall scores in the three term examinations of same session. Intelligence ability was determined with Draw-A-Person Quotient (DAPQ) using the Draw-A-Person Test while socio-economic status was determined using the occupational status and educational attainment of each parent. RESULTS: Academic performance of children with SCA showed statistically significant association with their socio-economic status (χ2 = 9.626, p = 0.047), and significant correlation with DAPQ (r = 0.394, p = 0.000) and age (r = -0.412, p = 0.000). However, no significant relationship existed between academic performance and school absence in children with SCA (r = -0.080, p = 0.453). CONCLUSIONS: Academic performance of children with SCA is influenced by their intelligence ability, age and socio-economic status but not negatively affected by their increased school absenteeism

Glanzmann\u2019s thrombasthenia: a rare bleeding disorder in a Nigerian girl

Introduction: Glanzmann\u2019s Thrombasthenia (GT) is a rare autosomal recessive bleeding disorder due to defective platelet membrane glycoprotein GP IIb/IIIa (integrin \u3b1IIb\u3b23). The prevalence is estimated at 1:1,000,000 and it is commonly seen in areas where consanguinity is high. Case Presentation: The authors report a 12 year old Nigerian girl of Igbo ethnic group, born of non-consanguineous parents, who presented with prolonged heavy menstrual bleeding which started at menarche 3 months earlier, weakness and dizziness. She had a past history of recurrent episodes of prolonged epistaxis, gastrointestinal bleeding and gum bleeding during early childhood. On examination, she was severely pale with a haemic murmur and vaginal bleeding. The initial diagnosis was menorrhagia secondary to bleeding diathesis possibly von Willebrand\u2019s Disease. She was on supportive treatment with fresh whole blood, fresh frozen plasma and platelets until diagnosis of GT was made in the USA. Currently, she is on 3 monthly intramuscular Depo-provera with remarkable improvement. Conclusion: To the best of our knowledge, this is the first documented report of GT in our environment where consanguinity is rarely practised. Our health facilities require adequate diagnostic and treatment facilities for rare diseases like GT

Mother-to-child transmission of HIV: the pre-rapid advice experience of the university of Nigeria teaching hospital Ituku/Ozalla, Enugu, South-east Nigeria

Abstract Background Mother-to-child transmission of human immune deficiency virus (HIV) is the most common route of HIV transmission in the pediatric age group. A number of risk factors contribute to the rate of this transmission. Such risk factors include advance maternal HIV disease, lack of anti-viral prophylaxis in the mother and child, mixing of maternal and infant blood during delivery and breastfeeding. This study aims to determine the cumulative HIV infection rate by 18 months and the associated risk factors at the University of Nigeria Teaching Hospital, Enugu. Results A retrospective study, involving HIV exposed infants seen at the pediatric HIV clinic of UNTH between March 2006 and September 2008. Relevant data were retrieved from their medical records. The overall rate of mother to child transmission of HIV in this study was 3.9% (95% CI 1.1%- 6.7%). However, in children breastfed for 3 months or less, the rate of transmission was 10% (95% CI −2.5%-22.5%), compared to 3.5% (95% CI 0.5%-6.5%) in children that had exclusive replacement feeding. Conclusions This retrospective observational study shows a 3.9% cumulative rate of mother-to-child transmission of HIV by 18 months of age in Enugu. Holistic but cost effective preventive interventions help in reducing the rate of mother-to-child transmission of HIV even in economically-developing settings like Nigeria.</p

Zinc levels in HIV-positive children at the University of Nigeria teaching hospital

Background: Zinc is an abundant trace element in the body involved in many physiological processes. Its deficiency has been described in HIV-infected children, especially in advancing illness. This study, therefore, seeks to assess zinc levels in HIV-positive children attending the HIV clinic at University of Nigeria Teaching Hospital (UNTH). Materials and Methods: This was a descriptive, cross-sectional study among HIV-positive children aged 5–60 months attending the HIV clinic at UNTH. A 100 participants were enrolled from August 2013 to May 2014. Data were obtained using a pro forma developed by researchers, and blood samples were collected and analysed using an absorption spectrophotometer. Serum zinc level deficiency was defined as the values <80 μg/dL. Data analysis was conducted using the SPSS version 26. Results: Most participants were males (53.0%). Their mean age was 47 months (standard deviation = 15.7). The median serum zinc level was 55.5 μg/dL (IQR = 35.0–84.8). The majority of the participant (72%) had zinc deficiency. There was a statistically significant relationship between serum zinc level and participants' socioeconomic status (P < 0.05) – higher socioeconomic status was associated with higher zinc levels. Conclusion: The study showed a high prevalence of zinc deficiency in children living with HIV, with a significant relationship between serum zinc level and the participants' socioeconomic status. There is a need for zinc supplementation for HIV children, especially the indigent ones