The outcome of growth and development assessment of under-fives using a new tool, the SMAT Score

Background: The death of growth and development screening tools in developing countries has grave implications for child health outcomes. The aim of the study was to determine the effectiveness of a novel screening tool in a rural Nigerian community.Method: Speech and language, Motor, Appearance and Temperament (SMAT) parameters of under- fives were queried using a novel tool, the SMAT Score. The effectiveness of the tool was assessed in three phases. In the first two phases the tool was administered to 210 under- fives (Subjects) independently. Those screened as having anomalies are classified as NOT SMAT while those screened otherwise as SMAT. In the third phase all NOT SMAT subjects and a number of randomly selected SMAT subjects were clinically evaluated. Outcomes of SMAT Score administration and clinical evaluation were subjected to psychometric assessments.Results: There were 210 subjects with age range of 0.5 to 4.9 years (mean 2.3 ± 1.3 years) studied. Out of these 34 (16.2%) were screened as NOT SMAT. All the 90 (51.1%) randomly selected SMAT subjects as against 1 (2.9%) of the NOT SMAT subjects were clinically evaluated as normal. Inter rater and test – retest agreement rate in SMAT Score administrators was 100%. SMAT Score sensitivity and negative predictive value was 100% respectively in all age groups. The specificity was 98.9% overall and 96.3% among infants. Higher SMAT Score positive predictive value (97.1%) was observed with the entire study population as against 87.5% among infants.Conclusion: SMAT Score effectively identified subjects with growth and developmental disorders. Its use has potential for improving health systems and consequently child health outcomes in developing countries.Keywords: Growth, Development, Assessment, Tool, Under-five

Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community.

Background: The campaign against epilepsy is hampered by the difference between those with the active disorder and the number of them receiving appropriate treatment (treatment gap) in sub-Saharan Africa. Identifying the determinants of this gap is crucial to providing and achieving optimal care.Objective: To identify the determinants of epilepsy treatment gap (ETG) in children and adolescents (Subjects) with epilepsy in a rural community.Methods: Subjects were identified through a community house to house survey. Information obtained from Subjects and their care givers included: sociodemographic characteristics, type and frequency of epileptic seizures,current and past treatment options utilized, reasons for treatment options used, and treatment options utilized for other health complaints.Results: Twenty three Subjects (6.4/1000 of the child and adolescent population) were identified as having epilepsy. Their age range was 4-19 years (mean 14.3±4.7 years). Most were males (82.6%) and adolescents (78.3%). Seizures were mostly generalized (95.7%) and occurred most frequently daily. Current treatment modalities were use of traditional medication (100%) and prayers (34.8%).None was currently on orthodox medical therapy (ETG, 100%) but 5(21.7%) had utilized orthodox medical therapy in the past. The main determinants of the ETG were strong cultural belief, weakness in the health system to epilepsy treatment and low socioeconomic status. Fever was the commonest other health complaint and use of orthodox medical therapy was significantly (p˂ 0.05) the main (16, 69.6%) treatment option utilized.Conclusion: Cultural belief, weak health system and low socioeconomic status were determinants of an absolute ETG. It highlights the need to strengthen initiatives that enhance accessibility to standard epilepsy treatment.Key words: Epilepsy treatmentgap, determinants, children, adolescents, rural communit

Diagnostic challenges and psychosocial impacts of hypersomnia in a Nigerian adolescent: A case report

Hypersomnia, a disorder of sleep characterized by excessive quantity of sleep and excessive daytime sleepiness (EDS), could adversely affect health outcomes in childhood. To highlight diagnostic challenges and the impact of childhood hypersomnia in a resource limited setting, a 14year old Nigerian who presented with a seven year history of hypersomnia was studied. Screening for sleep disorder using BEARS sleep algorithm and assessment for EDS using the Epworth Sleepiness Scale were both positivefor EDS. The assessment of sleep hygiene using the Adolescent Sleep Hygiene Scale was normal and the use of Raven’s Progressive Matrices to assess intelligence was also normal. There was no contributory pastmedical history or demonstrable etiology. Magnetic Resonance Imaging (MRI) of the brain, Electro Encephalogram (EEG), assay of serum electrolytes were all normal while screening test for trypanosomiasis was negative. Poor level of awareness, high cost of evaluation and limited facilities for diagnosis of sleep disorder were the major diagnostic challenges. Depression, poor academic performance, suicidal ideation andstigmatization were all associated with hypersomnia in the patient.Keywords: Hypersomnia, adolescence, depression, sleep disorders, diagnostic challenges

Impact of childhood mental health disorders on the family: A Case report

Background: Care of the children with mental health disorders is fraught with challenges particularly in developing countries and, where the family isthe major source of care. Consequently assessing the impact of these disorders on the family is relevant to providing these children with optimal care.Objective: To assess the impact of childhood mental health disorderson family function and parental burden.Method: A monogamous family that had 3 children diagnosed as having childhood onset schizophrenia using the International Classification of Disease version 10(ICD 10) Classification was studied. Family function was assessed using the Family APGAR Score and the Zarit Burden Interview(ZBI) Score used in assessing parental burden.\Results: The Family APGAR Scores were low (highly dysfunctional family) and the ZBI Scores high (highly burdened) in the family. Areas of serious dysfunction in the family were in adaptation, partnership and growth.In the ZBI Scores feelings about quality and cost of care offered, stress and other negative attributes associated with providing care, inability to meet other parental obligations and uncertainty about the future, were the major contributors to the highly burdensome outcome.Conclusion: The study highlights significant family burden and dysfunctionin a family who had three children with schizophrenia. It underscored the need for provision of more comprehensive health and social support  services to children with mental health disorders and their families.Key Words: Childhood, Schizophrenia, Parent, Burden, Family functio

Febrile seizures in Kaduna, north western Nigeria

Background: Febrile seizure is the most common seizure of childhood and has a good prognosis. However its presentation is fraught with poor management, with grave consequences, in our environment. Thus a review of its current status is important. Objective: To review the status of febrile seizures in Kaduna metropolis. Materials and Methods: A review of cases seen in the Department of Paediatrics, 44 Nigeria Army Reference Hospital, Kaduna between June 2008 and June 2010. Results: Out of the 635 cases admitted in the department 17 (2.7%) fulfilled the criteria for febrile seizures. There were 11 Males and 6 Females (M: F, 1.8:1). Age range was from 9 months to 5 years with a mean of 2.2 years ± 1.1 and peak age of 3 years. Twelve (70.6%) were in the upper social classes (I‑III). Fever, convulsion, catarrh and cough were major presenting symptoms. Incidence of convulsion was least on the 1st day of complaint. Fourteen (82.4%) of the cases were simple febrile seizures while 3 were complex. There was a positive family history in 5 (29.4%) of the cases. Eleven (64.7%) had orthodox medication at home, before presentation, 5 (29.4%) consulted patient medicine sellers and 7 (41.7%) received traditional medication as part of home management. Malaria and acute respiratory infections were the identifiable causes. Standard anti‑malaria and anti-biotic therapy were instituted, where indicated. All recovered and were discharged. Conclusion: There was a low prevalence of febrile seizures among the hospitalized children and a poor pre‑hospitalization management of cases. It highlighted the need for improved community awareness on the prevention and management of febrile seizures.Keywords: Fever, seizures, children, KadunaNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 201

Parental Challenges in Providing Care for Children with Special Health Care Needs in Kaduna, Northwestern Nigeria

Background: The care of children with special health care needs is fraught with lots of challenges. Parents play a pivotal role in the provision of care for these children and bear a significant number of these challenges. Parental ability to cope with these challenges is vital to the wellbeing of the children. Method: The challenges encountered by parents in the care of their Children with Special Health Care Needs (CSHCN) in Kaduna, were assessed using a structured questionnaire and a M.I.N.I. module at an awareness workshop. Results: There were 44 males and 29 females (M: F, 1:5:1) with a mean age of 40.1 ± 10.3 years. Majority (45, 61.6%) were in the mid and lower social classes (III-V).The most identified parental challenges were economic and medical, indicated by all the parents. Others were social, stress and educational in that order. Type of child's disorder, severity of the disorder and parental social class were indicated by all the parents as contributory factors to their challenges. Conclusion: The parents indicated multiple challenges and demonstrated a need for access to a wide range of comprehensive support services. Keywords: Parent, Challenges, Children with Special Health Care Need

Computerized tomography of children with seizure disorders

No Abstract

Malaria Parasitemia in Children Aged less than 5 Years Presenting with Fever in Kaduna, Northwestern Nigeria.

Background: Malaria is a significant cause of morbidity and mortality in sub Saharan Africa. Fever is the commonest manifestation and Children aged less than 5 years are most vulnerable. An appraisal of this disease among these children is important to reducing the impact of the disease.Objective: To determine the prevalence and identify factors affecting malaria parasitemia in febrile children aged less than 5 years.Methods: Blood samples taken from all febrile children aged less than 5 years who presented to the department of Pediatrics, 44 Nigeria Army Reference Hospital Kaduna(NARHK) between July 2011 and September 2011, were examined for presence of malaria parasites.Results: Out of the 730 febrile children assessed, 411 (56.3%) had malaria parasitemia with densities of +, 2+ and 3+ in 301(73.2%), 90(22%) and 20(4.8%) children respectively. Majority were males (476, 65.2%), Aged = 2 years (409, 56% ) and in the upper (I III) social classes (497, 68.1%). Most (523, 71.6%) presented within = 48 hours of illness. Anti-malaria drug use was observed in 426 (58.4%) children and Artemisinin-based Anti-malaria Combination Therapy (ACT) drugs were the commonest drugs used (247, 58%). Drugs were prescribed by caregiver (183, 43%), patent medicine seller (102, 23.9%), in a health facility (94, 22.1%) and by significant others (47, 11%) respectively. Only 95(13%) used Insecticide Treated Nets (ITNs) and 34(4.6%) used traditional herbal mixtures. Malaria parasitemia was significantly (p?0.05) associated with non use of anti-malaria drug, low social class, non usage of ITNs and age =2 years .Of those with malaria parasitemia 396(96.4%) were treated for uncomplicated malaria and recovered fully. Fifteen (3.7%) were admitted and treated for severe malaria, of which 13(86.7%) of them recovered fully and 2(13.3%) died.Conclusion: Malaria is still a major cause of morbidity among febrile children aged less than 5 years of age with the severe form occurring less frequently but with grave consequences.Keywords: Malaria parasite, Fever, Childre