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

Prevalence and practice of contraception in a cohort of Nigerian adolescent girls

Background: The adolescent-girl's sexual and reproductive health issues contribute significantly to adolescent morbidity and mortality, particularly in sub-Sahara Africa, where there is a limited availability and access to the relevant health services. The complications from pregnancy and childbirth are a leading cause of mortality among adolescent girls. Poor knowledge and low utilization of contraception have been associated with grave sexual health outcomes in the adolescent girl. A recurrent appraisal of contraception in adolescence is vital to improving adolescent reproductive health outcomes.Objectives: To determine the prevalence and characteristics of  contraceptive practice among Nigerian adolescent girlsMethods: A descriptive opportunity survey among adolescent girls in an urban camp in Kaduna was conducted. A standardized selfadministered structured questionnaire was used to obtain information about the girls' socio-demographic and contraception characteristics. Data entry and analysis was done using SPSS version 20.Results: There were 230 participants with a mean age of 15.6 years. Good knowledge of contraception was demonstrated by 104 (45.2%) participants. Use of male condom (163, 70.9%), injections (147, 63.9%), and pills (98, 42.6%) were the commonest mode of contraception indicated. Sexual  activity was indicated by 22 (9.6%) participants, 15 (6.5%) utilized  contraception, and 3 (1.3%) had a history of pregnancy. The drugstore was the main (8, 53.3%) source of contraceptives among the users. Friends (96, 41.7%) and school (90, 39.1%) were the commonest sources of information on contraceptives. Being bad, bodily harm, infertility, and obesity were believed to be associated with contraceptive use.Conclusion: Knowledge of contraceptives and their utilization was low, and associated with negative outcomes. It underscores the need to promote adolescent-friendly health services in our health system

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

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

Knowledge of Childhood Autism and Challenges of Management among Medical Doctors in Kaduna State, Northwest Nigeria

Autism is a neurodevelopmental disorder with serious implications in childhood. There is a significant gap in the identification and provision of health and social services for autism in Africa. The knowledge of autism among health care providers and identifying challenges associated with its management could facilitate bridging the gap and ensuring better outcomes. A self-administered tool, the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire, was used in assessing knowledge of autism among 175 medical doctors (participants) attending an annual scientific meeting in northwest Nigeria. Other parameters assessed were sociodemographic and professional characteristics of the participants and challenges encountered in the management of autism. Out of 175 questionnaires distributed, 167 (95.4%) were returned. Good knowledge (KCAHW score ≥15) was significantly associated with being a paediatrician or psychiatrist and practicing in a tertiary health facility (P<0.05), while poor knowledge (KCAHW score <15) was significant among general practitioners (P<0.05). The highest knowledge gap was associated with onset of autism and its comorbidities (KCAHW Domain 4) while the least was concerning communication impairments (KCAHW Domain 2). Major challenges encountered in autism management were dearth of specialist services, cost of evaluation, and poor caregiver perspectives of autism