Injection-induced sciatic nerve injury in Nigerian children

A CAJM journal article.Objectives: A retrospective study of all children with a diagnosis of sciatic nerve injury managed at the University College Hospital, Ibadan, Nigeria over a 12 year period was carried out in order to determine predisposing factors to the nerve injury and highlighting practical preventive measures. Design: The necessary data was collected from the case files of children seen at the hospital with a diagnosis of sciatic nerve injury, from 1988 to 1999. Results: There were 27 children aged five months to 12 years with a diagnosis of sciatic nerve injury. Twenty (74%) of the children were aged five years or less. While seven patients (26%) presented within two weeks of development of foot drop consequent on intramuscular (IM) injection given on the buttock, 20 patients (74%) presented much later. Fever was the most common complaint for which the injection had been given. The identity of the drugs given was not known in 10 patients. In the remaining 17 patients drugs administered were specified and included Chloroquine,Novalgin, Paraldehyde, Procaine penicillin, and Sulfadoxine- Pyrimethamine. Most of the patients had received the injections in privately owned medical facilities where staff with minimal training are often allowed to administer IM injections. Conclusion: It is suggested that the IM route for injection be strongly discouraged when a drug can be given by other routes. Only trained staff should be allowed to administer IM injections. Giving IM injections at sites other than the buttock maybe advantageous in children particularly those aged five years and below

Pre-Hospital Management of Febrile Seizures in Children Seen at the University College Hospital, Ibadan, Nigeria

Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome.Objectives: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria.Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded.Results: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socioeconomic class of the caregivers (P=0.008).Conclusions: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortalityassociated with febrile seizures in the locality.Keywords: seizures, febrile, cow’s urine, socio-economic statu

Neurologic complications of sickle cell disease in Africa A systematic review and meta-analysis

To summarize prevalence data on the neurologic complications of sickle cell disease (SCD) in Africa

Injection-induced sciatic nerve injury in Nigerian children

Objectives: A retrospective study of all children with a diagnosis of sciatic nerve injury managed at the University College Hospital, Ibadan, Nigeria over a 12 year period was carried out in order to determine predisposing factors to the nerve injury and highlighting practical preventive measures. Design: The necessary data was collected from the case files of children seen at the hospital with a diagnosis of sciatic nerve injury, from 1988 to 1999. Results: There were 27 children aged five months to 12 years with a diagnosis of sciatic nerve injury. Twenty (74%) of the children were aged five years or less. While seven patients (26%) presented within two weeks of development of foot drop consequent on intramuscular (IM) injection given on the buttock, 20 patients (74%) presented much later. Fever was the most common complaint for which the injection had been given. The identity of the drugs given was not known in 10 patients. In the remaining 17 patients drugs administered were specified and included Chloroquine,Novalgin, Paraldehyde, Procaine penicillin, and Sulfadoxine- Pyrimethamine. Most of the patients had received the injections in privately owned medical facilities where staff with minimal training are often allowed to administer IM injections. Conclusion: It is suggested that the IM route for injection be strongly discouraged when a drug can be given by other routes. Only trained staff should be allowed to administer IM injections. Giving IM injections at sites other than the buttock maybe advantageous in children particularly those aged five years and below

Prevalence of bacteraemia amongst children with febrile seizures at the University College Hospital, Ibadan

Background: Febrile seizures are common among children and these are known to result from the diverse aetiological factors, known to cause fever in children.Objectives: To determine the prevalence of bacteraemia amongst children with febrile seizures at the children’s emergency room of the University College Hospital, Ibadan, Nigeria.Methods: This was a prospective study involving 147 children who were presented with febrile seizures over a period of 13 months at the University College Hospital Ibadan. They all had their blood cultures sample taken under aseptic conditions. Other investigations performed on them included a packed cell volume, full blood count and blood film for malaria parasite.Results: A total of 83 males and 64 females with febrile seizures were studied. Their ages ranged from 4 to 60 months with a mean age of 26.35 + 13.76 months. Bacteraemia was diagnosed in 32(21.8%) of the cases. The predominant organism isolated from the blood of these patients was Staphylococcus aureus.Conclusion: Bacteraemia is a frequent finding in children with febrile seizures hence, it may be beneficial to carry out blood culture in such children on the suspicion of a probable bacterial infection.Keywords: Seizures, Febrile, Bacteraemi

The Impact of Interpersonal Relationships and Incentive Structures on the Performance of Actors in Informal Supply Chains

This dissertation examines operational challenges faced by intermediaries in informal supply chains, in which the relational and structural constraints present in traditional supply chains are relaxed. This research is organized into three papers, the first of which (Chapter 2) explores business relationships in the context of emerging market retail supply chains. Attempts to distribute durable, life-improving goods to customers at the Base of the Pyramid (BoP) have struggled to succeed at scale. One potential explanation is poor relationship management with informal retailers, which are embedded within communities. By analyzing data from a distributor selling to 331 formal and 493 informal retailers in India, we demonstrate that informal retailers recover more slowly than formal retailers after a sales agent reallocation. This indicates that disruptions to social/business relationships are particularly harmful when selling to retailers in informal markets. The second and third papers (Chapters 3 and 4) explore incentive design for distributed-task platforms. We use as a case study a supply chain for medical knowledge, featuring “informal” suppliers without formal contracts. Using data on 5,418 crowdsourcing contests for medical diagnosis, we examine how evaluation metrics (Chapter 3) and prize allocation mechanisms (Chapter 4) shape participants’ decisions and performance. Chapter 3 assesses the impact of evaluating participants using the longest “streak” of correct answers, rather than an accuracy-based metric. Streak evaluation increases volume of quality responses and speed of achieving consensus, largely through increased engagement. These findings are relevant in settings where streak-based-rewards are used to boost motivation; we find that they also boost performance. Chapter 4 studies how changing the source of prize-related uncertainty from the probability of winning to the amount at stake affects decision-making. We evaluate the impact of running a pool contest (in which participants who meet a performance threshold share prizes evenly) instead of a rank-order contest (in which prize distribution is determined exogenously and announced upfront). In pool contests, accuracy increases for average participants but decreases for top performers, suggesting that participants modify engagement levels in response to performance thresholds. This suggests that pool contests with carefully-selected thresholds can incentivize effort from participants with certain performance profiles.Ph.D

Post-neonatal Tetanus in Nigeria: The need for Booster doses of Tetanus Toxoid

Eighty-two (87 per cent) of the 94 cases of post-neonatal tetanus patients seen in the department of paediatrics, University College Hospital, Ibadan, over an 11-year period were aged five years and above. Persistent occurrence of this preventable condition for which an effective vaccine is available indicates deficiencies in the health system of the country. Although, a case fatality rate of 12 per cent compared favourably with those of centres employing more sophisticated treatment modalities, morbidity was high with patients spending an average of 23 days (range 3 to 76 days) in hospital. Although no reliable record of tetanus immunization was obtained in 37 of the patients, 34, 8 and 15 patients received doses of DPT immunization of 0, 1 - 2 and 3, respectively, during infancy. No patient had tetanus toxoid (TT) administered after infancy. The findings indicate that the current Expanded Programme on Immunisation (EPI) recommended by the WHO for developing countries of which three doses of DPT are given during infancy with no provision for booster doses, is inadequate for tetanus prevention during childhood. It is suggested that a clause be added to the EPI schedule, advising two extra doses of TT between ages four to six years and 11 to 12 years (entry into primary school and secondary school, respectively) for all children. In order to ensure compliance, these booster doses of TT could be made prerequisites for entry into these schools. Nigerian Journal of Paediatrics 2001; 28:35. pp. 35-3

Risk Factors For Epilepsy In Children With Cerebral Palsy

Background Cerebral palsy is a major cause of childhood disability and has been described as one of the three most common life-long developmental disabilities in childhood. It is more prevalent in the more socio-economically deprived populations of the world. Epilepsy is said to occur in 15-90% of children with cerebral palsy and this poses additional economic and psychological stress on affected children and their families. Objectives To describe the risk factors for epilepsy in children with cerebral palsy. Methods One hundred and seventy six children with cerebral palsy seen at the Paediatric Neurology clinic, University College Hospital, Ibadan, Nigeria over a period of two years were studied. The group with epilepsy was compared with that without epilepsy. Appropriate statistical tests were carried out using the SPSS 12 for windows software to identify significant predictors of epilepsy. Results Sixty five of the children studied had associated epilepsy, giving a prevalence rate of 36.9%. The significant predictors of epilepsy after adjusting for other variables were seizures in the first year of life and spastic hemiplegia. Neonatal seizures, home delivery and post infectious brain damage which were significantly independently associated with epilepsy were not significant following logistic regression analysis. Conclusion Epilepsy is a frequent problem in children with cerebral palsy. A history of neonatal seizures, occurrence of seizures in the first year of life, presence of spastic hemiplegia and post infectious brain damage all warrant a close evaluation and appropriate follow up for early detection of epilepsy in children with cerebral palsy. Introduction La paralysie cérébrale est une des causes majeures de handicaps chez l\'enfant. Dans le monde entier, elle intéresse surtout les couches socio- économiques défavorisées. L\'épilepsie peut survenir chez 90 % des enfants présentant une paralysie cérébrale, entraînant ainsi des contraintes économiques et psychologiques chez des familles déjà fort dépourvues et éprouvées. L\'objectif est de décrire les facteurs de risque de l\'épilepsie chez les enfants atteints de paralysie cérébrale. Méthode 176 enfants avec une paralysie cérébrale ont été observés à la clinique neurologique pédiatrique du centre hospitalier universitaire d\'Ibadan, au Nigéria, sur une période de 2 ans. Le groupe avec épilepsie a été comparé avec ceux qui n\'étaient pas atteints par cette affection. Des tests statistiques appropriés utilisant le SPSS 12 et un logiciel Windows a permis d\'identifier les facteurs prédictifs de l\'épilepsie. Résultat 65 des patients étudiés, avaient une épilepsie impliquant ainsi un taux de prévalence de 36.9 %. Les facteurs prédictifs significatifs d\'épilepsie après ajustement des zones variables étaient : les crises lors de la première année de la vie et l\'hémiplégie spastique. Les crises néo-natales, l\'accouchement à domicile et les séquelles cérébrales post infectieuses étaient significativement indépendant de l\'association avec l\'épilepsie. Conclusion L\'épilepsie est un problème fréquent rencontré chez les enfants ayant une paralysie cérébrale. Une histoire clinique de crises néo-natales apparaissant la première année de la vie, la présence d\'une hémiplégie spastique et des dommages cérébraux post infectieux doivent entraîner une détection précoce de l\'épilepsie chez l\'enfant atteint d\'une paralysie cérébrale. Keywords: Africa,Epilepsy, risk factors, cerebral palsyAfrican Journal of Neurological Sciences Vol. 25 (2) 2006: pp. 29-3