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

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

Evaluation of the Nitrite Test in Screening for Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia

Background: Urinary tract infection (UTI) is a significant cause of morbidity in children and individuals with sickle cell anaemia (SCA) have been reported to be at increased risk. It will be useful to have a simple means of screening such children for UTI with a view to instituting prompt treatment. Objectives: The objective of the study was to evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. Methods: This prospective study was carried out in the department of Paediatrics, University College Hospital, Ibadan. The study group consisted of 171 children aged one to 15 years with SCA presenting with fever (temperature e” 37.5oC). Midstream urine specimen was collected from each patient and subjected to nitrite test, microscopy, culture and sensitivity. Results: There was significant bacteriuria in 37 (21.6 percent) children. A positive test for nitrite was obtained in the urine of eight patients, seven of whom had bacteriuria. The nitrite test in detecting bacteriuria had a specificity of 99.2 percent, a sensitivity of 18.9 percent, a positive predictive value of 87.5 percent and a negative predictive value of 81.6 percent. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. Conclusion: The nitrite test is useful as a screening test for UTI in SCA children. However, in sick children, urine microscopy and culture should still be done in spite of a negative test. Nigerian Journal of Paediatrics Vol.31(1) 2004: 10-1

Foetal haemoglobin and disease severity in sickle cell anaemia patients in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>Sickle cell anaemia (SCA) is a major chronic health problem in Uganda. In patients with SCA, the level of foetal haemoglobin (HbF) has been found to be important in influencing the clinical course of the disease. Thus populations with high levels of HbF like those in Saudi Arabia have been described as having a milder clinical course with fewer complications as compared to populations with lower levels. Disease modifying drugs can increase the Hb F levels and modify the presentation of SCA.</p> <p>Methods</p> <p>This was a cross sectional study in which we determined foetal haemoglobin levels and examined the relationship between HbF levels and disease severity in SCA patients in Mulago Hospital, Kampala, Uganda. We consecutively enrolled 216 children aged 1 year to 18 years with SCA attending the Sickle Cell Clinic at Mulago Hospital whose guardians had given consent. The history included age at onset of initial symptoms and diagnosis, number of hospitalisations and blood transfusions and other complications of SCA (cardiovascular accidents, avascular hip necrosis and priapism). A detailed physical examination was performed to assess the current state and help describe the disease severity for each patient. Blood samples were drawn for HbF levels. HbF levels ≥10% was defined as high.</p> <p>Results</p> <p>Of the 216 children, (80) 37% had HbF levels ≥10%. Significant correlations were observed between HbF level and several clinical parameters independent of age including age at diagnosis (p value 0.013), number of hospitalisations (p value 0.024) and transfusions (p value 0.018) since birth.</p> <p>Conclusion</p> <p>A third of the children with SCA attending the Sickle cell clinic in Mulago Hospital have high HbF levels. Higher HbF level is associated with later onset of symptoms and presentation, and less severe disease characterised by fewer hospitalisations and blood transfusions. We suggest HbF levels should be determined at initial contact for patients with SCA to guide counselling and identify those who may need closer follow up and consideration for disease modifying drugs.</p