Qualité de vie chez des enfants nigérians épileptiques

Contexte L’épilepsie est un trouble neurologique de l’enfant entrainant une charge lourde dans les pays en développement. La gestion de l’épilepsie comprend le contrôle optimal de la maladie, ainsi quel’amélioration de la qualité de vie (HRQOL) des enfants touchés.Objectifs Cette étude a été menée afin d’évaluer l’HRQOL des enfants nigérians atteints par l’épilepsie ainsi que l’impact psychosocial de la maladie sur les parents des enfants concernés. Méthodes Un questionnaire normalisé adapté de la PedsQL questionnaire a été appliqué pour évaluer les HRQOL chez 66 consécutifs enfants épileptiques, âgés de ≥ 5 années à l’University College Hospital, Ibadan au cours d’une période de 3 mois. Résultats Vingt enfants (30,3%) ont montré d’importantes déficiences dans le HRQOL avec un impact majeur dans les domaines de la santé en général, la vie familiale, scolaire et l’estime de soi. Il y avait une associationstatistiquement significative entre la gravité de saisie, l’autorité parentale, l’impact émotionnel, le niveau d’éducation maternelle.Conclusion Les atteintes de la qualité de vie (HRQOL) est un problème majeur au Nigeria chez les enfants épileptiques. Le soutien familial étendu ne semble pas avoir d’effet sur l’amélioration du stress vécu. Cette étude suggère la nécessité d’un soutien psychosocial chez les enfants traités par les antiépileptiques

Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low- and middle-income countries: state of the evidence.

OBJECTIVES: To identify and assess the evidence for interventions to reduce stigma experienced by children with disabilities and their families in low- and middle-income settings. METHODS: Systematic review of seven databases (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) for studies of interventions that aimed to reduce stigma for children with disabilities published from January 2000 to April 2018. Data were extracted on study population, study design, intervention level(s) and target group, and type(s) of stigma addressed. A narrative approach was used to synthesise the results. RESULTS: Twenty studies were included. The majority (65%) of interventions targeted enacted stigma (negative attitudes) and the most common intervention approach was education/training (63%). Over half (54%) of interventions were delivered at the organisational/institutional level, and only four studies targeted more than one social level. The most common disability targeted was epilepsy (50%) followed by intellectual impairment (20%). The majority of studies (n = 18/20, 90%) found a reduction in a component of stigma; however, most (90%) studies had a high risk of bias. CONCLUSIONS: This review highlights the lack of quality evidence on effective stigma-reduction strategies for children with disabilities. Validation and consistent use of contextually relevant scales to measure stigma may advance this field of research. Studies that involve people with disabilities in the design and implementation of these strategies are needed

Effectiveness of a training programme on the knowledge and perception of Attention-Deficit Hyperactivity Disorder among primary school teachers in Kano, Nigeria

This study assessed the effect of Attention-Deficit Hyperactivity Disorder (ADHD) training on teachers’ knowledge and perception of the condition in Kano, Nigeria. It was a controlled trial of 200 primary schoolteachers from two Local Government Areas (LGAs). One LGA was randomly assigned to the intervention group and the other to a waitlist control (100 teachers per group). The intervention group received two training sessions on ADHD one week apart. The training was based on the Mental Health Gap Action Programme – Intervention Guide (mhGAP-IG). Participants completed the ADHD Knowledge Questionnaire, ADHD Attitude Scale, and Knowledge of Behavioral Intervention Questionnaire at baseline and one-week post-intervention. The participants ranged from 17 to 58 years (Mean = 34.1 years; SD = 8.7), comprising 112 females and 85 males. The intervention and control groups were broadly similar at baseline. Controlling for baseline scores and other differences (age, gender, duration of teaching experience, and if schools employed staff dedicated to helping children with mental health difficulties such as ADHD), the intervention group had significantly higher scores on Knowledge of ADHD and Knowledge of Behavioral Management of the condition, with effect sizes of 0.7 and 0.3, respectively. This intervention led to statistically significant improvements in the teachers’ knowledge of ADHD and behavioral intervention for ADHD. This provides further evidence of the feasibility and effectiveness of specific ADHD-training interventions for primary school teachers in Nigeria

Depleted circulatory complement-lysis inhibitor (CLI) in childhood cerebral malaria returns to normal with convalescence

BACKGROUND: Cerebral malaria (CM), is a life-threatening childhood malaria syndrome with high mortality. CM is associated with impaired consciousness and neurological damage. It is not fully understood, as yet, why some children develop CM. Presented here is an observation from longitudinal studies on CM in a paediatric cohort of children from a large, densely-populated and malaria holoendemic, sub-Saharan, West African metropolis. METHODS: Plasma samples were collected from a cohort of children with CM, severe malarial anaemia (SMA), uncomplicated malaria (UM), non-malaria positive healthy community controls (CC), and coma and anemic patients without malaria, as disease controls (DC). Proteomic two-dimensional difference gel electrophoresis (2D-DIGE) and mass spectrometry were used in a discovery cohort to identify plasma proteins that might be discriminatory among these clinical groups. The circulatory levels of identified proteins of interest were quantified by ELISA in a prospective validation cohort. RESULTS: The proteome analysis revealed differential abundance of circulatory complement-lysis inhibitor (CLI), also known as Clusterin (CLU). CLI circulatory level was low at hospital admission in all children presenting with CM and recovered to normal level during convalescence (p < 0.0001). At acute onset, circulatory level of CLI in the CM group significantly discriminates CM from the UM, SMA, DC and CC groups. CONCLUSIONS: The CLI circulatory level is low in all patients in the CM group at admission, but recovers through convalescence. The level of CLI at acute onset may be a specific discriminatory marker of CM. This work suggests that CLI may play a role in the pathophysiology of CM and may be useful in the diagnosis and follow-up of children presenting with CM

Urinary calcium: a promising predictive biomarker for early recognition of environmental lead exposure in children

Background: In the continuous search for accessible, reliable and sensitive biomarkers for early detection of environmental lead exposure, authors determined the interaction between blood lead level (BLL), the conventional marker of lead exposure, and the indices of calcium and bone metabolism in children.Methods: This cross-sectional study involved 309 apparently healthy children from eight public primary schools in Ibadan, Nigeria who were classified as Elevated BLL (EBLL) and control based on standard cut-off for childhood BLL. BLL, serum Ca (tCa), phosphate, magnesium (Mg), 25-hydroxy-Vitamin D, alkaline phosphatase (ALP), urinary calcium (uCa) and urinary deoxypyridinoline (uDPD) were determined using AAS, HPLC and ELISA as appropriate. Bone-specific ALP (B-ALP) and ionized calcium (iCa) were calculated using standard formulae. Data analyses involved Student’s t-test, Pearson correlation and multivariate regression analysis. p0.05). BLL had significant positive correlation with uCa (r=0.176, p=0.002) (p0.05). BLL could be accounted for by uCa by applying the equation, BLL=0.329+0.324uCa.Conclusions: Urinary calcium could be a promising predictive biomarker for early recognition of significant environmental lead exposure in children

Transcranial Doppler and Magnetic Resonance in Tanzanian Children With Sickle Cell Disease

Background and Purpose: We determined prevalences of neurological complications, vascular abnormality, and infarction in Tanzanian children with sickle cell disease. // Methods: Children with sickle cell disease were consecutively enrolled for transcranial Doppler; those with slightly elevated (>150 cm/s), low (150 cm/s was associated with frequent painful crises and low hemoglobin level. Absent/low CBFv was associated with low hemoglobin level and history of unilateral weakness. In 49 out of 67 children with low/absent/elevated transcranial Doppler undergoing magnetic resonance imaging, 43% had infarction, whereas 24 out of 48 (50%) magnetic resonance angiographies were abnormal. One had hemorrhagic infarction; none had microbleeds. Posterior circulation infarcts occurred in 14%. Of 11 children with previous seizure undergoing magnetic resonance imaging, 10 (91%) had infarction (5 silent) compared with 11 out of 38 (29%) of the remainder ( P=0.003). Of 7 children with clinical stroke, 2 had recurrent stroke and 3 died; 4 out of 5 had absent CBFv. Of 193 without stroke, 1 died and 1 had a stroke; both had absent CBFv. // Conclusions: In one-third of Tanzanian children with sickle cell disease, CBFv is outside the normal range, associated with frequent painful crises and low hemoglobin level, but not hemolysis. Half have abnormal magnetic resonance angiography. African children with sickle cell disease should be evaluated with transcranial Doppler; those with low/absent/elevated CBFv should undergo magnetic resonance imaging/magnetic resonance angiography

Data-driven malaria prevalence prediction in large densely populated urban holoendemic sub-Saharan West Africa

Over 200 million malaria cases globally lead to half-million deaths annually. The development of malaria prevalence prediction systems to support malaria care pathways has been hindered by lack of data, a tendency towards universal "monolithic" models (one-size-fits-all-regions) and a focus on long lead time predictions. Current systems do not provide short-term local predictions at an accuracy suitable for deployment in clinical practice. Here we show a data-driven approach that reliably produces one-month-ahead prevalence prediction within a densely populated all-year-round malaria metropolis of over 3.5 million inhabitants situated in Nigeria which has one of the largest global burdens of P. falciparum malaria. We estimate one-month-ahead prevalence in a unique 22-years prospective regional dataset of > 9 × 10^{4} participants attending our healthcare services. Our system agrees with both magnitude and direction of the prediction on validation data achieving MAE ≤ 6 × 10^{-2}, MSE ≤ 7 × 10^{-3}, PCC (median 0.63, IQR 0.3) and with more than 80% of estimates within a (+ 0.1 to - 0.05) error-tolerance range which is clinically relevant for decision-support in our holoendemic setting. Our data-driven approach could facilitate healthcare systems to harness their own data to support local malaria care pathways

Datasheet1_Development and validation of the Ibadan Simplified Developmental Screening chart.pdf

BackgroundDevelopmental assessment remains an integral part of the routine evaluation of the wellbeing of every child. Children in resource-poor countries are not routinely assessed for signs of developmental delay and developmental disorders are frequently overlooked. A major gap exists in the availability of culturally appropriate and cost-effective developmental screening tools in many low and middle income countries (LMICs) with large populations.ObjectiveTo bridge the existing gap, we describe the process of the development and validation of the Ibadan Simplified Developmental Screening (ISDS) chart, for routine developmental screening in Nigerian children.MethodsWe developed an item pool across 4 domains of development namely, the gross motor, vision-fine motor, communication and socio-behavioural domains. The ISDS chart consists of 3–4 item questions for each domain of development, and responses are to be provided by the caregiver. Each chart is age-specific, from 6 weeks to 12 months. A total score derived from the summation of the scores in each domain are plotted on the ISDS scoring guide with a pass or fail score. Each child was evaluated by the Ages and Stages Questionnaire as the standard.ResultsA total of 950 infants; 453 males and 497 females were enrolled. The estimates of internal consistency between the two instruments ranged between 0.7–1.0. Using the ASQ as the gold standard, the ISDS chart demonstrated a sensitivity of 98.8%, 78.4% and 99.7% in the gross motor, communication and the social and emotional domains respectively, for detecting infants who might require further assessment for developmental delays.ConclusionThe indigenous tool fills a major gap in the need for cost-effective interventions for developmental monitoring in LMICs. Future work should include the deployment of the tool in the wider population, using digital health approaches that could underpin policy making in the region.</p