Stroke prevalence amongst sickle cell disease patients in Nigeria: a multi-centre study

Background: Stroke is a life-changing, debilitating complication of sickle cell disease (SCD). Previous studies had recorded high stroke prevalence amongst this group of patients. Nigeria has a large population of people affected by this condition and this study aims to assess the stroke prevalence in this large population.Methodology: Stroke prevalence data from 14 physicians working in 11 tertiary health centres across the country was collated by doctors using the sickle cell registers and patient case notes. This data was then collated and used to obtain the overall stroke prevalence in adult and children.Results: The stroke prevalence in sickle cell disease patients in Nigeria was observed to be 12.4 per 1000 patients. Prevalence in the adult patients was 17.7 per 1000 patients and 7.4 per 1000 patients in children. Twenty three percent of the affected patients had more than stroke episode.Conclusion: The stroke prevalence in Nigeria is lower than previously recorded rates and further studies will be required to investigate other factors which may play a role.Keywords: sickle cell, stroke, Nigeria, prevalenc

Mortality in Sickle Cell Anemia in Africa: A Prospective Cohort Study in Tanzania

Background: The World Health Organization has declared Sickle Cell Anemia (SCA) a public health priority. There are 300,000 births/year, over 75% in Africa, with estimates suggesting that 6 million Africans will be living with SCA if average survival reaches half the African norm. Countries such as United States of America and United Kingdom have reduced SCA mortality from 3 to 0.13 per 100 person years of observation (PYO), with interventions such as newborn screening, prevention of infections and comprehensive care, but implementation of interventions in African countries has been hindered by lack of locally appropriate information. The objective of this study was to determine the incidence and factors associated with death from SCA in Dar-es-Salaam.Methods and Findings: A hospital-based cohort study was conducted, with prospective surveillance of 1,725 SCA patients recruited from 2004 to 2009, with 209 (12%) lost to follow up, while 86 died. The mortality rate was 1.9 (95% CI 1.5, 2.9) per 100 PYO, highest under 5-years old [7.3 (4.8-11.0)], adjusting for dates of birth and study enrollment. Independent risk factors, at enrollment to the cohort, predicting death were low hemoglobin (= 102 mu mol/L) [1.7 (1.0-2.9); p = 0.044] as determined by logistic regression.Conclusions: Mortality in SCA in Africa is high, with the most vulnerable period being under 5-years old. This is most likely an underestimate, as this was a hospital cohort and may not have captured SCA individuals with severe disease who died in early childhood, those with mild disease who are undiagnosed or do not utilize services at health facilities. Prompt and effective treatment for anemia in SCA is recommended as it is likely to improve survival. Further research is required to determine the etiology, pathophysiology and the most appropriate strategies for management of anemia in SCA

Steady state, Gender comparison of haemoglobin concentration and vital signs of children with Sickle Cell anaemia in Crises and Steady State at- tending UNTH Ituku-Ozalla Enugu, Nigeria

Abstract Sickle Cell anaemia (SCA) is a genetic haematological disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape. The current steady state haemoglobin concentration among children with sickle cell anaemia attending University of Nigeria Teaching Hospital since relocation to the present new site four years ago are not known necessitating the study. Objectives: To determine the steady state, gender comparison of haemoglobin concentration and vital signs among children with Sickle Cell anaemia in Crises and Steady State attending UNTH Ituku-0zalla Enugu. This is a prospective observational study involving 50 children with SCA in steady state, 50 in crisis and 50 with normal haemoglobin AA genotype carried out between June 2009 and October 2009. The steady state haemoglobin concentration among children with sickle cell anaemia in this environment was 7.2±1.2g/dl. The mean haemoglobin concentration among the group of subjects showed a significant gender difference (p=0.016). Females in both crises and steady state had fairly high haemoglobin concentration when compared to their male counterparts. The mean temperature, pulse and respiratory rate of sickle cell anaemia subjects in crises were 37.2±1.03oC, 101.15±19.73/mins and 34.0±3.36/mins respectively while the values for steady state and control were lower and statistically significant. The mean haemoglobin concentration of subjects in g/dl (crises 6.8+1.7 and steady state 7.2+1.2) was significantly lower than (10.8+1.2) obtained in the controls. Females with SCA had fairly high haemoglobin concentration when compared to the male counterparts

Some characteristics of paediatric admissions at the University of Nigeria teaching hospital Enugu-Nigeria.

Background: In spite of its limitations, documentation of health facility utilization is an aspect of planning for patient care. Information obtained from such studies is usually useful in evaluating existing facilities, documenting trends in patients needs and improving facilities for patients care. Objectives: To assess the characteristics of children who utilize the services of the University Teaching Hospital(UNTH) Enugu for admission and treatment. Design: A prospective study of the characteristics of children admitted consecutively over an eight month period into the Paediatric medical wards of UNTH was determined with the use of a structured questionnaire. Results: Of the three hundred and thirty seven children admitted into the wards, aged 5 weeks to 18 years, two hundred and five(61%), 78(23%) and 54(16%) belonged to the lower, middle and upper social classes respectively. There was a male preponderance (1.3:1) and 60.5% of the children were less than 5 years of age. The children emergency room (CHER) was the route of admission of 214(63.5%) of the children and was statistically significant for all social classes (p=0.006). The difference in duration of symptoms before presentation in hospital between upper (1and II) and lower social ( IV and V)classes was statistically significant (p=0.005). Conclusion: The services of this hospital are used mainly by the lower socio economic class of the society. There is a delay in presentation of patients even to emergency room. The delay in presentation of children to hospital for treatment could be due to lack of education or knowledge, economic hardships, and absence of health insurance. Keywords: Paediatric Admission, Teaching HospitalNigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp. 216-21

Hyper-reactive malarial splenomegaly: A case report and review of the management and pathogenesis

Hyper-reactive malarial splenom egaly is thought to represent a dysfunctional immune response to recurrent malaria infection. A 14 year old male child with hms, hypersplenism, ascites and peripheral lymphadenopathy is reported. There was initial poor response to proguanil aggravated by non compliance. He was started on a combination of proguanil and chloroquine with counseling and showed good and fast response. A review of the management and recent concept of pathogenesis is presented

Socio-demographic factors associated with asymptomatic bacteriuria in children with sickle cell anemia in a tertiary health facility in South eastern, Nigeria

Background: Urinary tract infection (UTI) is a common cause of chronic kidney disease in children. It is second only to respiratory tract infection in developed countries as a cause of morbidity and mortality arising from microbial infections. It is also common in a developing country like Nigeria and is the commonest cause of renal disorders in Port Harcourt, South South, Nigeria. UTI can be symptomatic or asymptomatic (asymptomatic bacteriuria). Asymptomatic bacteriuria is said to be more common in school aged girls and children of low socio-economic class. It has also been documented to be more common in children with sickle cell anaemia. Objectives:To determine the relationship between asymptomatic bacteriuria and age, sex and socio-economic status of children with sickle cell anaemia. Methods: One hundred children with sickle cell anaemia in stable state were screened for asymptomatic bacteriuria using midstream urine samples. The age, sex and social class of the children were obtained through a structured questionnaire administered to the parents/care-givers. The relationship between age, sex and social class with asymptomatic bacteriuria in these children was analyzed using SPSS software. Results: The age of the children ranged from 2-12 years. Six of the 100 children were noted to have asymptomatic bacteriuria and five of the six children were females (p=0.04).Five (83.3%) of the six children were five years and above. There was a predominance of positive cases (66.7%) in the higher socioeconomic class (p=0.03). Conclusion: Asymptomatic bacteriuria is commoner in school aged female sickle cell anaemia children of higher socioeconomic class. However, we suggest that further studies be done to confirm this finding especially with regards to the socioeconomic status of these children

Skin diseases among children attending the out patient clinic of the University of Nigeria teaching hospital, Enug

Background: The prevalence of skin diseases varies worldwide and information regarding local prevalence of its various causes may help the development of policies towards better management. Objective: To document the types of skin disorders seen among children attending the University of Nigeria Teaching Hospital, Enugu( UNTH). Methods: The medical register from the children out patient clinic was used to obtain information on pattern and outcome of skin diseases seen from January 1996 to December 2005. Results: Of the 16,337 children seen in children's out patient clinic (CHOP), 1506 (1.3%) had a skin disease. Age range was one week to 16 years with a mean ± SD of 3.89 ± 3.8 years. Children aged 0 5 years constituted 70.24% of patients with skin diseases. The commonest skin condition was pyoderma (29.81%) seen mainly in those below 5 years, followed by scabies (13.55%). Approximately 1/3 (33.3%) of the patients were referred to the dermatology clinic. Conclusion: Infectious skin diseases constitute a high percentage of skin disorders encountered in paediatrics. Almost half (48.4%) of the skin problems were diagnosed as non-specific dermatitis suggesting the need of better dermatological training of the paediatric residents