Home management of childhood diarrhoea: Need to intensify campaign

A review of home management of childhood diarrhea in under-five children among 203 Nigerian mothers was carried out over a period of 3 months in order to ascertain how effectively they manage their children with diarrhea outside a hospital setup (infrastructural health facility). Mothers whose children had diarrhea, with or without other symptoms, and presented at the Children’s Out Patient unit (CHOP), of the UNTH over the study period were consecutively interviewed through a questionnaire designed for the study. The questionnaires were designed and administered by the authors. There were 30 mothers in social class 1; 59 in social class 2; 52 in social class 3; 13 in social class 4, and 7 mothers in social class 5. Information was obtained on the method of detection, causes of diarrhea, and treatment including their knowledge and use of oral rehydration salts with or without anti diarrheal and antibacterial agents. Out of the 203 mothers interviewed, 140 (71%) correctly defined diarrhea. 112 (55.2%) could identify correct causes of childhood diarrhea. Only 80 (39.4%) could correctly manage diarrhea at home. About 76% (154 mothers) knew that they should use an oral rehydration salt; of this number, 56 (27.6%) could correctly prepare SSS, while 29 (14.3%) could do the same for the UNICEF ORS. In addition, anti bacterial, anti-diarrheal, and/or herbal preparations were used by 38 (18.7%) of the mothers. The level of knowledge of oral rehydration therapy has dropped in our locality since its inception in the early 1990s. There is need to intensify maternal education in this area since we now have a new generation of mothers who were not there during the inception of the program

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu

Background: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human  immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV.infected children. Malnutrition is prominent in HIV-infectedchildren due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which resultin poor intake, nutrient loss, and increased metabolic rate, respectively.Objectives: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu.Materials and Methods: The hematological and anthropometric indices of HIV.infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis.Results: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm3, platelets count 294 ± 78 ~ 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed,on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%).Conclusion: Hematological abnormalities and malnutrition occur in HIV positive children.Key words: Haematological, malnutrition, anaemia, childre

Coagulation profile of children with sickle cell anemia in steady state and crisis attending the university of Nigeria teaching hospital, Ituku-Ozalla, Enugu

Background: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome.Objectives: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype.Materials and Methods: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex.Results: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038).Conclusion: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.Key words: Children, coagulation profile, sickle cell anemi

Pattern and outcome of paediatric medical admissions at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu: a five year retrospective review (2007 – 2011)

Background: Most health information from Nigeria and other developing countries are based on hospital records which although may not be a true representative of the whole population, they serve as pointers. Such information has shown that infections and malnutrition remain the leadingcauses of morbidity and mortality , although non-communicable diseases also pose substantial threat to child health.Objective: To review the pattern, trend and outcome of paediatricadmissions at the University of Nigeria Teaching Hospital over afive year period.Methods: Patients admitted into the main pediatric wards of the hospital over a five year period were reviewed, through information obtained from their case notes. Neonates, surgical and trauma patients as well as patients admitted into the children’s emergency room were excluded.Results: Infections (44.5%) were the leading causes of hospital admissions while non-communicable diseases were the leading causes ofdeath in this study with an overall mortality rate of 9%.Conclusion: Despite all efforts over the years, infections continue to pose serious challenges to child health in developing countries. At the same time, non-communicable diseases are taking over as leading causes of mortality. Therefore, as we make stronger efforts to tackle infections and malnutrition, we should make provisions for improved diagnosis and management of non-communicable diseases.Key words: Outcome, Paediatric, medical admissions, Enugu

A prospective study of childhood malignancy in Enugu, Eastern Nigeria (2011-2013)

Background: The review of childhood cancers has most times been done in retrospect by most authors and this has its inherent limitations. Most reviews in Africa show that lymphomas are the commonest malignancies of childhood while acute leukemia ranks much lower.Objective: To do a prospective audit of the pattern of childhood malignancies in Enugu, southeast, Nigeria.Methods: Demographic and medical information on patients aged 1 -17 years admitted over a 36 month period for malignancies was obtained and recorded in pretested interviewed administered questionnaire. Data was analyzed using spss, 15 (Chicago II, USA) software.Results: A total of 103 patients were admitted with diagnosis of cancer with a male: female ratio of 1.3: 1 and median age of 7 years. Majority (63.1%) of patients were from the rural area with low socioeconomic background. There was a decline in the incidence of childhood lymphoma from 40% about 25 years ago to 34% in the present study. Although lymphoma remains the leading childhood malignancy, sarcomas and acute leukemia rather than renal and eye tumors ranked second and third respectively among childhood cancers in the center.Conclusion: There is a reversing trend in the pattern of malignancies of childhood in Enugu as acute leukemia becomes one of the leading malignancies of children.Key words: childhood, malignancy, lymphomas, leukaemi

Health-related quality of life in school-aged children with and without asthma in Enugu, South East Nigeria

Background: Identifying impaired quality of life is a recognized component of asthma management with no published data in Nigerian children withasthma. The aim of this study was to describe the health-related quality of life of school-aged children with and without asthma seen at the Asthma Clinic of the University of Nigeria Teaching Hospital, Enugu.Methods: Cross-sectional hospital -based study of children aged 7- 17 years (with and without asthma) attending the Paediatric Asthma and General Children Outpatient Clinic of the University of Nigeria Teaching Hospital (UNTH) from parts of the south – east region of Nigeria were consecutively enrolled. Quality of life (QOL) scores were obtained usingthe Paediatric Quality of Life inventory (PedsQLTM) questionnaire which measures the core dimensions of health: physical functioning, emotional functioning, social functioning and school functioning.Results: There were a total of 180 study participants: (90 with asthma and 90 without asthma). Overall quality of life scores for children with asthma was worse than in those without asthma; 75.5, SD19.3 and 82.7, SD14.5respectively (MD 7.1, CI = 2.3 to 12.3, p=0.01). Physical function domain was significantly more affected in asthmatics than nonasthmatics; 73.4, SD 23.2 vs. 84.4, SD17.3 respectively (MD 11.1, CI = 5.0 to 17.1, p=0.002). The psychosocial health summary scores in children with and withoutasthma were 77.6 SD 18.1 vs.81.1 SD15.1 (MD 3.5, CI= -1.4 to 8.4,p= 0.24), with the highest scores obtained in the social functioning domain for both asthma and nonasthma patients; 82.7, SD 20.3 and 87.6, SD 15.7(MD 4.9, p = 0.08) respectively. In both the overall and specificQOL domains, boys had higher scores than girls, irrespective of age or socioeconomic status with an inverse relationship between increasing age and QOL scores (r=-0.2, p=0.07).Conclusions: Children with asthma showed worse QOL and significant impairment in their physical functioning, more noticeable among the female study population. Information obtained from our QOL study forms a basis for a more informed management plan with regards to which age groups are more affected and the specific domains of health in children with asthma that need to be given closer attention to reduce asthma morbidity. The study emphasizes the need for QOL integration in asthmamanagement for a more holistic approach to outcome evaluation oftreatment rather than the physical outcomes

Audit of Blood Transfusion Practices in the Paediatric Medical Ward of a Tertiary Hospital in Southeast Nigeria

Objectives: To determine the indications, practices and outcomes of transfusion on children.Design: A descriptive retrospective study.Setting: Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria.Subjects: Children one month to 18 years that received blood transfusion.Main outcome measures: Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events.Results: The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The  indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia  (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were themain types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of . 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the  transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%).Conclusion: Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare

Bacteriology of urinary tract infection and antimicrobial sensitivities in under-five children in Enugu

Background: Urinary tract infection (UTI) is one of the serious bacterial infections in febrile young children, which may cause chronic morbidities. Studies from different parts of Nigeria have shown varying pattern in itsbacteriology and antibiotic sensitivities. Antimicrobial resistance rate among uropathogens is an increasing problem limiting therapeutic options, and underscores the need to determine local bacteriological pattern that will guide empiric antibiotic choices.Objectives: To identify the bacterial pathogens responsible for UTI in febrile under-five children in Enugu as well as their antibiotic sensitivity patterns.Methods: A cross-sectional descriptive hospital based study of eligible febrile children aged one to 59 months. Urine samples were collected using mid-stream and suprapubic aspiration methods. Standard laboratory  procedures were used to culture the urine specimens, identify the bacterialpathogens as well as their antibiotic sensitivity patterns. Descriptive statistics were used to analyse the outcome.Results: Significant bacteriuria occurred in 22 (11%) of the 200 samples. Escherichia coli isolates were the most common organisms in 7(31.8%) of the 22 positive samples. Others were Staphylococcus aureus, Klebsiella spp and Streptococcus faecalis isolated in 5 (22.7%), 3(13.6%), and 3(13.6%)of the positive samples respectively. Most of the isolates were sensitive to ofloxacin (90.9%), ciprofloxacin (81.8%), nitrofurantoin (77.3%) and ceftriaxone (72.7%). High levels of resistance to ampicillin, cotrimoxazole,amoxicillin, nalidixic acid and clavulanate-potentiated amoxicillin were observed.Conclusion: Escherichia coli is the most common cause of UTI in febrile under-five children studied. Ciprofloxacin and ceftriaxone showed better sensitivities are advocated for the empiric treatment of febrile UTI in Enugu.Key words: UTI, under-fives, bacterial pathogens, antibiotic sensitivitie

Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria

Background: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group.Objective: The objective of the following study is to determine the  prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics.Materials and Methods: Urine specimen of febrile children aged 1.59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity.Results: A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 } 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males (P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above (P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI.Conclusion: UTI is common in febrile under.fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.Key words: Fever, under.five children, urinary tract infectio

Prevalence of hypoxemia among children with sickle cell anemia during steady state and crises: A cross.sectional study

Background: Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso.occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonarycomplications are common in sickle cell disease (SCD) and may  exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD.Objectives: This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state.Materials and Methods: This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX.21N model.Results: A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (ƒÔ2 = 6.425, P = 0.04).Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above.Conclusions: Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individualsespecially those with acute chest syndrome. Key words: Enugu, hypoxemia, oxygen saturation, sickle cell anemi