Infant feeding practices and maternal socio-demographic factors that influence practice of exclusive breastfeeding among mothers in Nnewi South-East Nigeria: a cross-sectional and analytical study

BACKGROUND: Malnutrition is an underlying factor in more than 50% of the major cause of infant mortality-Pneumonia, diarrhoeal disease and measles which account for 70% of infant mortality. Therefore, programs to promote adequate nutrition for age can help reduce mortality from these disease conditions and indispensible to achievement of MDG 4. AIM: To describe the feeding practices of infants below six months of age and determine maternal socio-demographic factors that influences the practice of exclusive breastfeeding (EBF) among mothers in Nnewi, south-east Nigeria. METHODS: Four hundred mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) during 2012 were consecutively recruited after meeting the study inclusion criteria. Data on breastfeeding were based on infant feeding practice in the previous 24 hours. Exclusive breastfeeding was defined as infant feeding with only breast milk. RESULTS: Awareness (95.3%) and knowledge (82.0%) of EBF was high among surveyed mother but the practice of EBF (33.5%) was very low. Positive attitude towards EBF practice was shown by many (71.0%) of surveyed mothers. EBF practice decreased with increasing infant age, OR 0.72 (95% CI 0.34, 1.51) for 1–2 months, OR 0.58 (95% CI 0.23, 1.44) for 3–4 months and OR 0.20 (95% CI 0.06, 0.73) for 5–6 months compared to infants < 1 month old. Maternal education, socioeconomic class, mode of delivery and infants first feed were retained as important maternal predictors of EBF practice after adjustment for confounders. Decreased likelihood of EBF practice was found among mothers of lower educational attainment, OR 0.33 (95% CI 0.13, 0.81), mothers who delivered through caesarean section, OR 0.38 (95% CI 0.18, 0.84), mothers of higher socio-economic status [(middle class, OR 0.46 (95% CI 0.22, 0.99) and upper class, OR 0.32 (95% CI 0.14, 0.74)] while increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, OR 3.36 (95% CI 1.75, 6.66). CONCLUSION: Knowledge and awareness does not translate to practice of EBF. More effort by health workers and policy makers should be directed to mothers along the fault lines to encourage the practice of EBF

Malaria Prevalence and its Sociodemographic Determinants in Febrile Children- a Hospital-based Study in a Developing Community in South-east Nigeria.

Background: Malaria remains one of the major contributors of child mortality in many developing countries in Africa. Identifying its determinants will help prevention and prompt intervention in these settings. Methods: This cross-sectional descriptive study was conducted over an eight-month period on 382 children who presented with fever to the children outpatient and emergency units of a tertiary hospital in South-east Nigeria. A structured questionnaire was used to collect information on socio-demographic factors. Blood film microscopy for malaria and parasite density was done on all subjects that tested positive for malaria. Result: The malaria prevalence rate was 16.7%, 26.7%, 29.9% and 46.2% in children &lt;5 years, 5 to &lt; 10 years, 10 to &lt; 15 years and 15-17 years respectively. Logistic regression analysis showed that malaria was more prevalent in older children but children under the age of 5 years were more prone to higher parasite density. Also, children of mother with lower educational attainment, children from families of lower socio-economic class and resident in rural settings had higher likelihood of getting malaria infection. Conclusion: Sustained improvement in strategies to prevent malaria infection is still very imperative in children of all ages, especially the under-fives who are prone to severe forms, children of mothers with low educational attainment, from families of low socio-economic class and residents in rural communities

Paediatric Cervical Spine Tuberculosis: A Diagnostic Dilemma!

Tuberculosis (TB) is still a problem in Paediatrics practice. Diagnosis of extra-pulmonary tuberculosis in children has remained difficult despite the gains made by newer TB diagnostic investigations. We report a twelve-year-old female, with a history of neck pain, fever, headache and weakness of all the limbs. The results of TB diagnostic investigations were all negative and the child was treated for meningitis with no clinical response. However, she responded only to a therapeutic trial of anti-TB drugs with improvement of motor function of all the limbs. The child had completed 12 months anti-TB chemotherapy for extra-pulmonary tuberculosis with full recovery of all the neurological deficits. Currently she is on follow up. A high index of suspicion is needed for diagnosis and care of rare/emerging extra-pulmonary tuberculosis in childhood

Hypertension and prehypertension among adolescents attending secondary schools in urban area of South-East, Nigeria

Introduction:&nbsp;in the past, the need for regular blood pressure screening in children was doubtful, and the main reason against it is that hypertension is an adult illness and there is no evidence that screening healthy children for hypertension was worthwhile. We did this study to determine the prevalence of hypertension and prehypertension as well as some risk factors for hypertension among secondary school adolescents in an urban area of the South-East, Nigeria. Methods:&nbsp;this was a cross-sectional study of 984 adolescents aged 10-19 years in secondary schools in Awka South Local Government Area of Anambra state, South-East, Nigeria. The multi-stage sampling method was used to select the subjects. Data were collected from all eligible subjects with the aid of a questionnaire administered to them. Weight, height, and blood pressure were measured and recorded. Results:&nbsp;nine hundred and eighty-four adolescents were recruited for this study, and they comprised 470 (47.8%) males and 514 (52.2%) giving a male: female ratio of 1:1.1. Their ages ranged from 10-19 years. The mean systolic blood pressure and mean diastolic BP were 110.5±10.2mmHg 71.5±8.5mmHg respectively. Prevalence of hypertension and pre-hypertension were 6.3% and 5.0% respectively. There were a higher proportion of females (7.3%) than males (5.4%) with hypertension, and more females (5.8%) than males (4.2%) with prehypertension but these were not statistically significant. Overweight and obesity were significantly associated with hypertension. Conclusion:&nbsp;hypertension exists among secondary school adolescents in Awka South Local government area of Anambra state, with a prevalence of 6.3%, early detection and treatment will forestall the early development of complications

Exercise Induced Bronchospasm and associated factors in primary school children: a cross-sectional study

Abstract Background Exercise Induced Bronchospasm(EIB) is not equivalent to asthma. As many as 20%of school aged children are estimated to have EIB. In Nigeria, there is still a dearth of information on EIB as a clinical entity. This study determined the presence of EIB(using pre and post-exercise percentage difference in peak expiratory flow rate(PEFR) and associated factors such as age, gender, social class and nutritional status in primary school children in Nnewi, Anambra state, South-East Nigeria. The study also grouped those with EIB into those with asthma(EIBA) and those without asthma(EIBWA). Methods This was a community based cross-sectional study involving 6–12 year olds. The PEFR was taken at rest and after a 6 min free running test on the school play-ground using a Peak Flow Meter. A diagnosis of EIB was made if there was a decline of ≥ 10%. Those who had EIB were grouped further based on the degree of decline in post-exercise PEFR (a decline ≥ 10% < 25% → Mild EIB, ≥ 25% < 50% → Moderate EIB and ≥ 50% → Severe EIB) and then categorized as those with EIBWA/EIBA. Results EIB in the various minutes post-exercise was as follows: 19.2%(1stmin), 20.9%(5thmin), 18.7%(10thmin), 10%(20thmin), 0.7%(30thmin). Mild EIB accounted for the greater proportion in all minutes post-exercise and none of the pupils had severe EIB. Using values obtained in the 5thmin post-exercise for further analysis, EIBWA/EIBA = 84.1%/15.9% respectively. Mean difference in the post-exercise PEFR of EIB/no EIB and EIBWA/EIBA was -48.45(t = -7.69, p =  < 0.001) and 44.46(t = 3.77, p = 0.01) respectively. Age and gender had a significant association to the presence of EIB and 58% of the pupils with EIB were of high social class. The BMI for age and gender z-scores of all study subjects as well as those with EIB was -0.34 ± 1.21, -0.09 ± 1.09 respectively. Other features of allergy(history of allergic rhinitis: OR–5.832, p = 0.001; physical findings suggestive of allergic dermatitis: OR–2.740, p = 0.003)were present in pupils diagnosed with EIB. Conclusion EIB has a high prevalence in primary school children in Nnewi and the greater proportion of those with EIB had EIBWA. EIB therefore needs to be recognized as a clinical entity and stratified properly based on the presence or absence of asthma. This will help the proper management and prognostication

Respiratory Diphtheria in Two Children Presenting to A Tertiary Hospital in South–East Nigeria

Respiratory diphtheria is an acute and infectious disease that can progress to cardiac and neurological complications ultimately resulting in increased morbidity and mortality in affected individuals. Diagnosis was made in line with the WHO clinical case definition for Diphtheria. This is a report of two probable cases of complicated respiratory diphtheria presenting within 3 weeks of each other to the Paediatrics Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra state, South-East Nigeria. The first patient was a 5-year-old female who presented on referral with a history of fever, throat pain, noisy breathing and facial fullness, in whom bull neck appearance and membrane in the throat was observed. She was tachycardic, in respiratory distress, had elevated jugular venous pulse (JVP), soft tender liver and a greyish membrane in the throat. She was managed as a case of Diphtheric Carditis and discharged after 17 days on admission in stable condition. The second patient was also a 5-year-old, male, who presented with a history of fever, difficulty in swallowing, change of voice (progressing from hoarseness to whispers), cough and staggering gait. Onset of the illness was associated with membrane in the throat, bull neck and stridor. Examination revealed cranial nerve deficits, aphonia, hypotonia and staggering gait. CSF analysis was within normal. He was managed as a case of Diphtheric Neuropathy and was discharged home in stable condition after 16 days on admission. C. diphtheria IGG done 2 weeks post discharge was 0.19 IU/ml. The cases suggest that respiratory diphtheria still occurs in children in our environment. A high index of suspicion is needed to diagnose and properly nurse these children back to health. Keywords: Corynbacterium diphtheriae, Paediatric Pulmonolog

Asymptomatic proteinuria and elevated blood pressure among adolescents in urban secondary schools of South-East Nigeria

Background: Hypertension and proteinuria are known risk factors for cardiovascular disease and renal impairment. Early detection and treatment will reduce morbidity and mortality associated with them.Objective: To determine the prevalence of asymptomatic proteinuria with or without elevated blood pressure among secondary school adolescents in urban area of south-east Nigeria.Methodology: This was a cross sectional study of 995 adolescents aged 10-19 years attending public and private secondary schools in Awka-South Local Government Area of Anambra state, south-east Nigeria. A multi-staged sampling method was used to select the subjects. All the participants had their urine examined for protein using the combo- 9 (Midi test) according to manufacturer’s specification. Their blood pressure was measured after at least five minutes of rest in seated position using mercury sphygmomanometer, (Accoson® DEKAMET, MK.3 England). Data was analysed using SPSS version 16, (Chicago Illinois, USA).Result: A total of 995 adolescents were recruited and studied. They comprised of 475 (47.7%) males and 520 (52.3%) females, giving a male to female ratio of 1:1.1. Their ages ranged from 10-19 years with a mean of 14.6±2.0 years. Prevalence of hypertension was 6.2%. Thirty-eight females (7.3%) compared to twenty-four males (5.0%) had hypertension, but this was not statistically significant. (P-value =0.14) Ninety-six (9.6%) of all the subjects had protein in urine. Eighty-five had one plus (+), while 11 had two pluses (++) of protein.Conclusion: Asymptomatic proteinuria and hypertension exist among secondary school adolescents. There is need for periodic screening and intervention programme.Keywords: Hypertension, Urine, Protein, Renal Impairmen

Adolescent medical emergencies: baseline survey in a Nigerian tertiary hospital

Background: Globally, there is dearth of data on non-traumatic adolescent medical emergencies, with most studies focussing on adolescent traumatic, psychotic and obstetric emergencies. There is need for extension of focus to this neglected area, especially in Africa where differences in lifestyle, perception and socioeconomic status may influence adolescent health.Objective: To describe the morbidity pattern of adolescents admitted as medical emergencies in a Nigerian tertiary hospital and to identify factors that correlate with mortality amongst them.Methodology: This was a prospective study of all adolescents aged 10 to 19 years consecutively admitted into the Children Medical Emergency Ward of a Nigerian tertiary hospital, over a 2 year period. Their bio-data, clinical condition at time of presentation and outcome at discharge from the emergency room were documented. Bivariate analysis for correlation of these factors with mortality was done utilizing the Statistical Package for Social Sciences version 20.Results: Two hundred and two adolescents were admitted in the emergency room within the period. Their mean age was 13.3 +2.3 years with male to female ratio of 1.5:1. The major presenting symptom was fever with the predominant disease category being infectious and parasitic diseases in 31.2% of them. A sickle cell disease crisis was responsible for 15% of admissions and was the commonest single disease entity amongst them. The mortality rate was 6.4%. Acute exacerbations of chronic diseases were responsible for 85% of the mortalities. Chronic kidney disease with case fatality of 36% was significantly correlated with mortality [OR 8.4 CI 3.2-22.3]. Gender, age and maternal educational status had no significant correlation to the outcome.Conclusion: Acute exacerbation of chronic medical conditions account for poor outcome of medical emergencies in adolescents in the study centre. This calls for intensification of Preventive Medicare and adoption of the principle of pro active follow up of adolescents living with chronic diseases.Keywords: Non-traumatic, Acute exacerbations, Chronic diseases, Outcom

Parasite reduction ratio one day after initiation of artemisinin-based combination therapies and its relationship with parasite clearance time in acutely malarious children

Abstract Background In acute falciparum malaria, asexual parasite reduction ratio two days post-treatment initiation (PRRD2) ≥ 10 000 per cycle has been used as a measure of the rapid clearance of parasitaemia and efficacy of artemisinin derivatives. However, there is little evaluation of alternative measures; for example, parasite reduction ratio one day after treatment initiation (PRRD1) and its relationship with parasite clearance time (PCT) or PRRD2. This study evaluated the use of PRRD1 as a measure of responsiveness to antimalarial drugs. Methods In acutely malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP), the relationships between PRRD1 or PRRD2 and PCT, and between PRRD1 and PRRD2 were evaluated using linear regression. Agreement between estimates of PCT using PRRD1 and PRRD2 linear regression equations was evaluated using the Bland-Altman analysis. Predictors of PRRD1 > 5000 per half cycle and PRRD2 ≥ 10 000 per cycle were evaluated using stepwise multiple logistic regression models. Using the linear regression equation of the relationship between PRRD1 and PCT previously generated in half of the DHP-treated children during the early study phase, PCT estimates were compared in a prospective blinded manner with PCTs determined by microscopy during the later study phase in the remaining half. Results In 919 malarious children, PRRD1 was significantly higher in DHP- and AA-treated compared with AL-treated children (P  15 months, parasitaemia > 10 000/μl and DHP treatment independently predicted PRRD1 > 5000 per half cycle, while age > 30 months, haematocrit ≥31%, body temperature > 37.4 °C, parasitaemia > 100 000/μl, PRRD1 value > 1000 and no gametocytaemia independently predicted PRRD2 ≥ 10 000 per cycle. Using the linear regression equation generated during the early phase in 166 DHP-treated children, PCT estimates and PCTs determined by microscopy in the 155 children in the later phase were similar in the same patients. Conclusions PRRD1 and estimates of PCT using PRRD1 linear regression equation of PRRD1 and PCT can be used in therapeutic efficacy studies. Trial registration Pan African Clinical Trial Registration PACTR201709002064150, 1 March 2017, http://www.pactr.or

Clinical illness and outcomes in Nigerian children with persistent early-appearing anaemia following initiation of artemisinin-based combination treatments of uncomplicated falciparum malaria

In non-anaemic children with malaria, early-appearing anaemia (EAA) is common following artemisinin-based combination treatments (ACTs) and it may become persistent (PEAA). The factors contributing to and kinetics of resolution of the deficit in haematocrit from baseline (DIHFB) characteristic of ACTs-related PEAA were evaluated in 540 consecutive children with malaria treated with artemether-lumefantrine, artesunate-amodiaquine or dihydroartemisinin-piperaquine. Asymptomatic PEAA occurred in 62 children. In a multiple logistic regression model, a duration of illness ≤3 days before presentation, haematocrit <35% before and <25% one day after treatment initiation, drug attributable fall in haematocrit ≥6%, and treatment with dihydroartemisinin-piperaquine independently predicted PEAA. Overall, mean DIHFB was 5.7% (95% CI 4.8–6.6) 7 days after treatment initiation and was similar for all treatments. Time to 90% reduction in DIHFB was significantly longer in artemether-lumefantrine-treated children compared with other treatments. In a one compartment model, declines in DIHFB were monoexponential with overall mean estimated half-time of 3.9 days (95% CI 2.6–5.1), Cmax of 7.6% (95% CI 6.7–8.4), and Vd of 0.17 L/kg (95% CI 0.04–0.95). In Bland-Altman analyses, overall mean anaemia recovery time (AnRT) of 17.4 days (95% CI 15.5–19.4) showed insignificant bias with 4, 5 or 6 multiples of half-time of DIHFB. Ten children after recovery from PEAA progressed to late-appearing anaemia (LAA). Progression was associated with female gender and artesunate-amodiaquine treatment. Asymptomatic PEAA is common following ACTs. PEAA or its progression to LAA may have implications for case and community management of anaemia and for anaemia control efforts in sub-Saharan Africa where ACTs have become first-line antimalarials. Trial registration: Pan Africa Clinical Trial Registration PACTR201709002064150, 1 March 2017 http://www.pactr.or