Folic acid and brain function in childhood

Folic acid supplementation does not only prevent neural tube defects in the foetus but is an essential ingredient in the growth and development of the cerebral cortex. This micronutrient promotes the thickness of the cerebral cortex; the extent of the thickness being directly proportional to the intelligent quotient, neurocognitive and psychological output of the child. Children with thin cortices are prone to poor cognitive performance, autism and psychiatric disorders such as depression. Folic acid supplementation in the first three months of pregnancy largely protects against neural tube defects; studies have shown that children whose mothers take folic acid supplement throughout pregnancy exhibit relatively higher levels of emotional intelligence. Nevertheless, in spite of long-standing recommendations that women of child-bearing age take folic acid to protect against neural impairment, a large proportion do not comply; less than half of the world’s population lives in countries that require folic acid fortification of grain products. A large portion of pregnant women in poor world countries do not attend antenatal care hence have no access to prescription of essential haematinic/folic acid. It is recommended that all women who are either planning or capable of pregnancy take a daily supplements containing 0.4 - 0.8 mg (400-800 μg) of folic acid. Fortified foods like some breads, juices, and cereals contain adequate folic acid; others are leafy green vegetables, like spinach, broccoli, and lettuce beans, peas, and lentils. Fruits like lemons, bananas, and melons are also rich sources of folate. There is need for more advocacy regarding antenatal care of pregnant mothers with emphasis on folate supplementation before and throughout pregnancy, to boost the intellectual and psychological capacity of children into adulthood

Autism Spectrum Disorders in Calabar, Nigeria

ObjectivesAutism spectrum disorder (ASD) is a neurodevelopmental disorder that is prevalent worldwide. The incidence of autism has increased worldwide. However, there is a dearth of data in sub-Saharan Africa. The study is aimed at determining the clinical and socio-developmental profile of children with ASD in a tertiary hospital in Nigeria.Materials & MethodsThis study is a six-year retrospective review of the medical records of children who presented with clinical autism diagnoses at the Department of Pediatrics, University of Calabar Teaching Hospital. Relevant data were extracted from the medical records of those who met the diagnostic criteria. Descriptive statistics were presented in proportions, percentages, and tables.ResultsOf the 1806 children with neurological disorders seen in the clinic within the study period, twenty-eight were found to have symptoms of autism based on the American Psychiatric Association›s Diagnostic and Statistical Manual V (DSM -5) criteria, giving a prevalence of 1.6%. The mean age at diagnosis was 3.8 ±1.4 (range 2 to 10) years, with a male-to-female ratio of 3:1. About two-thirds of the children diagnosed were older than three years. Seven percent of the children had siblings with autism, 53.5% of children with autism in the study had hyperactivity as comorbidity, while seizures were found in 7% of cases.ConclusionThe prevalence of ASD among children seen in Calabar is 1.6%. Hyperactivity, mental retardation, and seizure disorders are associated comorbidities in the study. Late presentation is a common feature in this facility. Thus, increasing awareness is essential to enhance early recognition, timely diagnosis, and appropriate interventio

Aetiology and comorbidities of cerebral palsy in a developing country

Background: Cerebral palsy (CP) is a common disabling condition of movement and posture causing activity limitation arising from a static injury to the developing brain. Common risk factors for cerebral palsy in Africa include severe birth asphyxia, kernicterus and neonatal infections. This study is aimed at determining the aetiology and comorbidities associated with cerebral palsy in our environment.Methods: All children with CP presenting to the Paediatric Neurology clinic of the University of Calabar Teaching Hospital whose parent gave consent were recruited into the study. The biodata of the children and that of the parent’s/ care givers were obtained. A detailed pregnancy and delivery history, neonatal history, seizures during first three years of life and developmental mile stones was documented.Results: Seventy children with CP were recruited into the study of which 46 (65.7%) were males and 24 (34.3%) females. Majority of the children were from low social class and products of home, church or TBA’S delivery where supervision is poor. Severe birth asphyxia and CNS infections are the commonest identified risk factors. Spastic quadriplegic CP is the dominant type of CP followed by spastic hemiplegia. There is a significant statistical relationship between the aetiology and the type of CP. Epilepsy (60%) speech defect (42.9%) and microcephaly (40%) are the predominant comorbidities seen in the study. Cortical atrophy and ventricular dilatation are predominant CT findings in contrast to periventricular leukomalecia seen in developed countries.Conclusions: Majority of the patients with CP in this study are from low social class and were delivered in places with poor obstetrics care. Improved perinatal care through an adequate social support system may reduce the burden of the disease

Challenges with non-uptake of home-based HIV screening among siblings of HIV positive children in Calabar, Nigeria

Background: Knowledge of HIV status is critical to expanding access to HIV treatment, care and support in a timely manner. Household members of HIV positive persons often are also infected but unaware of their HIV status with consequent diagnosis and treatment gaps. Targeting siblings of index HIV infected children is an important approach of improving identification and enrolment into care. Homebased HIV counselling and testing (HBHCT) has been identified as an acceptable model to complement Provider initiated counselling and testing (PITC) efforts.This study was therefore conducted to assess the uptake of HBHTC among siblings of HIV positive children in Calabar.Methods: This cross-sectional descriptive study was conducted in two health facilities in Calabar. Siblings of HIV positive children were traced to their homes and HIV test was done using the home-based HIV counselling and testing model. Reasons for non-acceptance of HIV test at home were documented. Data was collected and analyzed using SPSS version 21 and p-value <0.05 was considered significant.Results: Out of 401 children recruited into the study, 314(78.3%) accepted home testing while 87 (21.7%) were tested at the health facility giving an uptake of 78.3% among siblings of HIV positive children. The reasons given for non-acceptance of home-based HIV test were; fear of stigmatization 87 (100%), fear of HIV status disclosure by 54(38.3%) and previous testing for HIV 80(92%). None statistically significantly predicted uptake of home-based HIV testing.Conclusion: Home-based HIV testing among siblings of HIV positive  children in Calabar has a high acceptability. However, fear of stigma, HIV status disclosure and previous HIV test were responsible for non-uptake.Keywords: HIV, Home-based HIV testing, Sibling, Stigma, Disclosure, Non-acceptance, Uptak

Awareness of National Health Insurance Scheme (NHIS) and Quality of Health Care Services among Civil Servants in Cross River State, Nigeria

As part of government effort to address the problems in the sector, the National Health Insurance Scheme (NHIS) was initiated to address the health problems in Nigeria. The study assessed awareness of NHIS and quality of health care among Cross River state civil servants. Simple and systematic random sampling technique was adopted in administering 561 questionnaires on civil servants. The generated data were statistically tested at the 0.05 level of significant using Pearson Product Moment Correlation analytical procedure..Results from the study showed that 92.3% of the respondents were aware of the existence of NHIS program while 65.8% registered with NHIS.  63.8 % Civil Servants in Cross River State had the knowledge that NHIS is designed to protect their families from financial hardship arising from huge medical bills and also 71.5 % respondents from the study were aware that NHIS will improve quality of health care in Nigeria. These are part of the objectives of the scheme to improve the quality of health care delivery. Civil servants in Cross River State have comprehensive knowledge of the National Health Insurance Scheme package as a desirable tool for satisfying their health needs.  However, the analysis revealed civil servants ‘awareness of NHIS was significantly related to the quality of health care service render to them. Keywords: NHIS, civil servants, awareness, healthcare

Incidence of Adverse Drug Reactions in Patients on Antiretroviral Therapy: A Study of Pharmaceutical Care in HIV Interventions in A Tertiary Health Facility in Southern Nigeria

Antiretroviral drugs are used to prolong and improve the quality of life for those infected, but this therapy has associated side effects and adverse drug reactions (ADRs) of varying degrees in frequency and severity. A better understanding of adverse effects is of interest not only to the HIV specialists as they try to optimize on therapy but also to the patient who may not be aware of these adverse reactions due to the multiple symptoms associated with the AIDS syndrome. Not much is known about ADRs in Nigeria.  The objective of this study was to determine the incidence and management of various ADRs occurring in patients accessing treatment and care at Dr. Lawrence Henshaw Memorial Hospital, Calabar, Nigeria. The study was a Cross-sectional retrospective study conducted by reviewing patient data from the pharmaceutical monthly summary form from May 2012 to-June 2013. Majority of the clients, 73(63%) were males while 43(37%) were females, 116 clients were screen for ADR and out of this number 84(72%) had an adverse drug reaction of various severity grades. The reported incidence of ADR was much higher among male clients 54(74%) than the female clients 30(70%). Interventions were provided for clients who reported ADR and the Number of clients documented for Adverse Drug Reactions (ADRs) interventions were 84(100%), some clients were provided with more than one ADR interventions. Keywords: ADRs, HIV., Intervention , Antiretroviral drug

Utilization of Insecticide Treated Nets by the Under-Five-Years Children and Pregnant Women in Calabar, Nigeria

A study has been carried out to determine the utilization of Insecticide Treated Nets (ITNs) by the under five years and pregnant women in the Calabar Metropolis. 34 item structured questionnaires was the instrument for data collection. The study population consisted of 440 households. The sampling technique used was multi-stage technique. Results from the study showed that under five years utilization of Insecticide Treated bed nets was 49.12%. About 55% of pregnant women in the study area utilized Insecticide Treated bed nets. Overall utilization of Insecticide Treated bed nets in the study area was 40.68%. Sources of Insecticides Treated bed nets distribution to pregnant women in the study area were ante -natal clinic 59.52%, NGO 20.24% and self purchase 20.24%. There is a need to scale-up ITNs distribution, if the targets of the World Health Organization general assembly target of zero death from malaria and complete eradication of malaria in 2030 have to be achieved, and 60% coverage of the use of insecticide treated bed nets by 2015. Keywords: Malaria, Mosquitoes, Pregnant women, Under-five-years

The Barriers to Accessibility and Availability of Essential Drugs in Public and Private Health Facilities in Calabar Metropolis, Cross River State, Nigeria

The barriers to accessibility and availability of essential drugs in public and private health facilities in Calabar metropolis, Cross River State, Nigeria has been studied. The study has revealed that all the pharmacists both in the private and public sector are aware of the concept of essential drugs and majority of them are of the opinion that the goals have not been achieved. The availability of essential drugs in the private sector though adequate costs of drugs are a barrier to their accessibility while in the public sector the costs of drugs are higher than in the private sector and the level of availability is poor. Factors that lead to the unavailability of these essential drugs are multifactorial. These include defects in the distribution and supply of the essential drugs to their points of usage, Inadequate funding for purchasing quantities of drugs that are needed, inability to pay suppliers so that they do not extend credit facilities to the health facilities .Drugs are wasted through expiries because correct quantification is not being done. Keywords: Accessibility, Availability, Barriers, Health facilities and Essential drug

Helminthic Infestation in Children Aged 6 to 59 Months with Diarrhea in Calabar

Background: Helminthic infections and diarrheal diseases have remained public health problem worldwide, especially in developing countries. Children below five years of age are at a higher risk. This study therefore aims to determine the prevalence, and intensity of intestinal helminths in children with and without the diarrheal disease. Materials and Methods: This was a cross‑sectional analytical study of 130 children aged 6 to 59 months, carried out in the Children Emergency Room and the Diarrhea Treatment and Training Unit of the University of Calabar Teaching Hospital (U. C. T. H), Calabar, Nigeria. Those admitted with and without diarrhoea were consecutively recruited. Data were obtained by administration of questionnaires to parents/caregivers whose children met the inclusion criteria. Clinical examinations including anthropometric parameters (weight and length/height) were carried out on all the children recruited for the study while mid‑upper arm circumference was done for children aged 12–59 months. Stool samples were collected from each child into a wide mouth universal, clean, dry, leak‑proof, container, with the help of their parents/guardians. Microscopy was carried out on the stool  samples collected within 1 h in the microbiology laboratory for the presence of ova, larva, or worm segment using direct microscopy with saline and iodine wet preparation and formol ether concentration. Ova were identified and quantified. The type of worm and intensity were recorded. Results: Out of the 130 children, 65 (50%) had diarrhea while the other 65 (50%) were without diarrhoea. The mean age of subjects with diarrhea was 16.86 ± 11.7 months and 17.60 ± 9.9 months for those without diarrhoea. There was no significant difference in sex distribution between the age groups (P = 0.86). The overall prevalence of intestinal helminthic infection in the study population was 1.5%. The prevalence of intestinal helminths in those with diarrhea and those without diarrhea was 3.1% and 0.0%, respectively, (P = 0.496). Only Ancylostoma duodenale (hookworm) was isolated in those with diarrhea and it was of light intensity. There was no significant  difference in the method of disposal and source of water, comparing subjects having diarrhea and those not having diarrhea (P > 0.05). The proportions of subjects that usually played in the sand, go on footwear outside home, and go on footwear at home, were not  significantly different comparing those having diarrhea and those not having diarrhea (P > 0.05). Conclusions: The prevalence rate of intestinal helminths in children with and without diarrhoea was low. There was general  environmental cleanliness and personal hygiene in the study population which were likely responsible for the low helminthic infection thus emphasizing the need for maintenance of good hygiene, access to good water supply and periodic intake of anti-helminthic drugs in view of the public health importance of helminthic infection and diarrhoea

Improving on the Accessibility and Availability of Essential Drugs in Calabar Metropolis, Cross River State

In this research the accessibility and accessibility of essential drugs in private and public facilities have been surveyed in the Calabar Metropolis, Cross River State with solutions proffered on how to improve upon the accessibility and availability of these essential drugs by respondents via structured questionnaires. About 37 (40.2%) of the respondents were of the opinion that drug suppliers should be paid on time to enable them extend credit facilities and also the cost of drugs should be reduced to make the drugs more affordable. 27 (29.3%) respondents called for the enforcement of relevant drug policies, avoid corruption which meant diversion of monies that should be used to purchase essential drugs for the populace and multiple prescriptions should be discouraged. About 20% of the respondents were of the opinion that there should be effective transportation and distribution of drug products so that stock outs will be avoided when the drugs are taken to places where they will be effectively utilized and the incidences of expired drugs will be minimized with less wastage. More so, about 15% of the respondent believed that health personnel should be trained in inventory management of drugs and public education on drug use should be enhanced. In addition, storage facilities of drugs should be improved and finally about 7% of the respondents believed that making pharmacists in charge of distribution and sales of drug will improve accessibility and availability. Furthermore, the research shows 16.19 % and 44.76 %; OB and GB overall drug availability in the public health facilities respectively and 64.76 % and 82.3 0 %, OB and GB overall drug availability in the private health facilities indicating a higher drug availability in the private facilities. In facilities, Salbutamol inhaler 0.1mg dose and Glibenclamide 5mg tablets are the most readily accessible and available drugs. Keywords: Improving, availability, accessibility, essential drugs