Treatment of relatives by doctors: experience from Calabar, Nigeria

To determine the involvement ofmedical practitionersworking in a tropical setting in the treatment of their relatives. Cross-sectional. Medical practitioners of all cadresworking in theUniversity of Calabar TeachingHospital, Calabar, Nigeria.Alarge teaching hospital inCalabar,Nigeria.Areferral centre for two states.Extent, type and effect of involvement in the practice.Majority (90.9%) of medical practitioners in our centre were found to have been involved in the treatment of their relatives. Services rendered included consultation, in which all respondents (100%) have partaken. Cardiopulmonary resuscitation (16.9%) and emergency surgery were performed by only a few (3.1%). Though fees were not charged for services provided by most; a few (13.1%) did so. Outcome of involvement was unfavourable in some instances: 9.4% lost relatives they were involved in treating.Majority of the respondents 51.7% believed it is unethical to treat relatives and advocated for only limited involvement.This is because the pressure fromrelatives for care cannot be entirely ignored.It is difficult in our environment not to accede to request to treat familymembers.We recommend that practitioners may offer only consultation, and in some cases treat minor ailments while referring more serious ones to appropriate colleagues. Keywords: Treatment of relatives; doctors; Calabar Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp 41-4

HIV Infection in hospitalized under-5 children with acute watery diarrhoea in Calabar, Nigeria.

Background: The signs and symptoms of HIV/AIDS in children are not quite distinct because of similarities in clinical presentation between HIV infection and endemic tropical diseases. Diarrhoea, one of the cardinal symptoms of HIV/AIDS, is a common childhood disease. Objective: This study was conducted to find the prevalence of HIV infection among children admitted with acute watery diarrhoea in our diarrhoea treatment and training unit. Method: Consecutive children aged below 5 years admitted into the unit with diarrhoea were recruited. The children were examined. The parents were counseled before blood was taken for HIV screening. In addition, parents of children who were sero-positive for HIV were also screened. Results: One hundred and fifty- two who made the inclusion criteria were studied. Eight (5.3%) were sero-positive for HIV, five of them being males. None of these mothers had antenatal care and they were all delivered at either home or traditional attendants' homes. All were under weight and six of them presented with severe dehydration. These factors reached statistical significant differences between children who were sero-positive and those who were not. None of these eight patients died from acute watery diarrhoea but two of them eventually died from complications of persistent diarrhoea. Conclusion: Children with HIV may present with acute watery diarrhoea. Children with diarrhoea that are underweight with severe dehydration whose sero-status are not known should be screened for HIV

Neonatal Morbidity And Mortality In Calabar, Nigeria: A Hospital- Based Study

Background: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004. Results: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission. Conclusion: Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age. Keywords: Neonatal Morbidity, Mortality. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 285-28

Prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea in University of Calabar Teaching Hospital, Calabar.

Background: The clinical features of hypoglycaemia and severe dehydration are similar, and these two can occur in a child presenting with acute diarrhoea. Hypoglycaemia occurring in a growing brain is deleterious and must be detected and treated. Objective: To determine the prevalence of hypoglycaemia among under-five children presenting with acute diarrhoea in UCTH, Calabar. Method: This was a prospective study of 150 children aged six weeks to five years presenting with acute diarrhoea in UCTH, Calabar from June 1st to October 31st 2008. Consecutive children who met the inclusion criteria were recruited into the study. Blood samples were collected for random blood sugar and serum electrotype estimation using One Touch Ultra Test Strips 2006 model and Flame photometry respectively. Results: The overall prevalence of hypoglycaemia in under-five children presenting with acute diarrhoea was 4%. There was no sex difference. It was commonest among children of the low socioeconomic class (83.3%). Risk factors to developing hypoglycaemia were longer duration of last feeds greater than five hours and severe  dehydration, both reaching statistically significant differences (p=0.022 and 0.002; FET respectively). Forty percent of patients who died had hypoglycaemia constituting 33.3% of patients with hypoglycaemia. Conclusion: Children with diarrhoea complicated with severe dehydration are prone to developing hypoglycaemia. It causes high mortality and thus this parameter should be checked for and managed on time.Key words: Hypoglycaemia, acute diarrhoea, under-five children

Malaria parasite positivity among febrile neonates

Background: Malaria, earlier considered rare in neonates, has been reported with increasing frequency in the last decade. Neonatal malaria diagnosis is challenging because the clinical features are non-specific, variable and also overlap with bacterial infection.Aim: To determine the prevalence of neonatal malaria and the associatedclinical features in newborn babies with fever.Patients and methods: One hundred and fifty neonates with fever admitted into the Newborn unit of the University of Calabar Teaching Hospital, over a six month period, were recruited consecutively. Symptoms and signs for each neonate were documented. Blood film for malaria parasites and investigation for sepsis workup were done before commencement of drugs.Results: One hundred and fifty babies were recruited. Most (85.3%) of the babies were aged .7 days. One hundred and thirty six (90.7%) of the mothers were booked for antenatal care (ANC). Most of the babies were from primiparous women (54.7%). Six babies (4%) had malaria  parasitaemia with four (2.7%) being congenital malaria and two (1.3%)acquired malaria. Plasmodium falciparum was the only species identified. All six with malaria were from the 136 booked mothers. Four of the affected six neonates also had septicaemia. The clinical features in babies with malaria only were, fever, fast breathing and jaundice while thosewith malaria and bacterial co-infection had, in addition, poor suck.Conclusion: Malaria infection and septicemia can coexist in some Nigerian newborns and since the clinical presentation of each of these condition are closely similar, it is recommend that malaria parasite investigation be included as part of the investigation in the newborns with fever. This approach can help to avoid a delay in applying the appropriate therapeuticinterventio

Worm Infestation And Anaemia Among Pre-school Children Of Peasant Farmers In Calabar, Nigeria.

Background: Worm infection and anaemia are common childhood conditions in Nigeria. We assessed the status of helminthiasis and associated anaemia among pre school children of peasant farmers aged 1-5 years living in a rubber plantation near Calabar, Nigeria. Design: Cross sectional. Method: Three hundred and fifty children were selected by multi-stage cluster sampling technique. Freshly passed stool was examined using Kato-Katz method while anaemia was estimated using haematocrit technique. Result: Of the 350 children, 174 (49.7%) had intestinal helminths: Ascaris lumbricoides 64.4%, hookworms 10.9% and Trichuris trichuria 1.1%. There were 41(23.6%) children with polyparasitism, 33 of them were due to Ascaris lumbricoides and hookworms. The worm load was generally light in intensity with egg per gram of stool ranging from 24-60,960. Males (28.9%) were infected more than females (20.8%). The frequency of infection increases with age. The prevalence of anaemia among the entire study population and in those infected with worms was 56.6% and 56.9% respectively. With polyparasitism there was a relative increase in the frequency of anaemia females > males. Conclusion: Worm infections and anaemia are common in our children. A comprehensive control strategy involving good sanitation, sinking of bore hole for clean water supply and regular deworming exercises are recommended. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 220-22

Neonatal seizures in Calabar: A revisit

Newborns admitted with convulsion in the University of Calabar Teaching Hospital, Calabar during the period 1st May 2004 to 30 April 2006 were studied prospectively. The aim was to determine the place of birth in relation to the cause of seizures, the current situation in terms of the aetiology, clinical spectrum and outcome. There were 55 neonates with convulsion representing 5% of admissions into the newborn unit during the period. Birth asphyxia, sepsis, and hypoglycaemia were important identifiable aetiological factors which operated either singly (45.5%) of cases) or in concert (54.5% of cases) in causing seizures. Hypocalcaemia and hyponatraemia contributed less. These results are similar to that of a previous study carried out in this centre ten years earlier . There was no statistical significant difference between home and hospital deliveries in relation to causes of seizures. Septicaemia was caused mainly by staphylococcus aureus, enterobactericae and unclassified coliforms. No neonatal meningitis was diagnosed. Surprisingly, there was a high prevalence of generalized seizures (76.4%). The mortality of 34.0% was related to onset of the seizures within 4 days of life but not the place of birth.The causes of neonatal seizures in our environment are mostly preventable. There is need to provide modern facilities for investigating newborn seizures, training and retraining of Traditional Birth Attendants, health education of expectant mothers

Heart Failure among Paediatric Emergencies in Calabar, South Eastern Nigeria

A study of heart failure among paediatric emergencies in the University of Calabar Teaching Hospital, Calabar, was prospectively carried out over a period of 9 months in the Children's Emergency Room (CHER). Two hundred & thirty four out of 1512 admissions presented with heart failure giving a prevalence of 15.5%. The main causes of heart failure among the 234 children were anaemia (73.1%), pneumonia (17.5%) and ventricular septal defect (3,8%). Pneumonia (61% of cases) and ventricular septal defect (78%) of cases) were largely encountered in infants. Majority (69%) of the patients with anaemic heart failure were aged between 1 and 5 years. The main diseases associated with anaemia were malaria (73.9%), sickle cell anaemia (12.5%) and septicaemia (6.3%). Heart failure constituted 1.7% (26 out of 1512) of total deaths in CHER during the period. The fatality rates for patients in whom heart failure complicated anaemia, pneumonia and ventricular septal defect were 9.9%, 12.2% and 44.4% respectively. Most of the deaths (77%) occurred within the first 24 hours of hospitalization. Anaemia and acute respiratory infections, which are the leading causes of heart failure in our children, must be promptly identified, treated and prevented. Key Words: Anaemia, heart failure, paediatric emergencies, pneumonia, prevalence. Mary Slessor Journal of Medicine Vol.4(1) 2004: 58-6

Prevalence of Persistent Proteinuria using Urine Protein/Creatinine Ratio in Asymptomatic Primary School Children in Calabar, Nigeria

Background: Quantitative urinary protein estimation is the cornerstone in the diagnosis, treatment and prognostication of renal diseases. This could either be carried out by 24-hour urine protein estimation or spot urine protein: creatinine (UPC) ratio. The latter is simple, convenient, quick and reliable. It can be used in the follow-up of asymptomatic proteinuric children at risk of developing chronic renal disease.Aim: To determine the prevalence of persistent proteinuria in asymptomatic primary school children in Calabar, Nigeria using the UPC ratio.Methodology: This was a descriptive cross-sectional study of 1,600 apparently healthy primary school children aged 5 to 12 years recruited by multi-stage sampling. Urinalysis using dipstick was performed and those with significant proteinuria (proteinuria ≥ 1+) had urinalysis repeated after two weeks. Those with persistent proteinuria were quantitated using the modified Biuret method while urine creatinine was measured with the modified Jaffe Kinetic method (done with the Biolabo creatinine kit). Urine protein:creatinine ratios > 0.20 were confirmed as persistent proteinuria.Results: Out of the 1,600 pupil, 761(47.6%) were males and 839(52.4%) females, giving a male to female ratio of 1:1.1. The mean age was 8.7 ± 1.9 ranging from 5-12 years.The modal age group was 9-10 years. The prevalence of persistent proteinuria using the dipstick urinalysis was 1.8% while with the UPC ratio was 1.6%. There was a high female preponderance 19 (1.2%) of persistent proteinuria, which was statistical significant. Age and social class did not contribute significantly to having persistent proteinuria.Conclusion: The prevalence of persistent proteinuria in these asymptomatic children using UPC ratio was almost similar to the repeat urinalysis done after two weeks. It is hereby recommended that where UPC ratio is not available a positive repeat urinalysis using first void early morning urine after two weeks can be used as persistent proteinuria. This information will enable proper treatment and follow-up which will forestall rapid progression to kidney damage.Keywords: Urinalysis,Protein: Creatinine Ratio,Asymptomatic Children