Estimation of zinc levels among children with malnutrition at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria

Objective: Zinc plays a critical role in many body functions and its deficiency is associated with impaired cognitive function, behavioral problems, memory impairment, growth retardation, increased incidence of diarrhoea and recurrent infections. Although severe zinc deficiency is not common, mild to moderate deficiency is quite common globally. It is estimated that some form of zinc deficiency affects about one third of the world population, with estimates ranging from 4% to 73% across sub Saharan Africa. To determine the prevalence of zinc deficiency among malnourished children at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Methods: Study was descriptive cross-sectional, carried out at the Paediatric department of UDUTH, Sokoto from April 2013 to June 2014. It was conducted among children aged between 6 and 60 months who presented to the OPD and those that were admitted into paediatric wards of UDUTH with malnutrition. Children with similar characteristics that were well nourished served as controls. Cohorts were recruited consecutively until the required sample size was obtained. 5mls of venous blood was taken for serum zinc analysis from each child.Results: A total of 550 children were studied with 275 apiece for cohorts. The mean age of the malnourished children was 26.2±14.6 months compared to 28.2±17.0 months recorded for the controls (p=0.157).The mean serum zinc levels for the study subjects 13.5±3.3μmol/Lwas significantly lower than that of the controls (15.8±1.9μmol/L) (t=9.42, df=548, p=0.0001).Conclusion: The prevalence of zinc deficiency among both malnourished children and the controls was 0% using WHO reference value for children below the age of 5 years. Prophylactic doses of zinc should be given in all malnourish children in situation where mineral mix is not added to feed or f75 and f100 are not available. There is need to adhere to and use recommended cut off values recommended by WHO for defining zinc deficiency by researchers.Keywords: zinc, malnutrition, Sokot

Serum Levels of Antioxidant Vitamins in Foetal Haemoglobin (HbF) Persistent Sickle Cell Anaemia Children in Sokoto, Nigeria

Background: sickle cell anaemia (SCA) is one of the commonest health problems of Nigerian children. Method: The serum levels of antioxidant vitamins A (retinol), C (ascorbic acid) and E (alpha-tocopherol) were determined in foetal haemogbobin persistent sickle cell anaemic (Hb SS + F), sickle cell anaemic (Hb SS) and normal (Hb AA) children. Results: The levels of antioxidant vitamins in Hb SS+F children were found to be insignificantly different (p>0.05) when compared to those of Sickle Cell anaemic (Hb SS) children. While significantly higher values (p<0.05) of the vitamins in normal children (Hb AA) were observed when compared to those in HbSS+F and Hb SS children. The slightly less depressed levels of the antioxidant vitamins in Hb SS+F children may probably be attributed to the relatively less frequent sickle- cell crises often found in these individuals. Conclusion: The less depressed serum levels of anti-oxidant vitamins in HbSS + F children may be contributory factor to their relatively stable clinical status. Therefore, it is recommended that HbSS + F children as well as HbSS children be placed on regular anti-oxidant vitamins - A, C and E supplement.Contexte: L'an\ue9mie dr\ue9panocytaire est l'un des plus fr\ue9quents probl\ue8mes de sant\ue9 chez l'enfant au Nigeria. M\ue9thode : Le taux s\ue9rique d'anti oxydants, vitamine A (r\ue9tinol), vitamine C (acide ascorbique) et vitamine E (alpha-tocopherol) a \ue9t\ue9 d\ue9termin\ue9 chez des enfants pr\ue9sentant une association h\ue9moglomine fetale - an\ue9mie dr\ue9panocytaire persistante (Hb SS + F), une dr\ue9panocytose (Hb SS) et une h\ue9moglobine normale (Hb AA). R\ue9sultats : Le taux de vitamines anti oxydants n'\ue9tait pas significativement diff\ue9rente entre les enfants pr\ue9sentant une Hb SS+F et ceux pr\ue9sentant une Hb SS (p>0.05). Par contre ce taux de vitamines est significativement plus \ue9lev\ue9 chez les enfants \ue0 Hb normal (AA) compar\ue9s \ue0 ceux ayant une Hb SS+F et SS (p<0.05). La faible baisse du taux de vitamines anti oxydants chez les enfants \ue0 Hb SS+F pourrait s'expliquer par la relative moindre fr\ue9quence des crises de dr\ue9panocytose souvent retrouv\ue9e chez ces enfants. Conclusion: La faible baisse du taux de vitamines anti oxydants chez les enfants \ue0 Hb SS+F pourrait constituer un facteur contribuant \ue0 leur relative stabilit\ue9 sur le plan clinique. Il est donc recommand\ue9 de mettre les enfants \ue0 Hb SS+F et SS sous traitement anti oxidant: A, C et E

Prevalence of uncomplicated malaria in a paediatrics outpatient department of a tertiary health institution in Sokoto, Nigeria

Background: Malaria remains one of the major tropical health challenges in the world today. It accounts for more than 80% of estimated 1.5-3 million deaths of children annually especially those aged 5 years and below. There is paucity of data on the prevalence of uncomplicated malaria in children in Sokoto. Objectives: To determine the prevalence of uncomplicated malaria in children aged 0-15 years. Methods: The health registers and outpatient cards of children aged 0-15 years that presented to the Paediatrics Outpatient Department/Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 1 st June 2007 and 31 st May 2009 were studied retrospectively. Information of the patients with regards to their age, gender, presenting features, date of presentation at the clinic, and diagnosis of malaria (clinical and parasitological) were extracted from the registers and case records and analyzed. Results: During the study period, a total of 15,909 children aged 0-15 years were seen in our clinic. Of this number, 7,224 had clinical and parasitological diagnosis of uncomplicated malaria giving a prevalence rate of 45.4%.those aged 5 years and below were 5,782 (49.6%) while the remaining 1,442 (34.0%) were aged above 5 years. Males were 4,068 (56.3%) while the females were 3,156 (43.7%) with M: F ratio of 1.3:1. The main presenting symptoms were fever (100%), reduced appetite (80.5%), reduced activity (75%) and chills (74%). The main presenting signs were pyrexia (84.5%), splenomegaly (38%) and hepatomegaly (14%). Malaria was the leading cause of paediatrics outpatient clinic attendance followed by acute respiratory infection and diarrhoeal disease. Though malaria occurred throughout the year, majority of the cases were seen during the raining and early dry reasons. Conclusion: Malaria is partly meso-endemic and hyper endemic in the studied area and children aged 5-years and below are the most susceptible. It is therefore, recommended that more efforts should be put in place towards malaria control and prevention particularly in this age group

Paediatrics HIV/AIDS: Clinical presentation and practical management challenges in Sokoto, Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a two-year period. Methods: This prospective study was carried out between 1 st January 2001 and 31 st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS, admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient was individualised. Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6%) patients were aged 5 years and below. Modes of transmission were vertical in 40 (97.6%), while 1 (2.4%) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100%), followed by fever (>one month) 39 (95%), chronic diarrhoea 39 (95%), recurrent cough 37 (90%) and oro-pharyngeal candidiasis 35 (85%) in that order. Thirty- six (87.8%) patients had protein - energy malnutrition (PEM), marasmus constituting 58%. Thirty-two (78%) patients were in WHO clinical stage 3 while the remaining 9 (22%) patients were in stage 4. The main types of infections were oral candidiasis, pneumonia, malaria, septicaemia, urinary tract infections, and tuberculosis. Case fatality rate was 91%. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study. Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group

Cerebral Malaria: Presentation and Outcome in Children in Sokoto

Malaria remains a major cause of high mortality in African Children. A high percentage of these deaths are caused by cerebral malaria (CM). Therefore, this study sought to determine prospectively, the clinical pattern and outcome of CM in children aged 6months to l2years admitted consecutively into the Emergency Paediatrics Unit (EPU), Usmanu Danfodiyo University Teaching Hospital Sokoto, over a one-year period. (1” June 1999 and 31st May 2000). The level of consciousness was assessed using the Blantyre coma scale for children. Intravenous Quinine dihydrochloride was the antimalarial drug of choice. A total of 971 children were admitted into EPU over the study period. Seventy eight (8.0%) of them had CM. fifty (64%) of the patients were aged 1-5 years. The principal presenting clinical features were fever in seventy eight (100%), loss of consciousness, 78 (100%), and convulsions, 66 (85%). Signs of decerebration, retinal haemorrhages and papilloedema occurred in 23 (30%), 7 (9%), and 5 (6.4%) patients, respectively. Fifty-eight (74%) patients survived, while 20 (26%) died. In conclusion, the hospital prevalence of CM in this series was 8% and ages I to 5 years were the ages of greatest susceptibility. Age less than 3 years, Blantyre coma score of 0, signs of decerebrate rigidity, acidotic (Kussmaul's) respiration, retinal haemorrhages, papilloedema, hypoglycaemia, and raised plasma urea concentrations were indicators, on admission, of poor outcome/prognosis. The case fatality rate of 26%, though within the range reported in literature, remains significantly high. Therefore, skilled, meticulous, and appropriate medical and good nursing care of these patients is strongly advocated. Nigerian Medical Practitioner Vol. 50 (3&4) 2006: pp. 55-6

An outbreak of cutaneous Leishmaniasis in a boarding senior secondary school in Sokoto, North Western Nigeria: Clinical Presentation and outcome

No Abstract. Nigerian Medical Practitioner Vol. 51 (5) 2006: pp. 86-8

SERUM LEVELS OF ANTIOXIDANT VITAMINS IN FOETAL HAEMOGLOBIN (HbF) PERSISTENT SICKLE CELL ANAEMIA CHILDREN IN SOKOTO, NIGERIA

Background: sickle cell anaemia (SCA) is one of the commonest health problems of Nigerian children. Method: The serum levels of antioxidant vitamins A (retinol), C (ascorbic acid) and E (alpha-tocopherol) were determined in foetal haemogbobin persistent sickle cell anaemic (Hb SS + F), sickle cell anaemic (Hb SS) and normal (Hb AA) children. Results: The levels of antioxidant vitamins in Hb SS+F children were found to be insignificantly different (p>0.05) when compared to those of Sickle Cell anaemic (Hb SS) children. While significantly higher values (p<0.05) of the vitamins in normal children (Hb AA) were observed when compared to those in HbSS+F and Hb SS children. The slightly less depressed levels of the antioxidant vitamins in Hb SS+F children may probably be attributed to the relatively less frequent sickle- cell crises often found in these individuals. Conclusion: The less depressed serum levels of anti-oxidant vitamins in HbSS + F children may be contributory factor to their relatively stable clinical status. Therefore, it is recommended that HbSS + F children as well as HbSS children be placed on regular anti-oxidant vitamins - A, C and E supplement

The pattern Of CD4 + T-lymphocyte count in under-5 children with protein energy malnutrition with or without HIV infection

Background: Protein-energy malnutrition (PEM), a major public health problem in the developing countries, has been associated with impaired cell-mediated immunity. Objectives: To describe the pattern ofCD4FNx01 T-lymphocyte count among malnourished children in relation to HIV infection. Methods: A prospective cross-sectional study conducted among children aged 6 months to 59 months with PEM seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto between 1 st November, 2009 and 30 th April, 2010. The age, sex and weight of the subjects were documented. The CD4FNx01T-lymphocyte count was determined using Partec cytoflow machine and HIV infection was confirmed with ELISA for children > 1-8 months and DNA PCR for those aged <18 months. Results: One-hundred children with PEM were recruited over a 6 month period. The mean age (#177;SD) was 19.8#177;9.2 months. Ninety-seven were aged < 3years with M: F ratio of 1.8:1.0. HIV infection was detected in twenty-seven of these children and 48.1% of the HIV infected had marasmus. The mean CD4FNx01 T-lymphocyte count in children with PEM without HIV infection was 1864.8 #177; 705.3 cells/pL compared to significantly lower mean count of 747.7+361.7 cells/pL among those with PEM with coexisting HIV infection (t= - 7.8, p= 0.0001). The mean CD4FNx01 T-lymphocyte count was significantly lower in children with PEM, particularly those with marasmus (p= 0.0001), and with coexisting HIV infection {p- 0.0001). Conclusion: The CD4FNx01 T-lymphocyte count was low among under-5 children with PEM. This depletion in CD4FNx01 T-lymphocyte count is further worsened by HIV infection among the children with PEM