Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City.

BACKGROUND: There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions. METHODS: This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests. RESULTS: A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ2 = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10-0.94; P = .04). CONCLUSION: There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident

Acute Disseminated Encephalomyelitis in A 4-Year-Old Female Treated for Cerebral Malaria: A Case Report

Acute disseminated encephalomyelitis (ADEM) is a multifocal demyelinating disease and a rare post-malarial neurologic sequela. It usually follows cerebral malaria few days to weeks after full recovery and there is absence of malaria parasites in the patient’s peripheral blood film. It can also follow bacterial and viral illnesses. Malaria is an endemic disease in tropical countries like Nigeria, but with careful literature search, no reported case of ADEM following complicated malaria in Nigerian children was seen. Reported cases of post malaria ADEM from other malaria endemic countries were in older children and young adults. We report a case of ADEM in a 4year old female who presented to our centre with features of complicated malaria (cerebral malaria and black water fever). She was treated for complicated malaria and recovered fully. Few days’ post recovery, she suddenly developed diffuse neurologic symptoms with a CT scan result which suggested ADEM. There was no malaria parasite seen in a repeat peripheral blood film and cerebrospinal fluid analysis showed elevated protein and lymphocytic pleocytosis. With institution of steroid therapy, she recovered remarkably and was discharged home. This case demonstrates the need for a high index of suspicion, close monitoring and follow up of children treated for cerebral malaria as ADEM is a treatable post malarial complication, which if undetected, can lead to permanent neurologic sequelae. Key words: Multifocal demyelinating disease, Neurologic sequelae, Non traumatic encephalopathy, Children

Respiratory Illnesses Presenting to The Children’s Emergency Room of a Tertiary Hospital in South–East Nigeria: A Retrospective Study

Background: Respiratory illnesses are a major cause of morbidity and mortality in children worldwide. The impact is more profound in low and middle income countries.Objective: To determine the pattern of the respiratory illnesses in children that presented to the Children Emergency Room (CHER) of Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary hospital in South-East Nigeria, over a 5-year period.Methodology: Clinical records of all children presenting over a 60-month period (July 2011 to June 2016) were retrieved and analyzed. Their age, gender as well as outcome of admission within 72hours in the CHER were reviewed.Results: A total of 4622 children were admitted over the specified period. Six hundred and sixty-eight (14.45%) had an Acute Respiratory Illness(ARI). Age range of the children was I month to 17years, mean age was 2.33 (± 3.56) years.Bronchopneumonia occurring in 27 (41.01 %)children was the most common diagnosis; followed by Bronchiolitis in 78 (11.68%), Aspiration pneumonitis in 41 (6.14%) and Acute Asthma in 40 (5.99%). There was equal gender distribution among the modal age of presentation.Majority of the cases 367 (54.94%) were transferred to the ward for continued care within 72hours of admission, while 54 (8.08%) died. The aetiology of the respiratory pathology (infectious or not) had a significant association with outcome of 72hours of admission in CHER (p = 0.01).Conclusion: Prevalence of ARIs among toddlers is still high. Efforts have to be re-enforced in order to reduce the negative impact of respiratory illness on child health and survival in the sub region. Key Words: Acute pulmonary morbidity, Chest infections, Paediatrics, Healthcare centr

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

Unrecognized respiratory morbidity among adolescents and young adults in Nigeria: Implications for future health outcomes

Background: Lung function impairment is a major determinant of morbidity and mortality. Unrecognized respiratory morbidity may be a missed opportunity to improve future health outcomes. Aim: The aim of this study was to investigate the prevalence of respiratory symptoms and the relationship to spirometry abnormalities and respiratory diagnosis among medical students in Lagos, Nigeria. Methods: This was a cross‑sectional study among students aged 16–35 years. We assessed frequency of respiratory symptoms, previous respiratory diagnosis, and spirometry abnormalities. The relationship between respiratory symptoms, spirometry pattern, and previous respiratory diagnosis was determined using the Chi‑square test and stepwise forward logistic regression analysis. Results: Of 640 participants, 464 (72.5%) performed good quality spirometry tests. Two hundred and forty‑four (52.6%) had at least one respiratory symptom. Preexisting conditions were only identified in 60 (12.9%): 49 (7.7%) asthma, 29 (4.5%) allergic rhinitis, 16 (2.5%) treated tuberculosis, and 8 (1.3%) bronchitis/chronic obstructive pulmonary disease. Using the Global Lung Function Initiative (GLI) lung function predicted values, obstructive (8.4%) and restrictive abnormalities (25.4%) were common. An obstructive pattern was associated with previous diagnosis of asthma, but there was no significant association for the restrictive spirometry pattern. Conclusions: Among otherwise healthy students, respiratory symptoms and lung function abnormalities are common. The vast majority are without a formal diagnosis. Asthma accounted for the majority of obstructive spirometry pattern seen, but the restrictive abnormalities based on GLI equations remain unexplained. Further research is required to determine the cause of these abnormalities and long‑term implications in apparently healthy young individuals

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