Blood pressure percentiles in a group of Nigerian school age children

Background: Determination of abnormal blood pressure (BP) in children is dependent on comparison with normal percentile values. The commonly used National Institute of Health (NIH) standard is generated from childrenoutside of Africa.Objective: To develop BP percentile values for Nigerian childrenbased on BP cuff width 40% to 50% of arm circumference.Methods: Subjects were pupils from nine primary schools in Midwestern Nigeria recruited using a multi-stage sampling technique. Their BP was measured using a cuff width of 40 to 50% of arm circumference and cuff length of at least 80% of arm circumference respectively. The mean of two BP readings were taken. Hypertension was defined as systolic and or diastolic BP >95th percentile of the study population.Results: There were 1549 subjects, aged 5 to 15 years, of which 757 (48.9%) were males. Prevalence of hypertension was 2.6%. Only age and weight were independent predictors of both elevated systolic and diastolic BP. The 5th, 10th, 50th, 90th and 95th percentiles of Systolic and diastolic BP were generated for both males and females pupils.Conclusion: BP Percentiles have been generated using BP cuff width 40 to 50% of the arm circumference for Nigerian children.Keyword: Blood pressure; hypertension; childhood; percentil

Association between caregivers' knowledge and care seeking behaviour for children with symptoms of pneumonia in six sub-Saharan African Countries

BACKGROUND: Pneumonia is the main cause of child mortality world-wide and most of these deaths occur in sub-Saharan Africa (SSA). Treatment with effective antibiotics is crucial to prevent these deaths; nevertheless only 2 out of 5 children with symptoms of pneumonia are taken to an appropriate care provider in SSA. While various factors associated with care seeking have been identified, the relationship between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia is not well researched. METHODS: Based on data from Multiple Indicator Cluster Surveys, we assessed the association between caregivers’ knowledge of symptoms related to pneumonia – namely fast or difficulty breathing – and care seeking behaviour for these symptoms. We analysed data of 4,163 children with symptoms of pneumonia and their caregivers. A Chi-square tests and multivariable logistic regression was performed to assess the association between care seeking and knowledge of at least one symptom (i.e., fast or difficulty breathing). RESULTS: Across all 6 countries only around 30% of caregivers were aware of at least one of the two symptoms of pneumonia (i.e., fast or difficulty breathing). Our study shows that in the Democratic Republic of the Congo and Nigeria there was a positive association between knowledge and care seeking (P ≤ 0.01), even after adjusting for key variables (including wealth, residence, education). We found no association between caregivers’ knowledge of pneumonia symptoms and actual care seeking for their child with symptoms of pneumonia in Central African Republic, Chad, Malawi, and Sierra Leone. CONCLUSIONS: These findings reveal an urgent need to increase community awareness of pneumonia symptoms, while simultaneously designing context specific strategies to address the fundamental challenges associated with timely care seeking