Pattern and outcome of admissions as seen in the paediatric emergency ward of the Niger Delta University Teaching Hospital Bayelsa State, Nigeria

Objective: To describe the pattern and outcome of childhood illnesses seen in a paediatric emergency ward of a tertiary centre in the Niger Delta region of Nigeria.Methods: Admission records of all children seen in the Children’s Emergency Ward (CHEW) between the 1st of January 2008 and 31st ofDecember 2011 were retrospectively reviewed and analysed.Results: A total of 1756 children were admitted into the emergency ward over a four year period (1st January 2008 to 31st December 2011). The age range was one month to 18 years with a mean of 36.6 months. There was a male preponderance with a male to female ratio of 1.4:1. Majority, 1386 (78.9%) of the patients were below the age of five years. The meanduration of stay was 2.2 days. The major causes of admission were malaria, 562 (32.0%), diarrhoeal disease 389 (22.2%), respiratory tract infections 162 (9.2%) and anaemic heart failure 112(6.4%). Peak admissions period and mortality were in the months of January, May and December. There were 799 transfers, 710 discharges, 94 discharges against medical advice and 20 referrals. Over the period, 133 children diedgiving a mortality rate of 7.6%. Major causes of mortality wereanaemic heart failure 32(24.1%), malaria 26 (19.6%), septicaemia 17(12.8%) and diarrhoeal disease 15 (11.3%).Conclusions: Infections are the major cause of morbidity and mortalityin the study environment with the under-fives being the most vulnerable.Key words: children, under-fives, emergency room, admissions, morbidity, mortalit

Harmful traditional practices in a newborn: A case report

Ninetynine percent of the nearly four million newborn deaths occur in developing countries with newborn deaths remaining relatively invisible and neglected1. In these countries, traditional attitudes and practices dominate newborn care and are often harzadous2. As most births and newborn deaths in developing countries occur outside health care facilities, a reduction in neonatal mortality may depend significantly on interventions involving adaptation of traditional care behaviours practiced at home3. However, despite the importance of traditional practices in the newborn period, little is known about the impact of these practices on newborn health2. We herein present a case of an eighteen day old female who was rushed to the hospital with severe wasting, recto-vaginal prolapse and septic umbilical cord resulting from repeated traditional homecare practices by her mother and grandmother. This case highlights the impact of harmful traditional home care practices on newborn health and emphasizes the urgent need for public enlightenment campaigns and other policy decisions and interventions aimed at reducing this societal menace.Keywords: Harmful traditional practices, newborn, neonatal morbidity, neonatal mortalit

Paediatric discharges against medical advice at a tertiary health centre in Bayelsa State, Nigeria

Introduction: Paediatric discharges against medical advice (DAMA) are common hospital experiences which limit appropriate and comprehensive treatment as a result of abrupt termination of physician care. The fact remains that the children who are the major culprits of this practice are not legally able to participate in this decision making process which may negatively affect their health.Objectives: This present study was carried out with the aim of identifying the DAMA prevalence, the socio-cultural characteristics and reason(s) for DAMA among the paediatric patients admitted into the Niger Delta University Teaching Hospital, Bayelsa.Methods: Case notes of all children who had been discharged against medical advice over a 2 year period(1st of June 2011 to 31st of May 2013) were retrospectively reviewed and analysed.Results: One hundred and fortyone children out of a total of 1872 children admitted into the paediatric wards had been discharged against medical advice, giving a DAMA prevalence rate of 7.5%. Out of 120 children whose case notes were retrieved and analysed, there were69(57.5%) males and 51 (42.5%) females with a male: female ratio of 1.4:1. Neonatal septicaemia (32.6%), birth asphyxia (27.9%) and prematurity (14.0%) were the major diagnosis in neonates while respiratory tract infections (18.2%), severe malaria (15.6%) and septicaemia (14.3%) were the commonest diagnosis in older children who were DAMA. Discharges against medical advice occurred commonly in the first week of admission (69.0%) and among infants (58.0%). Majority of the patients were from low and middle social classes (85.8%) with 30% of the children belonging to families with 4 or more children. The commonest reasons for DAMA were financial constraints (36.7%), lack of clinical improvement (7.5%) and inconvenience of child’s admission (7.5%). Only 27% of the children’s clinical condition had been noted to have improved before DAMA and fathers were the signatories to the discharge documents in 68% of cases.Conclusions: Discharges against medical advice remain a serious public health problem with infants being the most vulnerable. Government provision of free child health services, improving access to health facilities through creation of better road network, better patient- physician relationship, child advocacy and female empowerment would help to ameliorate this problem.Keywords: Discharges against medical advice, child care, advocacy, Nigeria

Epidermolysis bullosa simplex: A case report

Epidermolysis bullosa (EB) is a rare hereditary cutaneous disorder inherited mainly in an autosomal dominant fashion. It consists of a group of conditions that cause the skin to be fragile and blister easily. EB has been classified into three types namely; simplex, junctional and dystrophic. Although all three types of EB have different causes, their symptoms are similar, manifesting as painful blisters and sores. Epidermolysis bullosa is a very rare condition but may probably be more common in clinical practice than reported in literature, especially in places like Nigeria where there is under reporting of clinical cases. To the knowledge of the authors, there are few reported cases in Nigeria and none from Bayelsa State in the delta region of the country. We herein present a case of epidermolysis bullosa simplex (Dowling Meara type) in a 35 day old infant. This case is reported with the aim of increasing awareness of its existence in Nigeria and Bayelsa State in particular.Key words: epidermolysis bullosa simplex, case, skin ulcer

Congenital tuberculosis: A case report and review of the literature

Congenital tuberculosis (TB) is a rare infection transmitted from a mother to her foetus, either through an infected placenta or amniotic fluid. Congenital tuberculosis was previously thought to be rare but recent changes in the epidemiology of TB, have resulted in an increased risk.1 Affected infants usually present with non specific signs and symptoms, hence a high index of suspicion is required to make a diagnosis. Fewer than 300 cases have been reported worldwide till date1 and to the knowledge of the authors, there have been only three reported cases in Nigeria.2-4 We herein report a case of congenital tuberculosis with a review of other published cases in this high TBprevalent region of Southern Nigeria with the aim of creating awarenessof its existence in this region

Maternal Undernutrition and Long-term Effects on Hepatic Function

Undernutrition in utero, regardless of the source, can impair proper liver development leading to long-term metabolic dysfunction. Understanding the molecular mechanisms underlying how nutritional deficits during perinatal life lead to permanent alterations in hepatic gene expression will provide better therapeutic strategies to alleviate the undernourished liver in postnatal life. This chapter addresses the different experimental models of undernutrition in utero, and highlights the direct and indirect mechanisms involved leading to metabolic diseases in the liver. These include hypoxia, oxidative stress, epigenetic alterations, and endoplasmic reticulum (ER) stress. In addition, promising perinatal nutritional and pharmaceutical interventions are highlighted which illustrate how the placidity of the developing liver can be exploited to prevent the onset of long-term metabolic disease

Sensory Evaluation and Proximate Analysis of African Yam Bean (Sphenostylis stenocarpa Harms) moimoi

A moimoi-like dish, similar to the very popular steamed cowpea dish, was produced from the African Yam Bean (AYB). The AYB moimoi was compared with cowpea and soybean moimoi by a panel of eight (8) judges. The samples were compared for taste, colour, aroma texture and overall acceptability. For texture, aroma and overall acceptability, cowpea moimoi ranked highest followed by AYB moimoi and lastly soybean moimoi. Colour wise, AYB moimoi was preferred over cowpea moimoi followed by soybean moimoi. Texture wise, AYB and cowpea were scored equally followed by soybean moimoi. Proximate analysis of the product revealed total carbohydrate content of 40.8%, crude protein 18.4%, Ash, 7.1%, crude fibre 8.3%, crude fat 25.4% and moisture content, 20%. @ JASE

Malaria parasitaemia among long distance truck drivers in the Niger delta of Nigeria

Background: Malaria is the leading cause of morbidity and mortality in sub-Saharan Africa.Objective: The aim of this study was to determine the prevalence of malaria among long distance truck drivers in the Niger Delta of Nigeria.Methods: A total of one hundred consecutively recruited long distance truck drivers aged 21-60 years, with a mean age of 42.36 ± 5.23 years were screened for the presence of malaria parasitaemia.Results: Out of the 100 truck drivers screened, 35 (35%) were positive for malaria while 65 (65%) were negative. Plasmodium falciparum was responsible for all cases of malaria infection. The highest prevalence of malaria occurred among drivers in the 51-60 years age group (40.5%). The mean and standard deviation (SD) of parasite load was 1 020 (125) parasites/ìl in subjects positive for malaria. The mean CD4 count wassignificantly higher among non-parasitized truck drivers compared to P. falciparum parasitized drivers 820 ± 42.0 (731-902 cells/ μl) and 570 ± 30.0 (510-630 cells/ μl) respectively (chi square = 74.00; p = 0.03). We observed a significant negative correlation between plasmodial infection and CD4 lymphocyte count among Plasmodium falciparum-infected subjects with r = - 0.56 (p= 0.001).Conclusion: Preventative strategies including regular chemoprophylaxis, intermittent preventive treatment with antimalarials and provision of insecticide-treated bed nets should be implemented.Keywords: CD4 count, Malaria, Long distance drivers, Niger Delta, Nigeri