Birth Asphyxia in a Nigerian Mission Hospital in Benin City

Background: Although birth asphyxia is a leading cause of neonatal morbidity and mortality in Nigeria, it has received limited attention in terms of policy and funding priority partly because of lack robust perinatal statistics. Survivors have increased risk of long-term neurologic disability.Objective: To determine the prevalence of birth asphyxia and document the predisposing factors and outcome.Methods: In this cross-sectional study at St Philomena Catholic Hospital, the one-and-five-minute Apgar scores of 2,208 live-births were recorded. Those with low Apgar scores ( 6 at one minute) were studied and their data analyzed.Results: Birth asphyxia occurred in 83.8 per 1000 live-births. The associated significant factors were preterm and post-term deliveries, primiparity, grand multiparity, maternal age 19 years or 40 years andpregnancy-induced hypertension. Severe birth asphyxia was commonest in breech deliveries. Postasphyxial seizures occurred in 11.9% of asphyxiated infants with 86.4% of them occurring within the first 12 hours after birth. Birth asphyxia accounted for 25.9% of total neonatal deaths with 58.7% ofthese deaths occurring within the first 24 hours after birth. Overall case fatality rate was 15.7%. Poor suck, persistent hypotonia, drooling of saliva and seizures were the poor prognostic indicators associated with death. The frequency of severe birth asphyxia as well as deaths were higher in males than females.Conclusion: Disease-specific burden of birth asphyxia remains enormous and will be alleviated if careful attention is paid to management of labour of high-risk expectant mothers, coupled with availability of personnel skilled in neonatal resuscitation at these deliveries.Keywords: Birth Asphyxia, Prevalence, Outcome, Nigeria

Incidence of delivery of low birthweight infants in twin gestations

Twin gestations are commonly associated with delivery of low birthweight infants. Despite the fact that Nigeria has the highest incidence of twinning in the world, there is paucity of information on the characteristics ofLBWtwin infants in Nigeria. To determine the incidence and document some of the characteristics of low birth weight (LBW) twin infants.Adescriptive analysis of data on 119LBWtwin infants delivered between 1st January, 2000 and 31st December, 2003 in a Nigerian mission hospital in Benin City was carried out. The characteristics of the LBW twin infants was studied in relation to perinatal mortality. The overall incidence of LBWtwin infants was 51.7% with a female preponderance. Of the 107 livebornLBWtwins, 74 (69.2%) compared to 33 (30.8%) were preterm and term small-for-gestational age (SGA) infants respectively (

Psycho-social Issues among Adolescents with Diabetes Mellitus: Experience from Two Nigerian Hospitals.

Background: Diabetes mellitus is known to have adverse effect on the psycho-social functioning of the adolescent but its magnitude is poorly documented.Objective: To describe the psychosocial issues observed among Nigerian adolescent diabetics attending the Paediatric outpatient clinics of two Nigerian hospitals.Methods: In this cross-sectional study, information was obtained via an interviewer-administered questionnaire from 33 adolescents with diabetes mellitus attending Paediatric Clinics of two Nigerian hospitals. The socioeconomic status of the families of the subjects was assessed as well as their knowledge and attitudes towards diabetes mellitus.Results: Over one-third of the families (33.6%) of the participants were of low socioeconomic status. The aspect of the treatment which majority (75.8%) of the subjects disliked most was the insulin injection. Delayed menarche and short stature occurred in 15.8% and 9.7% of cases respectively. The two obese adolescents with type 2 diabetes were skipping meals as a strategy for weight reduction. Majority (93.5%) of the participants stated they were not enjoying things the way they used to before the diagnosis of diabetes.Conclusion: Psychosocial challenges are common among adolescents with diabetes mellitus, indicating the need to assist the patients and their families in adapting to the psychosocial burden of the disease.Key words: Adolescents, diabetes mellitus, psychosocial issues, knowledge, attitudes

Paediatric endocrine disorders as seen at the University of Benin Teaching Hospital over a ten-year period

Background: In most developing countries, data on the prevalence and distribution of paediatric endocrine disorders is lacking.Objective: To describe the pattern of endocrine disorders seen in the Department of Child Health, University of Benin Teaching Hospital (UBTH), Benin City, Nigeria between 2004 to 2013.Methods: In this retrospective study, the case files of children seen in the paediatric endocrinemetabolic clinic and those admitted into the wards at the UBTH, Benin City from January, 2004 to December, 2013 were audited.Information obtained included age at presentation, gender, principal complaints, and final diagnosis. For those who were admitted, theoutcome was noted. The hospital’s paediatric clinic register was examined to obtain the total number of new cases seen during the period under review.Results: A total of 13,735 new cases were seen in the Department of Child Health, UBTH during the ten-year period under review and 99 (0.72%) of these had endocrine disorders. The frequencies of the four leading groups of endocrine disorders seen were as follows: diabetes mellitus 17.2%; disorders  of sex development 13.8%; disorders of the thyroid gland  12.1%; and disorders of energy balance 11.2%. Short stature was a rarepresenting complaint.Conclusion: Diabetes mellitus and disorders involving sex development,thyroid gland, energy balance and pubertal development were the five leading groups of childhood endocrine disorders encountered in our clinical practice in UBTH.Key words: endocrine disorders, clinical pattern, children, hospital, Nigeria

Morbidity and mortality patterns of post-neonatal paediatric medical admissions in a large mission hospital in Benin City, Nigeria

This study was conducted to determine the morbidity and mortality pattern in children admitted into a mission hospital and to compare the results with those obtained from public hospitals. It was a retrospective study that reviewed the admission and outpatient attendance registers as well as the case records of all children aged between one month and 14 years admitted into St. Philomena Catholic Hospital (SPCH), Benin City, from 1st January 2000 to 31st December 2001. Out of the 8172 children seen at the paediatric outpatient clinic, 1210 (14.8%) were admitted; comprising of 646 (53.4%) males and 564 (46.6%) females. Under-fives accounted for 84.0% of these admissions. Slightly more cases were admitted during the wet season 632 (52.3%) than the dry season 578 (47.7%). Malaria and its complications (61.1%), gastroenteritis (16.6%) and acute lower respiratory tract infection (ALRTI) (8.7%) were the three commonest causes of childhood hospitalisation. Other causes include anaemia (3.7%), measles (3.6%) and febrile convulsion (3.3%). Overall, mortality rate was 4.1%, with under-fives accounting for 92.0% of these deaths. Mortality rate in under-fives was 18.0%, while mortality rate was 1.7 times higher in girls than boys. The commonest causes of death were malaria and its complications (52.0%), anaemia (18.0%), gastroenteritis (14.0%), measles (8.0%) and ALRTI (6.0%). High case fatality rates were found in cerebral malaria (27.8%), anaemia (20.0%), meningitis (20.0%) and measles (9.1%). The commonest cause of death among infants (excluding neonates) was gastroenteritis, while malaria-induced anaemia was the commonest cause of death among children aged 1-4 years. Malaria and its complications, gastroenteritis, ALRTI and severe anaemia are the most important causes of childhood morbidity and mortality in Benin City. Health interventions aimed at controlling these diseases should be strengthened if childhood morbidity and mortality are to be significantly reduced. Greater resources should be allocated to the health care needs of under-fives especially during the wet season

Vaccination default rates among children attending a static immunization clinic in Benin City, Nigeria

Immunization coverage among infants in Nigeria continues to be low despite availability of effective vaccines and accessibility of immunization clinics in urban areas. This study was conducted to determine the vaccination default rate and vaccine schedule that is most frequently defaulted. It also documented reasons for the defaults and suggested ways of minimising them. The immunization status of 174 children aged 9-11 months were determined by interviewing mothers regarding their children's immunization histories. Each child's immunization card was subsequently reviewed for confirmation. Overall default rate for the entire recommended series of vaccines was 26.7%. Measles vaccine was the most frequently defaulted. The commonest reason given by respondent mothers for defaulting immunization clinic appointments was the child's ill-health (37.5% of all cases). Immunization clinic appointment default rate is still high in Benin City, with measles vaccine being the most frequently defaulted. We therefore suggest ways of minimising vaccination clinic appointment defaults

Hypoglycaemia at point of hospital admission of children below five years of age with falciparum malaria: Prevalence and risk factors

Background: Hypoglycaemia is a well recognized complication of falciparum malaria in children but its diagnosis may be overlooked because all the clinical features may be mimicked by other features of severe malaria. Objective: To determine the prevalence of hypoglycaemia at the point of hospital admission of under-fives with falciparum malariaand identify its risk factors in patients seen in a Nigerian secondary -healthcare institution.Methods: At the point of admission, venous blood sample was collected into an appropriate sample bottle (fluoride-oxalate bottle) from 502 children who were below 5 years of age for malaria parasite examination (Giemsa stain). The blood sample was analysed using the glucose-oxidase method. Results: Ninety two (18.3%) of 502 children below five years ofage with falciparum malaria had hypoglycaemia (blood glucose below 2.6 mmol/L) at the point of hospital admission. Twenty three percent, 78 of 339 children below 36 months of age were hypoglycaemic compared to 8.6%, 14 of 163 children aged 36 months and above; p<0.01. Forty (13.1%) of 305 children in whom the time of last meal was 12 hours and below had hypoglycaemia compared to 52 (26.4%) of 197 in whom the time of last meal was greater than 12 hours; p<0.05. The duration of illness and the parasite density did not have significant bearing with theprevalence of hypoglycaemia.Conclusion: Age below 36 months and a time of last meal greater than12 hours have significant bearing with occurrence of hypoglycaemia in children with falciparum malaria. Routine monitoring of blood glucose at point of hospital admission is suggested.Key words: Hypoglycaemia, falciparum malaria, prevalence, risk factors, under-fives

Steroid-induced diabetic ketoacidosis in a 14-year-old boy with steroid-sensitive nephrotic syndrome: Case report and literature review.

In this report, we described the case of a 14-year-old boy with steroid-sensitive nephrotic syndrome who developed hyperglycaemia and ultimately, diabetic ketoacidosis, following high-dose steroid therapy for a primary renal disease. The nephrotic syndrome was diagnosed based on generalized oedema, massive proteinuria, hypoalbuminaemia and hypercholesterolaemia. Serum creatinine and random blood glucose levels were normal and there was no glycosuria. He was commenced on high dose prednisolone 40 mg 12 hourly and by the 8th day on prednisolone, he achieved remission and was discharged. However, four weeks later, he developed features of diabetic ketoacidosis (DKA) which was confirmed by the presence of hyperglycaemia (random blood glucose19.4 mmol/L), acidosis (serum bicarbonate 10 mmol/L) and ketonuria (2+). The DKA was managed with intravenous fluid (0.9% sodium chloride), continuous insulin infusion and antibiotics. After resolution of the DKA, he was switched to subcutaneous soluble insulin and thereafter, premixed insulin twice daily with a reduction in the dose of prednisolone and was discharged home after 30 days on admission. Blood glucose level has remained within normal range one year after discontinuing insulin and he is still in remission with regard to the nephrotic syndrome at follow up.Conclusion: The risk of diabetic ketoacidosis should be considered in the course of steroid therapy for nephrotic syndrome. To avoid missing of cases of steroid-induced diabetes mellitus, and ultimately DKA, both fasting and postprandial blood glucose values should be monitored.Key words: Adolescence, diabetes, ketoacidosis, nephrotic syndrome, steroid therapy

Hypoglycaemia at point of hospital admission of under-five children with acute diarrhoea: Prevalence and risk factors

Background: Hypoglycaemia is one of life-threatening immediate  complications of acute diarrhoea among under-five children but its diagnosis may be overlooked because all the symptoms may be mimicked by severe dehydration.Objective: To determine the prevalence of hypoglycaemia at the point of hospital admission of under-five children with acute diarrhoea and identify some of the risk factors.Methods: At the point of hospital admission, venous blood sample was collected into an appropriate sample bottle (fluoride-oxalate bottle) from 201 under-five children with acute diarrhoea for blood glucose  determination. The blood samples were analysed using the glucose-oxidase method. One of the authors administered a questionnaire to each of the caregiver to obtain information on the socio-demographic  characteristics and the clinical profile (e.g., presence or absence of vomiting, duration of acute diarrhoea, time of last meal of the patients, and administration of ORS at home. Hypoglycaemia was defined asblood glucose value below 2.6 mmol/L.Results: At the point of hospital admission, 7.7% (14 of 183; CI =3.7-11.7) under-five children with acute diarrhoea had hypoglycaemia(blood glucose < 2.6 mmol/L) but dropped to 4.9% (CI=2.9-6.9)when a cutoff point of < 2.2 mmol/L was applied. The risk factors forhypoglycaemia were the presence of severe dehydration (p<0.001),hypernatraemia and acidosis (p<0.001). The prevalence of hypoglycaemia was 7 times higher in children whose time of last meal was . 8 hours compared with their counterparts whose time of last meal was < 8 hours. Mortality rate was significantly higher in children with acute diarrhoea and hypoglycaemia compared with their counterparts with normoglycaemia(p<0.01).Conclusion: In acute diarrhea, hypoglycaemia is an important comorbidityamong children aged below 36 months and the significant associated risk factors for hypoglycaemia are severe dehydration, hypernatraemia andacidosis. Under-five children presenting with acute diarrhoea and hypoglycaemia at point of hospitalization are at a significantly greater risk of death.Key words: Acute diarrhoea, hypoglycaemia, hypernatraemia

Testicular-self examination among Nigerian adolescent secondary school boys: knowledge, attitudes and practices

Background. Testicular-self examination (TSE) is a cheap and easy-to-perform procedure for early detection of testicular cancer but data on this subject is lacking in Nigeria, particularly among male adolescents. Objective. To assess the knowledge, attitudes and practices of testicular-self examination among secondary school boys. Methods. Knowledge, attitudes and practices in relation to TSE were assessed, using anonymous structured self-administered questionnaires in a sample of 540 secondary school boys aged between 15 and 20 years. Results. Nearly all (98.7%) the male students had never heard of TSE and had hardly practiced TSE. Of the 7 students who admitted examining their testicles, none did so at the recommended level (10 or more times per year) and did not follow the standard procedure for TSE. Nearly half (47.2%) of the participants had a positive inten- tion to start performing TSE regularly after hearing of TSE (through the questionnaire and subsequent teaching on the subject). Conclusions. The level of knowledge, practice and the rating of the importance of TSE are all very low among adolescent second- ary school boys in Benin City, suggesting that these students are unaware of the value of this personal health surveillance tool. The students demonstrated a positive intention to start perform- ing TSE regularly after hearing of TSE (through the questionnaire and subsequent teaching on the subject)