Trend in asthma severity in steroid naive asthmatic children in Benin city, Nigeria

Background: Asthma imposes heavy health burden on children and families worldwide. It is a chronic inflammatory airway disease and as such, treatment of the asthmatics is aimed at relieve of bronchoconstriction and inflammation. Until about a decade ago, emphasis was on the bronchoconstriction rather than the inflammation.Objective: To determine the trend in severity of asthma in steroid naive children, in an era when steroid use in the treatment of asthma was uncommon.Materials and Methods: Case notes of patients managed for asthma from 1985 to 1995 and age 5 - 16 years were retrieved and reviewed (these case notes are usually stored in Prof. O. Oviawe’s office). Information extracted included age of onset of asthma, severity of asthma and drug medication at presentation and at 1 year. The GINA Guideline (2006) was used in classifying the asthma severity.Results: A total of 77 patients satisfied the criteria for the study. Of these, 53 were males and 24 females. Males: Female ratio was 2.3:1; age range 5 - 16 years; mean age ± SD (8.5 ± 3.13 years). At presentation, 48 (62.3%) patient had intermittent, 29 (37.7%) had persistent asthma, of these, 25 (86.2%) had mild persistent and 4 (13.8%) had moderate persistent. None had severe persistent asthma. At 1 year follow‑up, 29 (37.7%) now had intermittent asthma, while 44 (57.1%) had persistent asthma, of these, 23 (52.3%) had mild persistent, 20 (45.5%) had moderate persistent, while 1 (2.3%) had severe persistent. Medication therapy was β2‑agonist in 72 (93.5%) patients.Conclusion: The study supports progressive pathologic process possibly inflammatory in origin. It is opined that steroid naivity led to the trend seen in this study and judicious use of corticosteroids would have arrested the trend.Key words: Asthma, inflammatory, severity, steroid use, tren

Prevalence of HIV/Sputum AFB positivity among patients attending University of Benin Teaching Hospital (UBTH), Benin City, Nigeria

Human Immunodeficiency Virus (HIV) and Tuberculosis(TB) have synergistic interactions that speedily accelerate decline of the host’s immune system and accentuate the progression of each other. Eight hundred and ninety five patients referred from different units of University of Benin Teaching Hospital, Nigeria were screened for antibodies to HIV-1 and HIV-2 using ELISA and sputum microscopy for acid-fast bacilli. The result showed that, 92(10.3%) were HIV positive with females 68(14.2%) higher than males 24(5.8%) though not statistically significant (p=0.066), 123(13.7%) patients were AFB positive, with males 75(18.1%) significantly higher than females 48(10%) (p=0.046) and 14(1.6%) patients were co-infected. Although the co-infection rate was higher among females 9(1.9%) than males 5(1.2%), there was no significant difference (p=0.450). The age group 40-49 and 50-59 had the highest TB/HIV co-infection (2.5% each).Regular screening for TB in HIV patients and HIV in TB patients would demonstrate the true burden of TB disease amongst HIV infected patients.Key words: prevalence, TB, HIV, co-infection, Nigeria.LA PREVALENCE DE LA POSITIVITE DU VIH/EXPECTORATIONS AFB CHEZ LES PATIENTS QUIFREQUENT L’UNIVERSITE HOPITAL D’ENSEIGNEMENT DE BENIN (UBTH), BENIN CITY, NIGERIA.Le virus de l’immunodéficience humaine(VIH) et la tuberculose (TB) ont des interactions synergiques qui rapidement accélèrent le déclin du système immunitaire de l’hôte et accentuent la progression de l’un l’autre. Huit cent quatre – vingt quinze patients des différentes unités de l’université hôpital  d’enseignement de Benin, Nigeria, ont été criblés pour les anticorps a VIH – 1 et VIH – 2 en utilisant ELISA microscopique des expectorations pour les bacilles acide – Résistant. Le résultat a montrée que 92 (10,3%) étaient séropositifs avec des femelles 68(14,2%) plus élevé que les males 24(5,8%), mais passtatiquement significatif, (p=0,066), 123(13,7%) patients étaient AFB positif, avec les males 75(18,1%) significativement plus élevés que les femelles 48 (10%) (p=0,046) et 14 (1,6%) patients ont été Co – infectés. Bien que le taux de la Co – infection était plus élevé parmi les femelles 9(1,9%) que les males 5 (1,2%), il n y avait pas de différence significative (p=0,450). Le groupe d’âges 40 – 49 et 50 – 59 avait la plus forte Co - infection de TB/HIV (2,5%). Le dépistage régulier de la tuberculose chez les patients VIH et VIH chez les patients tuberculeux démontrerait le véritable fardeau de la maladie de la tuberculose chez les patients infectés par le VIH.Mots Clés : Prevalence, Tuberculose, VIH, Co – infection, Nigeria. 

Over-diagnosis of childhood asthma by medical residents: who is to blame?

Asthma is a common chronic childhood illness and results in considerable morbidity for sufferers. It also imposes serious socio-economic burden on families and the healthcare system. This leads to a depletion of scarce resources. To minimize these effects, proper diagnosis of asthma is important. Objective: To evaluate the ability of medical residents (doctors in training) to effectively and accurately diagnose asthma. Method: A semi-structured self-administered questionnaire on asthma management was filled out by medical residents from the six geo-political zones participating in an update course in Nigeria in August 2009. Results: Of sixty-four residents who completed the questionnaire, 28 (43.8%) were males and 36 (56.2%), females. Post graduation years (mean ± SD) and range were 6.47 ± 2.2 and 2 – 12 years respectively. The burden of asthma as seen in practice areas was occasionally (35, 54.7%), frequently (28, 43.8%) and rarely, (1, 1.5%). No medical resident reported “Not at all”. Of the 64 residents, (10, 15.6%) practiced appropriate method for asthma diagnosis, while (54, 84.4%) practiced inappropriate method for diagnosis. Nine (14.1%) residents reported availability and use of spirometer in their practice centre. Years post graduation and gender did not correlate significantly with appropriateness of asthma diagnosis; p = 0.616, p = 0.505 respectively. Conclusion: Study supports over-diagnosis of asthma by medical residents and consequently mis-management. Capacity building in area of asthma management will be enhanced by emphasis on asthma management in undergraduate curriculum, residency training and continuous medical education on the proper management of asthma

Pneumonia complicated by congestive heart failure in Nigerian children

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Knowledge of proper preparation of salt sugar solution (SSS) by Mothers of children presenting with diarrhoea in Benin City

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Evaluation of Feeding Practice and the Use of Home-made and Food-based fluids during diarrhea episodes by mothers in Benin-City

Background: Oral Rehydration Therapy, which includes the use of home-made, food-based fluids helps to prevent diarrhoeal dehydration. Information on the knowledge of the use of these home-made food-based fluids appears scanty, hence the need to evaluate the current status of maternal knowledge on the use of these fluids during diarrhoeal episodes.Methods: This cross-sectional study was carried out in two major hospitals in Benin City, Edo State. Subjects were mothers of children presenting with diarrhoea.Results: Out of the 104 mothers, only 47(45.2%) said the child should be fed frequently during episodes of diarrhoea. Only 7(6.7%) mothers agreed that garri water could be used. Nine (8.7%) and 6(5.8%) mothers agreed that green coconut water and boiled rice water could be used respectively.Conclusion: Majority of the mothers had no knowledge of the use of home-made fluids during diarrhoeal episodes in children. This is a dangerous trend which may worsen diarrhoea mortality.Key words: Diarrhoea, home-made food-based fluids, feeding practice

Underlying congenital heart disease in Nigerian children with pneumonia

Background: Pneumonia is a common cause of childhood morbidity and mortality globally. Some congenital heart disease (CHD) may predispose their sufferer to bronchopneumonia. Objective: To evaluate the contribution of CHD to pneumonia in children seen in a tertiary hospital. Methods: Over a year, consecutive children diagnosed radiologically with pneumonia were evaluated echocardiographically for CHD. Certain characteristics in children with pneumonia and CHD were compared to those without CHD. Results: There were 121 children with pneumonia of which 61(50.40%) were males and their mean age was 10.2 ± 10.93 months. The prevalence of CHD was 14(11.57%), the commonest CHD was ventricular septal defect (VSD) in 7(50.00%). Most of the CHD with septal defect had moderate to large defects. Children with CHD were 3 and 256 times more likely to have heart failure and murmur respectively compared to those without CHD, p = 0.084 and <0.0001. Children with CHD stayed longer in the hospital 11.50 ± 7.03 days than those without CHD 7.38 ± 5.34 days, p = 0.012. Conclusion: The children with CHD were more likely to have heart failure and murmur compared to those without CHD. Prevalence of CHD in children with pneumonia in this study is high, evaluation of children with pneumonia for CHD is therefore recommended