Review of childhood measles admissions at the National Hospital, Abuja

The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors.Retrospective.Atotal number of 43 children with measles presenting at the National HospitalAbuja, seen over a 40 months period; January 2002 andApril 2005. Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. The children were aged between seven to 12months, with 25 (58.1%) age 24months and below.Twenty three (53.5%) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5%). Associated protein energy malnutrition (PEM) was found in 30(69.8%) with 28 (65.1%) parents of these children being of lower social economic classes (III, IV &V). Recorded complications included gastroenteritis, bronchopneumonia, laryngo-tracheo-bronchitis as part ofcroup syndrome, tuberculosis, and otitis media. Three fatalities (7.0%) were record in this review, all in association with bronchopneumonia.Measles with its complications still present as a fatal illness even among vaccinated children

Adolescent malnutrition: Prevalence and pattern in Abuja Municipal Area Council, Nigeria

Objective: To determine the prevalence and pattern of malnutrition among adolescents in senior secondary schools in The Abuja Municipal area councilMethods: Study design: this is a cross-sectional study conducted among adolescents (10-19 years) in secondary schools. A multistage sampling technique was employed to select a total of 1700 students from classes in selected schools. All schools in the Abuja Municipal Area council (AMAC) were stratified into urban and rural schools. Eight schools were selected by balloting from a list of schools obtained from the Education centre. A school was selected from each of the four major districts of AMAC and four schools were selected from the rural making a total of 8 schools. Although the consent of the school authorities was obtained, individual subject also consented to the study before being enrolled. The study excluded those adolescents who were physically challenged thus limiting physical activity. Information was obtained via the use of questionnaires that were administered by trained personnel. Subject’s height and weight was taken using the floor-type height (H) and weight (W) measuring scale model ZT-120 using Massachusetts department of public health protocol. The nutritional status was determined using the formula: BMI= W/H2 , where W =weight (in kilograms) and H= height (in meters). The age and sex specific height and BMI percentile for each subject was determined using the 2007 WHO Height and BMI growth charts for age 5-19years. The students were then classified into one of the following categories using previously used standards: normal, stunted, wasted, overweight or obese. Data was analyzed using SPSS version 17 statistical package.Results: The mean age was 14.43±1.94 years; male 688, female 862, M:F ratio 1.1.3. Mean BMI, weight and height were 20.31±3.07kg/m2, 51.07± 10.80 kg, and 157.88±9.33 cm. The prevalence of wasting, stunting, overweight and obesity was documented as 1.7% (27/1550), 11.3% (175/1550), 13.2% (205/1550), and 2.6% (41/1550) respectively. Those in urban schools had higher mean BMI (20.91±3.22 kg/m2 versus 19.71±2.78 kg/m2) and height (160.41±9.14 cm versus 155.32±8.81 cm) and p values <0.05.Conclusion: There is a double burden of over-nutrition (overweight and obesity) and under-nutrition (stunting and wasting) among adolescents in Nigeria.Key words: Adolescent, malnutrition, school populatio

Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress

Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of under-water-seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device.Objectives: To provide evidence in support of the immediate clinical effectiveness of the NHBCPAP device.Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application.Results: Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2 were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively, p<0.05. The respiratory changes were however less marked among very low birth weight babies.Conclusion: The simplified customized device produces clinical responses similar to those reported for the conventional CPAP devices

Relationship between dietary habits and nutritional status among adolescents in Abuja municipal area council of Nigeria

Background: Dietary intake assessment is essential to understanding the nutritional status. Healthy eating pattern promotes optimal health, growth and intellectual development and prevents diseases, while poor dietary eating choices may cause malnutrition.Aims: To determine the dietary eating patterns and nutritional status among adolescents in secondary schools within Abuja Municipal area council (AMAC).Subjects and Methods: crosssectional among adolescents, 10 – 19years in secondary schools within AMAC, Nigeria. Using a multistage stratified sampling technique, four urban and four rural schools, 1550 students, were enrolled. Subject’s bio data, dietary habits and knowledge of nutrition and general physical examination were obtained. Dietary assessment included intake of main meals (breakfast, lunch and dinner), skipping meals; methods used to control weight in the previous 30days; knowledge and preference of a balanced diet and food choices. Subject’s height and weight and Body Mass Index (BMI) were determined using the 2007 WHO charts. Data was analyzed using SPSS version 17 statistical package and p value less than 0.05 was significant.Results: 1550 students were recruited, males 688 (44.4%) and females 862 (55.6%); mean age 14.43±1.94 years. Of the 780 urban adolescents, 502 (64.4%) were of upper class and 68 (8.7%) lower class; and of the 770 (49.7%) rural, 206 (26.8%) and 232 (30.1%) belong to upper and lower class respectively, p=.000. Stunting 174(11.2%) and overweight 195(12.6%) were the major forms of malnutrition recorded. Food preferences was based mainly on good taste in 546 (35.2%), balanced diet 530 (34.2%); and 539 (34.8%) had good nutritional knowledge of a balanced diet. Five hundred and forty six (35.2%) admitted to taking carbonated drinks within the previous 7days and 147 (9.5%) missed breakfast, lunch and supper as single meal. Breakfast only was skipped by 71(4.6%) while 160 (10.3%) took lunch outside the home. The methods used to control weight were eating less food or fats, fasting, use of diet pills, inducing vomiting/use of laxatives. Skipping meals and taking meals outside the home was significant for the sex, (p value <0.05), school setting (p value .000) and the infrequent intake of fruits/ vegetables (p value .025). Those that skipped meals showed significant stunting (p value .009), while those who took fruits and vegetables infrequently had significant wasting (p value .049).Conclusion: poor dietary habits were identified among the adolescent. Malnutrition especially stunting and wasting was identified among those that skipped meals and took little fruits and vegetables.Key words: dietary habits, adolescent, urban, rural, prevalence, nutritional status, carbonated drinks

Customized bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja for the treatment of respiratory distress syndrome (RDS)

Using the principle of under-water-seal pressure, we assembled a circuit to produce an effective Bubble Continuous Positive Airway Pressure device at theNational Hospital. The device is reasonably inexpensive and is suitable for use at secondary and tertiary health institutions for the care of the preterm infant with RDS

Hypomelanosis of Ito: Case report of a rare neurocutaneous syndrome in a neonate and review of the literature.

Hypomelanosis of Ito (HI) though said to be the third most common neurocutaneus disorder, is rarely reported in paediatric practice in Africa. A high index of suspicion must be maintained in children with cutaneous lesions as a seizure may be the first symptom that may bring the child to attention. A case of HI in a neonate is hereby reported to sensitize clinicians about this relatively uncommon disorde

Prune belly syndrome in a set of twins, a family tragedy: Case report

We report prune belly syndrome, a rare congenital malformation, in a set of twins delivered to a young couple with a history of three previous first  trimester spontaneous abortions, discordant HIV seropositivity and antenatal ultrasound report that indicated renal abnormalities in only one of the twins. The challenges of management are discussed.Keywords: Prune Belly Syndrome, Twins, Nigeria, Management challenge

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Factors Associated With Adolescent Malnutrition Among Nigerian Students

This study determined the factors associated with malnutrition among adolescents in senior secondary schools in The Abuja Municipal area council. This was a cross-sectional study conducted among adolescents (10-19 years) in secondary schools. A multistage sampling technique was employed to select a total of 1700 students from selected schools. All schools in the Abuja Municipal Area Council (AMAC) were stratified into urban and rural schools. Eight schools were selected by balloting from a list of schools obtained from the Education centre. A school was selected from each of the four major districts of AMAC and four schools were selected from the rural making a total of 8 schools. Although the consent of the school authorities were obtained, individual subject also consented to the study before being enrolled. The study excluded those adolescents who were physically challenged thus limiting physical activity. Socio-demographic information was obtained using an interviewer administered questionnaire. Subject's height and weight was taken using the floor-type height (H) and weight (W) measuring scale model ZT-120 using Massachusetts department of public health protocol. The nutritional status was determined using the formula: BMI= W/H2 , where W =weight (in kilograms) and H= height (in meters). The age and sex specific height and BMI percentile for each subject was determined using the 2007 WHO Height and BMI growth charts for age 5-19years. The students were then classified into one of the following categories using previously used standards: normal, stunted, overweight or obese. Data was analyzed using SPSS version 17 statistical package. A regression analysis of all investigated factors was done to determine those with significant association to malnutrition. The mean age was 14.43±1.94 years; male 688, female 862, M:F ratio 1.1.3. Mean BMI, weight and heightwere 20.31±3.07kg/m2, 51.07± 10.80 kg, and157.88±9.33 cm respectively. The prevalence ofoverweight, stunting, obesity and wasting wasdocumented as 13.2% (205/1550), 11.3% (175/1550),2.6% (41/1550) and 1.7% (27/1550) respectively. Lowsocial class, male gender, hawking after school andrural setting were associated with stunting (p&lt; 0.05)and female gender and watching Television for morethan 3 hours daily were associated with overweight(p&lt;0.05). Obesity occurred more in urban area

Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress

Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of under-water-seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device. Objectives: To provide evidence in support of the immediate clinical effectiveness of the NHBCPAP device. Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application. Results: Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2 were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively, p<0.05. The respiratory changes were however less marked among very low birth weight babies. Conclusion: The simplified customized device produces clinical responses similar to those reported for the conventional CPAP devices