Dip patterns in asthmatic and non-asthmatic children in Benin-city, Nigeria

Objective: Although the calibre of the airway is kept patent by multifactorial control system, there is evidence that the calibre ofthe bronchi varies with time of the day in normal subjects. Asthma isnow known to be a chronic inflammatory disease and this chronic  inflammation causes hyperreactivity and lability in the airway. Therefore,asthma is characterised as a disease where respiratory symptoms arebased on large variation in airway calibre leading to variations in resistanceto airflow over a short period of time.Method: Normal non-asthmatic children leaving within 10km of Universityof Benin Teaching Hospital (UBTH) and whose parents work at UBTH were recruited. These subjects aged 5 – 15 years were initially matched with an index asthmatic case both for sex and age (within six months range). Using a questionnaire the control were screened to exclude any case with history of respiratory, cardiac or any form of active disease or chest deformity or family history of asthma. This was followed by weight and height determination. Both the subject and control were then instructed on the correct use of the mini Wright Peak Flow meter and how to record it inthe diary provided. After five days of measurement, the diaries werecollected and the PEFR were analysed.Results: Two hundred and ten (210) asthmatics and one hundred andeighty healthy children completed the study. The two groups were similar for age, weight and height, but the mean daily PEFR was significantlylower for the asthmatic children (P<0.01). The circadian pattern of distribution of PEFR is similar both in asthmatic and the healthy children, the lowest PEFR was at 6am and maximum was at 2pm and thereafter, there was a gradual fall from the 6pm to 10pm, this was the dominant pattern both in asthmatic and the healthy children. Significant difference in magnitude of PEFR between the two groups occurred at 6am, 6pm and10pm (P<0.01). In all, the asthmatics had lower value. The PEFR ineach case at 2pm was similar; 302.6 l/min for normal children as against3.2 l/min for asthmatic children. Of the asthmatic subject, 205 (97.6%)had a discernable dip pattern compared with 4 (2.2%) in healthy subjects.Conclusion: Dip pattern exists both in asthmatics and non-asthmaticchildren, although, more of the asthmatics had a discernable dip pattern. The airway calibre shows a variation with the time of the day, both in asthmatics and normal subjects with lowest values in the morning and highest in the afternoon. But at each time of the day, the asthmatics had lower PEFR values than normal children. This maybe relevant in the management and follow-up of the asthmatics

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

Streptococcal throat carriage in a population of nursery and primary school pupils in Benin City, Nigeria

Background: Group A streptococcus (GAS) is a major cause of mortality in man. Regular disease surveillance can be achieved through evaluation ofthroat carriage.Objectives: To evaluate GAS throat carriage amongst nursery and primary schools pupils in Benin City, Nigeria.Method: This cross sectional study was carried out between September and November 2011. A multistage random sampling method was used to recruit the pupils. Throat swabs were obtained for microscopy and Lancefied grouping.Results: 426 pupils were recruited of which 363(85.2) were in primary and 63(14.8%) in nursery schools. The subjects were aged 2 to 15years and 203(47.7%) were males. Of the 426 pupils, 123 (28.9%) had positive throat swabs for â haemolytic streptococcus (âHS). None of the isolate wasGAS. The isolates were groups C (50.4%), D (38.2%) and G (11.4%).Conclusion: Although âHS throat carriage rate in this study is high, there was no GAS isolate. This may suggest low prevalence of GAS related diseases in the community.Keywords: group A Streptococcus; throat carriage; school childre

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

Pyogenic liver abscess mimicking pleural effusion

Pyogenic liver abscess is a major visceral abscess that may pose a diagnostic dilemma in a febrile child with prominent extra-abdominal symptoms. We present a case of a well-nourished, immunocompetent  four-year-old girl who had none of the common predispositions to a liver abscess. Hence, in this unusual setting, pyogenic liver abscess was not considered at the initial assessment, until closer evaluation and futile efforts to drain a seemingly large “pleural effusion” eventually revealed the diagnosis, which was confirmed by imaging. She underwent ultrasound-guided percutaneous drainage of the pyogenic liver abscess to avert the sequelae of this potentially fatal disorder. This underscores the need to think laterally when considering differential diagnoses for the sick child.S Afr Fam Pract 2012;54(5):459-46

Discursive ideologies in campaign speeches of Cyril Ramaphosa and Julius Malema in the 2019 South African presidential election

This work analyses the discursive ideologies embedded in campaign speeches of Cyril Ramaphosa of the African National Congress (ANC) and Julius Malema of the Economic Freedom Fighters (EFF) in the period before May 8, 2019, the South African general elections. The study is an attempt to uncover the hidden ideologies the candidates subtly employ to sway voters in their favour. The study employed Critical Discourse Analysis to analyse the campaign messages. The data for the study comprised the campaign exchanges of the two candidates retrieved from www.youtube.com. This study shows that the two presidential contenders, through their campaign speeches, employed different ideologies through which they hoped to sway the electorate in their favour. The incumbent, Cyril Ramaphosa, projects the ideology of renewal and the elements of ‘us’ versus ‘them’ in his campaign speeches. Julius Malema, on the other hand, being a young leader, sells the ideologies of economic liberation, ‘us’ versus ‘them’ and ‘young’ versus ‘old’, depicting that only the youth can lead South Africa to the promised land. The study submits that political discourse is laden with specific ideologies which are intended to convince the voters to vote for them. It is therefore important that the public be well informed so that they can rationally uncover and identify these  ideologies and either accept or reject them. Keywords: discursive, ideology, campaign, South African presidential election

IMPROVING STUDENTS’ ACADEMIC ACHIEVEMENT AND INTEREST IN GEOMETRY THROUGH AUDIO-VISUAL RESOURCES AS INSTRUCTIONAL STRATEGY

This study examined the effect of audio-visual resources as instructional strategy for improving students’ academic achievement in geometry. The design of the study is a quasi-experimental non-equivalent group design. A sample of 123 senior secondary schools II students was drawn from two Model schools in Edo State, Nigeria. Two research questions and three hypotheses tested at .05 level of significance, guided the study. The instruments used for data collection was Geometry Achievement Test (GAT) and Geometry Students’ Interest Inventory Scale (GSIIS). Audio-visual resources instructional approach and conventional lesson plans were developed by the researcher. The instruments were subjected to face and content validation by five experts. The reliability coefficient of GAT was found to be .75 using Kudder Richardson 21 K(R-21) formulae, while GSIIS had a reliability index of .90 obtained using Cronbach alpha method. Mean was used to answer research question while ANCOVA was employed to test the hypotheses. Results from the study showed among others that the utilization of audio-visual resources as an instructional strategy in technical colleges had positive impact on students’ achievement and interest in geometry. It was recommended among others that technical drawing teachers should employ audio-visual instructional strategy in teaching technical drawing especially in geometry as it enhances students’ academic achievement and interest.  Article visualizations

Awareness of childhood pneumonia in Benin City, Nigeria

Background: Mortality from pneumonia can be prevented by prompt recognition of symptoms of pneumonia by caregivers at home and appropriate seeking for medical care in a health facility. Active participation in pneumonia control by caregivers is dependent on the extent to which the members of the community are aware of  features of pneumonia and recognising that the child needs medical attention.Objective: To document the knowledge of community members about pneumonia using traders (market women and men in a popular market in Benin City, Nigeria).Design: A descriptive cross-sectional study.Setting: Edaiken market, Benin City, Nigeria.Subjects: All traders, women and men in Edaiken market Benin City Nigeria.Results: Of the 1374 respondents, 1220(88.8%) about pneumonia. Of these 1220, 57.9% correctly identified that pneumonia affects the lungs and exposure to breeze was the risk factor of pneumonia (86.7% of respondents). Knowledge score for  pneumonia was generally low with most respondents 1140(93.5%) scoring < 10 (Poor); and 79(6.5%) had scores 10 – 14 (Fair). Only one person (0.1%) had a score ≥ 15 (Good knowledge). Married individuals were five times more likely to have fair knowledge of pneumonia when compared to the unmarried individuals (OR = 5.0, p = 0.01). Also statistical significant proportion of respondents with presence of an under-five year old in the household had fair knowledge of childhood pneumonia when compared with household with no child younger than five years (p = 0.00).Conclusion: General knowledge of the traders in Benin City about childhood pneumonia was poor. There is need for improved public awareness on childhood pneumonia in this community

Traders’ Perception of Cooking Smoke as a Risk Factor for Childhood Pneumonia

Background: Childhood pneumonia is the foremost killer of under-fives. Indoor air pollution by smoke from cooking fuel is a major risk factor for childhood pneumonia. The knowledge of caregivers about risk factors can facilitate the practice of appropriate preventive measures. This study set out to evaluate the perception of traders about cooking smoke as a risk factor for childhood pneumonia.Methodology: A researcher administered, questionnaire based, cross-sectional study was carried out at a major market in Benin City prior to a market rally to celebrate World Pneumonia Day 2014. The respondents were traders. Information on biodata, place of cooking, fuel for cooking and presence of under-fives in the cooking area of homes of respondents was sought.Results: There were 1374 respondents of which 1192(88.5%) were females. Only 67(4.9%) respondents considered smoke from cooking fuel a risk factor for pneumonia while 99(7.2%) considered avoidance of smoke as a method for preventing pneumonia. Firewood (biomass fuel) was utilized by 272(19.8%) respondents. Respondents with no education were significantly more likely to use firewood (p<0.000). All respondents with under-fives reported having them in the cooking area. Having a child who had suffered pneumonia in the past was not significantly associated with knowing that smoke was a risk factor for childhood pneumonia p>0.05.Conclusion: There is poor awareness of smoke as a risk factor for childhood pneumonia while the use of unclean fuel is significant. As part of health education on childhood pneumonia, smoke as a risk factor should be emphasized. Government should make cleaner fuels more available, accessible and affordable.Keywords: Traders, Cooking Smoke, Ris

Effect of training on knowledge about cervical cancer and Human Papiloma Virus vaccine among health care personnel in Benin City

Background: Although the HPV vaccine is available for a fee in Nigeria it is not yet in the National Programme on Immunization (NPI) which is free. Health care workers can play an important role in improving uptake of the vaccine and in advocating for its inclusion in the NPI. However, this role may be limited by lack of knowledge. This study assessed the effect of training on health care workers’ knowledge of HPV, its relationship with cervical cancer and the role of HPV vaccine in prevention.Methods: This quasi-experimental study examined the responses to pre and post test evaluation of the knowledge and practice of health care workers from Benin City with regards to HPV, cervical cancer and HPV vaccines at a workshop organized to create awareness on the subject matter.Results: Of the 53 health care workers at the training, 46 (85%) knew that HPV was the causative agent of cervical cancer while only 13 (28.9%) and 15 (32.6%) knew that it was associated with oral and vaginal cancer, respectively. Majority of participants had heard about the HPV vaccine but only 15 (30.6%) had encouraged its use and 7 (14.3%) had prescribed it. Post test result showed marked improvement in most areas evaluated.Conclusion: The less than satisfactory knowledge of health care workers about HPV and its relationship with anogenital cancers was markedly improved by training. Training of health care workers should be done to address the dearth of knowledge prior to the deployment of the vaccine nationally.Keywords: Knowledge; Healthcare workers; HPV; HPV vaccine; Cervical cancer