Correlation of non-biological factors with anthropometric and haemoglobin measurements of children under 10 years old in southeast, Nigeria: Community-based study

Background: Childhood malnutrition also has non-biological determinants and little is known about it. Objective: To determine the differences in children’s height, weight and haemoglobin concentration across different sociodemographic characteristics. Design: The study was a community-based study. The weight and height of the children were measured. The Z-scores were calculated. Blood was taken for haemoglobin estimation. Regression analysis was done to determine correlates. Results: More rural children (32%) have stunting and the difference was statistically significant (p=0.003). There was no difference in the prevalence of underweight among under urban (32.4%) and rural (33.4%) children. Children from the rural areas were more likely to be moderate-severely anaemic (19.7%) and the difference was statistically significant (p = 0.003). Household size significantly relates to underweight and childhood anaemia (p = 0.002 and p = 0.036 respectively). Mother’s education were significantly related to tunting and childhood anaemia (p = 0.010 andp = 0.001 respectively). Childhood anaemia was significantly related to mother’s education (p = 0.001) and household (p = 0.036). Conclusions: Maternal age and education, household size and place of resident of a child affect children nutritional status. Improved education, and family planning can contribute to the reduction in the burden of malnutrition

Malaria diagnosis and treatment amongst health workers in University of Nigeria Teaching Hospital Enugu, Nigeria

Background: Confirmation of malaria and appropriate treatment are keys to malaria control.Objective: To determine the practice of malaria diagnosis and treatment in a Nigerian tertiary hospital.Materials and Methods: Retrospective review of patients’ records at the Children’s Clinic in UNTH.Results: Out of 6,684 children seen within the one year reviewed period, children diagnosed with malaria were 35.8 percent. Males were 60 percent and females were 40 percent. Children under five years were 72.6 percent of the total. Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs.Conclusion: The practice of presumptive treatment was high and few cases had a differential diagnosis. Training of health workers on the need to confirm malaria cases is required.Key words: Children, diagnosis, malaria, Nigeria, treatmen

Acceptance of malaria vaccine by a rural community in Nigeria

Background: Introduction of malaria vaccine is imminent. This study evaluated the prevalence of malaria among a non-febrile population and their willingness to accept a malaria vaccine.Methods: This was a cross-sectional, community-based study done in a rural community in south east Nigeria. A total of 156 household heads were interviewed using a structured questionnaire. The questionnaire was pre-tested before commencement of the study to correct ambiguity.Results: Majority (78.2%) acknowledged that malaria is the commonest illness in the community, while 55.1% believed that presumptive treatment is the best malaria preventive measure. Most (98.7%) of the study participants immunized their children against childhood vaccine preventable diseases, while 91.6% would be willing to accept a malaria vaccine. The prevalence of malaria parasitaemia among non-febrile respondents was 35.4% and the use of mosquito nets was 17.9%.Conclusion: The high prevalence of malaria among non-febrile populations, the practice of presumptive treatment of unconfirmed fever as malaria preventive measure and the low use of bed nets, points that it is time to introduce malaria vaccine. The high willingness to receive the vaccine is positive to the introduction of the vaccine.Keywords; Acceptance; Malaria, Vaccine, Nigeria

Audit of Blood Transfusion Practices in the Paediatric Medical Ward of a Tertiary Hospital in Southeast Nigeria

Objectives: To determine the indications, practices and outcomes of transfusion on children.Design: A descriptive retrospective study.Setting: Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria.Subjects: Children one month to 18 years that received blood transfusion.Main outcome measures: Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events.Results: The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The  indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia  (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were themain types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of . 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the  transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%).Conclusion: Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare

Management of childhood pain and healthcare providers’ willingness to use topical anaesthetic cream for minor procedural pain in Nigeria

Objective: To determine providers’ willingness to use (WTU) topical anaesthetic cream (TAC) to alleviate childhood pain. This information will be useful for successful implementation of TAC in Nigeria.Subjects and Methods: The study was undertaken in hospitals in southeast Nigeria. Intervieweradministered questionnaire was used to collect information: on the providers’ preferred waiting time and their WTU TAC. Likert scale was used to assess the providers’ level of uneasiness when performing painful procedures and their WTU the TAC. Multiple regression analyses were performed to measure the relationship of WTU with the different independent variables, after creating a binary option for some variables.Results: Providers surveyed were 232. Majority (94.8%) wanted the pain alleviated and 87.9% had made some attempts to alleviate the pain. Only one respondent (1%) knew about TAC, but none had used it before. Over 94% of the respondents were WTU TAC. The mean maximum preferred waiting time was 37.03 minutes. Many (68.8%) were concerned about the prolonged waiting time required and 19.8% and 12.5% with its availability and affordability respectively. In linear multivariate analyses, WTU was not statistically associated with designation, age, average weekly procedure and scale-rating of the childhood pain (p > 0.05).Conclusion: The WTU TAC was high, but the mean time willing to wait was lesser than mean recommended time of 45 minutes. If this latter limitation is circumvented, it may aid implementing the use of TAC in routine pediatric care.Keywords: Nigeria; Willingness to Use; Topical Anaesthetic Cream; Providers

Prevalence of depression among post-graduate medical trainees in selected institutions in eastern Nigeria: A multi-centre study

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Willingness to pay for rapid diagnostic tests for the diagnosis and treatment of malaria in southeast Nigeria: ex post and ex ante

<p>Abstract</p> <p>Background</p> <p>The introduction of rapid diagnostic tests (RDTs) has improved the diagnosis and treatment of malaria. However, any successful control of malaria will depend on socio-economic factors that influence its management in the community. Willingness to pay (WTP) is important because consumer responses to prices will influence utilization of services and revenues collected. Also the consumer's attitude can influence monetary valuation with respect to different conditions ex post and ex ante.</p> <p>Methods</p> <p>WTP for RDT for Malaria was assessed by the contingent valuation method using a bidding game approach in rural and urban communities in southeast Nigeria. The ex post WTP was assessed at the health centers on 618 patients immediately following diagnosis of malaria with RDT and the ex ante WTP was assessed by household interviews on 1020 householders with a prior history of malaria.</p> <p>Results</p> <p>For the ex ante WTP, 51% of the respondents in urban and 24.7% in rural areas were willing to pay for RDT. The mean WTP (235.49 naira) in urban is higher than WTP (182.05 Naira) in rural areas. For the ex post WTP, 89 and 90.7% of the respondents in urban and rural areas respectively were WTP. The mean WTP (372.30 naira) in urban is also higher than (296.28 naira) in rural areas. For the ex post scenario, the lower two Social Economic Status (SES) quartiles were more willing to pay and the mean WTP is higher than the higher two SES while in the ex ante scenario, the higher two SES quartiles were more WTP and with a higher WTP than the lower two SES quartile. Ex ante and ex post WTP were directly dependent on costs.</p> <p>Conclusion</p> <p>The ex post WTP is higher than the ex ante WTP and both are greater than the current cost of RDTs. Urban dwellers were more willing to pay than the rural dwellers. The mean WTP should be considered when designing suitable financial strategies for making RDTs available to communities.</p

Rural-Urban Differences in Maternal Responses to Childhood Fever in South East Nigeria

Childhood fevers due to malaria remain a major cause of morbidity and mortality among under-five children in Nigeria. The degree of vulnerability perceived by mothers will affect their perception of the severity and threat of their child's fever and the patterns of health care use. This study was undertaken to compare maternal responses to childhood fever in urban and rural areas of Enugu, south east Nigeria.Data was collected with pre-tested interviewer-administered questionnaires from 276 and 124 urban and rural households respectively. In each household, only one woman aged 15-49 years who had lived in each of the urban and rural communities for at least one year and had at least one child less than 5 years old was interviewed. Malaria was mentioned as the commonest cause of childhood fevers. Rural mothers were more likely to recognize danger signs and symptoms than urban mothers. Rural mothers use more of informal than formal health services, and there is more home management of the fever with urban than rural mothers. Chloroquine, ACT, SP and Paracetamol are the main drugs given at home for childhood fevers, but the rural mothers were more likely to use leftover drugs from previous treatment to treat the fevers than urban mothers. The urban respondents were also more likely to use a preventive measure. Urban mothers sought actions faster than rural mothers and the total cost of treatment was also higher in urban areas.Both urban and rural mothers are aware that malaria is the major cause of childhood fevers. Although rural mothers recognize childhood fever and danger signs better than urban mothers, the urban mothers' responses to fever seem to be better than that for rural mothers. These responses and differences may be important for geographical targeting by policy makers for malaria interventions

Unresolving Short Stature in a Possible Case of Mucopolysccharidosis

We present a metabolic disorder with main complaints of unresolving short stature following prolonged treatment for rickets. ES is a 4‑year‑old male who first presented to our hospital on self‑referral but had been seen previously at another tertiary health facility. The complaints were a swelling on the back and poor growth since 1 year of age with associated skeletal deformities: Chest wall, wrists, knees and ankle joints, which were progressive. Examination revealed a severely stunted child with a large head and caput quadratum, craniofacial disproportion, coarse facial features, saddle‑shaped nose, thick lips and bilateral corneal clouding/opacities. He had very poor language development for his age. His diagnoses based on clinical and radiological assessment was in keeping with Hurlers type of mucopolysaccharidoses. We highlight this case to emphasize the need for early consideration of other possible rare differential diagnoses in metabolic conditions in children.Keywords: Child, Metabolic, Mucopolysaccharidoses, Short statur