Ability of mothers to assess the presence of fever in their children: Implication for the treatment of fever under the IMCI guidelines

Background : Fever is a common reason for seeking medical attention, with febrile illnesses accounting for 10% to 20% of pediatric visits to emergency departments. A history of fever or presence of fever by palpation or measured temperature is required on the Integrated Management of Childhood Illnesses (IMCI) algorithms as a reason for the assessment of fever, which will lead to specific classifications that are linked to treatment protocols. Therefore, the WHO and its partners assume that mothers are able to assess their children for the presence of fever. Objectives : To evaluate the ability of mothers to determine the presence of fever in their children by tactile examination of their children. Methods : We prospectively studied 126 mother-child pairs attending the pediatric outpatient clinic of Ahmadu Bello University Teaching Hospital (ABUTH) . Mothers of children 2 months to 5 years of age who mentioned fever as part of the presenting complaints were studied using a structured questionnaire regarding their children\u2032s illness, temperature status and their educational level. Results : A total of 126 mother-child pairs were studied, of which 44 (34.9%) of the mothers had had their education extended to secondary school level and only 15 (11.9%) had their education extended to a tertiary level. Fever was present in 82 (65.1%) of the children when their temperatures were determined by thermometer. The mothers correctly identified 79 (sensitivity of 96.3%) of the children who were truly febrile and 19 (specificity of 43.2%) of those who were truly nonfebrile. The predictive value of a positive test was 76.0%, and the predictive value of a negative test was 86.4%. Conclusion : The results showed that mothers in our environment, as has been observed in other parts of the world, are able to correctly assess the presence or absence of fever in their children.Arri\ue8re-plan: La fi\ue8vre est une raison commune pour la recherche d\u2019une att enti on m\ue9dicale, avec maladies f\ue9briles repr\ue9sentent 10-20 % des visites d\u2019urgence p\ue9diatrique d\ue9partements. Une histoire de la peste ou la pr\ue9sence de la peste par palpati on ou mesur\ue9e temp\ue9rature est n\ue9cessaire sur les algorithmes de PCIME comme moti f de l\u2019\ue9valuati on de la peste, ce qui conduira \ue0 des classi e cati ons sp\ue9ci e ques qui sont li\ue9es \ue0 protocoles de traitement. Par cons\ue9quent l\u2019OMS et ses partenaires supposent que les m\ue8res sont mesure d\u2019\ue2nes leurs enfants pour la pr\ue9sence de la peste. Objectifs: Pour \ue9valuer la capacit\ue9 des m\ue8res \ue0 d\ue9terminer la pr\ue9sence de la e \ue8vre dans leurs enfants, tacti les d\u2019un examen de leurs enfants. M\ue9thodes : Nous avons \ue9tudi\ue9 mani\ue8re prospecti ve 126 paires de m\ue8re-enfant parti cipant \ue0 la p\ue9diatrique des pati ent clinique de ABUTH. M\ue8res d\u2019enfants de 2 mois jusqu\u2019\ue0 5 les ann\ue9es qui menti onn\ue9 la e \ue8vre dans le cadre des pr\ue9sentati on plaintes ont \ue9t\ue9 \ue9tudi\ue9es. \ue0 l\u2019aide d\u2019un questi onnaire structur\ue9 concernant leur maladie des enfants, temp\ue9rature statut et leur niveau d\u2019\ue9ducati on. R\ue9sultats:126 m\ue8re-enfant paires ont \ue9t\ue9 \ue9tudi\ue9s de qui 44(34.9%) de la les m\ue8res avaient eu leur \ue9ducati on \ue9tendue au niveau secondaire et seulement 15 (11,9 %) leur \ue9ducati on avait \ue9tendu \ue0 un niveau terti aire. La peste \ue9tait pr\ue9sente dans 82 (65,1 %) des enfants lorsque les temp\ue9ratures ont \ue9t\ue9 d\ue9termin\ue9s par thermom\ue8tre. Les m\ue8res correctement identif\ue9 79 (sensibilit\ue9 de 96.3 %) de la les enfants qui ont \ue9t\ue9 vraiment f\ue9briles et 19 (sp\ue9cificit\ue9 du 43,2 %) de ceux qui ont \ue9t\ue9 v\ue9ritablement non-f\ue9brile. La valeur pr\ue9dicti ve d\u2019un test positi f a \ue9t\ue9 76.0 % et le valeur pr\ue9dicti ve d\u2019un test n\ue9gati f a \ue9t\ue9 86,4 %. Conclusion: Les r\ue9sultats ont montr\ue9 que m\ue8res dans notre environnement, comme cela a \ue9t\ue9 observ\ue9s dans d\u2019autres parties du monde, sont en mesure d\u2019\ue9valuer correctement la pr\ue9sence ou l\u2019absence de peste dans leurs enfants

Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI): an extension of the STROBE statement for neonatal infection research.

Neonatal infections are estimated to account for a quarter of the 2·8 million annual neonatal deaths, as well as approximately 3% of all disability-adjusted life-years. Despite this burden, few data are available on incidence, aetiology, and outcomes, particularly regarding impairment. We aimed to develop guidelines for improved scientific reporting of observational neonatal infection studies, to increase comparability and to strengthen research in this area. This checklist, Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE- NI), is an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. STROBE-NI was developed following systematic reviews of published literature (1996-2015), compilation of more than 130 potential reporting recommendations, and circulation of a survey to relevant professionals worldwide, eliciting responses from 147 professionals from 37 countries. An international consensus meeting of 18 participants (with expertise in infectious diseases, neonatology, microbiology, epidemiology, and statistics) identified priority recommendations for reporting, additional to the STROBE statement. Implementation of these STROBE-NI recommendations, and linked checklist, aims to improve scientific reporting of neonatal infection studies, increasing data utility and allowing meta-analyses and pathogen-specific burden estimates to inform global policy and new interventions, including maternal vaccines

Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Background: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. Methods: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. Results: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. Conclusion: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Ability of mothers to assess the presence of fever in their children: Implication for the treatment of fever under the IMCI guidelines

Background : Fever is a common reason for seeking medical attention, with febrile illnesses accounting for 10% to 20% of pediatric visits to emergency departments. A history of fever or presence of fever by palpation or measured temperature is required on the Integrated Management of Childhood Illnesses (IMCI) algorithms as a reason for the assessment of fever, which will lead to specific classifications that are linked to treatment protocols. Therefore, the WHO and its partners assume that mothers are able to assess their children for the presence of fever. Objectives : To evaluate the ability of mothers to determine the presence of fever in their children by tactile examination of their children. Methods : We prospectively studied 126 mother-child pairs attending the pediatric outpatient clinic of Ahmadu Bello University Teaching Hospital (ABUTH) . Mothers of children 2 months to 5 years of age who mentioned fever as part of the presenting complaints were studied using a structured questionnaire regarding their children's illness, temperature status and their educational level. Results : A total of 126 mother-child pairs were studied, of which 44 (34.9%) of the mothers had had their education extended to secondary school level and only 15 (11.9%) had their education extended to a tertiary level. Fever was present in 82 (65.1%) of the children when their temperatures were determined by thermometer. The mothers correctly identified 79 (sensitivity of 96.3%) of the children who were truly febrile and 19 (specificity of 43.2%) of those who were truly nonfebrile. The predictive value of a positive test was 76.0%, and the predictive value of a negative test was 86.4%. Conclusion : The results showed that mothers in our environment, as has been observed in other parts of the world, are able to correctly assess the presence or absence of fever in their children

Images in Clinical Practice: Bilateral neonatal breast enlargement associated with mastitis

No Abstract Available Annals of African Medicine Vol.3(1 ) 2004: 4

Hyperactivity and inattention- A successful response to table coffee

No Abstracts.Nigerian Journal of Clinical Practice Vol.10(2) 2007: pp.182-18

Secondary causes of attention deficit and hyperactivity in Nigerian children: the Zaria experience

Hyperactivity, impulsiveness and inattention beyond the norm for a child's age are essential for the diagnosis of Attention Deficit and Hyperactivity Disorder (ADHD) in children. Although much is known about this disorder the cause of ADHD remains unknown. In this report, we have described 4 children with features of inattention and hyperactivity/impulsivity following cerebral infections. In all 4 children, they had a history of illness characterized by fever and convulsion, suggestive of meningitis or encephalitis from which they seem to have recovered. Whatever may be the significance of preceding cerebral infections in the aetiopathogenesis of ADHD will need to be evaluated, particularly in tropical countries, where infections and infestations, including meningitis, are still common. Sahel Medical Journal Vol. 9(1) 2006: 26-2

Conditions associated with risk of death within 24hrs of admission in children

Background: While infant and childhood mortality rates have remained high in underdeveloped countries, an important aspect of this mortality is the rate of death within 24 hours of admission to a Hospital. Method: We retrospectively reviewed the records of 202 children who died over a 20-month period. Results: Eighty one (40.1%) of these children died within 24 hours of admission, with 30/81 (37.0%) of them receiving no drug treatment up to the time their death. A history of convulsion, the presence of severe anaemia, heart failure and impaired conscious level at admission were significantly associated with the risk of dying within 24 hours of admission to the hospital. Conclusion: Delay in commencement of treatment, most likely caused by inability of parents or relatives to make available drugs for commencement of therapy is a major contributory factor for early death in our Hospital. Key Words: Risk of death, admission, children, delay Annals of African Medicine Vol.3(3) 2004: 134-13