Folate levels in children with sickle cell anaemia on folic acid supplementation in steady state and crises at a tertiary hospital in Enugu, Nigeria: a prospective, comparative study

IntroductionFolic acid supplementation is an integral aspect of the management of children with sickle cell anaemia (SCA) especially in Africa. In spite of this, there have been concerns about lower folate levels, especially during crisis. AimTo determine red cell folate levels of children with sickle cell anaemia in steady state and during crisis and compare with those with haemoglobin AA genotype. MethodThis study was prospective, hospital based, and comparative. Fifty children with sickle cell anaemia were recruited during crises and followed up until they met the criteria for attaining steady state. The controls were fifty children matched with those with SCA for age and gender and had haemoglobin AA genotype. Red cell folate estimation was done with the Electrochemiluminescence Immunoassay (ECLIA) method using the automated Roche Cobas e411 equipment. ResultsThe median (IQR) red cell folate level in children during sickle cell crisis was 265.95 (134.50) ng/ml, which was significantly lower than the median (IQR) of 376.30 (206.85) ng/ml obtained during steady state. Most children with SCA (41 out of 50) had significantly higher folate levels during steady state (T=1081, Z-score= -4.660, p < 0.001). Median level of red cell folate was lower during anaemic crisis compared to vaso-occlusive crisis, though not significantly so (N(50), U = 214.00, Z-score= -1.077, p = 0.305). The median red cell folate level of normal controls was 343.55 (92.90) ng/ml, which was significantly lower than the 376.30 (206.85) ng/ml obtained during steady state (N(50), U= 209.00, Z-score= -7.177, p <0.001). Conclusion Median red cell folate levels of the study participants were within normal limits, though most children with SCA had significantly higher levels during steady state compared to crisis. Normal controls had significantly lower red cell folate levels than the children with SCA during steady state

Observed Causes of Severe Respiratory Distress among Children with Congenital Heart Disease

Background: Severe respiratory distress is a clinical feature commonly observed among children with congenital heart disease (CHD), butthe underlying cause is often misdiagnosed. Objectives: This study is aimed at determining the common causes of severe respiratory distress observed among children with CHD. Methods: This study was a retrospective study on children who had severe respiratory distress with underlying CHD seen between June 2017 and June 2018, and were consecutively recruited from two teaching hospitals. Results: Forty‑seven children aged 2 months to 15 years were admitted for severe respiratory distress secondary to CHD at our center between June 2017 and June 2018. The most common CHD was isolated ventricular septal defect (VSD), which made up 36.2%, followed by tetralogy of Fallot with 23.4%. Identifiable causes of respiratory distress in these children were restrictive airway disease (36.2%) as the most common cause, followed by pulmonary edema from congestive cardiac failure (27.7%). Among children with heart failure, 57.1%, 47.4%, 0%, and 50% of infants, children aged 1–5, 6–10, and above 10 years, respectively, were affected. Conclusion: Restrictive airway disease was noted as the most common cause of severe respiratory distress among children with CHD. Keywords: Children, congenital heart disease, restrictive airway disease, severe respiratory distres

Bio-electric impedance analysis of body composition and glycaemic control in children and adolescents with type 1 diabetes in south-east, Nigeria

Background: Metabolic derangements in diabetes grossly affect components of body composition particularly the fat mass. Adequate glycaemic control is key to the reduction of risks of associated complications.Objectives: To determine the pattern of glycaemic control and body composition in children and adolescents with type 1 diabetes mellitus (T1DM).Methodology: This was a cross sectional descriptive study conducted in three centres in South-East Nigeria. Subjects were T1DM patients attending diabetic clinics at the hospitals who were consecutively recruited while controls were normal school children.Body composition was determined using bio-electrical impedance analysis method. Data was collected using a semi -structured proforma designed for the study and was subsequently analysed using SPSS version 22.0. The level of statistical significance was set at p< 0.05.Results: A total of 108 children and adolescents comprising 54 diabetic patients and 54 controls (age and sex matched) were studied. The mean age of the subjects was 16.3 ± 3.5 years.Majority of the patients had high HbA1c, with a mean and range values of 11.3 ± 2.4 and 7.0 – 13.0%, respectively. The body composition parameters among subjects including the body mass index, skeletal muscle percentage, visceral fat percentage and resting metabolic rate were lower than that of the controls.Conclusion: A majority of the subjects had poor glycaemic control with overall lower measured body composition parameters. There is need to improve glycaemic control and maintain normal body composition in children and adolescents with T1DM in order to minimize the risks of diabetic complications in them.Keywords: Body composition; Glycaemic control; Children; Adolescent

Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria

Abstract Background There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria. Objectives This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis. Methods This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study. Results A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1–0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1–6–6.8). Conclusion Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them

Effects of the coronavirus pandemic among adolescents and young people living in South-East Nigeria

Background: Information on the effects of the coronavirus pandemic on adolescents and young people, who are in a critical phase of transition to adulthood is sparse. We evaluated the effects of coronavirus disease (COVID-19) among adolescents and young people living in Southeast Nigeria.Objective: To evaluate the effects of the coronavirus pandemic on young people in NigeriaMethods: A cross-sectional (online and onsite) study of 328 Nigerian youths was conducted, and data on sociodemographic profile and effects of the pandemic collected through pre-tested self-administered questionnaires, were analysed using STATA 16.0, with the significance level for tests of association set at p<0.05.Results: The mean age of participants was 16.8±3.3 years. Two hundred and eleven participants (64.3%) experienced a fear of death significantly associated with a low monthly income (p<0.001), 62/328(18.9%) respondents had experienced intra-familial sexual abuse, significantly associated with age group (p=0.003). Positive effects reported by 190/328(57.9%) participants included learning new things (88/190 =46.3%), spending time with loved ones (39/190 =20.5%), spending time on studies (29/190 =15.3%, p=0.015), significantly associated with age group; and time for rest and self-discovery (34/190 =17.9%, p=0.038) significantly influenced by age group.Conclusions: A significant number of participants had a fear of death and intra-familial sexual abuse which was strongly associated with monetary poverty, and age; while some participants positively engaged in self-discovery, rest and studies. Thus, the mental health and social welfare of youths should be focused on, and positive skills enhanced during this pandemic and afterward