Predicting Urinary Tract Infection in Malaria Co-Morbidity among Under Fives

Fever presenting in children less than 5 years of age in malaria endemic areas will almost always be treated as cases of malaria. However fever is a common feature to other childhood illnesses including ARI and UTI. Besides; malaria is known to co-exist with these other morbidities including UTI. Undiagnosed and poorly treated UTI can lead to immediate and long term sequelae. Reliance on clinical features for the identification of presence of the co-morbidity could be quite tasking in the absence of discriminatory features. This work was meant to evaluate children less than 5 years of age presenting with fever (without localising signs) for discriminatory features (if any) for malaria; UTI co-morbidity. This was a prospective and cross sectional study carried out between June and August 2006. The study involved well nourished under fives with parasitologically proven malaria seen at the Children's Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH) Benin City. The presence of UTI was evaluated in this cohort using urinalyses; microscopy and culture. Of the 300 children evaluated; 27(9) had UTI-malaria co-morbidity. There was paucity of known symptoms or signs of UTI in those with the co-morbidity. The clinical features of abdominal pain; vomiting; irritability; showed very low sensitivity while the same features had high negative predictive values with respect to the presence of the co-morbidity (67.40). Tachycardia and tachypnoea also had very low sensitivity with regard to detecting the child with the co-morbidity. However; the features occurred significantly more in children without the co-morbidity. In conclusion; malaria-UTI co-morbidity occur frequently (in 1 out of every 10 children under 5 years of age with presumed sole diagnosis of malaria) to warrant the evaluation of such children; if the long term sequelae of undiagnosed and poorly treated UTI are to be minimized

Socio-demographic determinants and impact on academic performance of attention deficit/hyperactivity disorder in school children in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) affects children worldwide. In Nigeria, there is paucity of information on the socio-demographic associates of this important childhood condition. Methods: Across-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6 to 12 years, selected randomly among pupils drawn from Egor Local Government Area of Edo State. The subjects were screened using Disruptive Behaviour Disorder (DBD) Rating Scale to identify children with ADHD symptoms. Identified subjects were further evaluated with questionnaires to ensure that they met the other explicit non-symptom criteria contained in the DSM-IV manual, such as functional impairments. Children who were confirmed to have ADHD were compared with randomly selected controls to determine the association, if any, between the prevalence of the condition and some sociodemographic characteristics. Results: The prevalence of ADHD was 7.6%. There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. No significant association was found between the prevalence of ADHD and socioeconomic background, size of family, age of parents and characteristics of the child's primary caregiver. The children with ADHD had significantly lower school aggregate than that of selected control (Mean aggregate score of 51.7+16.1% versus 63.7+ 16.5%,p<0.001). Conclusion: The prevalence of ADHD in this study is relatively high. Community screening under the umbrella of the School Health Programme is required. Appropriate medications, educational support and psychotherapy when incorporated in the national health system will go a long way in redirecting affected children's developmental lives