The use of hydroxycarbamide in children with sickle cell anemia

Background: Although hydroxycarbamide (hydroxyurea [HU]) has been in use for decades in both adults and child populations with sickle cell disease (SCD), its reported use has remained low in Africa and Nigeria where the largest number of SCD patients reside. Availability, cost, and concerns about safety and efficacy are some of the challenges to its use. Objectives: This study highlights the experience of using HU for children with sickle cell anemia in Ahmadu Bello University Teaching Hospital, Zaria.Materials and Methods: A descriptive, retrospective observational study of children is presented. Demographic, clinical, and laboratory features of children on HU, the indications for therapy and adverse clinical events encountered were analyzed. Results: A total of 165 children were treated with HU over a 4­year period, their ages ranging between 0.9 and 17 years. A total of 85 (47.5%) had HU for >12 months, while 61 (34.1%) were on treatment <11 months, while 19 (10.2%) were lost to follow­up. There was a significant increase in the weight, height, fetal hemoglobin, mean corpuscular volume, and a significant reduction in white cell counts; with no differences in the packed cell volume, hemoglobin concentration, creatinine, alanine transaminase, and bilirubin levels. Adverse events and/or comorbidities were reported in 48 (56.5%) patients, while one patient discontinued treatment because of skin rash.Conclusion: This study highlights the increased utilization of HU among children in an African region, the observed clinical events,and laboratory parameters. The benefits are demonstrable, and the drug­related organ toxicities appear minimal

Amulets, bands and other traditional applications seen among emergency and neonatal pediatric admissions in a tertiary centre, Nigeria

This study aims to investigate the types and indications of amulets, bands and traditional applications among pediatric emergencies and neonatal admissions into the Federal Medical Centre, Bida, Nigeria. This was a cross-sectional study conducted between January and July, 2008. Children admitted into the emergency and neonatal units of the institution with traditional applications were recruited. Information on demography, time the application was introduced, the reason, cost implication and belief about the efficacy were obtained using a semi-structured questionnaire. Socio-Economic Class was defined using the Oyedeji Classification. The study was based at Federal Medical Centre, Bida and consisted of 666 children admitted into the hospital via the Emergency pediatric and the Neonatal Unit, with a seven-month period prevalence of 11.4% [76 patients]. Of the 76 cases screened for the use traditional applications, only 64 [84.2%] were recruited, the remaining did not agree to participate in the study. The mean age was 493.1 +/- 528.5 days. The study group included 37 males and 27 females [sex ratio 1.4:1] aged 11 days to 2920 days. The applications used included neck band [54.7%], ankle band [15.6%] and head paste [15.6%]. Reasons for the applications included prevention of childhood illnesses [17.2%], sutures closure [15.6%], as well as warding off evil spirits and convulsions [12.5%]. The socio-economic classification was I [1.6%], II [7.8%], III [15.6%], IV [45.3%], and V [29.7%]. Sixty [93.0%] parents believed the applications cannot be used with conventional medicine, while 53.1% of the participants, obtained them free of charge. The use of traditional applications, often for preventive purposes, is common among pediatric patients, especially of low socio-economic classifications. The majority of users considered them incompatible with simultaneous conventional medical care. This has adverse implications for time to presentation for conventional care and treatment outcomes. Promotive and preventive healthcare interventions are needed to reverse this trend. Future broad-based research is warranted