Pulmonary functions of children with sickle cell anaemia in steady state in Lagos, Nigeria

Background: are responsible for considerable morbidity and mortality in children with sickle cell anaemia (SCA). Spirometry is a useful tool for the detection and monitoring of respiratory disorders, but it is under-utilized by healthcare workers who care for children with sickle cell anaemia. Most of the studies assessing pulmonary functions in sickle cell anaemia were conducted among adults.Objective: To describe the lung functions profile of children with sickle cell anaemia in steady state.Methodology: In this study, spirometric indices of 100 children with SCA (HbSS) aged five years to 12 years were compared with 100 matched normal children (HbAA) in the control group.Results: Irrespective of gender, the mean Peak Expiratory Flow Rate (PEFR) values were significantly higher among the HbAA controls than their HbSS counterparts. The mean Forced Expiratory Volume in one second (FEV1) values of males and all subjects irrespective of gender were also significantly higher among the controls compared to HbSS subjects. The mean Forced Vital Capacity (FVC) values were higher among HbSS subjects than the HbAA controls, but the observed differences were not significant. The mean FEV1/FVC values were also not significantly different between the SCA subjects and the controls. The overall prevalence of restrictive pulmonary abnormalities among the HbSS group was 6.0% whereas none of the HbAA group had restrictive pulmonary disorders.Conclusion: Children with SCA, irrespective of gender, have significantly lower PEFR and FEV1. Restrictive lung abnormalities occur exclusively among subjects with SCA

Incidence and cost estimate of treating pediatric adverse drug reactions in Lagos, Nigeria / Incidência e estimativa de custo do tratamento de reações adversas a drogas de uso pediátrico em Lagos, Nigéria

CONTEXT AND OBJECTIVES: Adverse drug reactions (ADRs) may cause prolonged hospital admissions with high treatment costs. The burden of ADRs in children has never been evaluated in Nigeria. The incidence of pediatric ADRs and the estimated cost of treatment over an 18-month period were determined in this study. DESIGN AND SETTING: Prospective observational study on children admitted to the pediatric wards of the Lagos State University Teaching Hospital (LASUTH) in Nigeria, between July 2006 and December 2007. METHODS: Each patient was assessed for ADRs throughout admission. Medical and non-medical costs to the hospital and patient were estimated for each ADR by reviewing the medical and pharmacy bills, medical charts and diagnostic request forms and by interviewing the parents. Cost estimates were performed in 2007 naira (Nigeria currency) from the perspectives of the hospital (government), service users (patients) and society (bearers of the total costs attributable to treating ADRs). The total estimated cost was expressed in 2007 United States dollars (USD). RESULTS: Two thousand and four children were admitted during the study; 12 (0.6 percent) were admitted because of ADRs and 23 (1.2 percent) developed ADR(s) during admission. Forty ADRs were suspected in these 35 patients and involved 53 medicines. Antibiotics (50 percent) were the most suspected medicines. Approximately 1.83 million naira (USD 15,466.60) was expended to manage all the patients admitted due to ADRs. CONCLUSIONS: Treating pediatric ADRs was very expensive. Pediatric drug use policies in Nigeria need to be reviewed so as to discourage self-medication, polypharmacy prescription and sales of prescription medicines without prescription.

CONTEXTO E OBJETIVOS: Reações adversas a drogas (RAD) podem causar hospitalização prolongada com alto custo de tratamento. Este efeito das RAD em crianças nunca foi avaliado na Nigéria. A incidência de RAD em pediatria e o custo estimado de tratamento em um período de 18 meses foram determinadas neste estudo. DESENHO E LOCAL: Estudo prospectivo observacional de crianças admitidas nas unidades pediátricas do Hospital Universitário do Estado de Lagos (LASUTH) na Nigéria, entre julho de 2006 e dezembro de 2007. MÉTODOS: Cada paciente foi avaliado para RAD durante a admissão. Os custos médicos e não médicos para o hospital e para o paciente foram estimados para cada RAD pela revisão das contas médicas e da farmácia, pelos registros médicos, pelos exames necessários para diagnóstico e pelas entrevistas com os pais. Os custos foram estimados em nairas (moeda nigeriana) de 2007 a partir das perspectivas do hospital (governo), dos usuários de serviços (pacientes) e da sociedade (portadores dos custos totais atribuídos ao tratamento de RAD). A estimativa de custo total foi apresentada em dólares americanos (US) de 2007. RESULTADOS: Duas mil e quatro crianças foram admitidas durante este estudo; 12 (0,6 por cento) foram admitidas devido a RAD e 23 (1.2 por cento) desenvolveram RAD durante admissão. Quarenta RAD foram suspeitadas nesses 35 pacientes e envolveram 53 medicamentos. Antibióticos (50 por cento) foram as drogas mais suspeitas. Aproximadamente 1.83 milhões de nairas (US 15,466.60) foram gastos para cuidar de todos os pacientes admitidos por RAD. CONCLUSÕES: O tratamento das RAD pediátricas foi bastante caro. As políticas de uso de drogas em pediatria na Nigéria devem ser revistas para desencorajar a auto-medicação, a prescrição de polifarmácia e a venda de medicamentos de prescrição sem prescrição.