ABSTRACT
Aims: This study compares the performance of routine malaria diagnostic tests, and explores the challenges of malaria diagnosis in paediatric patients in an endemic setting in South West Nigeria. Study Design: Cross sectional study Place and Duration of the Study: The study was conducted at the children’s outpatient and emergency units of the University College Hospital, Ibadan, Nigeria. Patients seen between May and August, 2013 were enrolled in the study. Methodology: The records of all 532 children aged six months to12 years who received treatment for an acute febrile illness at the hospital during the study period were reviewed. The proportion of children classified as having malaria by clinical diagnosis, Rapid Diagnostic Test (RDT) and blood smear microscopy were compared. Factors associated with test positivity were explored using multivariate analysis. Results: By clinical diagnosis 45.2% of children were diagnosed as having malaria, 37.6% tested positive to malaria parasite on RDT and 19.3% had positive blood smears on microscopy. Logistic regression showed that with RDTs, younger children were less often found to be positive than older children [OR: 0.594 (0.401-0.879)]. A similar lower probability of positivity was found for younger children on microscopy [OR0.624 (0.391-0.996)]. Positive smears were however recorded 3.9 times more often for those who gave a history of fever compared to those who did not [OR: 3.882 (1.154- 13.057)]. Conclusion: The true malaria morbidity among these paediatric patients remains questionable due to the differences in the results produced by the different diagnostic methods. The clinical implication of RDT-positive but microscopy-negative samples may be grave if microscopy results are erroneous. Quality control systems and surveillance of routine malaria diagnostics are imperative to limit misdiagnosis of malaria in this endemic setting.
ABSTRACT
Background: Until recently; most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis. Objective: This study aims at defining the burden of paediatric endocrine disorders in Ibadan. Subjects/Methods: A review of records of children who presented at University College Hospital; Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out. Results: During the eight-year period; a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50) males and 37(39.4) females; and in 10(10.6) of them; had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35) patients were malnourished with weight less than 80 of the expected weight for age and only 9 were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4 of patients; Diabetes mellitus was diagnosed in 12.8; adrenal disoders in 10.6; pubertal disorders in 5.3 and growth disorders in 4.3 of the patients. Thyroid disorders were present in 6.4; obesity in 3.2 while the least common disorder was Diabetes insipidus (1). About 58 of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6 of these patients were lost to follow up; during the period. Conclusions: Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition
Subject(s)
Endocrine System Diseases , Endocrine System Diseases/diagnosis , Hospitals , Pediatrics , UniversitiesABSTRACT
Pulse oximetry is a non-invasive method of measuring oxygen saturation in clinical settings. This study was carried out to determine the level of knowledge and competencies relating to pulse oximetry and the ability to interpret the information.We conducted a nationwide, multi-centre, and questionnaire-based online survey between January and June 2010. A 32-item questionnaire relating to the use of pulse oximetry in children was answered by 224 in-training and 157 qualified paediatricians (median duration of practice 6 years) working in 24 states in Nigeria. Knowledge of pulse oximetry was evaluated on a scale of 0100%. Data were analysed using Chisquare and t-test statistics at 5% level of significance.The overall mean test score was 36.6±20.8% (range076.5%). The mean knowledge score among intraining and qualified paediatricians was 35.4±19.1%and38.3±23.1%,respectively(p>0.05). Only 16.3% of the respondents answered all three questions correctly relating to the relationship between oxygen saturationand partial pressure of oxygen. Pertaining to the accuracy of pulse oximeters, 3.9% of the respondents answered all 14 questions correctly. On indications for use of pulse oximetry, 29% correctly answered all nine questions. Only 18% of respondents correctly answered the seven questions on interpretation of pulse oximeter reading. Some 73% of respondents believed that training in the use of pulse oximetry was inadequate.A significant proportion of the paediatricians were untrained in pulse oximetry, lacked knowledge of basic principles, and made serious errors in interpretation of readings from pulse oximeters. We suggest that medical schools and residency training programmes place more emphasis on teaching the principles and uses of pulse oximetry