Attention deficit hyperactivity disorder in Ilorin: screening with the conner's teachers' rating scale

Background: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) or its risk in North Central Nigeria has not been adequately reported. The consequences of missing the disorder and its co-morbidities are usually costly to the society. Method: Using a multi-stage sampling technique, nine primary schools from where a total of 1,480 pupils were selected across the three local government areas within Ilorin metropolis (two public and one private school from each LGA) we selected. An ADHD assessment tool - the short version of Conner's Teacher Rating Scale was administered on the pupils through their respective class teachers after training the teachers on how to administer the tool. They were classified into Inattention ADHD and Hyperactive/impulsive ADHD. Results: Of the 1480 (741 males and 739 female) pupils recruited, public schools contributed 1033 (69.8%) pupils while 447(30.2%) were from the private schools. A prevalence of 15.8% was found for ADHD risk. Statistically significant differences were present in the male to the female distribution of the Inattention ADHD, Hyperactivity ADHD (each with p< 0.05) but not in the overall ADHD index(p> 0.05). The ADHD Index was higher in the public schools. Conclusion: Prevalence of primary pupils aged 6-12 years in Ilorin at risk of ADHD is 15.8%, no significant gender variation was found. It is hereby recommended that Pre-primary school entry screening for ADHD should be instituted considered to enhance early recognition and prompt intervention so as to save the country from bad childhood that develops into bad adulthood with its myriads of anti-social and behavioural consequences

Intelligence quotient of neurologically impaired children attending neurology clinic in a nigerian tertiary institution

Background: The need to identify the intellectual capability of neurologically impaired children dictates their educability which can be estimated through their intelligence quotient (IQ). Draw-a-man test for IQ estimation is available, easy and has been validated in Nigeria. Method: Through a prospective, cross-sectional study that lasted 12 months (January-December, 2011), children aged 4 years and above attending neurology clinic were recruited once they have no severe motor or sensory limitations affecting their upper limbs and can obey the instruction to draw a person. Anthropometry was carried out on them and they were comfortably seated to draw a person. The parents or caregivers were instructed not to make any suggestion or hint to them and no time limit was given. Their drawings were assessed using the 52 parameters of Ziler and interpreted accordingly. Ethical procedures were adhered to. The analysis was done using SPSS version 16 and an interactive calculation tool for chi-square tests of goodness of fit and independence. Results: Seventy-five (45 male, 30 female) children met the inclusion criteria. Their clinical conditions were Epilepsy 48 (64%), Cerebral Palsy 6 (8%), ADHD 5 (6.7%), Down Syndrome 4 (5.3%), Speech/Hearing impairment 3 (4.0%), Hypothyroidism 2 (2.7%) and 7 (9.3%) others. Their ages ranged from 4 years to 16 years (mean±SD = 9.7± 3.8 years). Their IQ distribution were Normal 4 (5.3%), Borderline 12 (16.0%), Mild Mental Retardation 16 (21.3%), Moderate Mental Retardation 19 (25.3%), Severe and Profound Mental Retardation 24 (32.0%) with no significant difference in relation to their birth order. Conclusions: Ninety-six per cent of the study population had IQ below normal. Epilepsy was the commonest condition seen in the Paediatric Neurology clinic and all categories of IQ are seen among children with epilepsy

Mortality pattern within twenty-four hours of emergency paediatric admission in a resource-poor nation health facility

BACKGROUND: Mortality among emergency paediatric admissions within the first 24 hours is high in resource- poor nations. Measures to reduce the childhood mortality rate can only be effectively planned and implemented when the causes and magnitude of this problem are well defined. OBJECTIVE: To determine the mortality pattern among emergency paediatric admissions within the first 24 hours in a health facility in Nigeria. METHODS: The clinical state and progress of post-neonatal patients who presented alive and were admitted into the emergency paediatric room of the University of Ilorin Teaching Hospital; Ilorin; Nigeria were monitored over a period of six months. The monitoring included records of diagnosis and outcome of management. RESULTS: A total of 606 children were admitted during the period of study out of which 51(8.4) died. Twenty-nine (57) of the deaths occurred within the first 24 hours of admission comprising 15 (51.7) males and 14 (48.3) females giving M:F ratio of about of 1:1. Majority of the deaths were among patients who reported late to the hospital. Loss of consciousness was a strong risk factor for mortality within 24 hours of admission. The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as malaria and protein-energy malnutrition for which sustained intervention strategies must be developed

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia.

BACKGROUND AND OBJECTIVES: Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity. MATERIALS AND METHODS: Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02. RESULTS: There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes. CONCLUSION: Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

Treatment of diarrhoea by proprietary-medicine vendors

Treatment of diarrhoea by 75 patent and proprietary medicine-store vendors in Ilorin; was investigated; using a questionnaire. The study revealed that 66.7 percent of those selling the medicines at the stores; were employees and of these; 30 percent were primary school children. Questions were seldom asked by the storekeepers; or the employees about the diarrhoea; nor was the child with diarrhoea asked to be seen for evidence of dehydration. Knowledge about the efficacy of oral rehydration therapy was totally lacking among the respondents in the stores