Acute Pain Management in Children with Sickle Cell Anaemia during Emergency Admission to a Teaching Hospital in Lagos; Nigeria

Background. Optimal pain management in children with sickle cell anaemia (SCA) begins with accurate and thorough pain assessment. However; little or no evidence of this practice exists among SCA patients in developing countries. Objectives. To evaluate pain management in children with SCA during emergency admission. Methods. Children with SCA who were =12 years old; on admission for a painful crisis and who were not using herbal remedies for pain relief; were prospectively studied at the Lagos University Teaching Hospital (LUTH) over a period of 1 year. A proforma data collection form was used to obtain information about the demographics of the patients and their parents; as well as pain score; and non-pharmacological and pharmacological treatments documented in the patients' case files. Pain was assessed for each patient using the Wong-Bakers Faces Pain Rating Scale. Results. The median age and weight of the patients were 4 years and 16 kg; respectively. Pain assessment by the physicians was documented in 10 (8.3%) patients. However; among those assessed for pain by the researchers; 90 (75%) had a moderate pain score of 5 - 8. Fluid therapy (n=110; 91.7%) and prayers (n=120; 100%) were the most common non-pharmacological therapies administered to the patients while admitted. Analgesics; either in combinations or as a single medicine; were administered to 100 (83.3%) patients. Paracetamol (n=90; 75%) and pentazocine (n=80; 66.7%) were the most frequently used analgesics. The dosage of the analgesics prescribed did not conform to the recommendations of the World Health Organization (WHO). Conclusion. The SCA children in this study were managed sub-optimally with analgesics. Pain management among this group of children did not fully conform to the guidelines of the WHO

Micturitional Dryness and Attitude of Parents Towards Enuresis in Children Attending Outpatient unit of a Tertiary Hospital in Abeokuta; Southwest Nigeria

Background: There is significant variability of the age at which children achieve dryness. Objectives: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. Method: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre; Abeokuta. Results: At age 36 months; 86 (51.8) and 34 (20.5) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p= 0.009). Twenty-four (26.7) children had nocturnal enuresis. Four (4.4) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem; a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). Conclusions: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore; health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class

Adverse Event Monitoring of Artemesinin Combination Therapy in Nigeria: the Challenges and Limitations of the Study

Artemesinin combination therapies (ACTs) are first line antimalarial drugs in malaria endemic regions of the world as recommended by the World Health Organization. ACTs are relatively new in Nigeria and there is little experience with their use. The pharmacovigilance of ACT drugs has been advocated in African countries so as to establish their safety in the African population. There is an on-going adverse event monitoring of the ACT drugs in Nigeria and a preliminary result has been published by the National Agency for Food and Drug Administration and Control. This commentary aims to discuss the challenges and limitations of the on-going pharmacovigilance of ACT drugs in Nigeria and proffer useful suggestions on how to overcome the problems