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Background: The paediatric age group has very peculiar anatomic and physiologic airways therefore, obstructionwhich commonly occurs in this population, can pose serious challenges in this age group.Aim: To study the pattern and aetiologyof acute upper airway obstruction in the paediatric age groupin University of Port Harcourt teaching hospital and to determine the place of tracheostomy in the management.Patients and Methods: It is a descriptive hospital based study of all paediatric patients; aged 0-15years with upper airway obstruction that presented to the ear, nose and throat department and the children emergency ward of university of Port Harcourt teaching hospital within the period of Original Research Article January 2014 to December 2019. Data on demographics, clinical presentations, causes and management were obtained using a Proforma. The diagnosis of upper airway obstruction is made in a child with any degree of respiratory difficulty with or without associated stridor or stertor arising from lesions above the thoracic inlet. Children with respiratory difficulty other than that from an upper airway obstruction were excluded from the study.Data obtained were analyzed with the IBM statistical package for social sciencesSPSS version 20. Results were presented in simple descriptive forms with tables.Results: One hundred and sixty paediatric patients with upper air way obstruction with age ranging from 0-15 years were studied. The prevalence of upper airway obstruction was 1.87%. There were more males than females; male to female ratio was 1.2:1. Age group 4-7 years were the most affected, 43.75%. Foreign body aspiration was the commonest cause. Majority of the patients had tracheostomy done, 48.75%. Mortality was n=1(0.625%).Conclusion: Upper air way obstruction among the paediatric age group is still common with foreign body aspiration as a very important cause in our setting. The very young are the most affected and tracheostomy appears to still be the main option of securing airway in these cases in our environment.
RESUMO
Background:Tuberculosis (TB) is a leading cause of death in children but it is underdiagnosed and underreported in children. Objective:To determine the prevalence of pulmonary TB in children among presumptive cases of TB and to compare the diagnostic efficacy of different screening tool for TB in children. Materials and Methods:This study was a descriptive prospective study carried out over one year in nine general health facilities that can provide diagnosis and treatment for tuberculosis in Rivers State, Nigeria. Children aged 0 –18 years with presumptive TB were explored. They were explored by carrying out a clinical assessment with chest radiograph, sputum or gastric aspirate for AFB microscopy and XpertMTB/RIF screening. Sociodemographic data and results of the screening tests was retrieved from their case records as well as the National Tuberculosis registers. Ethical approval for the study was obtained from the Rivers state Ministry of Health. Those with confirmed pulmonary TB were commenced on anti TB medications and followed up for at least 6months. Obtained data was analysed by SPSS version 20 and expressed as percentages, proportions and frequencies. A test of significance (chi square and t-test) was conducted between proportions and means as appropriate. In all a p value of less than 0.05 was considered significant. Results:Nine hundred and sixty three patients aged 0-18years had presumptive diagnosis of TB, 394 (40.9%) were males while 569 (59.1%) were females. The commonest presenting symptom was chronic cough which occurred in 735 (76.5%) of the patients. The prevalence of pulmonary TB was 19.1%. Significantly more males (60.9%) than female (39.1%) had confirmed tuberculosis (X2= 37.431, p-value <0.001). Significantly more children (54.3%) from the low socioeconomic class had confirmed pulmonary. Seventy two (39.1%) and 29 (15.8%) of the patients were AFB and XpertMTB/RIF positive respectively. Children aged 0-5 years were neither AFB nor XpertMTB/RIF positive. Of the children with confirmed TB, 98 (53.3%) had suggestive clinical features while 86 (46.7%) had suggestive X-ray features. More than a third (33.2%) of the children aged 0-5 years had their TB confirmed by suggestive X-rays and Clinical features. All the patients with TB were commenced on anti TB medications, 40 (21.7%) were lost to follow up (LTFU), 21 (11.4%) were transferred to other centres while 123 (66.8%) completed the treatment. Conclusion:The prevalence of pulmonary TB among presumptive TB cases in this study was comparable to findings from other studies and clinical diagnosis of Pulmonary TB remains very relevant in its management. Improving the clinical skills of physicians involved in TB care and treatment and the need for community/ facility collaboration to reduce cases of LTFU is advocated.