School Health Instructions in Primary Schools - A Study of Gwagwalada Area Council, Federal Capital Territory Nigeria.

BACKGROUND: School Health Instructions (SHI) entail the instructional aspect of school health programme, which provides a classroom opportunity for inculcating healthy habits into the school- age child. OBJECTIVE: To assess the status of implementation of school health instruction in primary schools in Gwagwalada Area Council of the Federal Capital Territory, Nigeria. METHODS: A cross-sectional descriptive study of 146 primary schools in the Gwagwalada Area Council of the Nigerian Federal capital was carried out to assess the implementation of SHI with respect to the contents, methods of delivery and teachers preparation for health teaching using an evaluation checklist for SHI. RESULTS: Of 146 schools, 115(78.8%) schools attained the minimum acceptable score of 27. Of the 40 public and 106 private schools, 27(67.5%) public and 88(83.0%) private schools attained the acceptable minimum score of 27. There was a statistically significant difference between the mean scores attained cumulatively in the various components of the school health instruction by the public and private schools (t=2.721, p= 0.008). Public schools had significantly more teachers with education-related qualifications than private schools (p<0.001). Teachings on HIV/ AIDS, safety education and community health were undertaken by 95.9%, 93.2% and 95.2% schools respectively. Only 5(3.4%) schools followed the recommendation of giving health instruction at least thrice a week. CONCLUSION: Implementation of SHI was adequate in the study area, with a better performance among the private schools.

CONTEXTE: L'enseignement de la santé à l'école (SHI) comprend l'aspect pédagogique du programme de santé scolaire, qui offre en classe la possibilité d'inculquer des habitudes saines à l'enfant d'âge scolaire. OBJECTIF: Évaluer l'état de la mise en œuvre de l'enseignement de la santé scolaire dans les écoles primaires du Conseil régional de Gwagwalada du territoire de la capitale fédérale, Nigéria. MÉTHODES: Une étude descriptive transversale de 146 écoles primaires du Conseil régional de Gwagwalada de la capitale fédérale nigériane a été menée pour évaluer la mise en œuvre de l'AMS en ce qui concerne le contenu, les méthodes de prestation et la préparation des enseignants à l'enseignement de la santé en utilisant une liste de contrôle SHI. RÉSULTATS: Cent quinze (78,8%) écoles composées de 27 (67,5%) écoles publiques et 88 (83,0%) écoles privées ont atteint le score minimum acceptable de 27, avec une différence statistiquement significative entre les scores moyens des deux catégories d'écoles (t = 2,721, p = 0,008). Les écoles publiques avaient beaucoup plus d'enseignants avec des qualifications liées à l'éducation que les écoles privées (p <0,001). Des enseignements sur le VIH / SIDA, l'éducation à la sécurité et la santé communautaire ont été dispensés respectivement par 95,9%, 93,2% et 95,2% des écoles. Seulement 5 écoles (3,4%) ont suivi la recommandation de donner des cours de santé au moins trois fois par semaine. CONCLUSION: La mise en œuvre de SHI a été adéquate dans la zone d'étude, avec une meilleure performance parmi les écoles privées. MOTS CLÉS: Enseignement de la santé à l'école, école primaire, privé, public, Conseil régional de Gwagwalada, Territoire fédéral de Capital, Nigéria.

Asymptomatic Proteinuria and Haematuria in Healthy Public Primary School Children in Abuja, Nigeria.

BACKGROUND: Urinary abnormalities detected on routine urinalysis in asymptomatic children may be indicators of underlying kidney diseases. OBJECTIVE: This study was conducted to determine the prevalence and risk factors for asymptomatic proteinuria and haematuria in healthy primary school children in Abuja. METHODS: Using multi-staged sampling method, early morning mid-stream urine was collected from healthy school children from urban and rural primary schools in Gwagwalada Area Council of Abuja, Nigeria for the presence of proteinuria and haematuria using urinalysis strips. Those positive for proteinuria and haematuria were retested after two weeks for persistence abnormalities. Urine microscopy was also done for the persistent haematuria subjects, and biodata collected. RESULTS: Of 861 urine samples analysed, 215 (25%) were from urban schools, and 646 (75%) from rural schools. There were 397 (46.1%) males. Their mean age was 9.5±2.1 years (range 6-12 years), with 9-10 years accounting for 36.4% of the study population. Proteinuria, haematuria, proteinuria+haematuria, persistent proteinuria, and persistent haematuria were seen in 7.0%, 10.6%, 3.6%, 4.2% and 5.5% of the subjects respectively. Microscopic haematuria was also documented in 5.2% subjects with persistent haematuria. Statistical significant association was seen between proteinuria with location of school (c2=9.529, p=0.002), and social class (c2=7.596, p=0.022). Significant association was also seen between haematuria and location of school (c2=14.218, p=0.001), social class (c2=11.290, p = 0.004). CONCLUSION: There was high prevalence of asymptomatic proteinuria and haematuria among healthy primary school children from the study area. This underscores the importance of routine urinary screening program in primary schools for early identification of affected children for intervention.

Pubertal breast development in primary school girls in Sokoto, North-western Nigeria

Background. There is wide variation in normal pubertal timing among various populations. Objectives. To determine the mean age of pubertal stages of breast development and menarche, and the influence of nutrition and ethnicity on pubertal onset in primary school girls in Sokoto, North-Western Nigeria.Methods. A cross-sectional study using a multistage random sampling design was conducted on 994 primary school girls in grades 3 - 6. Weight and height measurements and Tanner breast staging were done. Body mass index (BMI) was calculated, and a BMI-for-age percentile was used to categorise nutritional status. There were four major ethnic groups. P≤0.05 was taken as showing statistical significance. Results. The participants' mean age was 10.23 years (standard deviation (SD) 1.70, range 6 - 15 years). Of the 994 girls, 628 (63.2%) were pre-pubertal, and 366 (36.8%) were pubertal. Of the latter, 158 (15.9%) were in breast stage 2, while 112 (11.3%), 70 (7.0%) and 26 (2.6%) were in breast stages 3, 4 and 5, respectively. The mean ages (SD; range) of pubertal onset and menarche were 10.50 (1.33; 8 - 13), and 12.67 (1.65; 11 - 15), years, respectively. The overnourished (overweight/obese) and Igbo ethnic group girls had early-normal pubertal onset (p=0.006 and p=0.001, respectively). Conclusion. The mean ages of Tanner breast stages 1 - 5 and menarcheal age of girls in Sokoto, North-Western Nigeria, were within the age ranges reported worldwide. Pubertal onset was influenced by nutrition

Neonatal bacterial meningitis and dexamethasone adjunctive usage in Nigeria.

OBJECTIVE: Neonatal bacterial meningitis is devastating, with attendant high mortality and neurological sequelae. We, therefore, aimed to delineate its current incidence, etiologic, clinical, laboratory spectra, and the effect of steroid therapy on the outcome. METHODOLOGY: Babies admitted from 1992 to 1995 in the Special Care Baby Unit of the University of Maiduguri Teaching Hospital, Maduguri, Nigeria, with bacterial meningitis were studied prospectively. Neonatal bacterial meningitis was confirmed if the cerebrospinal fluid (CSF) microbiological, chemical, immunological and clinical criteria were satisfied. Detailed neurological follow-up was made. RESULT: Sixty-nine cases of neonatal bacterial meningitis were encountered, (25 were early-onset, and 44 late-onset); the incidence was 6.5/1000 live births. 22 Positive CSF cultures were grown in early-onset meningitis, and 28 in late-onset disease. Low birth weight showed higher risk of bacterial meningitis and it was significantly more likely in the preterm. X2 = 24.19, p = 0.000001). Gram-negative pathogens were more isolated (28/50, 56%); Escherichia coli (11) being the commonest, while of the Gram-positive pathogens Staphylococcus aureus was most predominant overall (13/50). Concomitant blood culture was positive in 39/50 (78%), inclusive of all 22 "definite" early-onset disease. The CSF WBC was minimally raised (25-30 x 10(6)/L) in 11 (22%) of "definite" neonatal bacterial meningitis. Detection of unusual pathogens was noteworthy: N. meningitidis (2) and H. influenzae (2), contributing 0.6 and 2.2 per 1000 live births and admissions, respectively. Overall mortality was 24.6%. Of the forty survivors, 9 (22.5%) had neurological sequelae: sensorineural hearing deficit (3), hydrocephalus (2), subdural effusion (2), hemiparesis (1), afebrile (recurrent) seizure (1), and there was reduced developmental quotients at 24 months follow-up in 33. Dexamethasone therapy decreased mortality significantly; p = 0.0004. CONCLUSION: The new information highlighted by this research includes the lack of Group B Streptococcus isolation, the finding of S. pneumoniae, N. meningitidis, H. influenzae and S. aureus as significant pathogens, usefulness of blood cultures in the detection of neonatal bacterial meningitis, increasing resistance of Gram-positive neonatal pathogens to cloxacillin, low CSF WBC, and the finding that the adjunctive use of dexamethasone significantly decreases case fatality and neurological sequelae.

Renovascular hypertension in a newborn: necessity of assessing blood pressure routinely.

A 7-day old neonate presented with heart failure secondary to severe hypertension. The hypertension was discovered on day 9 of life. Control of his hypertension was a difficult problem eventually requiring continuous intravenous sodium nitroprusside therapy, and ultimately a nephrectomy. The nephrectomized specimen revealed renal artery stenosis, renal artery thrombosis and renal vein thrombosis. His eventual outcome was excellent.

Meconium aspiration syndrome--unusual features.

A term infant with the meconium aspiration syndrome (MAS) is described. He had the typical clinical course of the disease despite appearing well nourished, and with good Apgar scores. At 5 months of age, he continued to do well with no sequelae. The reason for the initial passage of meconium in-utero remained speculative. The fact that the disease is preventable is emphasised.

Neural tube defects in the middle belt of Nigeria.

Forty-two babies were found to have neural tube defects during a 3-year prospective study in a large cosmopolitan West African city. An incidence of 7/1000 deliveries was noted. The commonest defect was meningomyelocele, in 45 per cent of cases. Other defects comprised anencephaly (5 per cent), Arnold-Chiari malformation (7 per cent), encephalocele (19 per cent), occipital meningocele (14 per cent) and spina bifida occulta (10 per cent). No case of consanguinity was encountered. More defects were found among females and low birth weight infants among those whose mothers were aged between 20 and 30 years, and in mothers with parity of four and above. The commonest associated defect was talipes equinus in 15/42 (36 per cent) infants. Developmental assessments (neurological follow-up status) done at the age of 18 months on five surviving cases of meningomyelocele showed very poor development.

Neonatal seizures and a 2-year neurological outcome.

A study of 57 infants with neonatal seizures admitted to the Special Care Baby Unit of the Jos University Teaching Hospital over a 3-year period showed perinatal asphyxia and hypoglycaemia as the principal aetiologic factors in 47 and 19 per cent of the cases, respectively. Seizures were commoner in preterm infants, and among them outcome was also poorer. As regards aetiological factors, outcome was poorest with perinatal asphyxia; with a mean (SD) mental age of 72.5 (9.1) weeks at a chronological age of 24 months. Outcome in infants with seizures and coma was most favourably predicted by the absence of abnormal neurological signs, and the way the infant was feeding at 7-10 days. All infants who were clinically and neurologically normal and taking more than half their estimated requirements by mouth at 7 days were not handicapped. The overall incidence was 7.5/1000 live births. The mortality (19.3 per cent) was closely related to the aetiology. In view of the fact that the associated adverse perinatal events are largely preventable, improved prenatal and perinatal health care delivery should lead to a decline in the frequency of neonatal seizures.

Prader-Willi syndrome: a case report.

A case of a male infant presenting in the neonatal period is described to highlight the morbidity of Prader-Willi. His features included marked hypotonia, feeding difficulty, hypogonadism and typically dysmorphic facies. Marked improvement in muscle tone was noted by 5 months of age. Emphasis is placed on its neonatal presentation and possible aetiologic mechanisms. The natural history is also noted.

Should we resuscitate? Ethical dilemmas.

Over a 2-year period, there were 312 perinatal deaths. A total of 144 (46.2%) of these deaths were due to lack of or delayed resuscitation at birth. This group comprised 45 infants with multiple congenital abnormalities, 31 with severe birth asphyxia, 25 with meningomyelocele, 20 with infections and 15 with kernicterus. Taking the decision not to resuscitate may be difficult, perplexing and agonizing for the families and health professionals. The decision may be easier if one can prognosticate as to intact survival and development. The physician, though he is not God, has to be firm and decisive--if intact survival or satisfactory developmental outcome is very unlikely, then ther is probably no need to resuscitate.

Congenital miliary tuberculosis.

A case of a premature baby who had the classical problems associated with congenital tuberculosis and presented a difficult diagnostic problem is described. Diagnosis was ultimately confirmed by liver biopsy. Treatment was initially with isoniazid alone, followed 2 weeks later by isoniazid and rifampicin. Isoniazid was replaced by ethambutol when an isoniazid-resistant culture was obtained. The baby responded extremely well to therapy and, at 2-year follow-up, was growing satisfactorily without any sequelae. To my knowledge, this is the first case of congenital tuberculosis with a miliary spread to be seen, treated and followed up in the developing world, where tuberculosis is prevalent.

Hidden sources of fluid and sodium intake in ill newborns.

Fluids used for flushing arterial catheters, bronchial lavage, and drug administration are not normally considered when assessing daily fluid intake, yet infants weighing less than 1000 g at birth gained up to 12 ml/kg/day of extra fluid and 2.4 mmol/kg/day (mean) of extra sodium from these hidden sources.