Environmental factors that determine visual skill development of under-fives in a developing country.

INTRODUCTION: During the early years of life, children get most of their information by relying on their visual observation. Knowledge of visual skill development and environmental risk factors influencing it provides useful guide for early identification of children who may develop some form of visual impairment. AIM: The aim of this study is to describe the visual developmental pattern and determine the environmental risk factors associated with delay in the visual skill area of under-five children. SUBJECTS AND METHODS: This was a cross-sectional study of 415 preschoolers aged 6-59 months. Visual function and visual comprehension were assessed using the Schedule of Growing Skills II tool (GL Assessment Ltd., London). Delay in the visual skill was defined as a developmental quotient in visual skill area below threshold point of 85%. Data were analyzed using descriptive statistics and logistic regression analysis with adjusted odds ratio (AOR) and 95% confidence interval (CI) (95% CI). Alpha value was set at P < 0.05. RESULTS: Mean age of the children studied was 32.6 ± 15.9 months. The prevalence of delay in visual skill area was 17.1%. The odds of delay in visual skill were higher among children of first birth order (AOR 1.83; 95% CI 1.05-3.30), those who lived in large households (AOR 2.34; 95% CI 1.32-3.14), children whose mothers had secondary level education and below (AOR 2.21; 95% CI 1.31-3.83), and those whose fathers earned ≤$100 per month (AOR 1.75; 95% CI 1.01-3.03). CONCLUSION: Identification and management of environmental factors negatively affecting visual skill development will help improve on the visual skill area and invariably child development.

A comparative assessment of motor function using the expanded and revised gross motor function classification system and the manual ability classification system in the same children with cerebral palsy in Shika, Zaria, Northwestern Nigeria.

BACKGROUND: Assessment of motor function in children with Cerebral Palsy (CP) is vital to the identification and management of their mobility needs. OBJECTIVE: To compare the Expanded and Revised Gross Motor Function Classification System (GMFCS-E&R) and Manual Ability Classification System (MACS) in the assessment of motor function in children with CP. METHODS: A review of motor activity in children with CP documented at the Departments of Paediatrics and Physiotherapy, Ahmadu Bello University Teaching Hospital, Shika, Zaria, between January 2005 and December 2009. RESULTS: A total of 28 children (16M: 12 F, 1.3:1) with an age range of 4 to 12 years (mean 6.2 ± 2.4 years) were studied. Birth asphyxia (46.43%) and Spastic Hemiplegia (71.43%) were the main identified predisposing factor and clinical type of CP respectively. The GMFCS-E&R identified 13 (46.43%) children with higher levels (I & II) of gross motor function against 4 (14.29%) children identified in the MACS higher levels (p=0.02). Also 6 (21.43%) of the children were identified as being in the GMFCS-E&R lower levels (IV & V) against 16 (57.14%) in MACS lower levels (p=0.00). The difference in the number of children identified as being in level III for GMFCS-E&R 9 (32.14%) and MACS 8 (28.57%) was not significant (p=0.77). Overall correlation between GMFCS-E&R and MACS levels was poor using Kappa statistics (Kappa=0.00). CONCLUSION: The GMFCS-E&R and MACS significantly identified higher and lower levels of motor functions respectively in the same children. The disparity underscores the complexity in assessing the motor function of children with CP.

Computerized tomography of children with seizure disorders.

BACKGROUND: Neuro-imaging is generally considered as part of the evaluation of seizures and epilepsy. There is limited information about its usefulness in our environment. We describe the pattern of CT findings in children with seizures in our environment. METHOD: We carried out a retrospective review of the computerized tomography findings in children with recurrent seizures over a one year period, November 2005 to October 2006. RESULTS: During the study period, 49 infants and children had computerized tomography performed on them out of which 19 had CT done for recurrent seizures. They ranged in age from 4 months to 16 years with 13 of them being boys. Generalized tonic--clonic seizures was the most predominant seizure type, being present in 10 of the 19 (52.6%) children while simple partial seizure, myoclonic jerk and mixed seizure types were present in 2 cases each. Abnormal scan was demonstrated in 10 of the 19 children (52.6%) with 3 of them having double cerebral lesions, giving a total of 13 cerebral lesion demonstrated by the CT scan. Cerebral infarct was the most common lesion demonstrated, being present in 5 of the 13 lesions (38.5%). Others were cerebral atrophy in 4 cases (30.8%), moderate ventricular dilatation 2 (15.4%) and 1 each ofporencephalic cyst, hydrocephalus and linear skull fracture. Of the 10 children with abnormal scan, 90% of them had significant past medical history, with birth asphyxia (44.4%) and meningitis (33.3%) being the commonest significant past medical history in them. CCONCLUSION There is a high incidence of abnormal scan findings in children with seizure disorder in our environment compared to what is obtained from the developed countries. Cerebral infarct appears to be the most common abnormal CT findings in our children with seizures.

Echocardiographic findings in children with surgically correctable non-cardiac congenital anomalies.

BACKGROUND: Congenital cardiac anomalies may co-exist with non-cardiac congenital malformations and, for those requiring surgical correction, there can be an anaesthetic risk. AIM: To estimate the burden of congenital heart disease (CHD) in children with surgically correctable non-cardiac congenital malformations. PATIENTS/METHODS: Records of 120 children aged between 1 week and 11 years [mean (SD) 0.6 (1.5) years] undergoing corrective surgery for non-cardiac congenital malformations were examined. Results of clinical cardiac examination and surgical and echocardiographic findings were analysed. RESULTS: Cleft lip or palate was the commonest surgical anomaly (46, 38.3%), followed by ano-rectal malformation (32, 26.7%). Forty-two children (35.0%) had an abnormal echocardiographic scan. A cardiac abnormality was detected clinically and confirmed by echocardiography in ten patients (8.3%), which represents 24% of all the cardiac abnormalities. The commonest cardiac anomalies were atrial septal defect (ASD) (30 children, 25%), followed by ventricular septal defect (VSD) (seven children, 5.8%). The frequency of ASD was highest in children with a cleft lip or palate (14/46, 30.4%). CONCLUSIONS: Over one-third of patients undergoing surgical correction of congenital malformations have co-existing CHD. Echocardiography is important for pre-surgical evaluation. No association between type of CHD and specific non-cardiac congenital malformations was found.

Body mass index of healthy Nigerian children.

BACKGROUND: To study the Body Mass Index of healthy Nigerian school children from different socio-economic backgrounds resident in Kaduna, northern Nigeria. METHOD: A cross-sectional prospective study of Body Mass Index was carried out on 3,802 healthy Nigerian school children aged 5 to 13 years resident in Kaduna, northern Nigeria. The subjects consist of 1,871 children from private schools (privileged) and 1,931 children from public schools (less privileged). The schools and pupils were selected by multi-staged clustersampling method. RESULT: Over 75% of the 'privileged' and the 'less privileged' children are from upper and lower socioeconomic classes respectively The mean Body Mass Index of the 'privileged' boys was 15.1 +/- 0.7 compared with 14.7 +/- 1.2 for the 'less privileged' boys. The corresponding mean Body Mass Index values for the 'privileged' and the 'less privileged' girls were 15.1 +/- 0.5 and 15.0 +/- 1.7 respectively. The difference in this index, between the boys as well as between the girls was statistically insignificant (p = 0.05 and 0.12 respectively). CONCLUSION: There was no statistical significant difference between the BMI of the 'privileged' and the 'less privileged' groups of children.

Congenital bilateral fusion of the maxillomandibular alveolar processes with craniosynostosis: report of a rare case.

A rare congenital anomaly of maxillomandibular fusion with pectus excavatum and craniosynostosis in a neonate is presented. The child was kept alive by nasogastric tube feeding. A modification of classification of syngnathia is proposed. The aetiopathogenesis and difficulty in management in our environment are discussed.

Body Mass Index of Healthy Nigerian Children

Background: To study the Body Mass Index of healthy Nigerian school children from different socio-economic backgrounds resident in Kaduna; northern Nigeria. Method: A cross-sectional prospective study of Body Mass Index was carried out on 3;802 healthy Nigerian school children aged 5 to 13 years resident in Kaduna; northern Nigeria. The subjects consist of 1;871 children from private schools (privileged) and 1;931 children from public schools (less privileged). The schools and pupils were selected by multi-staged cluster sampling method

Non-syndromal, true congenital ankylosis of the temporomandibular joint: a case report.

A case of a six-week old boy with bilateral congenital fibrous intra-articular ankylosis of the temporomandibular joint is presented The literature is reviewed and limitations to management are highlighted.