Anthropometric Predictors of Health-Related Quality of Life in Obese Patients Attending a Tertiary Hospital in Nnewi, South-East Nigeria: A Cross-Sectional Study.

BACKGROUND: Obesity as a disorder with excess body fat directly decreases quality of life. While Body Mass Index (BMI) has been used largely in health studies as a measure of obesity, it is largely unable to differentiate between body fat and lean body mass, hence other anthropometric measures can be used to assess body fat. OBJECTIVE: To determine the association of anthropometric indicators with health-related quality of life (HRQoL) in obese adults. MATERIALS AND METHODS: A cross-sectional study of obese adults (BMI ≥30kg/m2) attending the general outpatient clinic was conducted over four months. The quality of life was assessed using the short form-36 (SF-36) questionnaire. The anthropometric indicators used were BMI, waist circumference (WC), waist hip ratio (WHR), and waist-height ratio (WHtR). RESULTS: Physical component summary (PCS) was significantly related to BMI, WHtR, and WC. After adjusting for co-variables (gender, age, occupation, and marital status), they remained significantly associated with PCS. Mental component summary (MCS) was significantly related to BMI, WHtR, and WC. After adjusting for the known determinants of HRQoL, only BMI remained significantly associated with MCS (P = -0.004; r = -0.146). When all the indicators were included in the same regression model, no anthropometric indicator was significantly related to MCS while only WHtR was significantly associated with PCS (P = 0.001; r = -0.465). CONCLUSION: HRQoL in obese patients is related to measures of body fat. The physical and mental components of health-related quality of life are correlated differently with the various anthropometric measures of obesity. The WHtR was found to be an independent predictor of the physical component of HRQoL.

Development and validation of the Redeemer's University Suicidality Scale.

Background: The need for a culturally suitable scale for suicidality within the multilingual Nigerian society necessitated this research interest. Aim: The study is a development and validation of the Redeemer's University Suicidality Scale (RUSS). Setting: South western Nigeria. Methods: This comprised of initial generation of items; face and content validity, item refinement and administration of RUSS to 150 university undergraduates, using exploratory factor analysis at the first, second and third stages. In the fourth stage, 184 undergraduates responded to the 20-item RUSS, Suicide Ideation Scale (SIS) and General Health Questionnaire (GHQ-12). Data gathered at this stage were analysed for congruent validity, reliability and norms. Results: The principal component analysis extracted four components from items whose eigenvalues exceeded one. Twenty-one of the 25 items loaded best in the first, two in the second and one on the third component(s). Only items in the first component were retained. Item-total correlation further showed that the values of one item in the first component fell below the very good discrimination and was deleted from the scale. The RUSS has a Cronbach's alpha of 0.93. Congruence validity coefficient of r = 0.881 (p < 0.001) and r = 0.605 (p < 0.001) was observed between RUSS and SIS and between RUSS and GHQ-12, respectively. Conclusion: The RUSS is gender-sensitive, has acceptable psychometric properties and is recommended as a diagnostic tool for assessing suicidal behaviour in adolescents and adults. Contribution: This article contributes to the development of a culture sensitive measure for suicidality.

Effectiveness of cognitive behavioural therapy and social skills training in management of conduct disorder.

Background: Conduct Disorder (CD) is a repetitive disruptive behaviour that violates the rights of others, manifests in rules violation, aggression, hostility, and deceitfulness and has assumed prominence in its association with juvenile offending and criminality in adulthood. Despite this knowledge, little research attention is given to ascertaining effective psychobehavioural interventions to manage this problem, especially amongst Nigerian adolescents. Aim: This study examined the efficacy of two psychobehavioural strategies to manage CD amongst in-school adolescents in Ibadan, Nigeria. Setting: Ibadan, Southwestern Nigeria. Method: A randomised controlled trial (RCT) of adolescents with CD was performed. Sixteen participants (aged 12-17 years) who reported high CD from an assessment of 1006 in-school adolescents of selected secondary schools in Ibadan were randomly grouped to receive either cognitive behavioural therapy (CBT), social skills training (SST) or combined CBT and SST. The Frequency of Delinquent Behaviour Scaling Instrument (FDBSI) was used for assessments. Results: Significant reduction in CD was observed among participants exposed to CBT (t[6] = 8.510), p < 0.05) at 8 weeks, SST (t[6] = 12.728), p < 0.05) at 8 weeks, and combined CBT and SST (t[8] = 12.728, p < 0.05) at the 6 week mark of interventions respectively. Conclusion: From the study, CBT and SST are effective in managing CD. However, the combined psychobehavioural intervention of CBT and SST was more effective in managing CD, based on a faster therapeutic effect than the independent psychobehavioural intervention of CBT and SST.

Soil-transmitted helminthiasis: A neglected tropical disease among urban slum dwelling school-aged children of a sub-Saharan African city.

BACKGROUND: The need to generate a robust epidemiological data on the neglected tropical diseases is imperative, in order to encourage access to formal care, drive public policies and ensure the allocation of resources by policy-makers. OBJECTIVES: The objective of this study was to determine the prevalence of soil-transmitted helminthiasis (STH) and its association with nutritional variables among primary school pupils living in urban slums in a South-Eastern sub-Saharan African city of Enugu, Nigeria. METHODS: The stool samples of school-aged children living in urban slums were analyzed for ova of the helminths using the Kato-Katz methods, whereas the nutritional assessment (weight and height) was obtained and analyzed to indicate acute or chronic malnutrition. Degrees of helminthic load were then classified. The socioeconomic status was determined while the prevalence of STH and the relationship between it and the nutritional stratus was assessed to ascertain any significance between being malnourished and having STH as this will inform policy decisions. RESULTS: There were a total of 371 analyzed stool samples from 228 females (61.5%) and 143 males (38.5%), with 285 (76.8%) from the lowest socioeconomic class. The prevalence of STH was 18.1%, while that of acute and chronic malnutrition were 3.3% and 7.5%, respectively. The intensity of infestation was, however, light, with the highest mean egg intensity of 74.4 ± 32.8 documented for ascariasis. There was no statistically significant association between the presence of STH and various indices of acute and chronic malnutrition (P > 0.05). CONCLUSION: STHs prevalence is high among children living in urban slums. Nutritional status was, however, not adversely affected by helminthic infestation.

Oscillometric blood pressure profile of adolescent secondary school students in Abakaliki metropolis.

Context: Adolescence is characterized by a tremendous pace in growth, biological, and psychosocial changes. This may translate to rapid increases in anthropometric parameters and indulgence in youth risk behaviors, and these are the risk factors for arterial hypertension (HTN). Aim: This study aimed to determine the oscillometric blood pressure (BP) profile of apparently healthy secondary school adolescents in Abakaliki metropolis and its relationship with sex and anthropometric variables. Subjects and Methods: This multistage process selected 2401 students among those aged 10-19 years spanning from August 2015 to January 2016. BP was measured using the oscillometric method. Information on modifiable risk factors for HTN was obtained. Anthropometric parameters were measured. Data were analyzed with Student's t-test, analysis of variance, and correlation analysis. Results: The mean age (years) of the study population was 15.12 ± 2.29. The mean systolic BP (SBP) and diastolic BP (DBP) were 106.72 ± 11.37 mmHg and 63.60 ± 7.34 mmHg, respectively. Females had significantly higher mean DBP but with no significant gender difference in mean SBP. The means of anthropometric parameters were 49.19 ± 10.28 kg, 1.54 ± 0.10 m, and 20.46 ± 2.86 kg/m2 for weight, height, and body mass index, respectively, and all showed significant gender differences, with females having higher values except for height. A relatively low rate of indulgence in alcohol use compared to another study in the same region as well as a significant association of alcohol use among those found to have HTN was noted. The prevalence of HTN was 4.6%, which was significantly higher in females. Conclusions: Routine BP monitoring is recommended for adolescents, especially those with prevailing risk factors including a family history of HTN, obesity, and substance and alcohol misuse. Early detection will help in mitigating the effect of these cardiovascular risk factors.

RésuméContexte: L'adolescence est caractérisée par un rythme de croissance considérable, des changements biologiques et psychosociaux. Cela peut se traduire par rapide. l'augmentation des paramètres anthropométriques et l'indulgence dans les comportements à risque des jeunes, et ce sont les facteurs de risque de l'hypertension artérielle (HTN). But: Cette étude visait à déterminer le profil de pression artérielle oscillométrique d'adolescents apparemment sains du secondaire en La métropole d'Abakaliki et ses relations avec le sexe et les variables anthropométriques. Sujets et méthodes: Ce processus en plusieurs étapes sélectionné 2401 étudiants âgés de 10 à 19 ans entre août 2015 et janvier 2016. La mesure de la pression artérielle a été réalisée à l'aide de la méthode oscillométrique.Des informations sur les facteurs de risque modifiables pour HTN ont été obtenues. Les paramètres anthropométriques ont été mesurés. Les données ont été analysées avec la méthode de Student.test t, analyse de variance et analyse de corrélation. Résultats: L'âge moyen (années) de la population à l'étude était de 15,12 ± 2,29. La moyenne systolique BP (SBP) et diastolique BP (DBP) étaient respectivement de 106,72 ± 11,37 mmHg et 63,60 ± 7,34 mmHg. Les femmes avaient une moyenne significativement plus élevée DBP mais sans différence significative entre hommes et femmes dans le SBP moyen. Les moyennes des paramètres anthropométriques étaient de 49,19 ± 10,28 kg, 1,54 ± 0,10 m, et 20,46 ± 2,86 kg / m2 pour le poids, la taille et l'indice de masse corporelle, respectivement, et tous ont montré des différences significatives entre les sexes, avec les femmes ayant des valeurs plus élevées sauf pour la hauteur. Un taux de consommation d'alcool relativement faible par rapport à une autre étude menée dans la même région ainsi qu'une association significative de consommation d'alcool chez les personnes présentant un HTN. La prévalence de HTN était de 4,6%, ce qui était significativement plus élevé chez les femmes. Conclusions: La surveillance systématique de la TA est recommandée chez les adolescents, en particulier ceux à risque prédominant facteurs, y compris des antécédents familiaux de HTN, d'obésité et d'abus de substances et d'alcool. Une détection précoce aidera à atténuer les effets de ces facteurs de risque cardiovasculaires.

Seroprevalence and Risk Factors of Hepatitis B Virus Infection among Adolescents in Enugu, Nigeria.

OBJECTIVES: The aim of the study was to determine the prevalence and correlates of hepatitis B virus infection in adolescents in Enugu-urban. METHODS: A cross-sectional seroprevalence survey was conducted among school children aged 10-18 years. Subjects were selected using multistage sampling. Hepatitis B surface antigenaemia (HBsAg) was assayed for in blood using rapid enzyme-linked immunosorbent assay kits. Data were analyzed using statistical package for social sciences version 16.0 (p < 0.05). RESULTS: Four hundred and twenty children were recruited. Of these, 13 tested positive for HBsAg, giving an overall hepatitis B seroprevalence of 3.1%. Social class, scarifications/tattooing, circumcision and history of surgery were the significant modes of transmission. CONCLUSION: The seroprevalence of hepatitis B among children in the study population is high. Its screening in school children should be incorporated into school health services in our setting while awareness campaigns and health education on its modes of transmission and prevention should be promoted and strengthened.

Pulmonary function indices in children with sickle cell anemia in Enugu, south-east Nigeria.

OBJECTIVES: To determine the pulmonary function indices of children with sickle cell anemia (SCA) attending the pediatric sickle cell clinic at the University of Nigeria Teaching Hospital, Enugu, south-east Nigeria and to compare these indices with the results obtained from other regions.  METHODS: A case control study of lung function in children with SCA aged 6-20 years. The study was carried out in the University of Nigeria/University of Nigeria Teaching Hospital, Enugu State, Nigeria between October 2014 and January 2015. Measurements of the peak expiratory flow rate, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were evaluated. RESULTS: A total of 80 subjects were recruited into the study, comprising 40 homozygous HbSS (hemoglobin SS) patients and an equal number of controls. Children with SCA had statistically lower values of FEV1 (1.6±0.52), FVC (1.76±0.95), and peak expiratory flow rate (PEFR) (309.00±82.64) when compared with normal hemoglobin genotype FEV1 (12.01±0.53), FVC (2.12±0.54), and PEFR (364.10±87.85). The mean FVC, FEV1/FVC, and PEFR were also higher in the male control group compared with the HbSS male group, but these differences were not statistically significant. Female controls had significantly larger FEV1, FVC, and PEFR values compared with the HbSS females.  CONCLUSION: The lung function indices were significantly lower in children and adolescents with SCA compared with the matched controls with a hemoglobin genotype AA.

Relationship between serum cholesterol and body mass index in Nigeria schoolchildren aged 2-15 years.

BACKGROUND: Non-communicable disease is becoming a public health problem that it is already present in more affluent countries. The aim of this study was to determine the relationship between body mass index (BMI) and total serum cholesterol with its lipoprotein fractions in children aged 2-15 years. METHODS: Serum cholesterol was estimated using the enzymatic spectrophotometer cholesterol oxidase/peroxidase method. BMI was calculated as weight (kg)/height (m(2)). RESULTS: Total cholesterol and low-density lipoprotein were positively co-related with BMI (p < 0.05). Using linear regression, equations that can be used to predict serum total cholesterol from known BMI values were developed. CONCLUSION: There is a positive correlation between BMI and serum cholesterol. BMI which is non-invasive is recommended as a screening tool for cardiovascular risk in settings where serum cholesterol cannot be routinely estimated.

Disseminated Histoplasmosis in a 13-year-old girl: a case report.

BACKGROUND: Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immune-compromised individuals such as those with acquired immuno-deficiency syndrome. OBJECTIVE: To describe a case of disseminated histoplasmosis in an adolescent girl. METHOD: We report a case of disseminated histoplasmosis in a 13-year-old adolescent girl. She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies. RESULT: An autopsy was performed because a definitive diagnosis could not be made while the patient was still alive. The autopsy revealed central caseating areas in the lymph nodes and membranoproliferative glomerulonephritis. The periodic acid-Schiff staining technique for tissues showed viable yeast cells suggestive of histoplasmosis. Zeihl-Neelsen's staining for mycobacteria tuberculosis was negative. CONCLUSION: Undiagnosed case of disseminated histoplasmosis while the patient was alive is being reported in a 13-year-old girl. Disseminated histoplasmosis should be considered as a differential diagnosis of childhood chronic infections and malignancies as in Nigeria.

Factors associated with mortality in under-five children with severe anemia in Ebonyi, Nigeria.

OBJECTIVE: To determine the risk factors associated with poor outcome among under-five children with severe anemia in sub Saharan Africa. DESIGN: Cross-sectional. SETTING: University Teaching Hospital, Nigeria. PARTICIPANTS: Under-five children presenting with severe anemia (PCV <15%, Hb <5g/dL). METHODS: Between January and June 2006, children admitted with severe anemia were recruited. The biodata, socio-economic status, signs and symptoms were documented for each child after the initial stabilization. Laboratory investigations using blood, stool and urine samples were carried out. Data were analyzed using SPSS version 11.0. RESULTS: 140 out of the 1,450 patients admitted during the period of study had severe anemia (prevalence 9.7%). Malaria either alone or in combination was the most common cause of severe anemia [n=90 (64.3%)]. 117 patients (83.6%) recovered, while 4(2.8%) left against medical advice and 19 died (case fatality rate 13.6%). The variables associated with mortality were malnutrition (P=0.02), tachycardia (P= 0.03), coma (P<0.001), and absence of blood transfusion (P=0.001). On logistic regression analysis coma (P=0.002), not receiving blood transfusion (P=0.002) and female gender (P=0.04) predicted poor outcome. CONCLUSIONS: The study revealed high mortality rates among under-five children with severe anemia. Coma, malnutrition, female gender and absence of blood transfusion were associated with higher mortality in severe anemia.

Infant sleeping environment in South-eastern Nigeria (sleeping place and sleeping position): a preliminary survey.

Objective. To determine infant sleeping position/place and the factors associated with them in South-eastern Nigeria. Methods. this is a cross-sectional study on infant sleeping environment. Subjects were the mother/ infant pairs that attended the well baby clinics at the Institute of Child Health of the University of Nigeria Teaching Hospital, Enugu (ICH-UNTH), Mother of Christ Specialist Hospital (MCSH), Enugu and the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. Results. Lying on the side was the most common (51.1%) and the least stable sleeping position. Only 36.6% of infants who slept in that position were likely to be found in the same position the following morning; lying supine was the most stable (74.1%). The difference in stability of sleeping positions was statistically significant (P < .01). Twenty six point seven percent of the mothers routinely lay their infants in prone position. On logistic regression, maternal parity was the only factor that was predictive of nonprone sleeping position (P = .01). Bed sharing, though common (66.9%), was more among the experienced (P = .03) and less educated mothers (P < .01). Conclusion. There is a high level of prone sleeping position and bed sharing among infants in this study site. The potential consequences of these are unclear. There is therefore a need to conduct local studies to clarify its implication.

Maternal perception of pneumonia in children: a health facility survey in Enugu, eastern Nigeria.

In a health facility-based study to determine the knowledge of mothers regarding recognition of pneumonia in their pre-school children, 400 women were interviewed using a pre-tested structured questionnaire. Sixty-one per cent of them would recognise pneumonia by difficult breathing, 42% by fast breathing and 26.5% by severe cough. Few of the mothers mentioned signs suggestive of 'chest indrawing' (8.5%) and 'central cyanosis' (1%). The maternal knowledge score on pneumonia signs increased significantly with educational status and social class (p < 0.05). While a substantial number of mothers (51%) perceived fast breathing to be an indication of severe pneumonia, a sizeable number (87.5%) were unsure if late signs such as chest indrawing and central cyanosis suggested severe disease. On the basis of the WHO criteria, it is concluded that maternal recognition of pneumonia in children is at best modest while knowledge of signs indicating severe disease is poor. These findings underscore the need to modify the WHO criteria to include difficult breathing and to highlight during local ARI health education campaigns that late signs such as chest indrawing and central cyanosis indicate severe and potentially fatal pneumonia.