Effect of COVID-19 Pandemic on Utilization of Paediatric Health Services at the Federal Medical Centre, Asaba, Nigeria.

BACKGROUND AND OBJECTIVES: Corona virus disease was declared a global pandemic in March 2020 and it precipitated unprecedented and devastating crisis on non-COVID hospital visits in almost all the countries within the globe, with a downward slide in the number of paediatric consultations and emergency admissions. Thus, we assessed the utilization of services offered in the department of Paediatrics and the observed mortality rates in comparison to similar non-pandemic period. METHODS: This study was carried out in the department of Pediatrics, Federal Medical Center Asaba. All the admissions at the children's ward and emergency, then visits at clinics and the immunization center were reviewed using a consecutive sampling method from April 2019 to September 2019 (pre COVID-19) and April 2020 to September 2020 (during COVID-19 pandemic). RESULTS: The total number of vaccines given in the immunization clinic was higher during the pre-COVID-19 period, so also the number of clinic visits. There was a decline in admission by 68.2% from the pre-COVID period to the pandemic period and this decline was across all age groups and gender. Also, a 60.8% increase in mortality was observed during the COVID-19 period and mortality pattern showed no gender difference across both study periods. CONCLUSION: There was a decline in the utilization of health services at the Department of Paediatrics, Federal Medical Center Asaba, during the COVID-19 pandemic, with a rise in mortality, despite the fact that all the units of the department were fully operational within the period of pandemic.

CONTEXTE ET OBJECTIFS: La maladie à virus Corona a été déclarée pandémie mondiale en mars 2020 et a précipité une crise sans précédent et dévastatrice sur les visites hospitalières non COVID dans presque tous les pays du globe, avec une baisse du nombre de consultations pédiatriques et d'admissions d'urgence. Nous avons donc évalué l'utilisation des services offerts dans le département de pédiatrie et les taux de mortalité observés par rapport à une période non pandémique similaire. MÉTHODES: Cette étude a été réalisée dans le département de pédiatrie du Centre médical fédéral d'Asaba. Toutes les admissions au service pédiatrique et aux urgences, puis les visites dans les cliniques et au centre de vaccination ont été examinées selon une méthode d'échantillonnage consécutif d'avril 2019 à septembre 2019 (avant COVID-19) et d'avril 2020 à septembre 2020 (pendant la pandémie de COVID-19). RÉSULTATS: Le nombre total de vaccins administrés dans le centre de vaccination était plus élevé pendant la période pré-COVID-19, de même que le nombre de visites au centre. Le nombre d'admissions a diminué de 68,2 % entre la période pré-COVID et la période pandémique, et cette baisse a concerné tous les groupes d'âge et tous les sexes. Par ailleurs, une augmentation de 60,8 % de la mortalité a été observée au cours de la période COVID-19 et le schéma de mortalité n'a montré aucune différence entre les sexes au cours des deux périodes d'étude. CONCLUSION: Il y a eu une baisse de l'utilisation des services de santé au département de pédiatrie du Federal Medical Center Asaba pendant la pandémie de COVID-19, avec une augmentation de la mortalité, malgré le fait que toutes les unités du département étaient pleinement opérationnelles pendant la période de la pandémie. Mots-clés: Pandémie, Covid-19, Enfants, Mortalité, Clinique, Admission, Services de santé, Effet, Utilisation.

Correlation of Lead Poisoning and Intelligence Status of School Children in a Southern Nigerian Urban City.

BACKGROUND: Lead is a heavy metal of utmost public health significance in Nigeria. It is a known neurotoxin that impairs neurotransmission and brain function resulting in cognitive and motor deficits. Ingestion of lead contaminated food or water is the major route of exposure to lead manifesting as neurologic symptoms which can interfere with the intelligence of school children. AIM: To correlate the Intelligence quotient scores with the blood lead levels of primary school children in Southern Nigeria. METHODS: The study was a descriptive cross-sectional study amongst primary school pupils, conducted in Asaba, the capital of Delta state, Nigeria. Goodenough-Harris "Draw a Person Test" validated by Ebigbo and Izuora in Enugu, Nigeria was used to assess the intelligence of the pupils while blood lead levels was measured with Flame Atomic Absorption Spectrophotometer (FAAS). RESULTS: Three hundred and twenty subjects were recruited. Seventy-one subjects did not have lead poisoning (22%) while two hundred and forty-nine subjects had lead poisoning (77.8%). Mild, moderate and severe level lead poisoning constituted 22.5% (56/249), 28.1% (70/249) and 49.4% (123/249) respectively. Seventy percent (225) subjects had optimal IQ while 95 subjects had sub-optimal IQ and mean IQ score was 92.9 ± 25.1. There was no association and correlation between IQ status and levels of lead poisoning. CONCLUSION: A significant proportion of school children had optimal level of intelligence despite the high prevalence of lead poisoning seen among them. There was no association or correlation between different levels of childhood lead poisoning and Intelligence quotient status.

CONTEXTE: Le plomb est un métal lourd de la plus haute importance pour la santé publique au Nigeria. C'est une neurotoxine connue qui altère la neurotransmission et la fonction cérébrale entraînant des déficits cognitifs et moteurs. Ingestion de plomb contaminé la nourriture ou l'eau est la principale voie d'exposition au plomb qui se manifeste comme symptômes neurologiques, ce qui interfère avec l'intelligence des écoliers. OBJECTIF: Corréler les scores du quotient intellectuel avec letaux de plomb dans le sang des enfants des écoles primaires dans le sud du Nigéria. MÉTHODES: L'étude était une étude transversale descriptive parmi les élèves de l'école primaire, menée à Asaba, la capitale de l'État du Delta, Nigéria. Goodenough-Harris "Dessinez une personne Test" validé par Ebigbo et Izuora à Enugu, Nigeria a été utilisé pour évaluer l'intelligence des pupilles pendant que le sang mène les niveaux ont été mesurés avec l' Absorption Atomique de Flamme Spectrophotomètre (FAAS). RÉSULTATS: Trois cent vingt sujets ont été recrutés. Soixante et onze sujets n'avaient pas d'empoisonnement au plomb (22 %) alors que deux cent quarante-neuf sujets avaient une intoxication au plomb (77.8%). Intoxication au plomb légère, modérée et sévère constituaient 22,5 % (56/249), 28,1 % (70/249) et 49,4 % (123/249) respectivement. Soixante-dix pour cent (225) sujets avaient un QI optimal tandis que 95 sujets avaient un QI sous-optimal et le score de QI moyen était92,9 ± 25,1. Il n'y avait pas d'association et de corrélation entre État du QI et niveaux d'empoisonnement au plomb. CONCLUSION: Une proportion importante d'écolier savaient un niveau d'intelligence optimal malgré la forte prévalence de empoisonnement au plomb vu parmi eux. Il n'y avait pas d'association ou corrélation entre les différents niveaux de plomb infantile empoisonnement et statut du quotient intellectuel. Mots-clés: Empoisonnement au plomb, intelligence, enfance.

Modifiable Risk Factors for Chronic Kidney Disease in Adulthood seen among School Children in Asaba.

BACKGROUND: The burden of chronic kidney disease (CKD) is huge especially in developing countries like Nigeria. In Nigeria, treatment modalities for ESRD (renal replacement therapy) are not readily available and, where available, they are not affordable. Consequently, preventive nephrology aimed at early detection and prompt treatment of children with CKD risk factors has become the viable alternative in curbing this rising problem. AIM: To determine the burden of some modifiable risk factors for CKD in adulthood (hypertension, obesity, proteinuria, and microalbuminuria) among primary school children in Asaba and to ascertain if there is any association between the prevalence of such modifiable risk factors and socio-economic status (SES) or school type of the children. SUBJECTS AND METHODS: This is a cross-sectional descriptive study involving 400 primary school students in Asaba. Albuminspecific dipstick urinalysis was used to determine microalbuminuria while standard dip-stick urinalysis was used to determine proteinuria. Weight, height, body mass index (BMI) and blood pressure were measured for each child. RESULTS: Modifiable risk factors for CKD were found among primary school children in Asaba with prevalence rates of 3.5%, 9.8%, 17.3%, and 18.8% for hypertension, obesity, proteinuria and microalbuminuria respectively. Obesity and proteinuria showed significant linear trend with SES (p < 0.005 and P=0.004, respectively) and were significantly higher in those that attended private schools compared with public schools (P < 0.005 and P=0.004, respectively). The burden of hypertension and microalbuminuria among the children were not influenced by their SES (p =0.94 and P= 0.99, respectively) or the school type the children attended (P=0.35 and P=0.44, respectively). CONCLUSION: Obesity and proteinuria which are known risk factors for CKD in adulthood were noted mostly among children of high socioeconomic status.

CONTEXTE: Le fardeau de la maladie rénale chronique (IRC) est énorme, en particulier dans les pays en développement comme le Nigéria. Au Nigeria, les modalités de traitement de l'IRT (thérapie de remplacement rénal) ne sont pas facilement disponibles et, lorsqu'elles sont disponibles, elles ne sont pas abordables. Par conséquent, la néphrologie préventive visant à la détection précoce et au traitement rapide des enfants présentant des facteurs de risque d'IRC est devenue l'alternative viable pour enrayer ce problème croissant. OBJECTIF: Déterminer le fardeau de certains facteurs de risque modifiables d'IRC à l'âge adulte (hypertension, obésité, protéinurie et microalbuminurie) chez les enfants du primaire à Asaba et déterminer s'il existe une association entre la prévalence de ces facteurs de risque modifiables et la le statut économique (SSE) ou le type d'école des enfants. SUJETS ET MÉTHODES: Il s'agit d'une étude descriptive transversale portant sur 400 élèves du primaire d'Asaba. Une analyse d'urine sur bandelette réactive spécifique à l'albumine a été utilisée pour déterminer la microalbuminurie tandis que l'analyse d'urine sur bandelette réactive standard a été utilisée pour déterminer la protéinurie. Le poids, la taille, l'indice de masse corporelle (IMC) et la pression artérielle ont été mesurés pour chaque enfant. RÉSULTATS: Des facteurs de risque modifiables d'IRC ont été trouvés chez les enfants du primaire à Asaba avec des taux de prévalence de 3,5 %, 9,8 %, 17,3 % et 18,8 % pour l'hypertension, l'obésité, la protéinurie et la microalbuminurie respectivement. L'obésité et la protéinurie ont montré une tendance linéaire significative avec le SSE (p < 0,005 et P = 0,004, respectivement) et étaient significativement plus élevées chez ceux qui fréquentaient les écoles privées par rapport aux écoles publiques (P < 0,005 et P = 0,004, respectivement). Le fardeau de l'hypertension et de la microalbuminurie chez les enfants n'était pas influencé par leur SSE (p = 0,94 et P = 0,99, respectivement) ou le type d'école fréquentée par les enfants (P = 0,35 et P = 0,44, respectivement). CONCLUSION: L'obésité et la protéinurie qui sont des facteurs de risque connus d'IRC à l'âge adulte ont été notées principalement chez les enfants de statut socio-économique élevé. MOTS CLÉS: Hypertension, obésité, protéinurie, microalbuminurie, maladie rénale chronique.

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu.

BACKGROUND: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. OBJECTIVES: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. MATERIALS AND METHODS: The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. RESULTS: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). CONCLUSION: Hematological abnormalities and malnutrition occur in HIV positive children.

Chronic kidney disease in children as seen in a tertiary hospital in Enugu, South-East, Nigeria.

BACKGROUND: The prevalence of chronic kidney disease (CKD) in children has been reported to be rising locally and globally. There is a dearth of data and inadequate facilities for the management of CKD in children in most of the developing countries like Nigeria. OBJECTIVES: The objective of this study is to ascertain the prevalence of CKD among children seen at University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria and also to determine the stage of CKD at presentation, possible etiology, treatment options offered and the outcome. MATERIALS AND METHODS: A retrospective review of pediatric ward admissions in UNTH over a 5 year period (July, 2007 to June, 2012) was done. Information, including the age at presentation, symptoms, level of renal function, management and outcome, were obtained from the medical case notes. RESULTS: There were 3002 pediatric admissions within the period of review, of which 98 (3.3%) had CKD, giving incidence of 3.0 new cases per million-child population per year and the prevalence of 14.9 per million children population. Majority (54.1%) of those with CKD were over 10 years of age. Edema, oliguria and hypertension were the most frequent clinical features. The most common etiology was glomerular disease (63.6%) and 44.9% presented in CKD stage 4 and 5. Renal replacement therapy (RRT) was offered to 25 (25.5%) of the patients; 6 (24%) of whom had hemodialysis and 3 (12%) had acute peritoneal dialysis while 16 (64%) were managed conservatively. None of the patients had chronic or adequate dialysis. The overall outcome showed that 8 (8.2%) died while on admission, 15 (15.3%) left against medical advice (discharge against medical advice) because of financial constraints and could not access the therapy, 25 (25.5%) were discharged on conservative management and lost to follow-up while another 50 (51.0%) were discharged and still on follow-up. CONCLUSION: CKD in children poses myriad of challenges in management in our setting with late presentation of patients and limited resources being prominent. The majority of patients could not access and sustain RRT and the outcome continues to be daunting.