Are We Missing Hypothyroidism among Children with Sickle Cell Anaemia?

Background: Children with sickle cell anaemia have been reported to have potential risk of hypothyroidism from chronic blood transfusions and probable thyroid tissue ischaemia. However, few studies on hypothyroidism status of children with sickle cell anaemia in Nigeria are available. The objective of this study was to determine the prevalence of hypothyroidism among children with sickle cell anaemia. Methods: A cross sectional study that assayed the thyroid hormones and thyroid stimulating hormone (TSH) of 71 children with sickle cell anaemia was conducted at Olabisi Onabanjo University Teaching Hospital Sagamu. Using age appropriate hormonal reference values, the subjects were classified into subclinical, primary and secondary hypothyroidism. Results: The mean serum TSH, Free T3, and Free T4 were comparable irrespective of age category (p > 0.05). No subject was identified to have low TSH value while 7.0% had high TSH value. Low free T3 was identified in 1.4% and 8.5% had high free T3 values. Low free T3 and free T4 were seen in 11.3% each of the subjects. The overall prevalence of primary, secondary and subclinical hypothyroidism was 0%, 0% and 4.2%, respectively. Conclusion: Sub-clinical hypothyroidism does occur in Nigerian children with sickle cell anaemia. Routine screening for hypothyroidism is advocated in all children with sickle cell anaemia.

Mothers' knowledge about birth asphyxia: the need to do more!

BACKGROUND: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. OBJECTIVE: The objective of this study was to assess the knowledge of mothers, who received health facility-based antenatal care during their last pregnancy, about birth asphyxia and relate their knowledge to their places of antenatal care. MATERIALS AND METHODS: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. RESULTS: Out of 354 mothers, 56.5% received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5% of attendees of teaching hospital; and 26.4% of attendees of private antenatal clinics received counseling about birth asphyxia. Overall, 38.9% of the respondents had satisfactory knowledge about birth asphyxia; 47.5% of teaching hospital attendees; and 28.1% of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status, lack of counseling, and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. CONCLUSION: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia.

Mothers' Knowledge about Birth Asphyxia: The Need to do More!

Background: Health education is an important tool required for reducing the burden of birth asphyxia in the developing world. Objective: The objective of this study was to assess the knowledge of mothers; who received health facility-based antenatal care during their last pregnancy; about birth asphyxia and relate their knowledge to their places of antenatal care. Materials and Methods: A cross-sectional survey of mothers of infants attending the Immunization clinic in a Nigerian Teaching Hospital was done between July and October 2010 using a close-ended questionnaire. Consecutively consenting mothers were enrolled into the study. Results: Out of 354 mothers; 56.5 received counseling about birth asphyxia during antenatal clinic visits in their last pregnancy; 85.5 of attendees of teaching hospital; and 26.4 of attendees of private antenatal clinics received counseling about birth asphyxia. Overall; 38.9 of the respondents had satisfactory knowledge about birth asphyxia; 47.5 of teaching hospital attendees; and 28.1 of private clinic attendees had satisfactory knowledge about birth asphyxia. Lower socioeconomic status; lack of counseling; and nonattendance of teaching hospital antenatal clinic were associated with poor knowledge about birth asphyxia. Conclusion: Most of the mothers surveyed had poor knowledge about the risk factors and sequelae of birth asphyxia. The health system needs to improve health education of expectant mothers about birth asphyxia

Nutritional status of semi-urban Nigerian school children using the 2007 WHO reference population.

BACKGROUND: There is paucity of data on the nutritional status of school-age children in Sagamu town of Southwestern Nigeria. OBJECTIVE: To determine the nutritional status of primary school children in Sagamu Local Government Area, Nigeria. METHODS: A cross-sectional survey of primary school children aged 6 to 10 years in Sagamu, Southwestern Nigeria was done. Eight schools were selected using a multi-stage sampling technique. Children randomly selected proportionately from the schools were studied. The weight-for-age, height-for-age and BMI of these children were compared with the 2007 WHO reference values to diagnose underweight (WA <-2SD), stunting (HA <-2SD), thinness (BMI <-2SD), overweight (BMI > +1SD) and obesity (BMI > +2SD). RESULTS: A total of 1016 children comprising 479 (47.1%) boys and 537 (52.9%) girls were studied. The prevalence of malnutrition was 401(39.4%) and boys were more malnourished compared to girls (p =0.002). The overall prevalences of underweight, stunting and thinness were 260(25.5%), 144(14.2%) and 226(22.2%) respectively. Overweight and obesity were present in 31(3.0%) and 5(0.5%) of the population studied respectively. Boys were significantly more often underweight and stunted. CONCLUSION: The prevalence of under-nutrition among school children in Sagamu, Nigeria was high and the girls were generally better nourished than the boys. Efforts to reduce the burden of malnutrition in this population may include nutritional surveillance, food supplementation and free school meals.

Growth pattern of schoolchildren in Sagamu, Nigeria using the CDC standards and 2007 WHO standards.

OBJECTIVE: To compare the median weight, height and body mass index of school children with the 2000 CDC and 2007 WHO reference values. SETTINGS: Schoolchildren in Sagamu, Nigeria. DESIGN: Cross-sectional survey. METHODS: Between November and December, 2008, 1690 school children aged 6 to 16 years from 8 primary schools were surveyed using multi-stage sampling methods. The weight, height and body mass index (BMI) were recorded for each child. The Z-scores of the median anthropometric parameters for each age and sex were determined with the LMS statistical method using the values of L, M and S provided on the CDC and WHO charts. RESULTS: The weight, height and BMI Z-scores were less than the reference values provided on the CDC and WHO charts but were generally closer to the WHO standards compared to the CDC standards. The median weight, height and BMI for females generally plotted higher on CDC and WHO chart compared to the males. The prevalence of underweight and stunting were relatively lower while the prevalence of overweight and obesity was relatively higher among children aged 6 to 10 years using the WHO references compared to the CDC reference values. CONCLUSIONS: The WHO references would under-diagnose under-nutrition and over-diagnose overweight/obesity in the population studied.

The incidence and outcome of bilirubin encephalopathy in Nigeria: a bi-centre study.

OBJECTIVE: To determine the current trends in the incidence and outcome of bilirubin encephalopathy among Nigerian babies. METHODS: A review of the hospital records of babies managed for bilirubin encephalopathy at the Wesley Guild Hospital (WGH), Ilesa and Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, both in southwest Nigeria between 2001 and 2005 was carried out. The age, sex, weight, body temperature on admission, place of delivery and outcome of hospitalization were studied. The fatal cases and the survivors were compared for risk factors for mortality. RESULTS: Fifty eight (3.4%) and 57 (2.3%) babies had bilirubin encephalopathy out of 1706 and 2492 total neonatal admissions at OOUTH and WGH respectively. Of these 115 babies, 3 (2.6%), 84 (73.0%) and 28 (24.3%) were aged <3 days, 3-6 days and 7 days or more. Sixty eight (59.1%) babies were delivered in orthodox health facilities. Aside clinically suspected cases of G6PD deficiency, ABO incompatibility and septicaemia were commonly associated with bilirubin encephalopathy, Forty four (38.3%), 36 (31.3%) and 35 (30.4%) had Unconjugated bilirubin of <340 micromol/L, 341-425 micromol/L and >425 micromol/L respectively Sixty eight (59.1%) were discharged, 42 (36.5%) died while 5 (4.7%) were discharged against medical advice. Prematurity, low birth weight, severe anaemia and inability to do Exchange Blood Transfusion were significant risk factors for mortality among babies with bilirubin encephalopathy. Cerebral palsy, seizure disorders and deafness were the leading neurological sequelae (86.4%, 40.9% and 36.4% respectively) among the 22 survivors who were followed up. CONCLUSION: Bilirubin encephalopathy remains a common clinical finding in Nigeria and the associated mortalities and neurological sequelae are significant.

Do working children have worse academic performance?

OBJECTIVE: To examine the effect of child labor on school children's academic performance. METHODS: Primary school children engaged in child labor were compared with age, sex and school-matched controls for absence from school and scores obtained at sessional examination in English language, Mathematics, Sciences and Social studies. RESULTS: There was no significant difference in the mean rate of school absence (p = 0.80), mean aggregate examination scores (p = 0.1) and proportion of class repeaters (p = 0.16) among working school children and the controls. However, a significantly higher proportion of the controls had high (>75%) average examination scores compared with the working school children (p = 0.017). Similarly, the controls performed better than working school children in each of four core subjects but significant differences were observed only in Social Studies and Science (p = 0.006 and 0.001 respectively). CONCLUSION: There is some undermining of academic performance among children who combine schooling with child labor despite comparable school absence with the controls.

A ten-year study of measles admissions in a Nigerian teaching hospital.

BACKGROUND: Measles remains a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The last report on measles from our center was about 15 years ago. A review of the current status is necessary in order to strengthen interventional strategies. OBJECTIVES: To study the burden and epidemiological correlates of measles admissions in a Nigerian teaching hospital. DESIGN: Retrospective. SUBJECTS: Children admitted with measles infection and/or complications. METHODS: A review of medical records of measles admissions over the 10-year period, May 1994 and April 2004. RESULTS: One hundred and sixty four children (6.1% of paediatric admissions) aged 4 months to 12 years (28.4 + 28.82 months) were admitted with measles. Sixty-three infants (< or = 12 months old) accounted for 39.4% of patients with about half of them younger than nine months. History of vaccination against measles was obtained in 43 (29.5%) subjects. Forty- eight (32.9%) children were underweight weighing between 60-80% of the expected weight for age and six (4.1%) of them were marasmic weighing below 60% of expected weight for age. None of the patients had oedema. The commonest complication was bronchopneumonia (55.5%). Major complications were less commonly associated with children who weighed more than 80% of expected weight (p = 0.011). The case fatality rate was 7.5 % accounting for 0.4% of childhood mortality. Children without prior measles vaccination, those of low socio-economic status and those weighing less than 80% of expected for age all had significantly higher mortality rates. (p< 0.05 in each case). CONCLUSION: Measles incidence has risen in the last ten years in Sagamu and its environs but it is still largely a disease of young children. Therefore routine immunization and disease surveillance should be strengthened. Supplemental immunization activities should also be considered.

Current trends in the prevalence and aetiology of childhood congestive cardiac failure in Sagamu.

Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0-14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 +/- 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III-V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.