Microalbuminuria in type 1 diabetes mellitus children in University of Port Harcourt Teaching Hospital, Nigeria.

INTRODUCTION: glycaemic control is usually best achieved using the basal bolus regimen, however, this is not always available in resource-limited settings. Long-term complications like renal parenchymal disease are consequences of poor glycaemic control. Screening type 1 diabetes patients irrespective of their disease duration was used to buttress the need for ethical principles of justice to be incorporated in the care of type 1 diabetes children. METHODS: urine albumin creatinine ratio (UAC) was calculated for 20 type 1 diabetes mellitus children in the endocrinology clinic after submitting early morning urine over a 4-month period. The calculated ratio was compared between duration of disease (< 5 years and > 5 years) and between insulin regimen types (mixtard and basal bolus). Repeat tests were done for children who had elevated UAC ratio levels after 2 months. RESULTS: there were 5 males and 15 females and the mean UAC ratio of the cohort was 123mg/g with a range of 5.30 - 906 mg/g. Twelve children (8 diagnosed less than 5 years) had UAC ratio ≥ 30mg/g with a mean of 193.15. The repeat mean UAC ratio for these was 144.35 mg/g. Children who had diabetes for more than 5 years and were on mixtard had higher UAC ratio than those with diabetes < 5 years and on basal bolus. CONCLUSION: the prevalence of microalbuminuria is high in our cohort of type 1 diabetes children and these were children on mixtard and had diabetes greater than 5 years.

Newborn screening in Nigeria: Associating the screening of congenital hypothyroidism and sickle cell disease can be a winning choice?

ntroduction: Nigeria like many African countries has tried to start the newborn screening for congenital hypothyroidism and many failed. Since sickle cell disease is more common in Nigeria, the hypothesis is that incorporating it into a screening programme for congenital hypothyroidism will improve the uptake of the programme by parents and government. METHODS: Different aspects of newborn screening with difficulties and challenges in running newborn screening were identified and discussed. RESULT: Identifying that for newborn screening to be successful, several key factors have to be put in place including but not limited to organizational structure, system thinking, finance, legislative and political will. A proper recall system for test positives and diagnostic/confirmatory test must be put in place before the programme starts. Since several other screening programmes like sickle cell disease, cervical and breast cancer have run successfully in Nigeria, incorporating one of them into the newborn screening for CH can make the programme succeed as there will be better uptake by the population and the policy makers. CONCLUSION: The difficulty in establishing a newborn screening programme in Nigeria stem from health care financing, organizing the programme from screening through to recall and treatment, and ultimately, prevention of diseases.

Normative Thyroid-Stimulating Hormone Values for Healthy Nigerian Newborns.

BACKGROUND: Congenital hypothyroidism is a common congenital endocrine disorder prevailing all over the world. No nationwide screening exists for any sub-Saharan country. We present normative cord and capillary thyroid-stimulating hormone (TSH) values for healthy Nigerian newborns. SUBJECTS AND METHODS: A cross-sectional study was carried out in 6 university hospitals in Nigeria between January 1 and December 31, 2013. Cord and heel blood placed on 4 concentric circles on a Whartman filter paper were analysed for TSH within 1 week of collection using AutoDelfia 1235 immunoassay (Perkin Elmer Wallace, Boston, Mass., USA) at Charité - Universitätsmedizin Berlin, Berlin, Germany. The mean TSH levels of the newborns were determined, considering their sex, birthweight, socioeconomic status, and birth city. The association between the mean TSH level and other parameters was determined by analysis of variance. RESULTS: A total of 2,014 subjects were recruited during the study period. The mean TSH value for the subjects was 1.86 µIU/ml, and 98.1% of the newborns were within the 2.5th and 97.5th percentiles (range: 0.09-7.90 µIU/ml) of the TSH levels. We collected 247 cord and 1,767 heel samples, respectively, and the range was slightly higher in samples from cord blood. CONCLUSION: The study highlights the normal reference values for capillary/cord TSH levels in term Nigerian newborns. TSH was higher in one region, attributable to earlier sampling, but was not influenced by gender, socioeconomic status, or birthweight.

Survey on Knowledge of Healthcare Providers about Childhood Diabetes Mellitus in Tertiary healthcare Institution in; Port Harcourt; Nigeria

With increasing prevalence of childhood DM; it is important that health care providers know about the disease and manage this properly. We aimed to survey the knowledge and experience of health care providers in tertiary institution so as to make informed recommendations.Pretested self-administered and standardised questionnaires were distributed to nurses; and residents including paediatricians- in - training in a tertiary health institution. The knowledge and proficiency questionnaires were made simple and multi choice to reduce ambiguity. Mean knowledge was compared using ANOVA; and Tukey post hoc analyses and p values 0.05 were considered significant.Two hundred questionnaires were distributed and 185 were returned filled giving a response rate of 92.5%. There were 80 (43.2%) nurses; and 105 (56.8%) doctors; 41 (22.2%) of which were paediatricians or paediatricians-in-training. Paediatric residents had higher overall mean knowledge in all aspects evaluated. About 60% of respondents correctly identified diagnosis of DM based on FBG; and 61.6% got the response for random BG. Forty six (24.9%) of respondents did RBG for all children attending their facilities; only 16 of these were paediatric residents. Nurses were willing to give OHA to established T1DM children.Many health workers have little knowledge and practice experience in DM with the attendant effect of poor management of these children. We thus recommend a review of undergraduate medical curriculum; and CME to limit this dearth in knowledge

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria.

BACKGROUND: Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital. METHODS: This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0. RESULTS: Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs CONCLUSIONS: The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs.Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality.