Sexual Maturation of Female Adolescent Patients with Sickle Cell Anaemia in Lagos, Nigeria.

BACKGROUND: Sickle cell anaemia (SCA) has been shown to have adverse effects on growth and sexual development. Recent Nigerian studies have reported a declining trend in the age of sexual maturation and menarche in haemoglobin AA (HbAA) individuals. OBJECTIVE: To evaluate the sexual maturation of female patients with SCA aged 10 to 19 years seen at Lagos University Teaching Hospital Idi-Araba, Lagos and Sickle Cell Foundation. METHODS: It was a cross-sectional study involving 140 girls with SCA (subjects) and an equal number of girls with HbAA (controls) who were matched for age and socio-economic class over a fivemonth period. The evaluation involved anthropometry, calculation of BMI and determination of breast and pubic hair development using Tanner staging. RESULTS: The mean BMI for the subjects was 17.2±2.39 kg/m2and 20.2±3.09 kg/m2 for the controls (p < 0.001). The mean age at onset of breast development (B2) was 13 ± 0.39 years in the subjects and 10.5 ± 0.51 years in the controls (p < 0.001). The corresponding mean age for pubic hair development (PH2) was also higher at 13.8 ± 0.59 years for the girls with SCA and 10.4 ± 0.51 years for the controls (p <0.001), while menarche was achieved in the subjects at 14.7 ± 1.68 years and in the controls at 12.3 ± 1.33 years (p < 0.001). Upper socioeconomic class was associated with earlier menarche and faster transition from pre-pubertal stage to pubertal stage of sexual maturation in the controls but was not observed in the SCA subjects. CONCLUSION: Sexual maturity in patients with SCA lagged behind those of the HbAA controls.

CONTEXTE: Il a été démontré que la drépanocytose (ACS) a un effet néfaste sur la croissance et le développement sexuel. Des études nigérianes récentes ont rapporté une tendance à la baisse de l'âge de maturation sexuelle et de la ménarche chez les individus hémoglobine AA (HbAA). OBJECTIF: Évaluer la maturation sexuelle de patientes atteintes d'ACS âgées de 10 à 19 ans vues à l'hôpital universitaire de Lagos IdiAraba, Lagos et à la Fondation drépanocytaire. MÉTHODOLOGIE: Il s'agissait d'une étude transversale portant sur 140 filles atteintes d'ACS (sujets) et un nombre égal de filles atteintes d'AAb (témoins) qui ont été appariées pour l'âge et la classe socio-économique sur une période de cinq mois. L'évaluation comprenait des mesures anthropométriques, le calcul de l'IMC et la détermination du développement des poils mammaires et pubiens à l'aide de la stadification Tanner. RÉSULTATS: L'IMC moyen pour les sujets était de 17,2±2,39 kg/m2 et de 20,2±3,09 kg/m2 pour les témoins (p<0,001). L'âge moyen au début du développement mammaire (B2) était de 13±0,39 ans chez les sujets et de 10,5±0,51 ans chez les témoins (p<0,001). L'âge moyen correspondant pour le développement des poils pubiens (PH2) était également plus élevé à 13,8±0,59 ans pour les filles atteintes d'ACS et à 10,4±0,51 ans pour les témoins (p<0,001) tandis que la ménarche a été atteinte chez les sujets à 14,7±1,68 ans et chez les témoins à 12,3±1,33 ans (p <0,001). La classe socio-économique supérieure a été associée à une ménarche plus précoce et à une transition plus rapide du stade prépubertaire au stade pubertaire de maturation sexuelle chez les témoins, mais n'a pas été observée chez les sujets SCA. CONCLUSION: La maturité sexuelle chez les patients atteints d'ACS était inférieure à celle des témoins de l'HbAA. MOTS CLÉS: Hémoglobine SS, Maturité sexuelle, Ménarche.

Efficacy of Hexetidine, Thymol and Hydrogen Peroxide-Containing Oral Antiseptics in Reducing Sars-Cov-2 Virus in the Oral Cavity: A Pilot Study.

BACKGROUND: Studies have demonstrated the role of sputum as a site of severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2) transmission. However, there is limited literature on the virucidal efficacy of oral antiseptics against SARS-CoV-2 virus. This study investigated the virucidal efficacy of three oral-antiseptics compared to a placebo-control in the sputum of SARS-CoV-2 infected individuals. METHODOLOGY: A pilot study of adults with SARS-CoV-2 positive results, as determined by reverse transcription-polymerase chain reaction (RT-PCR) of <7 days. The oral antiseptics investigated were: Hexetidine (0.1% w/v); Thymol (0.063% w/v) and H2O2(1.5%) compared to de-mineralized sterile water (Placebo-control). The primary outcome measure was the proportion of negative RT-PCR results at 15-mins, 30-mins, 1-hour, 2-hours and 4-hours After Oral antiseptics Interventions (AOI) compared to the placebo-control. Statistical analysis was done using STATA 15.0 software with p-values of <0.05 considered statistically significant. RESULTS: Data from a total of 66 participants that were RT-PCR SARS-CoV-2 positive at baseline (0-min) was analysed. At 15-mins AOI, the highest proportion of negativation from sputum samples was observed in the Hexedine group, with 69.2% of the baseline PCR positive cases converting to negative compared to 46.7% in the placebo-control group. In addition, H2O2 demonstrated efficacy at 2-hours AOI compared to placebo-control (62.5% vs 37.5% respectively) and other oral-antiseptics. Across all time-points, the oral-antiseptic groups compared to the placebo-control group, there was no statistically significant difference in the proportion of sputum samples which converted to a negative status (p>0.05). CONCLUSION: The findings in this study suggest there was no significant difference in the proportion of participants who converted to a negative sputum status across the treatment groups at various time points. Future studies could compare the cycle threshold (ct) viral titre values of sputum samples to determine quantitative differences.

CONTEXTE: Des études ont démontré le rôle des expectorations comme un site de transmission du syndrome respiratoire aigu sévère-coronavirus- 2 (SRAS-CoV-2). Cependant, il existe peu de documentation sur l'efficacité virucide des antiseptiques oraux contre le virus du SRASCoV-2. Cette étude a examiné l'efficacité virucide de trois antiseptiques oraux par rapport à un contrôle placebo dans les expectorations de personnes infectées par le SRAS-CoV-2. MÉTHODOLOGIE: Une étude pilote menée auprès d'adultes dont les résultats sont positifs pour le SRAS-CoV-2, tels que déterminés par la réaction en chaîne de la polymérase par transcription inverse (RT-PCR) pendant 7 jours. Les antiseptiques oraux étudiés étaient : Hexetidine (0,1% p/v) ; Thymol (0,063% p/v) et H2O2 (1,5%) par rapport à l'eau stérile déminéralisée (Placebo-contrôle). Le principal critère d'évaluation était la proportion de résultats RT-PCR négatifs 15 minutes, 30 minutes, 1 heure, 2 heures et 4 heures après les interventions antiseptiques orales (AOI) par rapport au contrôle placebo. L'analyse statistique a été réalisée à l'aide du logiciel STATA 15.0, les valeurs p de <0,05 étant considérées comme statistiquement significatives. RÉSULTATS: Les données d'un total de 66 participants qui étaient positifs à la RT-PCR SARS-CoV-2 au départ (0 minute) ont été analysées. Au bout de 15 minutes, la plus forte proportion de négativation des échantillons d'expectoration a été observée dans le groupe Hexedine, 69,2 % des cas positifs au départ par PCR devenant négatifs, contre 46,7 % dans le groupe témoin placebo. En outre, l'H2O2 a démontré son efficacité à 2 heures après l'apparition de la maladie par rapport au groupe placebo (62,5 % contre 37,5 % respectivement) et aux autres antiseptiques oraux. Pour tous les points temporels, les groupes d'antiseptiques oraux comparés au groupe placebo n'ont pas présenté de différence statistiquement significative dans la proportion d'échantillons d'expectoration qui sont devenus négatifs (p>0,05). CONCLUSION: Les résultats de cette étude suggèrent qu'il n'y a pas de différence significative dans la proportion de participants qui sont passés à un statut négatif d'expectoration dans les groupes de traitement à différents moments. Les études futures pourraient comparer les valeurs du titre viral au seuil de cycle (ct) des échantillons d'expectoration afin de déterminer les différences quantitatives. MOTS CLÉS: SRAS-CoV-2, antiseptiques oraux, hexétidine, peroxyde d'hydrogène.

Dietary habits, physical activity and sleep pattern among in-school adolescents in Lagos, Nigeria

Background: Overnutrition has been documented at epidemic levels in children and adults. The associated risk factors may include poor dietary habits, sedentary behaviour, inadequate sleep and low parental education. Objective: To describe dietary habits, physical activity and sleep patterns among secondary school adolescents. Methods: A cross-sectional study of 1,120 adolescents recruited from public and private secondary schools in Lagos, Nigeria, was carried out to study the dietary habits, sleep patterns and physical activity in relation to nutritional status. Results: Ten per cent of the adolescents skipped breakfast, while 28% had fruits on up to five days of the week. Eleven per cent had a sweetened drink every day, while 20 % had a sweetened drink on most days of the week. One out of four (26%) adolescents had more than two hours of screen time daily, and only 5% engaged in sporting activities up to five times weekly. One-third of the students slept for less than six hours daily and experienced sleeping difficulties. Multivariate analysis showed that females were twice as likely not to participate in sports (OR = 2.38, CI = 1.3-4.37, p = 0.002 and to have a higher intake of confectionaries (OR = 1.47, CI = 1.07-2.04, p = 0.01. Conclusion: Poor dietary habits, inadequate physical activity and insufficient sleep were observed among secondary school adolescents. A multi-pronged approach to improve these behaviours is recommended

Frecuencia de enfermedad cardíaca congénita en niños con Síndrome de Down: ¿cuál es la influencia de la edad materna? / 1 OCCURRENCE OF CONGENITAL HEART DISEASE AMONG CHILDREN WITH DOWN SYNDROME: WHAT IS THE INFLUENCE OF MATERNAL AGE ?

La frecuencia del síndrome de Down es fuertemente dependiente de la edad materna y la incidencia varia según las edades maternas. Esta incidencia puede diferir de un país a otro de acuerdo a los factores sociales y ambientales predominantes en tales países. Este estudio pretende documentar la prevalencia de defectos cardíacos congénitos en pacientes con síndrome de Down, identificar la asociación entre la edad materna y la frecuencia de enfermedades cardíacas congénitas en estos sujetos. Métodos: El estudio fue prospectivo, cruzado-sectorial y consecutivo, involucrando a sujetos de dos centros los cuales eran un hospital terciario hospital vado y un centro cardiológico principal. Los niños con características clínicas de síndrome de Down fueron sometidos a ecocardiografías transtorácicas efectuadas por un cardiólogo. Resultados: Un total de 195 pacientes con síndrome de Down cuyas edades abarcaban entre 1 día a 12 años, fueron estudiados. La edad media + SD fue 241.03 + 529.71 días y la relación masculino a femenino de 1.04.1. El promedio de la edad materna iba desde los 19 a los 44 años con una edad media +SD de 32.36 + 5.43 años . Hasta el 16.9 % tenían un corazón estructuralmente normal. El defecto más común fue el defecto septal aurículoventricular 24.1 % . No hubo una asociación significativa entre la edad materna y la frecuencia de defectos cardíacos congénitos en estos sujetos. Conclusión: La incidencia de enfermedad cardíaca congénita es alta en los sujetos con síndrome de Down. Los defectos aurículoventriculares fueron los defectos cardíacos más comunes en estos sujetos. La incidencia de defectos cardíacos congénitos en los sujetos fue decreciendo de la edad materna de 36 años y por encima. La evaluación cardíaca rutinaria incluyendo la ecocardiografía se recomienda a todos los pacientes con síndrome de Down.

Summary The occurrence of Down syndrome is strongly dependent on maternal age and incidence varies at various maternal ages. This incidence may differ from one country to another according to the social and environmental factors predominant in such countries. The study aims to document the prevalence of congenital heart defects in patients with Down syndrome, identify the association between maternal age and occurrence of congenital heart disease among these subjects. Methods. The study was prospective, cross-sectional and consecutive, involving subjects from two centers which were, a tertiary hospital a private hospital and a major cardiology center. Children with clinical features of Down syndrome had transthoracic echocardiography done by a cardiologist. Results. A total of 195 patients with Down syndrome with their ages between 1 day to 12 years. The mean age + SD were 241.03 + 529.71 days and male to female ratio of 1.04.1. The mother´s age range was from 19 to 44 years with a mean age of + SD of 32.36+ 5.43 years. Up to 16.9 % had structurally normal heart. The most common heart defect was atrioventricular septal defect 24.1 %. There was no significant association between maternal age and occurrence of congenital heart defects in the subjects. Conclusion. The incidence of congenital heart disease is high among subjects with Down syndrome. Atrioventricular defects were the commonest cardiac defect among the subjects. The incidence of congenital heart defect in the subjects was decreasing from maternal age 36 years and above. Routine cardiac evaluation including echocardiography is recommended for all patients with Down syndrome

Pneumococcal-specific IgG levels after 13-valent pneumococcal conjugate vaccination in Nigerian children with sickle cell disease.

BACKGROUND: Children with sickle cell disease (SCD) are particularly susceptible to pneumococcal infection. Administration of the 13-valent conjugate pneumococcal vaccine which is now available in Nigeria may help to reduce the incidence. OBJECTIVES: To determine the serum level of pneumococcal-specific IgG (PIgG) in a cohort of patients with SCD after administration of a single-dose of a 13-valent pneumococcal conjugate vaccine. METHODS: The study was conducted between December 2011 and March 2012 among children with SCD aged 5 months to 5 years attending the sickle cell clinic in five public hospitals in Lagos. Altogether, 151 children with SCD and 52 without it (controls) were recruited by convenience sampling from the sickle cell clinics and well-child clinics. Blood samples were collected for PIgG concentrations before and 2 months after a single dose of the Prevenar 13 vaccine. Seroconversion was defined as a fourfold or greater increase in antibody concentration after vaccination while those with PIgG concentrations ≥200 µU/ml were considered to have protective levels. RESULTS: The age range of the total study group was 5-60 months with a mean (SD) of 39.04 (15.44) months and a median of 39 months. The mean (SD) ages of subjects with and without SCD were 38.91 (15.75) months and 16.39 (15.45) months, respectively. The PIgG concentration 2 months post-vaccination was significantly greater than the pre-vaccination levels in all age categories in both groups and almost all subjects had protective PIgG concentrations 2 months after vaccination. A four-fold increase in PIgG concentration was detected more commonly in the controls than in SCD patients. CONCLUSION: Prevenar 13 provided protective immunity in all vaccinated children but those under 2 years of age who had non-protective levels pre-vaccination benefited the most.

National neonatal resuscitation training program in Nigeria (2008-2012): a preliminary report.

BACKGROUND: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth. MATERIALS AND METHODS: Between 2008 and 2012, doctors and nurses drawn from all the geo-political zones were trained using the Neonatal Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire-based, cross-sectional surveys of doctor and nurse trainees from the six geo-political zones in Nigeria were conducted eight months after the primary training, to evaluate the post-training neonatal resuscitation activities. RESULTS: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post-training period. The nurses used bag and mask for infant resuscitation more frequently, compared to doctors, with the rate fluctuating between two-to-one and four-to-one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants. CONCLUSION: The NRT in Nigeria is well-subscribed and the frequency of secondary training is good.

Transcatheter closure of patent ductus arteriosus and atrial septal defect without on-site surgical backup: a two-year experience in an African community.

Congenital heart disease contributes significantly to the health burden of children in Nigeria. Interventions for congenital heart disease have been available in the developed world since the first report on device closure of patent ductus arteriosus (PDA) in 1967 by Porstmann. However, this did not start in Nigeria until October 2010. This study aimed to document the profiles of the patients who had undergone interventions for congenital heart diseases since the availability of the procedure, the challenges encountered, and the prospects associated with the interventions at the study site. All the patients referred to undergo interventions for congenital heart disease at the study center between October 2010 and 2012 were studied. The profile of the patient, including diagnosis at referral, indication for interventions, and interventions performed, were documented. The patients ranged in age from 3 to 62 years (mean age, 13.54 ± 17.7 years), and the male-to-female ratio was 1:3. The diagnosis at referral included PDA in 10 (83 %) of the 12 patients and secundum atrial septal defect in 2 patients (17 %). They all had transcatheter closure of the defects. Interventional procedures for congenital heart diseases currently are available locally, but the high degree of manpower training required, the cost, and the local availability of consumables are major factors limiting their use. Regional and international collaboration could be mutually beneficial.

Hypoglycaemia in Children Aged 1 Month to 10 Years Admitted to the Children's Emergency Centre of Lagos University Teaching Hospital; Nigeria

Background. Hypoglycaemia occurs in many disease states common in the tropics; and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality. Objectives. To determine the prevalence of and clinical conditions associated with hypoglycaemia. Methods. A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose 2.5 mmol/L. Results. The median age of the study subjects was 24 months; with a range of 1.5 - 120 months. A total of 248 patients (57.6) were 24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3 v. 5.4; p0.01). Conclusion. Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis

Serum iron status of under-five children with sickle cell anaemia in lagos, Nigeria.

Background. Iron status in patients with sickle cell anaemia is a matter of continuing investigation. Objective. This paper aims to determine the serum iron status of under-five, sickle cell anaemia patients. Methods. The study spanned from December 2009 to February 2010 at the Consultant Outpatient Clinics involving 97 HbSS subjects and 97 age- and sex-matched HbAA controls. Biochemical iron status was assayed in subjects and controls. Results. Age range of the children was seven months to five years, with a mean of 30.6 (±15.97) months. Irrespective of gender, mean serum iron values were higher in HbAA controls than their HbSS counterparts but the observed difference was not significant (P = 0.299 and 0.111, resp.). The mean total iron binding capacity values of males and females were also not significantly different for sickle cell anaemia subjects and controls (P > 0.05). Males and females with HbAA had significantly lower serum ferritin when compared with their HbSS counterparts. Irrespective of gender, mean transferrin saturation was lower in HbSS subjects but the difference was not statistically significant (P > 0.05). Conclusion. Children with sickle cell anaemia have higher serum ferritin than controls, implying relatively higher iron content in the reticuloendothelial cells.

Assessment of overweight and obesity among Nigerian children and adolescents using triceps skin-fold thickness and body mass index.

The prevalence of obesity is increasing in children and adolescents even in resource-poor countries. The study aimed to determine the prevalence of obesity in a group of Nigerian school children using triceps skin-fold thickness (SFT) and body mass index (BMI). The subjects were 1235 randomly selected primary and secondary Lagos school children aged 5-18 years, triceps SFT was measured with Harpenden® calipers and BMI calculated from weight and height. Using BMI, overweight and obesity were defined as values of 85th to 94th percentile for age and sex and ≥95th percentile, respectively. Using triceps SFT, obesity was defined as SFT > 85th percentile of the NHANES III study. Fifty-seven subjects (15 boys and 42 girls) had SFT > 85th percentile with a higher prevalence in girls than boys (6.4% vs. 2.6%, P = 0.001). The prevalence of BMI-defined overweight and obesity were also higher among girls (11.9% vs. 5.7%, P < 0.001 and 4.7% vs. 2.2%, P = 0.02, respectively). Females of upper socioeconomic class were more likely to be overweight (16.2% vs. 6.6%, P < 0.0001), obese (6.3% vs. 2.8%, P = 0.03) or have elevated SFT (8.2% vs. 4.2%, P = 0.03) than those of low socioeconomic status. Forty-seven of 57 subjects (82.5%) with elevated SFT also had high BMI. The prevalence of obesity is low in the study population but the much higher prevalence of overweight suggests that steps should be taken to control fatness before the figures worsen. In more than 80% of subjects, elevated SFT co-existed with elevated BMI.

International patients with congenital heart disease: what brings them to India?

BACKGROUND: Factors that have led to the increasing popularity of medical travel include the high cost of healthcare, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. AIM: The present study aims to elaborate the factors that attract international cardiac patients to India, to document the proportion of the admissions into the paediatric cardiac ward who are international patients, and to identify the sources of funding of the international patients. METHODS: This was a prospective, cross-sectional, and analytical study carried out between May 2009 and October 2009 in the paediatric cardiac care unit of a large tertiary care cardiac centre in India paediatric wards. Structured questionnaires were administered. RESULTS: A total of 1372 patients were admitted during the study period, of which 155 (11.3%) were patients from countries outside India. Majority of the patients were from Malaysia (45%), Nigeria (23%), and Tanzania (15%). The age ranged from 1 month to 39 years with an average of 61 months. The male to female ratio was 1:1.4 and the majority of subjects (72.5%) were in social classes 3 and 4. cheaper cost and better expertise was the prominent reason for choosing India. More than half of the respondents were either sponsored by the government or self-funded. For patients from Nigeria 53% (9) were sponsored by self (parent), 29% (5) by non-governmental organisations (NGO), 12% (2) by the parent employer, and 6% (1) by the government. CONCLUSION: There is a need for local development of facilities and training of personnel in specialised areas of healthcare to provide succour for a significant number of nationals who might otherwise have suffered and possibly have even died of their ailment. There is also the added advantage that such facilities would save foreign currency and help boost our economy.

Transcatheter closure of patent ductus arteriosus: report of the first case in Nigeria.

BACKGROUND: Since the first report on device closure of patent ductus arteriosus (PDA) by Porstmann et al in 1967, the procedure has gained wide acceptance and has been used all over the world, including parts of Africa. The advantages when compared to surgical closure include shorter procedure time and hospital stay and no scar being left. This mode of treatment was not available in Nigeria prior to this with patients having to travel abroad to benefit. PATIENT AND METHOD: Cardiac catheterisation laboratory became available in Lagos, Nigeria in 2009 and in October 2010, the laboratory collaborated with Lagos State University College of Medicine (LASUCOM) and Lagos State University Teaching Hospital (LASUTH), to perform a device closure on a 3-year old girl with PDA who had presented to LASUTH with heart failure at the age of 6 months. To the best of our knowledge, this is the first time the procedure has been performed in Nigeria RESULTS: The patient made a successful recovery and is haemodynamically stable, on no medications. CONCLUSION: Device closure of PDA is now safe and available in Nigeria.

Relationship between bioelectrical impedance analysis and body mass index in adolescent urban Nigerians.

BACKGROUND: Body mass index is often used to assess adiposity but it does not differentiate between fat and non-fat components of body mass. However, body fat composition may be assessed using bioelectrical impedance analysis. OBJECTIVE: The study aimed to relate body mass index to fat in the assessment of overweight and obesity among adolescent Nigerians. METHODS: Adolescent pupils aged 10 years to 18 years from randomly selected secondary schools in Lagos, Nigeria were studied. Body mass index was calculated while percentage body fat was measured using Tanita body® fat scale model BF 681. Overweight and obesity were defined using age and sex specific criteria for body mass index and for body fat. RESULTS: There were 753 pupils {377(50.1%) males and 376(49.9%) females}. The overall mean values of body mass index for males and females were 18.1±2.72 and 18.9±3.41 (p < 0.05) respectively. The corresponding figures for body fat were 9.5±4.48 and 18.9±7.51 (p<0.05) respectively. About three quarters (76.2%) of the females who had body mass index in the overweight and obesity range had high body fat in comparison to 44.4% of males (p < 0.05). CONCLUSION: Body mass index is more related to body fat in adolescent females than in their male counterparts.

Double-chambered right ventricle: an uncommon congenital heart disease. Case report and literature review.

A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive cardiac failure. An anomalous muscle band divides the right ventricle into two cavities, causing variable degrees of obstruction. Echocardiography is considered a useful method for the diagnosis of this pathology, especially in children. An eight-year-old patient with a small ventricular septal defect (VSD) and double-chambered right ventricle presented with a history of palpitations, easy fatigability and recurrent fever. On presentation, she had features of congestive cardiac failure. A complete diagnosis was initially missed with transthoracic two-dimensional (2-D) echocardiography but later obtained based on transthoracic 2-D echocardiography with Doppler facility. This was confirmed with cardiac catheterisation. The patient was referred for surgical correction, which was successful. Due to the rarity of this condition and the consequences of missing the diagnosis, we present this case in order to highlight the rarity of this congenital heart disease in childhood.

Micturitional dryness and attitude of parents towards enuresis in children attending outpatient unit of a tertiary hospital in Abeokuta, Southwest Nigeria.

BACKGROUND: There is significant variability of the age at which children achieve dryness. OBJECTIVES: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. METHOD: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre, Abeokuta. RESULTS: At age 36 months, 86 (51.8 %) and 34 (20.5 %) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p = 0.009). Twenty-four (26.7 %) children had nocturnal enuresis. Four (4.4 %) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8 % correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem, a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). CONCLUSIONS: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore, health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class.

Changes in the nutritional status of school children and adolescents in Abeokuta, Nigeria between 1983 and 2006.

BACKGROUND: The prevalence of overweight and obesity among children is increasing worldwide with significant health and social consequences. OBJECTIVE: The aim of this study was to determine the current nutritional status and its changes between 1983 and 2006 among school children and adolescents in a south western Nigeria town. METHODS: five hundred and seventy children aged 5 to 19 years from randomly selected primary and secondary schools in Abeokuta, Nigeria had their weights and height measured using standard techniques. The data obtained were compared with data obtained from a similar cross sectional survey carried out in 1983. The National Centre for Health Statistics/World Health Organisation guidelines and cut-off points were used to determine the degree of underweight and stunting. Obesity prevalence was assessed using weight for age greater than 120 % of expected. RESULTS: The mean age of the participants was 12.2 + 3.41 years, 296 (51.5 %) were males. The mean Weight-for-Age Z -score and Height-for-Age Z-score were -1.2773 + 1.14 and -0.8569 + 1.19 respectively. The prevalence rates of underweight and stunting were 24.7 % and 17.4 % respectively. Using weight greater than 120 % of expected weight for age, five (1.7 %) male and 7 (2.6 %) female children were obese compared to 3.3 % male and 5.1 % female children who were obese in 1983. CONCLUSIONS: The prevalence of overweight and obesity has remained relatively unchanged between 1983 and 2006. However,under-nutrition remains a major nutritional problem among school children and adolescents in Abeokuta, Nigeria.

The influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital.

BACKGROUND: Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting. AIMS AND OBJECTIVES: This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin, of children with homozygous SCA, aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital. MATERIALS AND METHODS: This is a cross-sectional study involving 100 children with SCA and 100 age-, sex-, and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method. RESULTS: This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P < 0.001). By contrast, this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P = 0.06) and (P = 0.12), respectively. The mean weight, height, and body mass indices of the subjects and controls were consistently below those of the NCHS standards. The magnitude of the difference from the NCHS standard was also more pronounced in the subjects, increased with advancing age and affected male subjects more than females. Progressive declines in the anthropometric attainment and hemoglobin concentration were observed from social class 1 to 4; this was statistically significant in controls (P = 0.00) but not in subjects (P > 0.1). However, SCA patients had significantly lower values than controls in each of the social classes. CONCLUSION: Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients.

Micturitional Dryness and Attitude of Parents Towards Enuresis in Children Attending Outpatient unit of a Tertiary Hospital in Abeokuta; Southwest Nigeria

Background: There is significant variability of the age at which children achieve dryness. Objectives: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. Method: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre; Abeokuta. Results: At age 36 months; 86 (51.8) and 34 (20.5) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p= 0.009). Twenty-four (26.7) children had nocturnal enuresis. Four (4.4) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem; a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). Conclusions: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore; health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class

The influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital

Background: Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting. Aims and Objectives: This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin; of children with homozygous SCA; aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital. Materials and Methods: This is a cross-sectional study involving 100 children with SCA and 100 age-; sex-; and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method. Results: This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P 0.001). By contrast; this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P 0.1). However; SCA patients had significantly lower values than controls in each of the social classes. Conclusion: Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients

Echocardiographic findings among children with sickle cell anaemia at the Lagos University Teaching Hospital.

BACKGROUND: Few studies documenting the echocardiographic findings of patients with sickle cell anaemia have been reported from Africa despite the high prevalence of the disease on the continent. AIMS AND OBJECTIVES: The present study aimed to determine echocardiographic cardiac dimensions and haemodynamic parameters of children with homozygous sickle cell anaemia (SCA), in steady state at the Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS: Sixty children with SCA and sixty age and sex matched controls with ages ranging from 1-15 years were studied. Their cardiovascular functions were determined by echocardiographic examination. RESULTS: Mean age of SCA patients and controls were 95.41 ± 49.06 months and 95.45 ± 50.9 months respectively (p = 0.97). Mean left atrial dimension (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPW), Interventricular septal thickness (IVS) and left ventricular mass (LVM) in SCA patients were significantly larger than those of controls (p < 0.001 for each parameter). Left ventricular fractional shortening (FS) and ejection fraction (EF) were within acceptable normal limits although significantly lower in SCA patients (p < 0.001). The mean haemoglobin concentration in the subjects (77.23 ± 12.88) was significantly lower than in the controls (121 ± 16.09) (p < 0.001). Each direct echocardiographic parameter (LAD, AO, LVEDD, LVESD, IVS, LVPW and LVM) correlated significantly with age in both groups while left ventricular functional parameters (FS and EF) did not in both groups. Chamber dimensions, LVPW, FS and EF were inversely correlated with haemoglobin concentration in the subjects.