Serum Iron Status of Children with Cyanotic Congenital Heart Disease in Lagos, Nigeria.

OBJECTIVES: Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory secondary erythrocytosis. This study aimed to determine the serum iron status and prevalence of iron deficiency among children with cyanotic congenital heart disease attending the Paediatric Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. METHODS: This cross-sectional case-control study took place between May and October 2015 at the Lagos State University Teaching Hospital. A total of 75 children with cyanotic congenital heart disease and 75 apparently healthy age-, gender- and socioeconomically-matched controls were analysed to determine serum iron status and the prevalence of iron deficiency as defined by the World Health Organization criteria. RESULTS: The mean age of the children was 47.5 ± 2.9 months (range: 6-144 months old). Iron deficiency was significantly more frequent among CCHD patients compared to control subjects (9.3% versus 0%; P = 0.006). While latent iron deficiency was more prevalent among children in the control group compared to those with CCHD, this difference was not statistically significant (13.3% versus 9.3%; P = 0.303). No cases of iron deficiency anaemia were observed in the studied sample. CONCLUSION: Neither the children in the control group nor those with CCHD had iron deficiency anaemia. However, iron deficiency was significantly more prevalent among children with CCHD in Lagos. Periodic serum iron status screening is therefore recommended for this population.

Age of pubertal events among school girls in Lagos, Nigeria.

BACKGROUND: Globally, there is a secular trend towards the reduced age for sexual maturity and menarche. This study aimed to determine the current age and factors associated with attainment of various stages of puberty in Nigerian girls. METHODS: This study was a cross-sectional study involving 800 girls aged 6-15 years. The subjects were selected by stratified random sampling method from schools in Oshodi Local Government Area, Lagos State. They were interviewed and a physical examination was carried out to classify them into the various Tanner stages of breast and pubic hair maturational stages. RESULTS: The median age of girls at first stage of breast maturation (B2), first stage of pubic hair development (PH2) and at menarche were 9.0, 9.0 and 12.0 years, respectively. Breast development was significantly related to normal nutritional status (adjusted odds ratio [AOR] 4.5, p<0.001), overweight (AOR 40.2, p<0.001), obesity (AOR 154.2, p<0.001) and upper social class (AOR 15.7, p<0.031). Pubic hair development was significantly related only to overweight (AOR 4.7, p<0.007) and obesity (AOR 15.7, p<0.001) while achievement of menarche was significantly related to overweight (AOR 0.1, p=0.005), obesity (AOR 0.1, p=0.0009), high social class (AOR 4.7, p<0.001) and being a member of the Hausa tribe (AOR 35.8, p<0.029). CONCLUSIONS: There is decline in age of pubertal maturation of girls in Nigeria and the major contributory factors appear to be overweight and obesity. These findings are consistent with the pattern in developed countries.

Serum cystatin C levels in Healthy Nigerian neonates: Is there a need for normative values in Nigerian babies?

Cystatin C is an endogenous marker of renal function. Normal reference values have been documented in neonates outside Africa, but no study has been documented in African neonates. With reports that race may affect serum cystatin C values, this study was carried out to generate normal values in apparently healthy term neonates at birth and three days of life neonates in Nigeria. This was a hospital-based prospective study. A cohort of 120 apparently healthy term neonates were recruited at birth. Serum cystatin C was measured from the cord blood at birth and venous blood when they were three days old using enzyme-linked immunosorbent assay (ELISA) method. The mean serum cystatin C values for cord blood and 3rd day venous samples were 1.67 ± 0.52 mg/L and 1.62 ± 0.52 mg/L, respectively (P = 0.87). The cord blood and 3rd day serum cystatin C values for males were 1.67 ± 0.47 mg/L and 1.68 ± 0.51 mg/L, respectively (P = 0.77) and the values for females were 1.68 ± 0.56 mg/L and 1.58 ± 0.52 mg/L, respectively (P = 07.22). The serum cystatin C levels were similar among the different birth weight groups and gestational age (P >0.05). The cord blood and 3rd day serum cystatin C values were similar. Serum cystatin C values were independent of gender and birth weight of neonates. The values of serum cystatin C in Nigerian neonates were comparable to that reported for neonates in other regions of the world. It is recommended that ELISA technique may be reliably used to measure serum cystatin C levels in neonates.

Hyperglycemia in Acutely Ill Non-diabetic Children in the Emergency Rooms of 2 Tertiary Hospitals in Lagos, Nigeria.

OBJECTIVES: The study aimed to determine the prevalence of hyperglycemia in sick children admitted into the emergency rooms and to investigate its relationship with adverse outcomes. METHODS: A prospective study involving 2 tertiary hospitals in Lagos. Study subjects included all children aged beyond 1 month. An Accu-Chek Active glucometer was used for the bedside blood glucose determination. Hyperglycemia was defined as blood glucose greater than 7.8 mmol/L. RESULTS: A total of 1045 patients were recruited with hyperglycemia being recorded in 135 patients (prevalence rate of 12.9%). Mean age of the hyperglycemic patients was 29.0 ± 31.23 months. Prevalence rates of hyperglycemia among the leading diagnoses were 17.4% in acute respiratory tract infections, 11% in malaria, 15.3% in septicemia, 14.9% in gastroenteritis, and 18.2% in burns. Other conditions include sickle cell anemia, meningitis, and malnutrition. Mortality rate was significantly higher overall in hyperglycemic compared with the normoglycemic patients (15.4% vs 8.0%, P = 0.011). With regard to specific diagnoses, significantly higher mortality rates were recorded in hyperglycemic patients with acute respiratory tract infections (28% vs 8%, P = 0.011) and malaria (21.4% vs 5.0%, P = 0.006) than in their normoglycemic counterparts. CONCLUSIONS: Hyperglycemia is common in ill children admitted to the emergency rooms and is associated with 2 to 4 times higher mortality in common childhood diseases encountered. Blood glucose determination is important in all acutely ill children at presentation. The practice of empirical administration of intravenous glucose in some resource-constrained facilities where blood glucose testing facilities are not readily available should be discouraged.

Iron deficiency anaemia among apparently healthy pre-school children in Lagos, Nigeria.

BACKGROUND: Iron deficiency, and specifically iron deficiency anaemia, remains one of the most severe and important nutritional deficiencies in the world today. OBJECTIVE: To estimate the prevalence and associated factors for iron deficiency anaemia among pre-school children in Lagos. METHODOLOGY: The study was conducted from December 2009 to February 2010 at the outpatient clinics of Lagos State University Teaching Hospital, Lagos. Serum iron, total iron binding capacity, transferrin saturation and serum ferritin were assayed in subjects. The primary outcome measured was iron deficiency anaemia established based on the following criteria: hemoglobin <11.0 g/dl1 plus 2 or more of the following: MCV <70fl, transferrin saturation <10% or serum ferritin <15ng/dL. Statistical analysis included Pearson Chi square analysis and logistic regression analysis. RESULTS: A total of 87 apparently healthy subjects were recruited. Only one subject had iron depletion and this child belonged to the ≤ 2 years age category. None of the recruited subjects had iron deficiency without anaemia. Nine of the study subjects (10.11%) had iron deficiency anaemia. The prevalence of iron deficiency anaemia was significantly higher among younger age group than in the older age group (19.1% Vs 2.1%, p = 0.022). The prevalence of iron deficiency anaemia was significantly higher among subjects with weight-for-age, and weight-for-height Z scores below two standard scores (83.3% and 75.0% respectively, p = <0.001 and 0.001 respectively). CONCLUSION: The overall prevalence of iron deficiency anaemia among study subjects was 10.11%. Iron deficiency anaemia was more common in children aged two years and below. Weight-for-age and weight-for-height Z scores below minus two standard scores were strongly associated with iron deficiency anaemia.

Helicobacter pylori associated with breastfeeding, nutritional status and recurrent abdominal pain in healthy Nigerian children.

INTRODUCTION: There is limited knowledge about the associations of Helicobacter pylori (H. pylori) infections in developing countries. This study aimed to determine the current prevalence and associations of H. pylori infection with breastfeeding practices, nutritional status, and recurrent abdominal pain (RAP) in a group of apparently healthy children and adolescents in Lagos, Nigeria. METHODOLOGY: This was a prospective hospital-based study conducted at the Lagos State University Teaching Hospital that involved 118 children who came to the hospital for routine pediatric care. Seroprevalence status of the children was determined by measuring immunoglobulin G antibodies against H. pylori using enzyme-linked immunosorbent assay (ELISA). RESULTS: Seventy-five (63.6%) children were seropositive for H. pylori. The prevalence of H. pylori infection increased significantly from 40.4% in children less than five years of age to 85.1% at six to ten years of age (χ(2) = 20.9, p < 0.001). H. pylori infection was associated with low social class (OR = 3.24; 95% CI = 1.20-8.23, p = 0.016) and with RAP (OR = 3.47; 95% CI = 1.55-7.79, p = 0.002), but no association was observed with exclusive breastfeeding, duration of breastfeeding, and under-nutrition. CONCLUSIONS: The prevalence of H. pylori infection is high, particularly among children from low socioeconomic backgrounds in Lagos, Nigeria. It is associated with RAP. The effect of this infection on children's health requires further studies.

Body fat distribution of children and adolescents in Abeokuta, Southwest Nigeria.

Excessive central fat in children and adolescents is a risk factor for cardiovascular and metabolic disorders. This study aimed to compare the body fat distribution patterns of children and adolescents in Abeokuta, Nigeria with international reference standards. Five hundred seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, triceps and subscapular skinfold thickness (TSF, SSF), and circumference at the waist and hips (WC, HC) were measured. Body mass index (BMI), subscapular:triceps skinfold ratio (STR), waist:hip circumference ratio (WHR), and waist: height ratio (WHtR) were derived. Females had higher mean BMI, TSF, SSF, WC, HC, WHR, and WHtR, while males had significantly higher STR. The mean BMI, WC, TSF, and SSF values were lower for our subjects than for African-American subjects at all ages. On the other hand, in both sexes, STR was higher among Nigerian than African-American subjects up to 12 years old. Thereafter the values were similar. The mean WC was similar to those reported for African-American males up to 8 years, and females up to 7 years of age; thereafter, African-American had higher values. The prevalence of central obesity using WC and WHtR measures was 4.4% and 5.8%, respectively. There is a need to validate each index against serum lipid profiles and other cardiovascular and metabolic risk factors.

Ulcerative colitis in a Nigerian girl: a case report.

BACKGROUND: Ulcerative colitis (UC) is uncommon in the tropics and sub-tropics. We report a case of UC in a 7 year old girl whose parents were both Nigerians. This report is to alert healthcare professionals in sub-Saharan Africa that UC is not a rare health problem, especially in children. CASE PRESENTATION: The patient presented with frequent passage of blood stained stool, abdominal pain and significant weight loss. The diagnosis was entertained after she was investigated for common causes of chronic diarrhea in our setting and the findings were negative. The patient symptoms abated after she was commenced on steroid therapy. CONCLUSION: Under-diagnosis and misdiagnosis may account for a dearth of information on UC in African children.

Prevalence of and risk factors for stunting among school children and adolescents in Abeokuta, southwest Nigeria.

Stunting adversely affects the physical and mental outcome of children. The objectives of the study were to determine the prevalence of and risk factors associated with stunting among urban school children and adolescents in Abeokuta, Nigeria. Five hundred and seventy children aged 5-19 years were selected using the multi-stage random-sampling technique. Stunting was defined as height-for-age z-score (HAZ) of < -2 standard deviation (SD) of the National Center for Health Statistics reference. Severe stunting was defined as HAZ of < -3 SD. The mean age of the children was 12.2 + 3.41 years, and 296 (51.5%) were males. Ninety-nine (17.4%) children were stunted. Of the stunted children, 20 (22.2%) were severely stunted. Identified risk factors associated with stunting were attendance of public schools (p < 0.001), polygamous family setting (p = 0.001), low maternal education (p = 0.001), and low social class (p = 0.034). Following multivariate analysis with logistic regression, low maternal education (odds ratio = 2.4; 95% confidence interval 1.20-4.9; p = 0.015) was the major contributory factor to stunting. Encouraging female education may improve healthcare-seeking behaviour and the use of health services and ultimately reduce stunting and its consequences.

Self-medication for infants with colic in Lagos, Nigeria.

BACKGROUND: Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved. METHODS: It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire. RESULTS: Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin (49.5%) and Gripe water (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic. CONCLUSION: Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.

Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria.

BACKGROUND: The use of complementary and alternative medicine (CAM) is on the increase globally with a high prevalence in children and adults with chronic illnesses. Many studies have evaluated the epidemiology of medicine use for children in developing countries but none has evaluated the use of CAM for children with chronic illnesses. The aim of this study was therefore to determine the prevalence, pattern of use, parental sources of information, perceived benefits, cost, and adverse effects of CAM in children with epilepsy, sickle cell anaemia and asthma in Lagos, Nigeria. METHODS: Parents of children with epilepsy (122), asthma (78) or sickle cell anaemia (118) who presented consecutively to the paediatric neurology, respiratory and haematology clinics of the Lagos State University Teaching Hospital (LASUTH), Ikeja were interviewed with a structured open- and close-ended questionnaire. The information obtained comprised the demography of both the patients and their parents; past and present treatments received by the patients; the type of CAM, if any, used by the patients; and the sources, cost, benefits and adverse effects of the CAM used. RESULTS: A total of 303 CAMs were used by the patients, either alone or in combination witother CAM. CAM was reportedly used by 99 (31%) patients (epilepsy--38%, sickle cell anaemia--36% and asthma--25%). The majority (84%) of these patients were currently using CAM. The use of CAM was stopped six months prior to the study by 16 patients (16%). Biological products were the most frequently used CAMs (58%), followed by alternative medical systems (27%) and mind-body interventions (14%). Relations, friends and neighbours had a marked influence on 76% of the parents who used CAM for their children. Eighty-five (86%) parents were willing to discuss the use of CAM with their doctors but were not asked. CAM use was associated with adverse reactions in 7.1% of the patients. CONCLUSION: Parental use of CAMs to treat their children with epilepsy, asthma and sickle cell anaemia is common in Nigeria. Efforts should be made by doctors taking care of these patients to identify those CAM therapies that are beneficial, harmless and cheap for possible integration with conventional therapy.

Possible risk factors for congenital malaria at a tertiary care hospital in Sagamu, Ogun State, South-West Nigeria.

Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns aged <7 days, was considered rare in endemic areas until recent studies started reporting high prevalence rates. Various theories have been postulated to explain this phenomenon, but they are not proven conclusively from research. Against this background, a prospective study was designed with the following objectives. To determine the prevalence of congenital malaria parasitaemia and identify possible risk factors amongst newborns delivered in O.O.U.T.H Sagamu, Ogun State. Over a 6-month period, 192 live newborns and their mothers were consecutively recruited into the study. Within 3 days of life, neonatal peripheral blood samples were collected for malaria screening by blood film microscopy and detection of plasmodium lactate dehydrogenase (pLDH) with the OptiMAL Rapid Malaria Test kit. Maternal peripheral blood samples were taken simultaneously, to check for malaria infestation by blood film microscopy, and questionnaires were administered on the mothers to identify possible factors associated with the development of neonatal parasitaemia. Neonatal clinical and laboratory data were recorded in a pro forma designed for the study. Data analysis was done with Epi-info version 6 software and level of significance set at <5%. Twenty-one of 192 newborns delivered in O.O.U.T.H within the study period were diagnosed as having congenital malaria by blood film microscopy, giving a prevalence rate of 10.9%. The main identified innate neonatal risk factor for congenital malaria parasitaemia was prematurity. First-order pregnancy, history of fever within 3 months of delivery and peripheral parasitaemia at delivery (p < 0.001) were the variables that were significantly higher in the mothers of the parasitemic newborns. We conclude that congenital malaria parasitaemia in tropical endemic areas is not rare. Pre-term neonates, infants of primigravidae, women with history of fever within 3 months of delivery and women with post-partum peripheral parasitaemia may benefit from routine screening for malaria.

Performance of a rapid antigen test for the diagnosis of congenital malaria.

OBJECTIVE: To assess the performance of OptiMAL, a rapid malaria antigen capture dipstick, in diagnosing congenital malaria. METHODS: Live newborns aged 0-3 days, delivered at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between August 2004 and January 2005, were screened for malaria parasitaemia with an immunochromatographic test (OptiMAL) and blood film microscopy. OptiMAL detects plasmodium lactate dehydrogenase (pLDH). RESULTS: Twenty-one of 192 newborns (10.9%) were diagnosed with congenital malaria by blood film microscopy. The OptiMAL test was negative in all infants. CONCLUSION: OptiMAL rapid malaria antigen capture dipstick might not be useful for diagnosing malaria parasitaemia in newborns. Blood film microscopy remains the gold standard for the diagnosis of congenital malaria.