Urinary tract infection in febrile children with sickle cell anaemia.

BACKGROUND: Sickle cell anaemia (SCA) is very common in Maiduguri, North-Eastern Nigeria. Children with this disease have increased tendency to develop frequent and severe infections especially of the urinary tract, bones and lungs. The prevalence of urinary tract infection (UTI) has however not been reported in this part of the Nigeria. OBJECTIVE: To determine the prevalence of bacteriuria and bacterial isolates in the urine of febrile children with sickle cell anaemia. METHODS: This was a prospective study carried out on 250 children with SCA and 250 controls with HbAA aged 6 months to 15 years. Following clinical assessment, midstream urine or urine obtained by suprapubic bladder aspiration was collected and subjected to microscopy and culture. RESULTS: Bacteriuria was found in 65 (26%) of children with SCA and controls 514 (20.4%) of controls, p>0.05. Escherichia coli [16 (27.7%)] and Klebsiella species [16(24.6%)] were the predominant isolates in SCA group, while Escherichia coli [13(37.3%)] and Coliforms (25.4%) were predominant in the control group. Significant bacteruria occurred in patients with other clinical conditions such as pneumonia and septicaemia. CONCLUSION: Urinary tract infection is common in children with SCA. Routine screening is therefore recommended during febrile illnesses.

Prevalence of headache and migrainous headache in Nigerian Africans: a community-based study.

In a door-to-door survey in a Nigerian town with stable population of about twenty thousand, 18,594 subjects were screened with a questionnaire, which involved a complete census, administered by non-doctor, including primary health care personnel. Migrainous headache was diagnosed on the basis of combination of responses to the questionnaire shown in a pilot study validated by neurological examination to have 92% sensitivity and 99% specificity. Crude life time prevalence ratio of at least one episode of headache unspecified was 51 percent (50% in males and 52% in females). The crude prevalence ratio of migrainous headache was 5.3 per 100 (5 per 100 in males and 5.6 per 100 in females), with peak age-specific prevalence ratios in the first decade in both males and females. Migrainous headache was three times as common in females as in males in the second and third decades. Prevalence of migrainous headache in Nigerian Africans appears less than in Caucasians. No social status was at special risk to developing migrainous headache.

Cerebral palsy in Ibadan, Nigeria.

In a three-year study of cerebral palsy (CP), CP accounted for 16.2 per cent of new referrals to a child neurology clinic. 63 per cent of these had potentially preventable causes (not including intracranial infections), associated with chronic shortage of care personnel and inadequate finances for effective rehabilitation services. It is suggested that training and deployment of nurse-physiotherapists, combined with intensive health education, is a feasible solution to the problem.

Craniopharyngioma in Nigerian children.

Between 1971 and 1986, 20 Nigerian children (less than 1 year to 15 years of age) with craniopharyngiomas were treated at the University College Hospital (UCH) in Ibadan. The children made up 71% of all patients with craniopharyngiomas seen in the hospital during the study period. The mean age of the 12 boys and 8 girls was 9.2 years. The predominant symptoms and signs were raised intracranial pressure and visual disturbance. Characteristic radiological features occurred in over 60% of cases; about two-thirds of the tumors were cystic. The advanced tumor stage upon arrival at UCH limited the amount of radical surgery that could be done; 31% died soon after surgery.

Prevalence of the epilepsies in Nigerian Africans: a community-based study.

A door-to-door survey to detect commonly occurring neurologic diseases was carried out in Igbo-Ora, a large Nigerian town with a population of approximately 20,000. Effective health care facilities have been operating in the community since 1963. Primary health care workers and nondoctor personnel administered a complete census, a screening questionnaire, and a simple screening neurologic examination. The pretested screening questionnaire had been shown in a pilot study to have a sensitivity of 95% for identifying those with epilepsy. Individuals positive on the screening phase of the survey were evaluated by neurologists and neurosurgeons, who used well-defined criteria to make the diagnosis. There were 101 (48 males and 53 females) who suffered from active epilepsy (5.3 cases/1,000) on prevalence day. The highest age-specific prevalence ratios occurred in those below age 20. The most common of the identifiable seizure types was complex partial seizures (52 cases). The prevalence ratio of epilepsy in this Nigerian town (with an effective health care system) is similar to that reported in some developed countries and several times lower than figures derived from studies in developing countries. These data suggest that an improved health care system would probably reduce the prevalence and burden of epilepsy in developing countries.

Neurological disorders in Nigerian Africans: a community-based study.

In a Nigerian town with a stable population of 20,000, a door-to-door survey was conducted, using a questionnaire involving a complete census and a simple neurological evaluation which had previously showed a 95% sensitivity and an 80% specificity for detecting neurological disease. Positive responders were evaluated and categorised, using agreed criteria for diagnoses. Nearly 100% cooperation was obtained. Life prevalence ratio for at least one episode of headache was 51/1000. Crude point prevalence ratio for migrainous headache was 5.3/100, and peak age-specific ratio was in the first decade. Prevalence ratio for epilepsy was 533/100,000 and peak age-specific prevalence ratio occurred in the 5-14 years age groups. The prevalence ratio for peripheral nerve disorders was 268/100,000, and age-specific prevalence ratio for tropical neuropathy increased with age. Prevalence ratio for stroke was rather low at 58/100,000, but was probably due to the people's attitude to the disabled elderly and high mortality of stroke which showed annual mortality rate of 70/100,000 which increased with age to 1519/100,000 per year in the eighth decade. Crude prevalence ratios (cases per 100,000) for others are 112 for neurological complications (including sciatica) of spondylosis, 15 each for poliomyelitis, motor neurone disease, development speech disorders, 10 each for syncope, hereditary neuropathies. Parkinson's disease, benign essential tremor, primary cerebellar degeneration, cerebral palsy, mental retardation, organic psychosis (probable intracranial tumor) and 5 each for muscular dystrophy, pyomyositis, spina bifida occulta, alcohol dependence and cerebral malaria. The implications of the findings are important for development of community neurological services in the developing countries.

Haemophilus influenzae meningitis: a 5-year study in Ibadan, Nigeria.

A total of 131 children with Haemophilus influenzae meningitis was studied over a period of 5 years. Of these, 92% and of those who died from this disease, 94% were 2 years old or less. Mortality was 26% and morbidity among the survivors was 36%. Most of the children studied were marasmic. The seasonal incidence is discussed since incidence peaked mainly in the dry season with a secondary peak in the rainy season. Haemoglobin (H6) electrophoresis, done in respect of a few children, showed a significantly higher incidence of Hb SS among patients than in the general population. This relationship is being studied further. The prognosis did not appear to be significantly affected by the choice between a combination of penicillin and chloramphenicol on the one hand and ampicillin alone on the other. A combination of penicillin and chloramphenicol is preferred to chloramphenicol alone in initiating therapy because 100% of strains of H. influenzae isolated in our laboratory are susceptible to chloramphenicol but only 75% of strains of Streptococcus pneumoniae are susceptible to this drug.

Intracranial neoplasms in children in Ibadan, Nigeria.

Analysis of 89 intracranial tumors in children presenting at the University College Hospital, Ibadan, Nigeria, between 1960 and 1982 is reported. These tumors are commonest in the first decade of life and occur more in males than in females. Fifty-three per cent of the primary brain tumors are supratentorial. The commonest sites are cerebellum, cerebrum, and the pons. The common histological types are astrocytomas, medulloblastomas, ependymomas, and oligodendrogliomas. Craniopharyngiomas are among the most frequent supratentorial neoplasms in Ibadan children and the central nervous system involvement in cases of Burkitt's lymphoma is a frequent complication.

Meningococcal meningitis in childhood. A five-year study of meningococcal meningitis in Ibadan, southern Nigeria.

Meningococcal meningitis is uncommon in the rain belt of southern Nigeria. Only twenty-six children were treated in one hospital in five years. Almost half the total number were seen during the four dry months of the year. However, the incidence in any one year was not necessarily correlated with the season. It appears that the longer the disease lasted before admission, the better the prognosis. Also, if the disease was severe enough to require admission within 24 hours of onset, the prognosis was poor. Survivors did not develop complications.

Pneumococcal meningitis in sickle cell disease in childhood.

In a population of children with pneumococcal meningitis, 71 had hemoglobin electrophoresis, and 17 of these were found to have homozygous hemoglobin S (24%). These 17 children were compared with 19 similarly infected children who had hemoglobin A and were matched for age and duration of symptoms before treatment. There was no difference in the symptoms or laboratory data, except for the hematocrit value, but patients with fatal disease came to the hospital later than control patients. The mortality and morbidity were similar even though control patients had a wider range of serious sequelae. Although patients with homozygous hemoglobin S were shown to be much more susceptible to pneumococcal meningitis, they were not at an increased risk from its effects.

Conjugated hyperbilirubinaemia in Nigerian infants.

A prospective study of 101 Nigerian infants with conjugated hyperbilirubinaemia seen over 6 years shows that extrahepatic biliary tract obstruction, idiopathic hepatitis, and bacterial infections were the common causes. A firm diagnosis was based on clinical, biochemical and histological features when the patient presented early. However, most of the infants presented late and the superimposed features of prolonged cholestasis made differentiation of the probable causes difficult. Erythrocyte peroxide haemolysis test and laparatomy aided diagnosis in these cases. Seventy five per cent of the patients with sepsis treated with antibiotics, and 70% of those with hepatitis treated symptomatically, recovered. Surgery was successful in only 15% of the patients with biliary tract obstruction. These were those who had either diverticulum of the common bile duct, localized atresia or stenosis or in whom biliary obstruction was due to viscid bile.

Congenital generalized fibromatosis. An African case with gingival hypertrophy and other unusual features.

What is believed to be the first reported case of congenital generalized fibromatosis in an African infant is described. Features in our patient, which were not noted in previous reports of the disease, include gingival hypertrophy, ankylosis of joints, skeletal hyperostosis, and lymphatic dilation of the ileal villi. Corticosteroid therapy was tried in the patient, but did not produce any beneficial effect.