Superior sagittal sinus thrombosis complicating typhoid Fever in a teenager.

Cerebral venous sinus (sinovenous) thrombosis (CSVT) is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST). We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

Co-existence of urinary tract infection and malaria among children under five years old: a report from Benin City, Nigeria.

Children with fever are a majority in the various emergency rooms all over the world, and especially in the tropics. Most in sub-Saharan Africa will be treated for malaria, whether confirmed or not. It therefore follows that some of the morbidities other than malaria may go undiagnosed. The comorbidities with malaria that may have similar presentation among under-fives therefore are difficult to detect, and diseases like respiratory tract infections and urinary tract infections (UTI) are left to debilitate affected children. The exact burden of UTI co-existing with malaria in Nigeria remains ill defined. This study looks at the co-existence of UTI in under- fives with a primary diagnosis of malaria. Well-nourished children aged less than five years with confirmed malaria seen at the Children Emergency Room of the University of Benin Teaching Hospital were recruited into a prospective cross-sectional study between June and August 2006. The prevalence of UTI was 9% (27 of 300 children), with those aged less than 24 months comprising the majority. The uropathogens isolated included Staphylococcus aureus (55.6%), Escherichia coli (29.6%) and Kleibsiella pneumonia (14.8%). The isolates demonstrated high in vitro sensitivity to clavulanic acid-potentiated amoxicillin, ciprofloxacin and gentamicin, but were resistant to other commonly used antibiotics like amoxicillin and co-trimoxazole. The study indicates that UTI is a silent comorbidity in children aged less than 5 years with malaria and there is a need to evaluate these children in order to prevent the long-term morbidity of chronic renal diseases.

Predicting Urinary Tract Infection in Malaria Co-Morbidity among Under Fives

Fever presenting in children less than 5 years of age in malaria endemic areas will almost always be treated as cases of malaria. However fever is a common feature to other childhood illnesses including ARI and UTI. Besides; malaria is known to co-exist with these other morbidities including UTI. Undiagnosed and poorly treated UTI can lead to immediate and long term sequelae. Reliance on clinical features for the identification of presence of the co-morbidity could be quite tasking in the absence of discriminatory features. This work was meant to evaluate children less than 5 years of age presenting with fever (without localising signs) for discriminatory features (if any) for malaria; UTI co-morbidity. This was a prospective and cross sectional study carried out between June and August 2006. The study involved well nourished under fives with parasitologically proven malaria seen at the Children's Emergency Room (CHER) of the University of Benin Teaching Hospital (UBTH) Benin City. The presence of UTI was evaluated in this cohort using urinalyses; microscopy and culture. Of the 300 children evaluated; 27(9) had UTI-malaria co-morbidity. There was paucity of known symptoms or signs of UTI in those with the co-morbidity. The clinical features of abdominal pain; vomiting; irritability; showed very low sensitivity while the same features had high negative predictive values with respect to the presence of the co-morbidity (67.40). Tachycardia and tachypnoea also had very low sensitivity with regard to detecting the child with the co-morbidity. However; the features occurred significantly more in children without the co-morbidity. In conclusion; malaria-UTI co-morbidity occur frequently (in 1 out of every 10 children under 5 years of age with presumed sole diagnosis of malaria) to warrant the evaluation of such children; if the long term sequelae of undiagnosed and poorly treated UTI are to be minimized

Socio-demographic determinants and impact on academic performance of attention deficit/hyperactivity disorder in school children in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) affects children worldwide. In Nigeria, there is paucity of information on the socio-demographic associates of this important childhood condition. Methods: Across-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6 to 12 years, selected randomly among pupils drawn from Egor Local Government Area of Edo State. The subjects were screened using Disruptive Behaviour Disorder (DBD) Rating Scale to identify children with ADHD symptoms. Identified subjects were further evaluated with questionnaires to ensure that they met the other explicit non-symptom criteria contained in the DSM-IV manual, such as functional impairments. Children who were confirmed to have ADHD were compared with randomly selected controls to determine the association, if any, between the prevalence of the condition and some sociodemographic characteristics. Results: The prevalence of ADHD was 7.6%. There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. No significant association was found between the prevalence of ADHD and socioeconomic background, size of family, age of parents and characteristics of the child's primary caregiver. The children with ADHD had significantly lower school aggregate than that of selected control (Mean aggregate score of 51.7+16.1% versus 63.7+ 16.5%,p<0.001). Conclusion: The prevalence of ADHD in this study is relatively high. Community screening under the umbrella of the School Health Programme is required. Appropriate medications, educational support and psychotherapy when incorporated in the national health system will go a long way in redirecting affected children's developmental lives

Knowledge, attitude and practice of school health programme among head teachers of primary schools in Egor Local Government Area of Edo State, Nigeria.

BACKGROUND: School health program (SHP) is an important component of the overall health care delivery system of any country. In developing countries such as Nigeria where infant and early childhood mortality is high its importance cannot be overemphasized. For this reason and the recent action plan of the Federal Government of Nigeria concerning SHP, the knowledge, attitude and practice of SHP among head teachers of primary schools in a Local Government Area in Nigeria was evaluated. METHODS: A pre-tested questionnaire designed to evaluate the knowledge attitude and practice of SHP by the researchers was administered by assistants to 133 head teachers of 104 private and 29 public primary schools in Egor Local Government Area of Edo State, Nigeria. The School premises were also inspected to check provision of pipe borne water, sick bay, toilet facilities and the adequacy of the school environments among other things. RESULTS: None of the head teachers had adequate knowledge of SHP. 93.1% from private compared to 48.3% from public schools had poor knowledge of SHP (chi2 = 56.86, p < 0.05). A favorable attitude was demonstrated by all the teachers. Up to 40.4% of private compared to 31.0% of public schools have SHP. Overall 27.7% of the schools had no toilet facility, 33.3% had pit latrine while 40.0% had water closet. Only 25.6% had hand washing facilities. Regarding health services, 51.0% of private schools compared to 27.6% of public schools perform medical inspection of the pupils. Similarly 39.4% private compared to 3.4% public schools have sick bay (chi2 = 11.11; p < 0.05). A total of 16.5% of the schools undertake medical screening of food handlers/vendors, while 20.2% private compared to 3.4% public schools screen food handlers/vendors (chi2 = 4.47; p < 0.05). CONCLUSION: The poor status of SHP in Nigeria may be attributed to failure of policy enunciation, poor primary health care base and lack of supervision.

Home management of febrile convulsion in an African population: a comparison of urban and rural mothers' knowledge attitude and practice.

To determine the knowledge, attitude and practice (KAP) of home management of febrile convulsion (FC), by mothers in the community, focus group discussions (FGD) were conducted in two communities, Uselu (urban) and Evbuomodu village (rural), both in Edo State, Southern Nigeria. The study was conducted between December 2000 and February 2001. Our findings show that 71% of urban mothers compared to 25% of rural mothers attributed the cause of FC to fever (chi(2)=24.17: p<0.001). Seventy-five percent of mothers from rural community and 28.6% of urban mothers attributed the cause to witchcraft and/or evil spirits. Twenty-five percent of rural mothers also attributed abnormality of the spleen as a cause of FC. All the mothers, both urban and rural, were not directly involved in the management of the convulsive episode due to panic and confusion. Ninety-two percent of urban and all the rural mothers permitted the use of traditional medicine while 7.1% of urban mothers employed prayers during convulsion. Twenty percent of urban and twenty-two percent of rural mothers use urine (human and or cow's) for treating FC at home. Other home remedies include kerosene, fuel and crude oil. Mass enlightenment campaign for the community, especially the rural, against use of harmful traditional remedies to treat FC at home is strongly advised.