Pattern and Prevalence of Intestinal Helminthiasis among Human Immunodeficiency Virus-Infected Children at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.

BACKGROUND: Children infected with the human immunodeficiency virus (HIV) may be more prone to helminthic infestation because they have depleted immunity, which increases their susceptibility to infection and infestations, even with minimally pathogenic organisms such as helminths. AIM: The prevalence and pattern of intestinal helminthiasis among children living with HIV attending the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu. PATIENTS AND METHODS: A cross-sectional study in which 70 HIV-infected children were consecutively recruited from the Pediatric HIV clinic and matched for age and sex with 70 children recruited from the children outpatient clinic (CHOP) of UNTH Ituku-Ozalla. Stool samples of study participants were collected and analyzed using the Kato-Katz method and subsequently examined under the microscope for helminths' eggs and larvae. The worm intensity was determined using the theoretical analytic sensitivity (TAS) of 24 eggs per gram (EPG) to obtain the number of eggs per gram of feces. The CD4+ count, which describes the severity of immunosuppression in HIV-positive children was determined using the PARTEC Cyflow counter for the CD4+ lymphocyte count, whereas HIV screening was performed using the rapid diagnostic tests for HIV (Determine, Statpack and Unigold). Data were analyzed using IBM SPSS. RESULTS: The prevalence of intestinal helminthiasis among HIV-infected and non-infected children was 27.1% and 12.9%, respectively (P = 0.038). HIV-positive children were more likely to have intestinal helminthiasis than HIV-negative children (odds ratio [OR] =2.525, 95% confidence interval [CI]: 1.052-6.063). Ascaris lumbricoides was the predominant helminthic species in both HIV-infected and non-infected groups; however, there was no statistical significance between intestinal helminthic species and HIV status (P = 0.655) but the severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count (P = 0.028). The risk factors for intestinal helminthic infestation examined were similar in both HIV-positive and HIV-negative children (P > 0.05). CONCLUSION: There was a significantly higher prevalence of helminthic infestation among HIV-infected children compared to their HIV-negative counterparts. The severity of intestinal helminthiasis was significantly associated with decreasing CD4+ count.

Psychological Distress among Caregivers of Children Admitted into the Children Emergency Room of a Nigerian Tertiary Hospital.

BACKGROUND: Many caregivers experience significant psychological burden which may impact on the management of a sick child. OBJECTIVE: To determine the prevalence and associated factors of psychological distress among caregivers of children admitted at the Children Emergency Room. METHODS: This was a descriptive cross-sectional study among caregivers of children who were hospitalized for at least 24 hours. The 28-item General Health Questionnaire (GHQ 28) was used to assess the psychological distress among the caregivers. GHQ scores were stated as means ± standard deviation (SD). Chi-square or Fisher's exact test was used to test for association between sociodemographic variables and psychological distress. Mean GHQ scores in the various domains of psychological dysfunction were compared among groups using the independent sample t-test; at p<0.05. RESULTS: Of the 97 caregivers who participated in the study, 96 had their data analyzed. The caregivers were aged 19 to 63 (mean 34.25 (8.46)) years; 86 (89.7%) were females and 48 (50%) had tertiary education. The prevalence of psychological distress among the care givers was 69.8%. Caregivers had high levels of anxiety but low levels of depression. Those with lower educational attainment had higher scores on severe depression domain (p = 0.001). Unemployed caregivers had higher mean scores on the anxiety/insomnia (p = 0.039) and social dysfunction domains (p = 0.031). Those with large family sizes scored higher on the anxiety/insomnia domain (p = 0.03). CONCLUSION: Psychological distress was high among caregivers of children admitted at the children emergency room.

CONTEXTE: De nombreux aidants éprouvent une expérienceimportante charge psychologique pouvant avoir une incidence sur la prise en charge d'un malade enfant. OBJECTIF: Déterminer la prévalence et les facteurs associés de détresse psychologique chez les personnes qui s'occupent d'enfants admis à l'Salle d'urgence pour enfants. MÉTHODES: Il s'agissait d'une étude transversale descriptive parmi les soignants d'enfants qui ont été hospitalisés pendant au moins 24 heures. Le Questionnaire général sur la santé (QGH) en 28 éléments a été utilisé pour évaluer la détresse psychologique chez les soignants. Les scores GHQ étaient indiqué comme moyen ±'écart-type (ET). Chi-carré ou Fisher's le test exact a été utilisé pour tester l'association entre sociodémographiques variables et détresse psychologique. Scores GHQ moyens dans les domaines différentes de dysfonctionnement psychologique ont été comparés entre les groupes à l'aide du test t de l'échantillon indépendant; à p<0.05. RÉSULTATS: Sur les 97 aidants qui ont participé à l'étude, 96 leurs données ont été analysées. Les aidants étaient âgés de 19 à 63 ans (moyenne 34.25 (8.46)) ans; 86 (89.7 %) étaient des femmes et 48 (50 %) avaient l'enseignement supérieur. La prévalence de la détresse psychologique chez les les soignants étaient 69.8 %. Les aidants avaient des niveaux élevés d'anxiété, mais faibles niveaux de dépression. Ceux dont le niveau de scolarité est inférieur avaient des scores plus élevés dans le domaine de la dépression sévère (p = 0.001). Les aidants au chômage avaient des scores moyens plus élevés sur l'anxiété / insomnie (p = 0.039) et les domaines de dysfonctionnement social (p = 0.031). Ceux qui ont les grandes familles ont obtenu des scores plus élevés dans le domaine de l'anxiété / insomnie (p = 0.03). CONCLUSION: La détresse psychologique était élevée chez les aidants naturels des enfants admis à la salle d'urgence des enfants. Mots-clés: Soignant, enfants, urgence, détresse psychologique, Stitués dans la prise en charge des patients atteints de LA COVID-19.

Management of community acquired pneumonia (CAP) in children: Clinical practice guidelines by the Paediatric Association of Nigeria (PAN

The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to assist clinicians in the care of children with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among children in the clinical course of CAP.The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians to make timely diagnosis and institute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated.The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.

The prevalence of allergic diseases among children with asthma: What is the impact on asthma control in South East Nigeria?

BACKGROUND: Allergic diseases are known to occur in children with asthma and its coexistence with asthma may impact on asthma control in affected children living in a low-income country. The study is to determine the allergic profile of children with asthma and the association with asthma control and attendant social risk factors. MATERIALS AND METHODS: This was a cross-sectional study of consecutively enrolled children with physician diagnosed asthma, attending clinics in a tertiary center in Nigeria. The presence of asthma, allergy types, and asthma control levels were determined using the Gobal initiative on asthma (GINA), international study of asthma and allergy in childhood and asthma control test questionnaires, respectively. RESULTS: There were 207 children with asthma enrolled from the Pediatric Asthma Clinic at University of Nigeria Teaching Hospital, Enugu. The median age was 10 years and interquartile range of 7-11 years. There were 127 (61.4%) from middle and high socioeconomic class and 86.5% who lived in the urban areas. Of the study participants, 41.5% had one or more allergy symptoms; rhinitis (33.3%), conjunctivitis (29.0%), and dermatitis (7.2%). Allergy symptoms persisted from infancy in 55.9%. Children from large families had a lower prevalence of allergies. Having any allergy symptom and belonging to a small-sized family were both associated with asthma exacerbations. Most children studied, (69.1%) had their asthma under control. Allergy persistence from infancy and type of allergy were not significantly associated with the level of asthma control. CONCLUSION: Allergic diseases are common in children with asthma in our environment, but did not significantly impact on asthma control. Socioeconomic factors such as urbanization and family size had effects on the achievement of asthma control but not on allergy status.

Steroid-induced impairment of glucose tolerance: Prevalence among pediatric patients on long-term steroid use in Nigeria.

INTRODUCTION: Glucocorticoid (referred to from here on as simply steroid) is used for effective treatment of various inflammatory disorders since its discovery in 1940s. However, these useful drugs cause important side effects, such as impairment of glucose tolerance. We sought to determine the prevalence of steroid-induced impairment of glucose tolerance in pediatric patients on long-term steroid use. MATERIALS AND METHODS: A cross-sectional, descriptive and hospital-based study. Consenting subjects who met the inclusion criteria were screened with random glucometer measurements repeated twice. An average of both readings obtained from the initial measurement of their random blood glucose (RBG) and a repeat during the next clinic visit was taken as the RBG. RESULTS: Hundred patients were studied, 66 males/34 females. Subjects with nephrotic syndrome were 61 while 39 had asthma. Mean age of 10.13 years (range: 0.5-18 years); mean body mass index (BMI): 18.2 kg/m2 (range: 6.6 to 26.30 kg/m2 ). The subjects with nephrotic syndrome were on oral prednisolone while the asthmatics were on inhaled fluticasone, budesonide and oral methylprednisolone. Mean (range) duration of steroid use was 9.74 (0.5-72) months. Mean (range) RBG was 3.49 (3.3-7.5) mmol/L. None of the subjects showed abnormal RBG. However, the RBG was further categorized into low, moderate and high normal RBG. A positive correlation between longer duration of steroid use as well as high doses of both oral and inhaled steroids, and high normal RBG existed (P = .015). No statistically significant relationship existed between body mass index (BMI) percentile and RBG (P = .437). CONCLUSION: Low to moderate doses of oral and inhaled steroids should be used when indicated as they are associated with lesser risk of impairment of glucose tolerance in the pediatric population.

Physical growth and nutritional status assessment of school children in Enugu, Nigeria.

BACKGROUND: Physical growth of a child is a reflection of its state of nutrition. In some developing countries such as Nigeria with changing economy and rapidly growing population, the nutritional status of the children is a reflection of the general well-being of the society. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which participants were selected using a multistage sampling method. Heights and weights of randomly selected school children aged 6-12 years were measured using standard protocols. Weight-for-age, height-for-age, and body mass index (BMI)-for-age expressed as Z-scores were used to characterize the nutritional status. Descriptive statistics was used to determine the frequency and standard deviations (SDs) of the anthropometric measurements. Age and gender differences in the mean body weight, height, and BMI were evaluated using an independent samples t-test. Significant levels were set at P< 0.05. RESULTS: A total of 1305 males and 1311 females were enrolled in the study. The mean age was 8.9 ± 1.9 years. Their mean height, weight, and BMI were 136.6 ± 10.2 cm, 29.7 ± 7.7 kg, 15.7 ± 2.4 kg/m2, respectively. Their mean ± SD scores of the WAZ, HAZ, and BAZ were 0.33 ± 1.20, 0.78 ± 1.17, and - 0.51 ± 1.27, respectively. A majority (78.9%, 2090/2616) were in the normal growth category. Wasting, overweight, obesity, underweight, and stunting were noted in 9.3% (243/2616), 6.3% (166/2616), 4.4% (117/2616), 0.9% (26/2616), and 0.4% (13/2616) of the children, respectively. Wasting was more in males (P = 0.069), and overweight was more in females (P = 0.138). CONCLUSION: A majority of the children have normal growth with the remainder in both extremes of malnutrition. Institution of school-feeding programs in all Nigerian schools as well as nutrition education/campaign directed at parents and their children will help forestall the double burden of under- and over-nutrition among our children.

Accidental Childhood Poisoning in Enugu, South-East, Nigeria.

BACKGROUND: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time. AIM: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu. SUBJECTS AND METHODS: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted. RESULTS: Sixty-five cases of childhood poisoning were recorded during the 10-year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65). CONCLUSION: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications.

Accidental Childhood Poisoning in Enugu; South-East; Nigeria

Background: Accidental childhood poisoning is one of the recognized causes of morbidity and mortality in children under the age of 5 years worldwide. The prevalence and type of substance ingested vary from place to place and over time.Aim: This study was conducted with the aim of ascertaining the frequency and pattern of accidental childhood poisoning in Enugu.Subjects and Methods: This retrospective study was conducted at the Emergency Paediatric Unit of the University of Nigeria Teaching Hospital, Enugu, South­East, Nigeria from January 2003 to December 2012 (10 years). All the cases of childhood accidental poisoning that presented within the period were reviewed and important information extracted.Results: Sixty­five cases of childhood poisoning were recorded during the 10­year period, giving an incidence rate of 442 per 100,000 children. The mean age was 22.15 ± 11.7 months. Male:female ratio was 1.5:1. The prevalence was higher among those with low socioeconomic background. Kerosene poisoning was the most common agent. The overall mortality rate was 3.1% (2/65).Conclusion: Accidental childhood poisoning is common in Enugu, with appreciable mortality, with kerosene being the most common agent. We advocate regulatory policy on proper ways of storing kerosene and other harmful household chemicals and medications

Morbidity and mortality pattern of childhood illnesses seen at the children emergency unit of federal medical center, asaba, Nigeria.

BACKGROUND: Morbidity and mortality from childhood illnesses has remained a major point of interest globally. Malaria, respiratory tract infection and diarrheal diseases are the leading causes of childhood morbidity and mortality. AIM: The aim of the following study is to determine the pattern of morbidity and mortality of children seen at the children emergency room of a tertiary hospital, Federal Medical Center in Asaba, Nigeria. SUBJECTS AND METHODS: A descriptive study of post-neonatal childhood admissions over a 5 year period (January 2007-December 2011) was undertaken. Information obtained included age, gender, diagnosis, month of admission and outcome. Descriptive and inferential statistics were used to analyze the demographic characteristics of the patients and associations with outcome variables. RESULTS: A total of 3,830 children with aged ranges between 1 month and 180 months were admitted within this period of study from January 2007 to December 2011: 2,189 males (57.2%, 2189/3830) and 1,641 (42.8%, 1641/3830) females. More than 70% (2912/3830) were under 5 years of age. The common indications for admission were malaria (30.3%, 1159/3830), diarrheal diseases (20.4%, 780/3830), respiratory tract infections (RTIs) (19.0%, 728/3830) and sepsis (4.4%, 168/3830). There were 221 (5.8%, 221/3830) deaths and more deaths were recorded in children <12 months of age, P < 0.01. Major causes of death were complicated malaria (24.4%, 54/221), sepsis (19.9%, 44/221), diarrheal diseases (18.1%, 40/221) and RTIs (7.7%, 17/221). CONCLUSION: Preventable infections are the major causes of morbidity and mortality in CHER and children <5 years of age are commonly affected.

Knowledge of Asthma among Doctors Practicing in Three South Eastern States of Nigeria.

BACKGROUND: Asthma is a chronic airway disease that has a significant impact on patients with substantial global socioeconomic burden. Appropriate knowledge by health care practitioners is important in the management of asthma. AIM: The aim was to assess the knowledge of asthma among doctors practicing in health care facilities in three South-Eastern states of Nigeria. SUBJECTS AND METHODS: This was a descriptive cross-sectional study. The participants were selected using multi-staged sampling method and interviewed with structured, self-administered questionnaires. Comparison of the different outcome variables using the Chi-square (categorical) and Student's t-test (noncategorical) with the characteristics of the participants were done. RESULT: A total of 283 doctors were interviewed. Eighty-eight percent of them identified asthma as a common disease in our environment, (P = 0.04) but unrelated to socioeconomic status. Knowledge of epidemiology was poor among medical officers and registrars (P = 0.04). Most of the doctors (80%)(226/283) recognized the pathogenic significance of bronchospasm in exacerbation, while 58.6% (166/283) of them considered chronic inflammation as a significant factor in asthma pathogenesis P < 0.001. Majority of the doctors (84.1%) (238/283) were aware of the use of steroids in acute exacerbation, while 59.4% (168/283) considered aminophylline as the first line medication in exacerbation (P = 0.02). Knowledge about the use of steroids as controller medication was noted in 1.7% (5/283) of the respondents. Only 47.3% (134/283) of the participants were aware of the Global Initiative on Asthma guideline, (P = 0.03). CONCLUSION: There was good knowledge of epidemiology and clinical features of asthma, but a small number of the doctors had knowledge of pathophysiology and treatment of the disease. For best practices in asthma management, there is a need for further education.

Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria.

BACKGROUND: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group. OBJECTIVE: The objective of the following study is to determine the prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics. MATERIALS AND METHODS: Urine specimen of febrile children aged 1-59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity. RESULTS: A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 ± 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males ( P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above ( P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI. CONCLUSION: UTI is common in febrile under-fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.

Asthma control and quality of life in school- age children in Enugu south east, Nigeria.

AIMS AND OBJECTIVES: This study set out to assess the quality-of-life of school-age children in relation to their level of asthma control. PATIENTS AND METHODS: A cross-sectional descriptive study of children with asthma using the Paediatric Asthma Quality of Life questionnaire (PAQLQ) and the Asthma Therapy Assessment Questionnaire (ATAQ) to respectively assess the health-related quality of life and the level of asthma control. RESULTS: Ninety children with mean age of 11.8(SD, 2.8; 95% CI, 11.2 to 12.4) years, were enrolled. Fifteen children (16.7%) were well-controlled, 17 (18.9%) were partly-controlled while 58 (64.4%) had uncontrolled asthma. The mean asthma control score for all participants was 3.2 (95% CI, 2.8 to 3.7). The mean quality-of-life score was 5.3 (SD, 1.2; 95% CI, 4.9 to 5.5). The lowest score was in the symptom domain: 5.1 (SD, 1.4; 95% CI, 4.9 to 5.5), and among the 14-17 year age group (4.5 SD, 1.5; MD=1.1; p=0.002). The emotional domain was the least affected 5.4 (SD, 1.3; 95% CI, 5.1 to 5.7). Children with well-controlled asthma had the best quality-of-life scores in symptom domains: 5.6 (SD, 1.3; 95% CI, MD=0.6, p=0.63). Quality of life scores were not significant in determining asthma control (MD=0.1, p=0.98). Age was noted as the strongest quality-of-life predictor (B=-0.2, p=0.002). CONCLUSIONS: QOL scores are better in children with well-controlled asthma. Adolescent age group marks a period of both poor asthma control and quality of life in children with asthma.

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu.

BACKGROUND: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. OBJECTIVES: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. MATERIALS AND METHODS: The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. RESULTS: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). CONCLUSION: Hematological abnormalities and malnutrition occur in HIV positive children.

Clinical features of acute gastroenteritis in children at university of Nigeria teaching hospital, ituku-ozalla, enugu.

BACKGROUND: Acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children world-wide with the highest incidence in the developing countries. The persistence and effect of this condition require a study of the features and characteristics of the disease especially, within any (each) locality in order to offer possible control solutions. AIM: To determine, the clinical and social characteristics associated with AGE among children seen in the University of Nigeria Teaching Hospital, Enugu. SUBJECTS AND METHODS: A hospital-based population study in which children admitted in the children emergency room of the University of Nigeria Teaching Hospital whose parents/caregivers gave their consent were enrolled, over a 7 month period. Appropriate statistical tools: Chi-square, t-tests, correlation and logistic regression were used to determine significant values and associations. RESULTS: A total of 76 children with AGE were enrolled; 69.7% (53/76) were males. The mean age of the subjects was 11.3 (6.6) months. Majority 94.7%, (72/76) of cases of AGE occurred in children less than 24 months, with children 6-11 months contributing the highest percentage 42%, (32/76). The study population was predominantly urban dwellers; 78.9%, (60/76, P = 0.40) and water cistern constituted 77.6% (58/76) of waste disposal method. Those who had potable water supply were 23.7%, (18/76, P = 0.30) and 19.7% of the children were exclusively breast fed. Fever and vomiting were the commonest associated symptoms, occurring in 82.9% (63/76) and 73.7% (56/76) of the subjects respectively. A good percentage of the subjects 64.5%, (49/76) had ORS before presentation. CONCLUSION: AGE is more common in older infants among those who were not exclusively breast-fed and the severity was unrelated to place of domicile and waste disposal habits.

Profile of pediatric abdominal surgical emergencies in a developing country.

We aim to determine the profile and determinants of outcome of pediatric abdominal surgical emergencies in southeastern Nigeria. We prospectively analyzed 115 children with abdominal surgical emergencies managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria, from January 2008 to June 2009. The emergencies were typhoid intestinal perforation (TIP) 22 (19.1%), intussusception 20 (17.4%), obstructed hernia 17 (14.8%), neonatal intestinal obstruction 11 (9.6%), appendicitis 11 (9.6%), trauma 8 (6.9%), ruptured omphalocele/gastroschisis 8 (6.9%), Hirschsprung's disease 7 (6.1%), adhesive bowel obstruction 7 (6.1%), and malrotation 4 (3.5%). The mean time to diagnosis was 3.5 days (range, 4 hours to 12 days). Ninety-three cases had an emergency operation, while 22 were managed nonoperatively. After a mean hospital stay of 10.8 days (range, 2-38 days), 35 (37.6%) of the operated patients had one or more postoperative complications. There were 10 (8.7%) deaths. Overall, TIP had a higher postoperative complication rate (P < 0.001), while neonates had a higher mortality (P < 0.001). Delayed presentation and lack of neonatal and pediatric intensive care facilities were daunting challenges. A pediatric abdominal surgical emergency in our setting has high morbidity and mortality. Efforts geared towards improvement in time to diagnosis and perioperative care may result in better outcomes.

Practice of Asthma Management among Doctors in South-East Nigeria

The major role of airway inflammation in childhood asthma has been recognised for more than a decade; and anti-inflammatory drugs now form the mainstay of treatment. In order to optimise treatment and achieve a better outcome; different guidelines have been introduced for asthma management. Examining the practice of the medical practitioners who manage asthma will help establish the gaps and provide informed advice on the current national and international guidelines. Our objective was to investigate the appropriate treatment of acute bronchial asthma by medical practitioners in south-east Nigeria. Two hundred and eighty-five doctors were interviewed using a structured questionnaire. Evaluation for differences in asthma management by doctors with different years of practice and heath facilities was carried out. Results were analysed with Epi info version 3.5. We concluded that management based on newer trends in childhood asthma management and adherence to management guidelines is less common among doctors that work in non-tertiary health facilities and among doctors that graduated more than 15 years ago or less than 5 years ago. This needs to be improved for optimal management of these patients. The need for regular continuing medical education for all doctors cannot be over emphasised

Risk factors associated with congenital malaria in Enugu, South Eastern Nigeria.

There is paucity of data on the risk factors associated with congenital malaria in Nigeria. This study assessed the risk factors for congenital malaria in a population of neonates delivered at the University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria. It was a prospective cross-sectional study of neonates who were delivered in the institution from 2 April 2003 to 15 April 2004 as well as their mothers. Thick and thin blood films were made from maternal, baby and cord blood as well as the placenta for each mother/baby pair to determine malaria parasite density counts and for species identification. The maternal samples were obtained as soon as labour was confirmed while the cord and baby's blood as well as placental smears were taken within 1 h of delivery. Data analysis was by means of descriptive and inferential statistics as well as univariate and multivariate logistic regression at the 95% confidence level using the statistical software SPSS for Windows Version 10. A total of 658 mother/baby pairs were recruited into the study within the 13-month period. Out of this number, 625 mother/baby pairs completed the study and their data were subsequently analysed. A total of 356 (56.96%) mothers and 203 (32.48%) babies were smear positive for Plasmodium falciparum. On univariate logistic regression with presence or absence of the congenital malaria as the dependent variable, six out of the 13 putative risk factors tested were statistically significant. These were low compared with higher socioeconomic classes (OR = 1.41, 95% CI = 1.18 - 1.69, p = 0.00); low compared with normal birth weight (OR = 2.14, 95% CI = 1.39 - 3.30, p = 0.001); positive placental malaria parasitaemia (OR = 6.29, 95% CI, 4.73 - 8.37, p = 0.000), positive maternal blood malaria parasitaemia (OR = 5.04, 95% CI = 3.74 - 6.78, p = 0.000), positive cord blood malaria parasitaemia (OR = 26.87, 95% = 15.79 - 45.74, p = 0.000) and parity of 0 - 1 compared with other parities (OR = 1.31, 95% CI = 1.11 - 1.55, p = 0.002). On multivariate logistic regression, three of the six factors that were significant on univariate logistic regression remained significant. These were: positive placental malaria parasitaemia (OR = 2.55, 95% CI = 1.45 - 4.47, p = 0.001); positive cord malaria parasitaemia (OR = 18.90, 95% CI = 10.68 - 33.46, p = 0.000 and parity of 0 - 1 compared with other parities (OR = 1.66, 95% CI = 1.09 - 2.52, p = 0.02). It was concluded that the risk factors for congenital malaria identified in this study emphasise the need for effective preventive and curative treatment of malaria not only during pregnancy but also during delivery in malaria endemic areas. Additionally, congenital malaria should now rank high among the list of differential diagnosis of fever in the newborn in such endemic areas.

Epidemiology of malaria in infancy at Enugu, Nigeria.

This was a retrospective study to ascertain the prevalence and clinical features of malaria in infants in Enugu between January 1998 and January 2000. Case notes of two thousand children were reviewed, one hundred and fifty-five (7.75%) had a diagnosis of malaria, with a male/female ratio of 1.2:1. The age range was two days to twelve months with a mean of 5.06 +/- 3.24 months. Nine infants (5.8 %) were less than seven days old. Ninety-nine of the patients (63.9%) had temperature > or = 37.5 degrees C. Diarrhea was a symptom in 52 (33.5%) patients, while vomiting alone or in combination with diarrhea was a presenting feature in 37 (23.87%) of the children. Twenty-eight children (18.1%) had respiratory symptoms of which, two had bronchopneumonia. Other associated illnesses included. septicaemia: 6(3.8%). infective diarrhea; 5(3.2%), and urinary tract infection; 4 (2.6%). Malaria is common in infants less than 6 months of age and associated with symptoms common with other childhood illnesses.

Caregivers's knowledge, attitude and practice on childhood malaria and treatment in urban and rural communities in Enugu, south-east Nigeria.

OBJECTIVE: To ascertain caregivers's knowledge, attitude and practice regarding malaria and treatment of children in rural and urban communities in Enugu, Nigeria. STUDY DESIGN: This was a cross-sectional study, and caregivers were selected by convenience sampling. METHOD: In total, 224 and 184 respondents were interviewed in paediatric outpatient clinics in rural and urban areas, respectively, using structured questionnaires. RESULTS: Most respondents in rural and urban areas has heard of malaria (99% urban, 74% rural; P < or = 0.05). Both groups were unaware of the particular susceptibility of children and pregnant women to the disease, and respondents preferred to use self-medication (urban 79%, rural 20%). The rural and urban caregivers were quite familiar with and used antimalarial drugs such as chloroquine (urban 23%, rural 15%) and sulphadoxine-pyrimethamine (urban 50%, rural 6%), although in inappropriate dosages. They were also aware of preventive measures against malaria such as insecticide-treated nets (urban 32%, rural 56%), but there was low usage in both communities (7 and 2%, respectively). CONCLUSIONS: Both rural and urban communities were aware of malaria as a disease, but practices were grossly inadequate. The provision of affordable healthcare facilities and the use of health education to change knowledge, attitude and practice will help meet the target goals of the 'Roll Back Malaria' campaign in the area.