Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor.

BACKGROUND: Severe malnutrition contributes up to 50% of childhood mortality in developing countries is frequently characterised by electrolyte depletion, including low total body phosphate. During therapeutic re-feeding, electrolyte shift from extracellular to intra-cellular compartments may induce hypo-phosphataemia (hypo-P) with resultant increased morbidity and mortality. This biochemical imbalance is under-recognised, and the frequency of this problem among African malnourished children is unclear. OBJECTIVES: To determine the magnitude of hypo-phosphataemia in children under five years of age presenting to Kenyatta National Hospital with kwashiorkor and marasmic kwashiorkor and to evaluate the relationship between hypo-phosphataemia and nutritional intervention during the first five days of treatment. DESIGN: Short longitudinal survey. SETTING: The General Paediatric wards of the Kenyatta National Hospital (KNH), Nairobi. SUBJECTS: Children under five years of age presenting with kwashiorkor or marasmic kwashiorkor at KNH were recruited into the study. MAIN OUTCOME MEASURES: Low serum phosphate level (< 1.20 mmol/l) and patient outcome (survival or death) during the first five days of treatment. RESULTS: One hundred and sixty five children were enrolled between June 2005 and February 2006 of which 107 (64%) had kwashiorkor and 58 (36%) had marasmic kwashiorkor. They were of mean age 20 months (range 3-60), and 95 (58%) were male. The prevalence of hypo-phosphataemia was 86% on admission, increased to 90% and 93% on day one and two respectively, and then declined to 90% by the fourth day. At admission 6% were hypo-phosphataemic, increasing to 18% and 22% on day one and two respectively, and declining to 11% by day four. On admission mean serum phosphate was below normal at 0.91 mmol/l, declined significantly to 0.67 mmol/l and to a nadir of 0.63 mmol/l after the first and second day of treatment respectively, then rose slightly to 0.75 mmol/l on the fourth day (p < 0.001 comparing each follow-up mean level with the admission level). There was a positive association between severity of nadir serum phosphate level and mortality (p = 0.028). There were no deaths among children with normal nadir serum phosphate levels. However, among children with mild, moderate and severe nadir hypo-phosphataemia, 8,14 and 21% died respectively. Children with dermatosis and hypomagnesaemia showed a trend for association with mortality (p = 0.082 and 0.099 respectively). CONCLUSION: Hypo-phosphataemia is frequent among children with kwashiorkor and marasmic kwashiorkor presenting at KNH. Serum phosphate levels decline significantly during the first two days of nutritional intervention, and severity of

Gaucher's disease at a national referral hospital.

OBJECTIVES: To determine the prevalence and to characterise Gaucher's disease in terms of socio-demographic data, clinical presentation, and management as seen at Kenyatta National Hospital. DESIGN: A retrospective record based study. SETTING: Kenyatta National Hospital, a referral and teaching hospital. MAIN OUTCOME MEASURES: Prevalence (number of cases seen a year), of Gaucher's disease, sociodemographic data, clinical presentation, mode of diagnosis and treatment modalities of Gauchers disease. RESULTS: Nine patients were studied, four males and five females giving a prevalence of 0.9 cases seen a year and a M:F ratio of about 1:1. The most common presentation was splenomegaly in nine (100%) cases and hepatomegaly in seven (78%) patients, neurological and bone symptoms were rare, in one (11%) cases and in two (22%) cases respectively. Diagnosis was mainly on basis of presence of Gaucher cells in bone marrow and splenic aspirate as enzyme assay was unavailable. Management was mainly supportive and enzyme therapy was only available for two (22%) patients. Anaemia was the most common complication with seven (78%) patients and one death occurred due to osteomyelitis. Only four (44%) patients were followed up for a period of four years. CONCLUSIONS: Gaucher's disease is a rare condition at the Kenyatta National Hospital (KNH). The presentation of most patients is organomegaly, (hepatosplenomegaly) and best fits the type 1 or non-neuronopathic Gaucher's disease. Neurological manifestations are rare. Management of this condition at the KNH is mainly supportive and enzyme therapy still remains out of reach for most patients.

Seroprevalence of hepatitis B markers in pregnant women in Kenya.

OBJECTIVE: To evaluate hepatitis B serological markers in pregnant women from various geographical sites in Kenya. DESIGN: A cross-sectional observational study of women attending antenatal clinics. SETTING: The Kenyatta National Hospital and eight hospitals from five provinces in Kenya. SUBJECTS: All women in their third trimester of pregnancy attending the antenatal clinic over the period June 2001 to June 2002. MAIN OUTCOME MEASURES: For each pregnant woman age and gestation were documented. Hepatitis serological markers were evaluated. RESULTS: A total of 2241 pregnant women were enrolled. Among them 205 women (9.3%) were positive for HbsAg and from these 18 (8.8%) were found to have HbeAg. Protective antibodies (anti-HbsAg) were detected in 669 (30.2%) of the women. There were notable significant regional differences for HbsAg rates. CONCLUSIONS: These results confirm the presence of high disease carrier rate and the corresponding previously reported low level of HbeAg suggesting questionable low rate of perinatal transmission but high rate of horizontal transmission.

Bacteraemia, urinary tract infection and malaria in hospitalised febrile children in Nairobi: is there an association?

BACKGROUND: There is laboratory evidence of altered immune function in children with malaria. Bacterial infections have been documented to complicate severe forms of malaria. However, it remains unclear whether such infections are attributable to the malaria, other risk factors, or are coincidental. OBJECTIVE: To determine the prevalence of bacteraemia and urinary tract infections (UTI) in febrile hospitalised children with and without malaria. DESIGN: A cross-sectional survey. SETTING: General paediatric wards, Kenyatta National Hospital, Nairobi. SUBJECTS: Children aged between three months and 12 years admitted with an acute febrile illness, with no obvious focus of bacterial infection. MATERIALS AND METHODS: Using a standardised questionnaire, information on socio-demography, symptomatology, and nutritional status was obtained. Malaria slides, blood and urine cultures were performed on each child. RESULTS: Malaria parasitaemia was present in 158 (60%) of 264 children presenting with acute febrile illness with no obvious focus of bacterial infection. Bacteria were isolated from blood and/or urine of 62 (23%) of all enrolled children. Bacteraemia was prevalent among 11.4% of 158 children with malaria and among 13.2% of 106 without malaria. Gram-positive organisms comprised 28.1% of blood isolates, gram-negative 62.5%, and atypical bacteria 9.4%. UTI was prevalent among 13.3% of 158 children with malaria and 16.0% of 106 children without malaria. Gram-positive organisms comprised 18.4%, gram-negative 78.9%, and atypical bacteria 2.6% of the urine isolates. Presence of malaria parasitaemia was not associated with an increased risk of bacteraemia (OR 0.9, 95% CI [0.4-0.7], or UTI (OR 0.8 95% CI [0.4-1.6] in this study population. CONCLUSION: Among children hospitalised in Nairobi with fever and no obvious bacterial infective focus, there should be a high index of suspicion for malaria, followed by bacteraemia and UTI. Malaria parasitaemia does not appear to be associated with increased risk of bacterial co-infection.

Pattern of use of skin care products in children with and without eczematous skin lesions.

OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

Galactosaemia in an infant: case report.

Galactosaemia is a disorder of galactose metabolism in which raised levels of galactose and galactose-l-phosphate damage various organs. It is a very rare disease (incidence 1 in 60,000) and the diagnosis is often missed, leading to poor prognosis. A case of clinical galactosaemia that was diagnosed at the age of 11 months is reported. It is important to be aware of this condition as early treatment may prevent some of the complications.

Iron deficiency anaemia in children of a peri-urban health facility.

OBJECTIVE: To ascertain the prevalence of iron deficiency anaemia(IDA) and its risk factors. DESIGN: A cross-sectional survey. SETTING: A peri-urban health centre in Nairobi, Kenya. SUBJECTS: Four hundred and three children, aged six months to six years. INTERVENTION: Demographic data were obtained and each child examined for signs of iron deficiency anaemia. Blood was drawn for haemoglobin determination. MAIN OUTCOME MEASURE: The diagnosis of iron deficiency anaemia was made using a pre-defined criteria. RESULTS: Iron deficiency anaemia had a prevalence of 7.4% (95% CI = 4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with iron deficiency anaemia with a prevalence of (14.6%) in infants. No association was found between IDA and sex, birthweight, weaning age and weaning diet, sanitation, water source or mother's education. CONCLUSION: The prevalence of iron deficiency anaemia in this health facility was relatively low and was predominantly mild.

PIP: This cross-sectional survey, conducted in a periurban health center in Nairobi, Kenya, determined the prevalence of iron deficiency anemia (IDA) and its risk factors among 403 children aged 6 months to 6 years. Demographic data were obtained and each child was assessed for signs of IDA. Blood was drawn for hemoglobin determination. The diagnosis of IDA was made using predefined criteria. Findings revealed that the prevalence of IDA was 7.4% (95% confidence interval = 4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with IDA, with a 14.6% prevalence rate in infants. No association was found between IDA and factors such as sex, birth weight, weaning age and weaning diet, sanitation, water source, or education of the mother. Although the study showed that IDA was not a major health problem in the area, as evidenced by the low prevalence rate and presence of only mild cases, there is still a need for emphasis on health education at the health facility since young children are at high risk of IDA.