Outcome of short-term emergency department observation care of children with sickle cell disease and vaso-occlusive crises: initial experience from south-western Nigeria.

BACKGROUND: Short-term emergency department (ED) observation care may prevent prolonged and unnecessary hospital admission in patients with sickle pain. This study highlights the outcomes of short-term ED care of acute pain in children with sickle cell disease (SCD). METHODS: Children aged 6 mo to 19 y with SCD and painful crises who were managed by short-term ED care from July 2017 to June 2019 were studied retrospectively. Biodata, pain score, type of care, length of hospital stay, inpatient transfer rate (the proportion that required transfer for full admission) and return rate (the proportion that returned to the hospital for retreatment of unresolved pain) were documented. RESULTS: From July 2017 to June 2019, 122 children with SCD were admitted to the ED for painful crises, of whom 118 (96.7%) with 167 hospital visits were managed by short-term ED observation care. The median length of stay was 10.5 h. In 50.3% of encounters, patients were successfully managed without requiring further care. However, in 17.4% of encounters, they had their ED observation care terminated and converted to full admission. The overall return rate for acute care within 1 wk for either persistence of symptoms or any other complaint was 31.7%. CONCLUSIONS: Dedicated short-term ED observation care has the potential to provide effective and timely management of acute pain in children with SCD.

Prevalence and predictors of hypoxaemia in hospitalised children at the emergency unit of a resource constrained centre

Background: Hypoxaemia is often poorly detected and treated in emergently-ill children in resource-poor centres because of the non-availability of pulse oximeters and similar facilities to detect it. This study sets out to determine the prevalence and simple predictors of hypoxaemia among children with or without respiratory features at the emergency unit of the Wesley Guild Hospital, Ilesa, Nigeria.Methods: Children aged one month to 14 years were consecutively recruited and prospectively studied over an eight month period. All the children had their peripheral oxygen saturation (SpO2) measured at presentation using a portable pulse oximeter (Nellcor(R) N-200, USA) and hypoxaemia was defined as SpO2 < 90%. Relevant history and examination findings were compared among hypoxaemic and nonhypoxaemic children. Multivariate analysis was used to predict the presence of hypoxaemia.Results: Four hundred and two children were recruited with male to female ratio of 1.3:1 and105 (26.1) presented with respiratory features. Eighty three (20.6%) were hypoxaemic including 40 (38.1%) of those with respiratory features at admission. Infancy, chest in-drawing, cyanosis and grunting were associated with hypoxaemia (p < 0.05) among those with respiratory features, while infancy, pallor and tachycardia were significant among those with no respiratory features. Grunting (OR = 7.875; 95% CI=1.029- 15.797; p = 0.045) and Cyanosis (OR =13.579; 95% CI = 1.360- 14.379; p = 0.009) independently predict hypoxaemia among the children with respiratory features.Conclusion: Hypoxaemia occurred in approximately one out of five ill children admitted to the emergency unit of the WGH, Ilesa and was significantly associated with mortality. Emergently ill children with cyanosis and grunting especially infants should preferentially be placed on oxygen therapy even when hypoxaemia cannot be confirmed

Head circumference of rural Nigerian children--the effect of malnutrition on brain growth.

OBJECTIVE: To compare head circumference measurements of the well nourished with those of the malnourished children for each sex. DESIGN: Cross sectional. SETTING: Imesi, Ile-Ife village, Nigeria. SUBJECTS: 644 children in the first six years of life. MAIN OUTCOME MEASURES: Head circumference. RESULTS: The mean head circumference values of malnourished children of both sexes fell mostly below the values for their well nourished age mates. The curve for well nourished girls fell by a little below, and for malnourished girls by over two standard deviations below Tanner's 50th percentile curve. For the boys, the curve for the malnourished children fell by over one standard deviation below the curve for their well nourished age mates. CONCLUSION: The significant reductions in head circumferences found in malnourished children may have serious implications for their future performance and achievement. Therefore, sufficient community concern and appropriate world action aimed at eradicating protein energy malnutrition is solicited.

Secular trends in the growth of children aged 0-6 years in a rural Nigerian community.

Cross-sectional anthropometric measurements were taken between 1987 and 1990 in 673 children aged 0-6 years in Imesi Ile village, Nigeria. The height and weight curves obtained fall behind corresponding growth curves in the same community three decades previously. Mid-upper arm circumference values indicated moderate to severe malnutrition in 25.8% of children aged 1-5 years. The heights of 67.1% and weights of 59.7% of the children fell below the third percentile of a Nigerian equivalent of an international reference population standard. Possible reasons for deterioration of the nutritional status of children in the community include the prevailing adverse socio-economic conditions, changes in child rearing practices over the years, persistence of unsatisfactory living conditions and failure to sustain the implementation of innovative programmes previously introduced into the community. It is suggested that present programmes aimed at promoting the health of rural communities should be reviewed to improve sustainability and should be backed up by measures to improve socio-economic and living conditions.

A 10 year retrospective evaluation of cases of post neonatal tetanus seen in a paediatric unit of a university teaching hospital in south western Nigeria (1985 to 1994).

A review of 56 children with post neonatal tetanus admitted over a 10 year period (January 1985 t December 1994) was undertaken at the Wesley Guild Hospital, IIesa, South Western Nigeria. The male: female ratio was 1.8:1. About 64.3 pc of the cases were above six years of age (mean 7.6 years). Wounds on the lower limb were identified as portal of entry in 39.2 pc of cases and discharging Otitis media in 21.4 pc. Otitis media was the usual portal of entry among the pre-school children (six years) in 55 pc of the cases. The patients were managed with antibiotics, alternating does of diazepam, phenobarbitone and chlorpremazine and nasogastric tube feeding. It was noticed (in 1992) that the patients showed varying degrees of talkativeness and disinhibition during therapy, which tended to subside one to two weeks after discontinuation of chlorpremazine and phenobarbitone. One case had a relapse which occurred one week after complete cessation of the initial symptoms which had taken four weeks to nurse. Resolution of symptoms followed the removal of a foreign body from the left foot on the 58th day of admission. Mortality was recorded in 39.3 pc of cases. Only 12.5 pc of the survivors completed the scheduled immunization doses after discharge.

Two unusual cases of kwashiorkor: can protein deficiency explain the mystery?

Two children with unusual features of kwashiorkor are reported. One, an exclusively breastfed 7-month-old girl, had been admitted earlier, treated for pneumonia and discharged 3 weeks before she presented with kwashiorkor. The other was an identical twin who was admitted for kwashiorkor and gastro-enteritis. The twin sister was underweight but relatively well. Both children died. Potent aflatoxins were detected in the organs of these children on post-mortem examination. The occurrence of kwashiorkor in a fully breastfed infant and in an identical twin does not accord with the extant belief that the aetiology of kwashiorkor is wholly nutritional, but suggests a disease probably of multifactorial origin.

Anthropometric measurement in children aged 0-6 years in a Nigerian village.

Seven hundred and three Nigerian village children in their first six years of life were subjected to anthropometric measurements and physical examination in early 1988. The heights of 66.9% and weights of 60.5% of them fell below the third percentile of a Nigerian equivalent for international reference population standard. Mid upper arm circumference values indicated moderate to severe malnutrition in over 25% of all 1-5 year old children surveyed. Fever, cough, headache and diarrhoea were the commonest symptoms encountered in the children. Mild pallor of the conjunctival mucosa and physical signs of protein energy malnutrition were commonly seen. Fungal and septic skin lesions were present in 11.45 and 11.1% of the children respectively, whilst rhinorrhoea was seen in 4.7%, otitis media in 6% and pharyngotonsillitis in 3.3%. Thirty four (4.8%) of the children had haemic whereas five had pathological murmurs. Dental calculi were present in 15.8%, umbilical herniae in 18.2%, hepatomegaly in 48.2% and splenomegaly in 23% of the children. Seven (1%) had cerebral palsy. The implication is that malnutrition, sickle cell disease, malaria and other infections are the prevailing causes of morbidity in the preschool aged children surveyed. Desirable improvements include upgrading socio-economic and living conditions and instituting appropriate control measures.

Incidence of bacteraemia among children with severe anaemia in Wesley Guild Hospital, Ilesa, Nigeria.

One-hundred-and-fifty-two severely anaemic patients, aged 6 months to 14 years were studied with a view to ascertaining the incidence of bacteraemia in them. Haemoglobin genotype AA was seen in 68 (45 per cent) of the patients, 38 (25 per cent) patients were of haemoglobin genotype SS; 35 (23 per cent) patients were of haemoglobin genotype AS; three (2 per cent) patients were of haemoglobin genotype AC and eight (5 per cent) patients were of haemoglobin genotype SC. Positive blood cultures were obtained in a total of 15 (10 per cent) patients. Of these 15 patients, 10 (22 per cent) patients were sicklers (9 HbSS; 1 HbSC) of a total of 46 sicklers studied. The remaining five (5 per cent) patients that had positive blood cultures were non-sicklers out of a total of 106 non-sicklers studied. There was a statistically significant difference between the sicklers and non-sicklers who had positive blood cultures (P < 0.05). The presence or absence of positive blood culture did not correlate with the severity of anaemia in either the sicklers or the non-sicklers. It is suggested that any severe anaemic patient with clinical features suggestive of sickle cell anaemia must have a blood culture done in the course of management. An 'identify at all costs' approach should not apply to severe anaemic children who are non-sicklers. The yield is low and cost high, clinicians should be selective in deciding in which patients blood cultures are warranted.