Validation of pediatric height estimation formulae in suburban communities in South-east Nigeria: a cross-sectional study.

BACKGROUND: Height measurement is one of the common essential anthropometric measurements in clinical pediatrics. The most accurate method of determining a child's height is to measure the height. However, in emergency situations and some resource limited settings, obtaining the actual height of a child may not be feasible hence the need to estimate. The most common age-based formulae for height estimation in children is the Nelson-Wheech formula, 6n + 77 where n = age in years. The accuracy of this height estimation formulae has not been assessed in a developing setting like ours with high prevalence of malnutrition. This study therefore sought to evaluate the accuracy of the height estimation formula in children in communities across Enugu southeast Nigeria. METHOD: Children 2-12 years old who met the inclusion criteria were enrolled over 12 months from three of the 17 Local Government Area of Enugu State. Height was measured using a standard stadiometer and estimated height was calculated 6n + 77. Data collected was analyzed using SPSS. RESULT: Of the 4046 children enrolled, majority (86.1%) were of normal height. The formula underestimated height of children in the two, 3, 4, 5, 6, 7, 9 and 10 years old categories by a factor of 1.2%-10.0% while overestimating height in 8-year old children by 5.1%, 11-year old by 0.2% and 12-year by 2.9%. Overall, the estimated height using the formula was within ± 10% agreement of the actual height of surveyed children in 77.0% of children surveyed. CONCLUSION: The 6n + 77 formula is a reasonable but not entirely accurate for height estimation for children in our setting.

Snakebite in children in Nigeria: A comparison of the first aid treatment measures with the world health organization's guidelines for management of snakebite in Africa.

Background: Snakebite and envenomation remains a public health problem with significant morbidity and mortality in children in developing countries. The World Health Organization (WHO) in 2010 developed guidelines for the prevention and management of snakebite in Africa. Aim: The aim of this study was to compare the pattern of first aid treatment among children presenting with snakebite/envenomation with the 2010 WHO guideline for the prevention and clinical management of snakebite in Africa. Patients and Methods: All children who presented with snakebite over a 7-year period in a teaching hospital in Enugu, Nigeria. The first aid treatment given to these children was obtained and was compared with the provisions of the WHO guideline for the prevention and clinical management of snakebite in Africa (2010). Data collected were analyzed using SPSS version 22. Results: Five (71.4%) of the snakebites occurred in the rainy season and in the dark involving the lower limbs in 85.7% of cases. Six (87.5%) of the patients received one form of first aid before presentation to a health facility. None received first aid interventions in line with the WHO recommendation. Topical application of herbal concoctions to the site of the bite (37.5%) was the most common intervention. One (14.3%) of the children was promptly brought to the health facility following snakebite. The interval from bite to presentation to the health facility ranged from 1 to 12 h (median 5 h: 43 min). Conclusion: Huge gaps still exist in the first aid treatment given to snakebite victims compared to the WHO guidelines.

RésuméContexte: La morsure de serpent et l'envenomation demeurent un problème de santé publique avec une morbidité et une mortalité importantes chez les enfants des pays en développement. L'Organisation mondiale de la Santé (OMS) a élaboré en 2010 des lignes directrices pour la prévention et la gestion des morsures de serpent en Afrique. Objectif: L'objectif de cette étude était de comparer le modèle de traitement des premiers soins chez les enfants présentant des morsures de serpent/envenomation avec la directive 2010 de l'OMS pour la prévention et la prise en charge clinique des morsures de serpent en Afrique. Patients et méthodes: Tous les enfants qui se sont présentés avec des morsures de serpent sur une période de 7 ans dans un hôpital d'enseignement à Enugu, Nigeria. Le traitement de premiers soins accordé à ces enfants a été obtenu et a été comparé aux dispositions de la ligne directrice de l'OMS pour la prévention et la prise en charge clinique des morsures de serpent en Afrique (2010). Les données recueillies ont été analysées à l'aide de la version 22 du SPSS. Résultats: Cinq (71.4%) des morsures de serpent se sont produites pendant la saison des pluies et dans l'obscurité impliquant les membres inférieurs dans 85,7% des cas. Six (87,5 %) des patients ont reçu une forme de premiers soins avant d'être présentés à un établissement de santé. Aucun d'entre eux n'a reçu d'interventions de premiers soins conformément à la recommandation de l'OMS. Application topique des concoctions à base de plantes sur le site de la morsure (37,5%) était l'intervention la plus courante. Un (14,3%) des enfants a été rapidement amené à l'établissement de santé à la suite d'une morsure de serpent. L'intervalle allant de la morsure à la présentation à l'établissement de santé variait de 1 à 12 h (médiane 5 h : 43 min). Conclusion: Il existe encore d'énormes lacunes dans le traitement des premiers soins accordé aux victimes de morsures de serpent par rapport aux lignes directrices de l'OMS.

Weight estimation in Paediatrics: how accurate is the Broselow-tape weight estimation in the Nigerian child.

BACKGROUND: Determination of weight in children is an important aspect of their assessment. It has a wide range of usefulness including assessing their nutritional status and drug dose calculation. Despite its usefulness, weight estimation in children in certain conditions can be challenging particularly in emergency situations or in children who are severely ill or cannot stand on standard scales. The Broselow Tape which is a validated tape that is used to estimate weight based on length was developed using height/weight correlations from Western data. However, considering the variations in anthropometric measurements of children from different geographic locations, there is need to ascertain how accurate it is to estimate weight using the Broselow tape among children in Nigeria. AIM: The study was carried out to determine the accuracy in the use of the Broselow Tape in weight estimation among Nigerian children. METHOD: A total 1456 children aged 1-12 years who satisfied the inclusion criteria were enrolled over a 2½ year period from two tertiary health facilities in Enugu state Nigeria. Weight was taken using standard weighing scale and Broselow tape. Data collected was analysed using SPSS. RESULT: Of the 1456 children studied, majority (84.2%) had normal Body-Mass-Index (BMI) while about 4.6% had a low BMI percentile for age. The mean weight difference between the two methods was not significantly different between the 1 to 6 years old category. Significant differences were observed from 7 up to 12 years. The Broselow Tape overestimated weights in 1 year old by 3.88%, 2 years 1.58%, 3 years by 2.13%, 4 years (1.94%) and 5 year (0.07%). After 5 years, the degree of overestimation rises sharply to 4.25% in 6, 9.25% in 7, 7.29% in 8 and 9.29%. 9.18, 11.61% & 6.75% in 9, 10, 11 and 12 years old respectively. The proportion of estimated weights that was within 10- 20% of the actual weight was higher in the 1-6 years age categories compared to weight estimates in older age categories. CONCLUSION: Weight estimates obtained using the Broselow tape correlated better in children that are 6 years or younger compared to those in the older age categories. There is need for re-validation and/or adjustments of the Broselow tape especially in children over 6 years old.