Comparative study of nutritional status of children and adolescents with sickle cell anemia in Enugu, Southeast Nigeria.

BACKGROUND: Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported. AIMS: To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. METHODS: The study was a cross-sectional analytical study involving 175 subjects and controls aged 1-18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated. Z scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201+ Analyzer. RESULTS: Subjects had significantly lower Z- scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (P = 0.001). CONCLUSIONS: Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.

Rotavirus diarrhoea hospitalizations among children under 5 years of age in Nigeria, 2011-2016.

BACKGROUND: The high burden of rotavirus acute gastroenteritis (AGE) is well documented among children under 5 years of age, with the majority of mortality occurring in developing countries. Nigeria ranked second worldwide in the number of rotavirus deaths in 2013. As Nigeria plans to introduce rotavirus vaccine soon, a pre-vaccine documentation of rotavirus disease burden is necessary to determine vaccine impact. METHODS: Routine rotavirus surveillance was conducted during 2011-2016 in 3 sentinel sites in Nigeria using the standard WHO protocol. Children under 5 years of age hospitalized for acute gastroenteritis were enrolled and demographic, clinical and outcome data were collected. A stool sample was subsequently obtained and tested for human rotavirus antigen using the Enzyme-linked immunosorbent assay (ELISA). RESULTS: 2694 children with acute gastroenteritis were enrolled during January 2011 to December 2016; of these, 1242 (46%) tested positive for rotavirus. Among the rotavirus positive cases, 66% and 94% were younger than 12 months and 24 months respectively. Marked peaks in rotavirus positivity were seen in January of each year. Vomiting, and use of oral and intravenous fluids occurred more often in rotavirus positive cases as compared to rotavirus negative cases. CONCLUSION: The high prevalence of rotavirus disease highlights the need for urgent introduction of rotavirus vaccine in Nigeria. Additionally, this study provides pre-vaccine introduction disease-burden data that will serve as a baseline for rotavirus vaccine impact-assessment once vaccine has been introduced in the national immunization program.

Unusual presentations of Giardia lamblia; a report of four cases.

OBJECTIVE: To create awareness that giardiasis can mimic acute clinical symptomatologies and result in missed diagnosis. METHOD: The case files of four acute and life threatening presentations that were misdiagnosed initially but later found to be Giardia lamblia infestations from laboratory stool results and responded to treatment for giardiasis were reviewed. RESULTS: One of the cases was diagnosed as food poisoning, a second as a case of hypovolemic shock and the third also as a hypovolemic shock, though also considered to have sepsis and the last, a case of acute exacerbation of asthmatic attack. Three of the cases were less than 24 months and vomiting was seen in 3 of them. CONCLUSION: Giardiasis in childhood can be acute and life threatening and should be considered in such ill children, especially if they also have digestive system symptomatology.

Sensitivity pattern of bacterial isolates in childhood sepsis in clinical practice at Onitsha.

OBJECTIVE: To determine the commonest organism cultured from the blood of children suspected to have bacterial sepsis and their antibiogram sensitivity using the commonly used antibiotics in a private practice and see if there are differences from established data from other areas. METHOD: Children beyond neonatal age presenting to a children's specialist hospital in southeast Nigeria over a 2 year period with fever and other features of systemic inflammatory response syndrome (SIRS) thought to be due to bacterial infection (but without focal point of infection) had their blood cultures done. A review of their case notes and an analysis of their blood culture and antibiogram sensitivity results was done. RESULTS: Fourteen cases fitted the criteria and were analysed. Staphylococcus aureus was the commonest organism and of the profiled antibiogram the sensitivity pattern showed that ciproxin, gentamycin, chloramphenicol and erythromycin were the best. CONCLUSION: Staphylococcus aureus is still a major cause of childhood bacterial sepsis. Gentamycin and erythromycin are safe and useful antibiotics in their treatment and are recommended.

Concurrent use of cyclophosphamide and prednisolone in childhood nephrotic syndrome in South-East Nigeria; a report of 5 cases.

INTRODUCTION: Nephrotic syndrome is a chronic renal disease that can lead to end stage renal disease. There are different histological types with global variations in frequency. Literatures reviewed showed that the African variant is less likely to be minimal change variant. No clear treatment protocol for it has been most beneficial. OBJECTIVE: This paper aims to evaluate the outcome of a treatment protocol using cyclophosphamide and prednisolone concurrently. METHODS: A low dose and short duration concurrent use of cyclophosphamide and prednisolone was used for treating children with nephrotic syndrome who had not developed derangements of their renal function. The case files of those that were treated and followed up over a 10 year period or until they were above 18 years of age were analysed for their clinical parameters. RESULTS: Five cases were treated and all have been in clinical remission for more than 4 years as at the time of the review, though 2 of them relapsed twice initially. They were all aged above 6 years and had microscopic hematuria. The 3 cases whose ESRs were done had high levels. Two cases that presented 1 yr after the onset of their symptoms resolved without relapse while 2 out of the remaining 3 in whom this interval was less than 6 months relapsed. CONCLUSION: This treatment protocol appears beneficial to childhood nephrotics in this environment and should be used.

Anthropometry and blood pressure in Nigerian children

Objective : To determine if there is a correlation between blood pressure and anthropometry in children of Igbo ethnicity.Subjects, Materials and Methods: One thousand, six hundred and thirty-four boys and 1669 girls were studied. Their ages ranged from 6 to 14 years. Their blood pressures, weights and heights were measured. The Quetelet's indices were determined and the correlation coefficients, r, found.Results:For boys, weight correlated (r=0.3205) more than height (r=o.2585) with systolic blood pressures. These values were nonetheless statistically significant. For their diastolic blood pressures, it was observed that all the variables showed weak correlation; weight (r=0.1785), height (r=0.1504), Quetelet's index (r=0.0828)The values for the girls showed moderate correlation of all the variables with their systolic blood pressure; weight (r=0.4249), height (r=0.3972), Quetelet's index (r=0.3915). Their diastolic blood pressures showed statistically. significant though weak correlation with the variables; height and Quetelet/'s index (r=0.1667) each, weight (r=0.1656).Conclusion: This study shows that in the Nigerian children examined, blood pressure is affected by anthropometry, and of all the anthropometric values, weight affected blood pressures most. Anthropometry influenced systolic blood pressure more than diastolic blood pressure