Correlates for psycho-active substance use among boarding secondary school adolescents in Enugu, South East, Nigeria.

BACKGROUND: Psycho-active substance use among adolescents is a national and global problem and its attendant effects on adolescents cannot be overemphasized. The objectives of this study are to determine the prevalence and pattern of psychoactive substance use among adolescents; the substances involved and the extent of the problem in this locale. METHODS: This is a cross-sectional study that assesses the pattern of psychoactive substance use among secondary school adolescents in Enugu, south East, Nigeria. The study was carried out among adolescents attending six secondary boarding schools in Enugu metropolis of Enugu State of Nigeria. The WHO Student Drug Use Questionnaire was adapted for this study. Data were analyzed using the Statistical Package for Social Sciences program (SPSS), version 17. Chi-square and multivariate regression were used as a test of significance for qualitative variables. A p-value less than 0.05 were accepted as significant for each statistical test. RESULTS: Out of 900, a total of 896 respondents, comprising 400 and 82 boys (482) (53.8 %) and 400 and 14 girls (414) (46.2 %) completed the questionnaires. This gave a response rate of 99.6 %. The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts. Kola nut is the most widely used psychoactive substance both for current use, past year use and the respondents' life time use. It shows a lifetime prevalence of 63.5 % and a current use prevalence of 34.9 %. More than half of the users of each of the psychoactive substances take it occasionally, using them on 1-5 days in a month. On the other hand, almost one-quarter of the users of each of the substances take it on 20 or more days in a month. CONCLUSION: The study revealed that the prevalence of current use for psychoactive substances ranges from 0.4 to 34.9 % while that for life use ranges from 0.8 to 63.5 %. The least being cannabis and the most being kola nuts.

Prevalence and socioeconomic correlates of autism among children attending primary and secondary schools in south east Nigeria.

OBJECTIVES: The objectives of the study were to determine the prevalence and socio-economic determinants of autism among children attending primary and secondary schools in South East, Nigeria. METHODS: This was a cross-sectional study that assessed the prevalence and socio-economic pattern of childhood autism among children attending primary and secondary schools in Enugu and Ebonyi states, South East Nigeria. The questionnaire was adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000). The study was carried out between June and October, 2014. The schools were selected by listing all the mixed schools in the urban and semi- urban areas by simple random sampling. RESULTS: A total of 721 subjects completed the questionnaire. The age of respondents ranged between 3 and 18 years, with mean age of 12.71 and standard deviation of 3.03 years. Twenty one children fulfilled the criteria for autism giving a prevalence of 2.9%. There is a significant association between age in categories (fishers exact test, p = 0.013) and social class (p=0.033). CONCLUSION: The prevalence of autism was 2.9%; and the socio-economic characteristics of childhood autism in South East Nigeria are similar to those in other parts of the world.

Poor availability of skilled birth attendants in Nigeria: a case study of enugu state primary health care system.

BACKGROUND: The Government of Enugu State plans to offer free perinatal services at the primary health care (PHC) centers in order to improve perinatal outcomes in the state, but it was not clear whether there are skilled birth attendants (SBAs) at the PHC level to implement the program. AIMS: To determine whether there are sufficient numbers of SBAs in the public PHC system in Enugu State of Nigeria. SUBJECTS AND METHODS: This cross-sectional survey involved enumeration of health workers who worked at each public PHC facility in Enugu State and included verification of the qualifications and trainings of each health worker. Data analysis was performed with the help of Stata statistical package version 13 and results were presented in tables and as simple proportions. RESULTS: There were 55 nurses and no midwife or doctor in the 152 PHC clinics studied. This number represents 0.36 nurses per health facility or about 9% (i.e., 55/608) of a minimum of 608 SBAs required for 24-h perinatal services at the 152 PHC clinics. There were 1233 junior community health extension worker/community health extension workers (JCHEW/CHEWs), averaging 8.1 JCHEW/CHEWs per PHC clinic. CONCLUSIONS: Enugu State has an acute shortage of SBAs. We recommend employment of qualified SBAs and in-service training of the JCHEW/CHEW and nurses to upgrade their midwifery skills. Incorporation of competency-based midwifery training into the pre-service training curricula of nurses and JCHEW/CHEW would provide a more sustainable supply of SBAs in Enugu state.

Depression among adolescents attending secondary schools in South East Nigeria.

BACKGROUND: Depression among adolescents is an uncommon and frequently unrecognized issue in pediatrics. Children and adolescents however suffer from both depression and associated symptoms. METHODS: The study was carried out among adolescents in secondary schools from two states; Enugu and Ebonyi metropolises within the age range of 9-18 in Enugu metropolis. The instrument employed for data collection was a structured self-administered questionnaire developed from the Goldberg Depression Questionnaire, a Screening Test for Depression. It is particularly suited for students in this age group. The families were assigned socio-economic classes using the recommended method (modified) by Oyedeji. OBJECTIVES: The aims and objectives of this study were to determine the prevalence of several levels of depression among adolescents attending secondary schools in two states. RESULTS: A total of 453 adolescents who are attending secondary schools from two states were recruited in this study. Depression is non-existent before the age of 10 years according to this study. The prevalence of moderate depression was lowest (2.3%) at the age of 10 and highest at (6.2%) the age of 13. The prevalence of severe depression was lowest (1.9%) at the age of 11 and highest (7.4%) at the age of 12. Female gender is a risk factor for depression. Children whose parents are separated showed higher incidences of depression in all the spectra studied. CONCLUSION: Adolescents exhibit different levels of depression with a female preponderance.

Prevalence of malnutrition among pre-school children in South-east Nigeria.

BACKGROUND: Malnutrition can be defined as a state of nutrition where the weight for age, height for age and weight for height indices are below -2 Z-score of the NCHS reference. It has posed a great economic burden to the developing world. OBJECTIVES: The objective of this study is to assess the prevalence of malnutrition among pre-school children in Abakiliki in Ebonyi state of Nigeria. METHODS: This is a cross-sectional studies that assess the prevalence of malnutrition and associated factors among children aged 1-5 years attending nursery and primary schools. Nutritional assessment was done using anthropometry and clinical examination. RESULTS: A total of 616 children aged one to 5 years were enrolled into this study. Three hundred and sixty-seven (59.6%) were males while 249 (40.4%) were females. Sixty of the 616 children (9.7%) had acute malnutrition based on WHZ-score. Moderate acute malnutrition (MAM) was present in 33 children (5.3%) while 27 (4.4%) had severe acute malnutrition. CONCLUSIONS: The prevalence of global and severe acute malnutrition using z-score is 9.7% and 4.4% respectively while that of stunting is 9.9% with a male preponderance.

Attention deficit hyperactivity disorder: a neglected issue in the developing world.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a neglected illness in a developing country. OBJECTIVES: The objectives of this study are to investigate the prevalence and pattern of ADHD among children in a Nigeria. METHODS: A structured self-administered questionnaire was used to collect information from the parents of children (and older children) who attended children outpatients' clinic during the study period. The DSM-IV-TR diagnostic criteria for attention deficit hyperactivity disorder were used. RESULTS: Two hundred and seventy-three (273) out of 282 questionnaires were filled completely, giving a response rate of 96.8%. Nine (9) children fulfilled the stated criteria for ADHD giving a prevalence rate of 3.2%. There is no association between gender and ADHD (P = 0.784). CONCLUSIONS: The prevalence of ADHD in our setting is 3.2%, which is similar to that obtained elsewhere in the world.

Neonatal analgesia: A neglected issue in the tropics.

Pain control in newborns is poorly understood and often neglected in neonatal practice in many settings in our environment. Managing pain among newborns can be quite challenging and the effectiveness of various interventions used to ameliorate pain in this category of patients are either unknown or poorly understood by many a people engaged in the care of newborns in one way or the other. A search for published works on neonatal analgesia was performed using Google and PubMed. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were definition, pathophysiology and management of pain in neonates. Relevant information was extracted and processed. Contrary to what is widely believed in many quarters, howbeit erroneously, there is compelling evidence that newborns do indeed feel pain. Supportive care, comprising of use of sucrose, glucose, breastfeeding, kangaroo mother care are worthwhile measures in ameliorating pain in the newborn. Novel therapies (such as sensorial saturation and swaddling) have been evaluated and proven useful. The use of sedation did not show any beneficial results.

The use of unprescribed antibiotics in management of upper respiratory tract infection in children in Enugu, South East Nigeria.

BACKGROUND: It is a documented fact that upper respiratory tract infection (URTI) is more of a viral illness. OBJECTIVES: This study aims at documenting the prevalence of the use of unprescribed antibiotics in children aged <5 years with upper respiratory symptomatology. METHODS: Four hundred twenty-three mother-child pairs were enrolled for this study. Chi-square and logistic regression analysis were used to find association between use of unprescribed antibiotics and variables of interest. RESULTS: The prevalence of unprescribed antibiotics in children aged <5 years in the management of URTI is 75.9%. The antibiotics abuse was commoner in older children with URTI (45.9% in children aged 12-24 months) and among mothers with higher educational attainment. CONCLUSION: Antibiotics abuse among mothers is high. Government, through its responsible agencies, should enforce stricter control or outrightly stop sale of antibiotics over-the-counter to prevent the dreaded antibiotics resistance.

Synopsis of congenital cardiac disease among children attending University of Nigeria Teaching Hospital Ituku Ozalla, Enugu.

BACKGROUND: The objective of this study was to determine the pattern of congenital cardiac disease among children attending UNTH, Enugu, Nigeria. The nature of these abnormalities and the outcome were also considered. The exact etiology is unknown but genetic and environmental factors tend to be implicated. The difference in the pattern obtained worldwide and few studies in Nigeria could be due to genetic, environmental, socioeconomic, or ethnic origin. METHODS: A retrospective analysis of discharged cases in which a review of the cases of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All the children presenting with cardiac anomalies were included in the study and the cases were investigated using ECG, X-ray and echocardiography studies. RESULTS: A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. The overall prevalence of cardiac disease is 0.22%. The commonest symptoms were breathlessness, failure to thrive and cyanosis. Almost all types of congenital detects were represented, the commonest being isolated ventricular septal detect (VSD), followed by tetralogy of Fallot. One of these cardiac anomalies presented with Downs's syndrome and another with VACTERAL association. CONCLUSIONS: The results of this study show that 0.22% per cent of children who attended UNTH in Enugu State had congenital cardiac abnormalities and the commonest forms seen were those with VSD.

Use and/or misuse of antibiotics in management of diarrhea among children in Enugu, Southeast Nigeria.

BACKGROUND: Diarrheal diseases are a leading cause of under-5 morbidity and mortality worldwide. OBJECTIVE: To determine the use and/or misuse of antibiotics on children with diarrheal disease by caregivers. METHOD: An observational prospective study involving 210 children and their caregivers seen at the pediatric outpatient clinic of a tertiary hospital between January and May 2012 was undertaken. RESULTS: The mean age of the children was 18.07 ± 14.29 months. One hundred twenty-four (59%) were male, whereas 86 (41%) were female. Almost half of the children (46.7%) used unprescribed antibiotics during an episode of diarrhea. CONCLUSIONS: Antibiotics are being abused in children with diarrhea and caregivers need to be educated against this urgently.

Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria.

BACKGROUND: Paracetamol (also known as acetaminophen) is the commonest available analgesic and anti-pyretic. It is readily accessed from pharmacy, patent medicine and provision shops as over the counter drug making it a potential drug of abuse, especially in children. We sought to find its use and/or misuse in children seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu. OBJECTIVE: To determine the dosage, formulation, and frequency of paracetamol administration to children by caregivers and factors associated with its use and/or misuse. METHOD: An observational prospective study involving 231 children and their caregivers seen at the paediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu between June and November 2011 was undertaken. Data on paracetamol use before presentation to the clinic, in addition to demographic and other data were obtained from the caregivers using a structured questionnaire. Ethical consent for the study was obtained from the Hospital Ethics and Research Committee and informed consent was further obtained from the caregivers of the children. RESULTS: A total of 231 children aged six weeks to 16 years and their caregivers participated in this study. The mean ages of the children and their caregivers were 3.8 and 33.9 years, respectively. One hundred and thirty three of the children studied were males while 98 were females. Most of the children (75.6%) received paracetamol at home before presenting. Paracetamol tablet alone or in combination with the syrup was mostly used (60%) and this observation was made across all age groups. The commonest reason for using paracetamol tablet instead of the syrup was that it was more effective. Most caregivers relied on past experience (71.2%) rather than on enclosed information leaflet to decide the appropriate dosage. Half of the children also received other medications, mainly anti-malarials and antibiotics. CONCLUSIONS: Paracetamol was commonly given to children on "self prescription" basis and the tablet formulation was most frequently used, with the possibility of misuse and overdose. Caregivers need to be educated on age-appropriate formulations which are less likely to lead to overdose.

Congenital malformations among newborns admitted in the neonatal unit of a tertiary hospital in Enugu, South-East Nigeria--a retrospective study.

BACKGROUND: Congenital abnormalities are not uncommon among newborns and contribute to neonatal and infant morbidity and mortality. The prevalence and pattern of presentation vary from place to place. Many a time the exact etiology is unknown but genetic and environmental factors tend to be implicated. METHODS: The objective of this study was to determine the prevalence of congenital malformations among newborns admitted in a tertiary hospital in Enugu, the nature of these abnormalities and the outcome/prognosis. For purposes of this study, congenital abnormalities are defined as obvious abnormality of structure or form which is present at birth or noticed within a few days after birth. A cross-sectional retrospective study in which a review of the records of all babies admitted in the Newborn Special Care Unit (NBSCU) of the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu over a four year period (January 2007-April 2011) was undertaken.All babies admitted in the unit with the diagnosis of congenital abnormality were included in the study. Information extracted from the records included characteristics of the baby, maternal characteristics, nature/type of abnormalities and outcome.Data obtained was analyzed using SPSS 13. Rates and proportions were calculated with 95% confidence interval. The proportions were compared using students T-test. Level of significance was set at P < 0.05 RESULTS: Seventeen (17) out of a total of six hundred and seven newborn babies admitted in the newborn unit of UNTH over the study period (Jan 2007-March 2011) were found to have congenital abnormalities of various types, giving a prevalence of 2.8%. Common abnormalities seen in these babies were mainly surgical birth defects and included cleft lip/cleft palate, neural tube defects (occurring either singly or in combination with other abnormalities), limb abnormalities (often in combination with neural tube defects of various types), omphalocoele, umbilical herniae, ano-rectal malformations and dysmorphism associated with multiple congenital abnormalities. CONCLUSIONS: The results of this study show that 2.8% of babies admitted to a Newborn Special Care Unit in a teaching hospital in Enugu had congenital abnormalities and that the commonest forms seen were mainly surgical birth defects and includes cleft lip/cleft palate and neural tube defects.