Hypercholesterolaemia in schoolchildren in Lagos, Nigeria: an indication of a growing threat of cardiovascular disease?

BACKGROUND: There is growing burden of cardiovascular disease in developing countries and the pathogenesis of artherosclerotic damage starts in childhood OBJECTIVE: The study is to examine the prevalence of hyperlipidaemia in schoolchildren in Lagos, as it relates to both socio-demographic and anthropometric correlates METHODS: A cross-sectional study was carried out among urban and rural adolescent schoolchildren aged between 10 and 19 years in Eti-Osa Local Government Area (EOLGA) of Lagos State. A structured questionnaire was used to get information relating to socio-demographic characteristics, family history of cardiovascular disease, lifestyle habits and socio-economic class, and the students were examined for height, weight and cholesterol levels. RESULTS: Two hundred and eighty eight subjects in the urban region and 72 subjects in the rural region of Eti-Osa LGA participated in the study. The mean age was 15.6 +/- 2.2 years with a range of 10 to 18.9 years. The mean serum total cholesterol was 148.1 mg/dl with a range of 100 to 254 mg/dl. There was significant correlation between serum cholesterol and gender only in the 12-13.9 year group. Neither place of residence nor age had any significant correlation to serum cholesterol. Thirteen (3.6%) students had elevated serum total cholesterol of e"200 mg/dl. Four subjects had BMls above the 95th centile, giving a prevalence rate of 1.1%. They were females, living and schooling in the urban area and three-quarters were of high socio-economic class. CONCLUSION: Strengthening pre-enrollment medical and physical examinations, regular measurement of weight, height and BMI and laying emphasis on important lifestyle modifications early in the formative years are important to prevent development of non-communicable disease later in life.

Cardiovascular dysfunction in HIV-infected children in a sub-Saharan African country: comparative cross-sectional observational study.

OBJECTIVE: Cardiac dysfunction is rarely diagnosed in HIV-infected children in our setting and standard care does not include baseline and follow-up echocardiography. We aimed to determine the prevalence, pattern and predictors of HIV-related cardiac dysfunction. METHODS: Pre-diagnosed HIV-infected children aged 18 months to 12 years from a tertiary teaching hospital in Lagos, South-West Nigeria were enrolled in a comparative, observational cross-sectional study; matched with apparently healthy controls of the same age group, were recruited sequentially between May 2004 and 2007. Proportions of pre-defined cardiac abnormalities such as heart failure diagnosed by clinical examination and dilated cardiomyopathy and ventricular dysfunction by echocardiography were determined. RESULTS: Prevalence of cardiac abnormalities in HIV-infected children was 75.9%. Abnormalities included heart failure, dilated cardiomyopathy (33.7%), decreased LVSF of ≤ 25% in 33.7%, increased left ventricular mass (20.5%) and pericardial effusion (14.5%). CONCLUSION: Structural and functional abnormalities are prevalent in HIV-infected African children and therefore justify inclusion of routine echocardiography in their standard care.

Relationship between bioelectrical impedance analysis and body mass index in adolescent urban Nigerians.

BACKGROUND: Body mass index is often used to assess adiposity but it does not differentiate between fat and non-fat components of body mass. However, body fat composition may be assessed using bioelectrical impedance analysis. OBJECTIVE: The study aimed to relate body mass index to fat in the assessment of overweight and obesity among adolescent Nigerians. METHODS: Adolescent pupils aged 10 years to 18 years from randomly selected secondary schools in Lagos, Nigeria were studied. Body mass index was calculated while percentage body fat was measured using Tanita body® fat scale model BF 681. Overweight and obesity were defined using age and sex specific criteria for body mass index and for body fat. RESULTS: There were 753 pupils {377(50.1%) males and 376(49.9%) females}. The overall mean values of body mass index for males and females were 18.1±2.72 and 18.9±3.41 (p < 0.05) respectively. The corresponding figures for body fat were 9.5±4.48 and 18.9±7.51 (p<0.05) respectively. About three quarters (76.2%) of the females who had body mass index in the overweight and obesity range had high body fat in comparison to 44.4% of males (p < 0.05). CONCLUSION: Body mass index is more related to body fat in adolescent females than in their male counterparts.

Diagnostic usefulness of N-terminal pro-brain natriuretic peptide among children with heart failure in a tertiary hospital in Lagos, Nigeria.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NTproBNP) is useful in the diagnosis and management of adult patients with heart failure. OBJECTIVE: The objective of the study was to determine the usefulness of NT-proBNP in diagnosing congestive heart failure (CHF) in children and its correlation with left ventricular ejection fraction (LVEF) and clinical heart failure score. METHODS: Plasma NT-proBNP was measured in 28 children with CHF and age matched controls. Heart failure assessment was done using modified Ross score and all had echocardiography done. RESULTS: Mean plasma NT-proBNP of children with CHF (377.86±1026.49pg/mL) was significantly higher than that of controls (353.61±328.50 pg/mL) (p<0.001). A plasma NT-pro BNP of 951pg/mL was used as the cut off value for heart failure. The sensitivity, specificity, negative and positive predictive values were 57%, 96%, 69% and 94% respectively. NT-pro BNP levels showed a high positive correlation with the modified Ross score (r= 0.502; p<0.001) but low correlation with LVEF (r= -0.137; p>0.3). CONCLUSION: Our findings indicate that measuring NT-pro BNP may be useful as a diagnostic tool in congestive cardiac failure in children. The fact that its levels also correlated positively with modified Ross score thereby objectively determining severity of heart failure suggests that this biomarker may also be useful as an evaluation tool in congestive cardiac failure in children.

Echocardiographic findings among children with sickle cell anaemia at the Lagos University Teaching Hospital.

BACKGROUND: Few studies documenting the echocardiographic findings of patients with sickle cell anaemia have been reported from Africa despite the high prevalence of the disease on the continent. AIMS AND OBJECTIVES: The present study aimed to determine echocardiographic cardiac dimensions and haemodynamic parameters of children with homozygous sickle cell anaemia (SCA), in steady state at the Lagos University Teaching Hospital (LUTH). MATERIALS AND METHODS: Sixty children with SCA and sixty age and sex matched controls with ages ranging from 1-15 years were studied. Their cardiovascular functions were determined by echocardiographic examination. RESULTS: Mean age of SCA patients and controls were 95.41 ± 49.06 months and 95.45 ± 50.9 months respectively (p = 0.97). Mean left atrial dimension (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular posterior wall thickness (LVPW), Interventricular septal thickness (IVS) and left ventricular mass (LVM) in SCA patients were significantly larger than those of controls (p < 0.001 for each parameter). Left ventricular fractional shortening (FS) and ejection fraction (EF) were within acceptable normal limits although significantly lower in SCA patients (p < 0.001). The mean haemoglobin concentration in the subjects (77.23 ± 12.88) was significantly lower than in the controls (121 ± 16.09) (p < 0.001). Each direct echocardiographic parameter (LAD, AO, LVEDD, LVESD, IVS, LVPW and LVM) correlated significantly with age in both groups while left ventricular functional parameters (FS and EF) did not in both groups. Chamber dimensions, LVPW, FS and EF were inversely correlated with haemoglobin concentration in the subjects.

Structural heart disease in children in Lagos: profile, problems and prospects.

OBJECTIVES: Structural heart disease (SHD) contributes significantly to the health burden of children in Nigeria, unfortunately comprehensive cardiovascular programme including definitive surgery is currently not available locally. This may have contributed to the paucity of research in paediatric cardiology. Available epidemiologic data are limited and mostly outdated. We studied the current distribution SHD in Lagos and compared findings with reports elsewhere. Problems and prospects associated with cardiovascular care at the study site were highlighted. MATERIALS AND METHODS: Children referred from public and private health facilities for cardiovascular evaluation including echocardiography between January 2004 and December 2005 were studied. PDA in premature babies, PFO and post surgical SHD were excluded. Proportions and relative frequencies of different heart lesions were calculated and analysed using appropriate statistics. RESULTS: Congenital heart disease (CHD) significantly outnumbered acquired heart disease (AHD) (p=0.0001) in these children aged 4 weeks to 15 years (mean age = 3.8 +/- 2.5 years); the relative frequencies were VSD (41.7%), VSD (41.7%), ASD (20.2%), TOF (11.8%), AVCD/ECD (7.0%), PDA (5.7%), PS (3.1%), single ventricle and TGA (2.2%) each. PS was dominant in males, while septation defects were dominant in females. Pericarditis with effusion (31%), RHD (28.6%), myocarditis (14.3%) and dilated cardiomyopathy (14.3%) were the commonest AHD. CONCLUSION: Contrary to previous hospital reports CHD rather than RHD and other AHD are dominant in some African settings like Lagos, and their relative frequencies are similar to reports elsewhere. The wide range of children with diverse native CHD is a reflection of non-availability of definitive surgical facilities locally. Regional and International collaboration could be mutually beneficial.

Acute asthma in a children's emergency room: a clinical audit and management guideline proposal.

BACKGROUND: Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians. AIM: This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care. METHOD: This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined. RESULTS: There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively. CONCLUSION: This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.

Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria.

BACKGROUND: The main treatment for cerebral malaria is parenteral antimalarials. Mannitol and urea are used as adjunct therapy for cerebral malaria, but the World Health Organization does not recommend them. OBJECTIVES: To compare mannitol or urea to placebo or no treatment for treating children and adults with cerebral malaria. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (June 2004), CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to June 2004), EMBASE (1974 to June 2004), LILACS (1982 to June 2004), and reference lists of articles. We contacted relevant organizations and researchers. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing mannitol or urea to placebo or no treatment in children and adults with cerebral malaria. DATA COLLECTION AND ANALYSIS: No trials met the inclusion criteria. MAIN RESULTS: No trials met the inclusion criteria. REVIEWERS' CONCLUSIONS: We identified no randomized or quasi-randomized controlled trials to support or refute the use of mannitol or urea as adjuncts for treating cerebral malaria in clinical practice. This is likely to require a multicentre trial.