Use of complementary medicines among HIV-infected children in Lagos, Nigeria.

BACKGROUND: Complementary medicine (CM) use is common among children with chronic illnesses such as epilepsy and asthma. Lack of data on the profile of CM use among children with human immunodeficiency virus (HIV) infection necessitated this study. METHODS: Parents or caregivers of HIV-infected children attending the paediatric HIV-clinic in a teaching hospital in Lagos, Nigeria, were randomly selected and interviewed with a semi-structured (open- and close-ended) questionnaire. Clinical details of the patients were extracted from their case files. RESULTS: A total of 187 parents/caregivers were interviewed. Most of the parents/caregivers (181; 96.8%) have used CMs for their children. Mind-body interventions (181; 36.6%) and biological products (179; 36.2%) were frequently used. Relatives, friends and neighbours influenced CM use in 37.1% of the children. CMs were used mostly to treat weight loss (79; 43.7%), cold (40; 22.1%), and fever (39; 21.6%). CONCLUSION: CM use is common among HIV-infected children in Lagos.

Medication administration errors among paediatric nurses in Lagos public hospitals: an opinion survey.

OBJECTIVE: There is paucity of data on paediatric medicine administration error (MAE) in developing countries. This study aimed to investigate the experience of MAEs among paediatric nurses working in public hospitals in Lagos, Nigeria. DESIGN: A confidential, self-reporting questionnaire was the instrument for the study. SETTING: Public hospitals in Lagos, Nigeria with established paediatric services and departments. PARTICIPANTS: Paediatric nurses. METHODS: The questionnaire was administered to 75 nurses working in public hospitals in Lagos to obtain information on the experience of medication errors during their entire career, as well as to know their views on the nature of MAEs and the contributing factors. RESULTS: Fifty nurses responded to give a response rate of 66.7%. All the participants were females with a mean ± s.d age of 35.3 ± 10.7 years. Thirty two (64%) had committed at least one medication error over the course of their career. Wrong dose error (24; 48%) and wrong timing of medicine administration (20; 40%) were the MAEs frequently committed by the participants. The consequences of the errors included shock (23; 46%), restlessness (21; 42%), disorientation (11; 22%), and respiratory depression (10; 20%). Increased workload (26; 52%) and not double checking medicine doses (12; 24%) were the major factors the nurses perceived to be contributing to MAEs. Only 15(30%) nurses had reported MAEs to their superiors. Fear of intimidation, retribution or being punished (11; 22%) and lack of policies in place to report errors (13; 26%) were the two major barriers to reporting MAEs. Half (50%) of the nurses indicated that policies were available in their work places to prevent medication errors. CONCLUSIONS: Medication administration errors were frequently committed by the participants and resulted in some inconsequential effects, morbidity and deaths. Appropriate measures should be implemented to prevent future occurrences of MAEs.

Obesity and blood pressure levels of adolescents in Abeokuta, Nigeria.

BACKGROUND: We determined the prevalence of general and central obesity and their relationship with blood pressure levels among adolescents in Abeokuta, Nigeria. METHODS: We selected 423 adolescents from seven schools in Abeokuta, Nigeria, using a multistage random-sampling technique. Body mass index (BMI), waist circumference (WC) and blood pressures were measured. RESULTS: Twenty-one (5%) children had general obesity and 109 (24.5%) had central obesity. Of those with general obesity, 20 (95.1%) children were centrally obese. With simple linear regression analysis, BMI and WC explained 10.7 and 8.4%, respectively of the variance in systolic blood pressure (SBP), and 3.6 and 2.7%, respectively of the variance in diastolic blood pressure (DBP). Following logistic regression analysis, BMI was the major factor determining SBP levels (OR 0.8, 95% CI: 0.65-0.99, p < 0.05). CONCLUSION: BMI remains an important anthropometric screening tool for high blood pressure in Nigerian adolescents.

Micturitional dryness and attitude of parents towards enuresis in children attending outpatient unit of a tertiary hospital in Abeokuta, Southwest Nigeria.

BACKGROUND: There is significant variability of the age at which children achieve dryness. OBJECTIVES: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. METHOD: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre, Abeokuta. RESULTS: At age 36 months, 86 (51.8 %) and 34 (20.5 %) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p = 0.009). Twenty-four (26.7 %) children had nocturnal enuresis. Four (4.4 %) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8 % correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem, a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). CONCLUSIONS: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore, health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class.

Changes in the nutritional status of school children and adolescents in Abeokuta, Nigeria between 1983 and 2006.

BACKGROUND: The prevalence of overweight and obesity among children is increasing worldwide with significant health and social consequences. OBJECTIVE: The aim of this study was to determine the current nutritional status and its changes between 1983 and 2006 among school children and adolescents in a south western Nigeria town. METHODS: five hundred and seventy children aged 5 to 19 years from randomly selected primary and secondary schools in Abeokuta, Nigeria had their weights and height measured using standard techniques. The data obtained were compared with data obtained from a similar cross sectional survey carried out in 1983. The National Centre for Health Statistics/World Health Organisation guidelines and cut-off points were used to determine the degree of underweight and stunting. Obesity prevalence was assessed using weight for age greater than 120 % of expected. RESULTS: The mean age of the participants was 12.2 + 3.41 years, 296 (51.5 %) were males. The mean Weight-for-Age Z -score and Height-for-Age Z-score were -1.2773 + 1.14 and -0.8569 + 1.19 respectively. The prevalence rates of underweight and stunting were 24.7 % and 17.4 % respectively. Using weight greater than 120 % of expected weight for age, five (1.7 %) male and 7 (2.6 %) female children were obese compared to 3.3 % male and 5.1 % female children who were obese in 1983. CONCLUSIONS: The prevalence of overweight and obesity has remained relatively unchanged between 1983 and 2006. However,under-nutrition remains a major nutritional problem among school children and adolescents in Abeokuta, Nigeria.

Micturitional Dryness and Attitude of Parents Towards Enuresis in Children Attending Outpatient unit of a Tertiary Hospital in Abeokuta; Southwest Nigeria

Background: There is significant variability of the age at which children achieve dryness. Objectives: We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. Method: A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre; Abeokuta. Results: At age 36 months; 86 (51.8) and 34 (20.5) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p= 0.009). Twenty-four (26.7) children had nocturnal enuresis. Four (4.4) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem; a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). Conclusions: The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore; health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class

Providing safe medicines for children in Nigeria: The impediments and remedies.

Promoting safety of medicines for children is a global concern which has prompted the World Health Organization (WHO) to launch a campaign of "Making Medicines Child Size". Children in Nigeria were once victims of unethical clinical medicine trials and repeated victims of use of fake and adulterated medicines. Considering the magnitude of harms children had suffered in Nigeria from the use of medicines, there is a need for literature review to identify the factors preventing children from accessing safe medicines and to suggest remedies to the problems. Lack of access to up- to- date medicine information, lack of training and research in pediatric clinical pharmacology, deficiencies in undergraduate and postgraduate teaching of medicine risk management and clinical pharmacology and therapeutics, irrational medicine use due to lack of pediatric focus on essential medicine list and inappropriate home storage of medicines by parents, lack of evidence- based medicine (EBM) practice, lack of national adverse drug reaction surveillance among children, and weak national drug policies were the major problems identified. It is to be hoped that development and provision of a pediatric national drug formulary for health professionals in Nigeria, creating a comprehensive national pediatric drug research network in collaborations with developed countries, reviewing the undergraduate and postgraduate curriculum in pediatrics to include teaching of basic elements of rational prescribing, drug dose calculations, adverse drug reactions and pharmacovigilance, increasing access to essential medicines for children, postgraduate teaching of EBM, and strengthening of the national drug policies would improve children's access to safe medicines in Nigeria.

Physical activity and body mass index of school children and adolescents in Abeokuta, Southwest Nigeria.

BACKGROUND: Physical inactivity and sedentary lifestyles are known to predispose to overweight and obesity. These lifestyles are also known to track from childhood into adulthood with consequent cardiovascular and metabolic problems. This study aimed to describe the frequency of physical activity and the relationship between physical activity and body mass index of urban Nigerian school children and adolescents. METHODS: Children from seven schools in Abeokuta, southwest Nigeria were selected using a multi-staged random sampling technique. RESULTS: Of 570 children, 411 (72.1%) were involved in moderate to vigorous physical activities. Involvement in physical activity was higher in older children (P<0.001), males (P<0.001), and children of mothers with a higher educational level (P=0.03). Eleven (1.9%) children were overweight or obese whereas 163 (28.6%) were underweight. There were more children with underweight than overweight among the subject population with a high level of physical activity (35.6% vs. 4.4%, P=0.499). CONCLUSIONS: A large proportion of the children in urban Nigeria participate in physical activity. The prevalence of overweight and obesity is low but undernutrition is a major nutritional problem among these children.

Waist circumference values of Nigerian children and adolescents.

AIMS: This study aimed to determine the waist circumference (WC) of apparently healthy Nigerian children and adolescents and to compare the obtained values with available data for children from other parts of the world. METHODS: A representative sample of children from 7 schools in Abeokuta, a state capital in South West Nigeria, was selected using the multi-staged random sampling technique. The sample population consisted of 570 children with ages ranging from 5 to 19 years. RESULTS: WC increased with age in both sexes. The mean value of WC of children aged 5-9 years was about the same in both sexes (p = 0.113). However, in children older than 9 years, females had higher WCs than males (p = 0.000). Comparison of the 50th percentile WC of Nigerian children with that of American and Spanish children showed that both Nigerian male and female children had the lowest WC values. However, the values were similar to British male children up to 9 years and female children up to 14 years. CONCLUSION: The WC value varied with age, sex and race. These data are expected to serve as a baseline against which future data can be compared.

Parental reporting of suspected adverse drug reactions in children in Lagos, Nigeria.

OBJECTIVES: To determine the feasibility of parental reporting of suspected adverse drug reactions (ADRs) to community pharmacies in Nigeria. METHODS: Fifteen registered pharmacies were randomly selected in Lagos, Nigeria. Caregivers who procured antibiotics, antimalarials, paracetamol or ibuprofen for a child up to 12 years of age in these pharmacies between July and September 2007, were asked to report suspected ADRs in their child by filling in a questionnaire given to them by the pharmacist. If the caregivers suspected an ADR within 5 days of administering the medicine, they were asked to return the questionnaire within the following 7 days. RESULTS: 9023 drugs were procured for 2868 children (1807 (63%) of whom were male) and 689 (8%) of these drugs were administered by injection. Antibiotics (1975, 24%) were the most frequently procured type of drug of the four groups surveyed (antibiotics, antimalarials, paracetamol and ibuprofen) and chloroquine (445, 46%) was the most frequently procured antimalarial. 509 (18%) caregivers reported 575 suspected, mostly mild, ADRs (509 to antibiotics, 42 to antimalarials and 24 to analgesics). The two most frequently reported suspected ADRs were diarrhoea in 292/575 (51%) children and skin rashes in 103/575 (18%). The overall prevalence of ADRs in these children was 509/2868 (18%). CONCLUSION: Parental reporting of suspected ADRs to antibiotics, antimalarial and analgesics in their children is feasible in Nigeria. This method of pharmacovigilance should be used more extensively.

Tumor lysis and acute renal failure in Burkitt's lymphoma: A review on pathophysiology and management.

Morbidity and mortality in patients with hematologic malignancies are significantly increased by development of acute renal failure. This is more likely in the developing world where facilities for renal replacement therapy are scarce. This review discusses the pathophysiology of acute renal failure due to tumor lysis syndrome in patients with Burkitt's lymphoma, the commonest hematological malignancy in the pediatric age group in sub-Saharan Africa, and evaluates the possible management options. Tumor lysis can also develop in association with other hematologic malignancies, both spontaneously and following treatment, and these principles are applicable in all such cases.

The pattern of malaria infection in under-fives in Ile-Ife, Nigeria.

Over 90% of the burden of malaria occurs in sub-Saharan Africa. Children, especially under-fives, are the most vulnerable. In Nigeria, Africa's most populous nation, it accounts for 25 and 30% of infant and childhood deaths, respectively. One hundred and seventy-six children who fulfilled clinical and parasitological criteria for the diagnosis of malaria, 26.4% of all under-fives, who presented to the Seventh Day Adventist Hospital in Ile-Ife during the months of May to September 2005 were studied to identify the factors that were associated with severe malaria in the target population. The proportion of children with severe malaria in the study was 17%, while the case-fatality rate was 3.5%. Of the 17 variables examined, high malaria parasite density, non-use of mosquito-bite preventive measures and poverty remained independently and significantly associated with an increased risk for severe malaria. Progress in stemming the burden of malaria depends on accurate knowledge and understanding of the epidemiology and control of the disease in the affected populations.

Prevalence of overweight and obesity in Nigerian preschool children.

The problem of obesity is taking a worldwide dimension. However, there is paucity of data on obesity in Nigerian children. This study was therefore conducted to determine the prevalence and factors associated with overweight and obesity among Nigerian preschool children. A total of 270 children were recruited from 216 households using multistage cluster sampling technique. The prevalence of overweight and obesity were 13.7% and 5.2% respectively while the prevalence of underweight was 8.5%. Although, there was no statistically significant relationship between exclusive breastfeeding for 6 months, duration of breastfeeding and the prevalence of overweight (P = 0.569, 0.669 respectively), the prevalence of overweight decreases with increase in the duration of breastfeeding. Ninety-nine (36.3%) children were given infant formula feeds with 92 (93.9%) children introduced to infant formula feeds before the age of 6 months. The use of infant formula feeds was significantly associated with reduction in the prevalence of overweight (P = 0.041). No linear relationship was detected in the association between overweight and socioeconomic class. The population shows heterogeneity in their nutritional problem by having mixture of obesity and underweight. There is need for trend of obesity to be monitored so that timely intervention will be taken and associated morbidity and mortality from obesity prevented.

Low prevalence of malnutrition in a rural Nigerian community.

This study was carried out to determine the prevalence of malnutrition in a rural Nigerian community. Using the modified Wellcome Classification, the prevalence of protein energy malnutrition (PEM) was 20.5%. The prevalence of underweight, wasting and stunting were 23.1%t, 9% and 26.7%, respectively. The low prevalence of PEM in this rural Nigerian community may be due to the services and intervention provided by a non-governmental organization in the community. This method of intervention is similarly achievable in any other community.

A-5 year review of cerebral malaria in nigerian children.

BACKGROUND: Cerebral malaria is thought to be common in the under fives in a malaria holoendemic region like ours. But we are recently seeing cases of cerebral malaria in children older than 5 years. This study was carried out to determine the Morbidity And Mortality Pattern Of Cerebral Malaria. MATERIALS AND METHODS: This was a retrospective review of cases of cerebral malaria seen over a five-year period (1999-2003) at the Paediatrics Department of the Obafemi Awolowo University Teaching Hospital Complex Ile-Ife. All case notes of patients admitted with a diagnosis of cerebral malaria were retrieved and relevant data extracted to a standard form. RESULTS: One hundred and fifty four (154) patients were managed as cerebral malaria, out of a total of 5,456 admissions over this period. Eighteen were aged less than one year, 128 were aged 1-5 years while eight were aged >5 years. Eight of the 154 patients died (5.2%). However 16 (10.3%) had various neurological deficits at discharge. CONCLUSION: Cerebral malaria is still a major complication of malaria in our practice and it is no longer a problem of under-five children alone.

The use of antimalaria drugs and insecticide treated nets in Ile-Ife, Nigeria.

BACKGROUND: The Roll Back Malaria Initiative (RBMI) is aimed at halving the malaria mortality in the year 2010 using prompt diagnosis and treatment of malaria and the use of Insecticide Treated Nets (ITNs). METHODS: This is a cross sectional study of children aged 1 month to 14 years with confirmed malaria to assess the burden of malaria and to evaluate the home use of anti-malarial drugs and ITNs among children with malaria in Ile Ife, Nigeria. RESULTS: Of the total of 1047 children seen, 190 (18.1%) had malaria and were surveyed. Complications were present among 74 (38.9%) children and a significantly higher of the under-fives had complications (p by Fisher's exact test = 0.0018). Chloroquine was administered to 63 (67.0%) children within the first 24 hours of the illness although only 25 (26.6%) children had the correct dosage. One hundred and fifty three (80.5%) were aware of the use of untreated bed nets in preventing malaria while 38 (20.0%) and 4 (2.1%) were aware of ITNs and used ITNs respectively. The awareness of ITNs increased with increasing maternal education. CONCLUSION: Awareness of the parents about ITNs and their use are poor. Health education on appropriate antimalarial drug use and ITN use should be intensified. ITNs should be made more widely available.

Management of pain in children: a review of the literature.

BACKGROUND: Pain is a very common situation encountered in clinical practice. It is as common in children as in adults and often it is underevaluated and undertreated. The aim of this review is to stimulate and sensitize paediatricians and other child health care providers to the importance and necessity of adequate appreciation, evaluation, and management of pain in children. METHODS: Review of the pertinent literature. Selected references to highlight the mechanism of pain, pain assessment tools and therapeutic approach to management, were included in this review. RESULTS: Pain in children is underevaluated and undertreated. This is so even in developed countries. A study put the prevalence of pain among children at 26%, and that two out of every three patients with pain were not detected, and that one out of three patients detected received no treatment. Popular dogma held that the human child does not feel pain and that giving the child powerful analgesics may lead to addiction. Despite the availability of several pain assessment tools, they are under used in paediatric practice. Pain pathways develop in the second trimester, so the smallest neonate is able to respond to noxious stimulation. CONCLUSION: Childhood pain is still underevaluated and under treated. The adequate management of pain in children is an important factor in better outcome of childhood illnesses.

Childhood poisoning at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

A retrospective study of children admitted into the Children Emergency Room of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, between 1989 and 1998 was undertaken. There were 127 cases constituting 0.52% of the total paediatric admissions over the study period. Poisoning was commoner among the lower socioeconomic classes and in males than females. 102 (80.3%) of the children involved were below the age of five years and poisoning was unintentional in 98.4%. Kerosene was the commonest agent accounting for 40.9% of all cases; followed by caustic soda (20.4%) and traditional mixtures (19.7%). Oral administration of palm oil is the commonest home remedy. Morbidity was commonest with caustic soda while traditional mixture was responsible for 80% of the mortality. Fifteen (11.9%) patients died constituting 0.84% of total childhood mortality during the study period. We conclude that childhood poisoning is still a significant cause of morbidity and mortality in children seen at the Obafemi Awolowo University Teaching Hospital. Improvement in the socioeconomic status of parents and health education on proper storage of household chemicals will help in reducing the incidence and mortality from poisoning.