Urinary Screening for Detection of Asymptomatic
Haematuria and Proteinuria in Children in Urban and Periurban Schools in Port
Harcourt
FE Ikimalo, FU Eke, KEO Nkanginieme, J Ikimalo
Summary
Nigerian Journal of Paediatrics 2003;
30:1.
In
order to determine the prevalence of asymptomatic haematuria and proteinuria, a
survey was carried out among pupils of two primary schools; one located in the
urban area and the other in the periurban area of Port Harcourt Local Government
Area. The prevalence rate of significant asymptomatic proteinuria was one
percent and that for haematuria was 0.6 percent. There was no significant
difference in the prevalence rate of asymptomatic proteinuria or haematuria
between children in the periurban school when compared to those in the urban
school. Although the yield from mass urinary screening was low, majority of
those detected to have significant urinary abnormalities had persistence of
those abnormalities when followed up. Urinalysis should therefore be done
routinely as part of the school health programme in primary schools and
children found to have urinary abnormalities should undergo further evaluation
and follow up over a long period
Keywords:Urinary
screening, Asymptomatic haematuria, Asymptomatic Proteinuria.
Risk Factors for Malnutrition
Among Under-Five-Year olds in an Inner City Community inIbadan:
A Case-Control Study
TO Lawoyin, MO Onadeko, O Kolude
Summary
Nigerian
Journal of Paediatrics 2003. 30:7
Background:Morbidity and mortality rates associated with malnutrition
in the under-five-year olds are high especially among children from the low
socio-economic class, yet not all children from this deprived environment
develop malnutrition.
Objectives:
To identify risk factors associated with
the development of malnutrition in the under-five-year olds in a homogeneous
inner city community.
Design:
A community-based, case-control study.
Materials and Methods:
One hundred and thirty eight children
(subjects and controls) aged less than five years living in the traditional
area of Idikan, Ibadan, participated in the study. All households with children
under five years were listed and visited over a period of three months. All
children in these households were examined and those with weight-for-age less
than 2 standard deviations of the NCHS median value were enrolled as subjects.
A control, who was not malnourished, was selected for every subject identified;
they were matched 1:1 by age and sex from the same compound or adjacent compounds.
Results:
The youngest malnourished child was two
months old while the mean age of the subjects was 22.5 ± 14.1 months. A
significantly higher proportion of subjects than controls had primary
caretakers who were not their parents (16.9 percent vs 6.2 percent;
p<0.0001), and were commenced on complementary diet earlier (t=2.06,
p=0.04). There were no significant differences in morbidity pattern among
subjects and controls for fever, acute respiratory tract infections and
diarrhoeal diseases (p>0.05). In the case-control analysis, low paternal
education (incomplete primary school education and less)(p<0.0001), not
being up to date with immunization (p=0.037), and starting complementary feeds
before the age of six months (p=0.026), were associated with an increased risk
of malnutrition. When confounding covariates were controlled in multivariate
analysis, only age less than six months at adding complementary feeds was
significant (p=0.038) but only explained 51.6 percent in the variance due to
malnutrition.
Conclusion: Infants should be breastfed exclusively for the
first six months of life, and breastfeeding should continue up to the age of
two years. Immunization coverage needs to be improved in the community. These
measures should help in reducing malnutrition in the community.
Keywords: Malnutrition,
Under-five morbidity, Low socio-economic environment, Immunization,
Cardiac
Arrhythmias in Children with Sickle Cell Anaemia
F Bode-Thomas, OO Ogunkunle , AB Omotoso
Summary
Nigerian Journal of
Paediatrics2003;30:13
Background
: Sickle cell anaemia (SCA) is an important cause of
morbidity and mortality in tropical Africa. Recurrent episodes of
vaso-occlusive crisis often lead to organ ischaemia and/or infarction.
Arrythmias are common and reliable manifestations of myocardial ischaemia and
often follow infarction. The prevalence and pattern of cardiac arrhythmias
among SCA patients has not been studied extensively, particularly in children.
Objective: To determine whether or
not, patients with SCA are more prone than others to cardiac arrhythmias.
Patients and Methods: The
standard 12-lead ECGs of 35 patients with SCA presenting during 40 episodes of
vaso-occlusive crisis (Group A) were compared with those of 40 age- and
sex-matched sicklers in the steady state (Group B) and with 40 age- and
sex-matched patients with anaemia due to causes other than haemoglobinopathy
(Group C).
Results: Cardiac arrhythmias
were detected in four (10 percent) of the crisis episodes in Group A patients
compared to three (7.5 percent) of patients in Group B and only one (2.5
percent) of the patients in Group C (p>0.3). In Groups A and B, the
arrhythmias were all of atrial origin. The mean haematocrit level of Group A
subjects with arrhythmias was significantly lower than those without (p=
0.037).
Conclusions: Although
differences did not reach statistical significance, the results suggest that
patients with SCA appear to be more prone to cardiac arrhythmias than others,
whether or not they are in crisis. Further studies involving larger populations
are indicated.
Feeding Practices and Weight Gain in the
First Six Months of Life
KC Ejianya, HA Cole, OF Njokanma , G
Okpuno
Summary
Nigerian Journal of
Paediatrics 2003;
30:18.
The renewed effort to
encourage the practice of breast feeding has awakened interest in the study of
the relationship between different modes of infant feeding and growth patterns.
This relationship was studied in a cohort of 196 children in the first six
months of life. The babies were classified as exclusively breastfed (receiving
no other form of food or drink except the mother’s breast milk), mostly
breastfed (receiving <3 sessions of supplementary feeds per day) and
mostly formula fed (receiving > 3 sessions of supplementary feeds per day).
In the first three months of life, the mean growth velocity was higher for
exclusively breastfed babies (32.8 ± 7.3 g/day) than for their counterparts
receiving supplementary feeds (31.3 + 6.6 g/day and 31.0 ± 6.0 g/day,
respectively). The mean cumulative weight was also higher in exclusively
breastfed babies (6399 ± 797g vs 6367 ± 724g and 6363 ± 696g) despite having
the lowest mean birth weight. During the following three months, there was
marked deceleration of growth rates involving all three groups with the exclusively
breastfed babies the most affected: 49 percent deceleration for exclusively
breastfed babies, 43 percent for mostly breastfed babies and 40 percent for
mostly formula fed babies. However, exclusively breastfed babiesretained
the higher cumulative weight achieved earlier. None of the observed differences
was statistically significant. It is concluded that body weight changes between
three and six months of life, do not show a convincing advantage for the
introduction of supplementary feeds. Extraneous considerations of convenience,
economy and immunology tend to lend support to exclusive breastfeeding during
this period.
Keywords: Exclusive breast feeding, Formula feeding,
Growth velocity.
The Impact of Oral Rehydration
Therapy on Childhood Diarrhoeal Disease in Ilorin
A Ojuawo, A
Njoku, O Adedoyin
Summary
Nigerian
Journal of Paediatrics 2003;30:23.
Background: Diarrhoeal disease remains a leading
cause of morbidity and mortality in childhood. The advent of oral rehydration
therapy (ORT) including home treatment of diarrhoea has affected the incidence
of dehydration.
Objective: To assess the impact of oral rehydration
therapy on childhood diarrhoeal disease.
Design: Cross sectional study.
Methods: The duration of the diarrhoeal illness,
the degree of dehydration, treatment given at home and the outcome were studied
in children seen at the Diarrhoea Training Unit (DTU) of the University of
Ilorin Teaching Hospital during the periods July 1993 to June 1994 and July
1997 to June 1998.
Results: Eight hundred and ninety one patients
presented in the DTU over the one-year period in 1993/94 compared to 109
patients over the same period in 1997/98. There was a significantly higher mean
duration of diarrhoea before presentation in the 1993/94 group (58.3 ± 13
hours) compared to the 1997/98 group (25.7 ± 6.1 hours) (t = 2.12, p <
0.025). Severe dehydration was seen in 11 percent of the cases in the 1993/94
group compared to five percent in the 1997/98 group (χ2 = 9.42, P < 0.01). Seventy-six percent
of the patients in the 1993/94 group and sixty-six percent in the 1997/98 group
received various antidiarrhoeal drugs before presentation.
Conclusion: The application of oral rehydration
therapy resulted in the reduction of cases of severe dehydration seen in children
with diarrhoea in Ilorin. The parents presented earlier in the 1997/98 than in
the 1993/944 group but the use of antidiarrhoeal drugs was still common. There
is therefore, a need for further training of health workers and mothers on the
home management of diarrhoea. The use of drugs that are not indicated in the
management of diarrhoea should be discouraged, while ORT use should be
strengthened.
Key words: Diarrhoea, Dehydration, Oral rehydration therapy,
Anti-diarrhoeal drugs.
A Bi-centre Study of the Pattern and
Evolution of readily detectable Neurological Sequelae of Acute Bacterial
Meningitis
GO Akpede, SO Dawodu, GEA Iyasere, SC Olomu
Summary
Nigerian
Journal of Paediatrics
2003;30:27.
The pattern and evolution of obvious post-meningitic sequelae
were determined in 187 post-neonatal children followed up at two tertiary
centres. The pattern of sequelae was classified using previously described
schemes, as well as by the number of deficits per child. One hundred and
eighty-seven children were assessed on discharge, 157 after six weeks of
discharge and 134 after three months. The incidence of sequelae was 40/187
(21.4 percent) on discharge versus 23/157 (14.7 percent) after six weeks (p =
0.106) and 18/134 (13.4 percent) after three months (p = 0.069) of follow up.
Two (1.4 percent) of the 147 children who were apparently normal on discharge
had sequelae on follow up, while two (7.4 percent) of the 27 children
discharged with major sequelae, died. Among 17 children who were followed up
for at least six months, three (18 percent) at >6 wks to <6 months
and ten (59 percent) at >6 months (p = 0.034) had persistent
deficits. Among the 42 children with sequelae, 29 (69 percent) had major
deficits alone (n = 15) or with minor deficits (n = 14). Fifteen (36 percent)
had one, 14 (33 percent) two and 13 (31 percent) >3 deficits. There
was full or partial resolution of deficits in 15/19 (79 percent) children with
sequelae who were treated with and in 6/15 (40 percent) (p <0.05) who were
not treated with dexamethasone on admission. There was no significant
relationship between the pattern and evolution of sequelae and selected
characteristics of the acute illness including its severity, pattern of
aetiologic agents and response to initial antibiotic therapy. However,
characteristics of the acute illness were significantly (p <0.01)
associated with a high incidence of sequelae.