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   2008| April-June  | Volume 15 | Issue 2  
    Online since April 21, 2016

 
 
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ARTICLES
Structural heart disease in children in Lagos: profile, problems and prospects
CA Okoromah, EN Ekure, OO Ojo, BA Animasahun, MI Bastos
April-June 2008, 15(2):82-88
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 Available epidemiologic data are limited and mostly outdated.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.
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Prevalence of malaria parasitaemia and associated factors in febrile under-5 children seen in Primary Health Care Centres in Jos, North Central Nigeria
EI Ikeh, NN Teclaire
April-June 2008, 15(2):65-69
OBJECTIVE: This study was carried out to determine the prevalence of malaria in febrile under-5 children attending Primary Health Care Centres in relation to some demographic factors, duration of symptoms, previous antimalarial intake, presence of pyrexia, exclusive breast-feeding, mid upper arm circumference and body temperature. METHODS: Giemsa-stained thick and thin blood films prepared from blood specimens of 260 febrile under-5 children selected randomly from 5 Primary Health Care Centres in Jos, North Central Nigeria were examined microscopically for malaria parasite. RESULTS: A prevalence of 56.9% was recorded in this study, and only Plasmodium falciparum was encountered. Educational status of their mothers is high as only 3.8% are illiterates. Duration of illness before the visit to the centres lasted from 1 day (12.3%) to 4 days representing 39.2%. Fever, malaise, vomiting and diarrhoea are the clinical symptoms found in the patients. Majority of the patients were infants (0-12 months) representing 53.1% of the screened population and had a malaria prevalence of 52.2%. The other age groups; 13-24, 25-36, 37-48 and 49-60 months recorded 57.1%, 63.6%, 81.8% and 75% respectively (P<0.05). The males recorded a prevalence of 57.9% as against 55.9% in female (P>0.05). Prevalence in relation to duration of symptoms was 64.9% for 3 days, while the least prevalence of 42.9% was for the 2 days' duration (P>0.05). Patients with no previous antimalarial intake had a prevalence of 56.8% while those with previous antimalarial intake recorded 57% (P>0.05). Patients who had pyrexia at the time of presentation had a prevalence of 56.3% as against 57.5% in those without pyrexia (P>0.05). Patients on exclusive breast feeding had 58.3% as against 42.6% in those not on exclusive breast feeding (P<0.05). Only 16 (6.2%) of the patients had a MUAC of 12 cm and recorded the highest prevalence of 87.5%, 137 (52.7%) with a MUAC of 13-15 cm recorded 72.3%, while 107 (41.2%) with a MUAC of >15 cm had a malaria parasitaemia prevalence of 32.7% (P<0.05). Patients with body temperatures of 370 degrees C recorded the highest prevalence of 60.4%, while those with 37.1 degrees C-38 degrees C, 38.1 degrees C-39 degrees C and 39.1 degrees C-40 degrees C recorded prevalences of 60.2%, 55.6% and 23.1% respectively. CONCLUSION: The presence of a high prevalence of malaria parasitaemia in very vulnerable under-5 children in an urban centre calls for an urgent and serious implementation of various control measures against malaria; so as to reduce the sequelae and complications associated with this infection. The cause of fever in the absence of identifiable malaria parasite suggests that other infectious agents might be responsible for the pyrexia.
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Refractive errors in Mercyland Specialist Hospital, Osogbo, Western Nigeria
CO Adeoti, BE Egbewale
April-June 2008, 15(2):116-119
BACKGROUND: The study was conducted to determine the magnitude and pattern of refractive errors in order to provide facilities for its management. MATERIALS AND METHOD: A prospective study of 3601 eyes of 1824 consective patients was conducted. Information obtained included age, sex, occupation, visual acuity, type and degree of refractive error. The data was analysed using Statistical Package for Social Sciences 11.0 version) Computer Software. RESULTS: Refractive error was found in 1824(53.71%) patients. There were 832(45.61%) males and 992(54.39%) females with a mean age of 35.55. Myopia was the commonest (1412(39.21% eyes). Others include hypermetropia (840(23.33% eyes), astigmatism (785(21.80%) and 820 patients (1640 eyes) had presbyopia. Anisometropia was present in 791(44.51%) of 1777 patients that had bilateral refractive errors. Two thousand two hundred and fifty two eyes has spherical errors. Out of 2252 eyes with spherical errors, 1308 eyes (58.08%) had errors -0.50 to +0.50 dioptres, 567 eyes (25.18%) had errors less than -0.50 dioptres of whom 63 eyes (2.80%) had errors less than -5.00 dioptres while 377 eyes (16.74%) had errors greater than +0.50 dioptres of whom 81 eyes (3.60%) had errors greater than +2.00 dioptres. The highest error was 20.00 dioptres for myopia and 18.00 dioptres for hypermetropia. CONCLUSION: Refractive error is common in this environment. Adequate provision should be made for its correction bearing in mind the common types and degrees.
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Breastfeeding practices of mothers in a rural community of Sokoto, Nigeria
MO Oche, AS Umar
April-June 2008, 15(2):101-104
BACKGROUND: Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants and has a unique biological and emotional influence on the health of both mother and child, hence the global effort aimed at promoting, protecting and supporting breastfeeding. OBJECTIVES: This study aimed to determine the prevalence and pattern of breastfeeding in a rural community of Sokoto state. STUDY DESIGN: Descriptive cross-sectional study. MATERIALS AND METHODS: A total of 260 standardized pre-tested structured questionnaires were interviewer administered based on a set of eligibility criteria. RESULTS: Out of the 260 mothers that were eligible for the study, 240 agreed to participate in the study. Only 20 (8%) of the respondents had initiated breastfeeding less than one hour after delivery, while majority, 165 (69%) did so after 24hours. Exclusive breastfeeding was highly practised in this community as 188 (78.7%) of the mothers gave only breast milk up to six months after delivery. None of the mothers breastfed for less than six months while 171 (71%) did so for 19-24 months. The relationship between educational attainment and duration of breastfeeding was not statistically significant (P>0.05). Majority of the mothers 141(76%) continued breastfeeding even when they felt their child was old enough to be weaned. CONCLUSION: The prevalence of breastfeeding was found to be high in this community; however, there is the need to promote early initiation of breastfeeding to sustain and improve on the rates.
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The use of artemisinin-based combination therapies (ACTs) in public secondary health facilities in Lagos, Nigeria
IA Oreagba, SO Olayemi, SK Omotosho, AT Onajole, O Awodele, AA Akinyede
April-June 2008, 15(2):94-100
OBJECTIVES: The objectives of the study were to assess the prescription pattern of Artemisinin Combination Therapies (ACTs) in uncomplicated malaria and the knowledge, attitude and practice of physicians as regards use of ACTs in the outpatient clinics of public secondary health facilities in Lagos State. PATIENTS AND METHODS: All the ten General Hospitals under the Lagos State Health Management Board were studied and classified as either rural or urban. 1878 retrospective antimalarial prescriptions of outpatients between March, 2005--March, 2006 were systematically sampled and questionnaires were distributed to prescribers in April--May, 2006. Prescription assessment was based on the recent Nigerian National Antimalarial Treatment Policy and WHO/INRUD drug use indicators. RESULTS: The percentage of prescriptions containing ACTs was found to be rather small (5.9%) inspite of the high proportion (59.2%) of prescribers who were favourably disposed to the National antimalarial policy change from Chloroquine to ACTs as first line. There was no statistically significant difference in frequency of ACTs prescription between the rural and urban health facilities. The prescription of Artemisinin derivatives as monotherapy was 18.2%. The prescription of Chloroquine was found to be more predominant, (48.8%) in all the health facilities. CONCLUSION: Despite the national policy change from Chloroquine to (ACTs) as the first line antimalarial, their use in the public secondary health facilities in Lagos State does not reflect this policy change and it appears that Chloroquine still remains the choice antimalarial drug.
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Malaria case management among Primary Health Care workers in Sokoto
AS Umar, OO Abdulkareem
April-June 2008, 15(2):76-81
INTRODUCTION AND OBJECTIVES OF THE STUDY: Among the current strategies for malaria control in Nigeria include early recognition and adequate treatment of cases through capacity building of health workers. This therefore forms the basis of this study; so that an evidence based intervention programme will be designed for area and cadre specific identified gaps among PHC Workers in Sokoto with a view to achieve better control measures.STUDY DESIGN AND METHODOLOGY: A total of 195 PHC Health workers in Sokoto who met the eligibility and inclusion criteria were enlisted and enrolled into the study (descriptive cross-sectional) using table of random numbers. The data was collected using a self-administered questionnaire containing relevant questions on respondent biodata and Knowledge on the management of cases of malaria. RESULTS: Overall, only 71 (36.4%) of respondents were found to have adequate and effective treatment practices of malaria infection. However, age (p=0.4294), professional cadre (p=0.2988) and years of experience (p=0.1922) are not important determinants of malaria treatment pattern observed among respondents. CONCLUSION: This finding highlights ineffective treatment practices that may hinder the attainment of the goals of roll back malaria to reduce malaria cases by 50% by the year 2015. Hence periodic training and re-training of health workers based on identified gaps must be undertaken.
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Relationship between Schistosoma haematobium infection and urinary tract infection among children in South Eastern, Nigeria
ME Eyong, EE Ikepeme, EE Ekanem
April-June 2008, 15(2):65-69
BACKGROUND: Reports of studies on the relationship between Schistosoma haematobium and urinary tract infection from different regions are conflicting. Hence, the need to determine the situation in each endemic area. OBJECTIVE: To determine if S. haematobium infection is associated with Urinary Tract Infection (UTI) among children in an endemic area of Cross River State, Nigeria. SUBJECTS AND METHODS: Mid-stream urine specimen was collected under strict aseptic procedures into wide-mouthed screw-capped sterile plastic containers. All the specimens were kept in a cooler at approximately 4 degrees C for 5-10 hr before delivery to the laboratory. Urine microscopy was carried out by gram staining and urine was cultured using blood agar and Mac Conkey agar plates. Collection of urine specimens for schistosoma ova was done between 10.00 am and 2.00 pm when ova count of S. haematobium is expected to be at its peak. RESULTS: Prevalence of urinary schistosomiasis was 51.0%. One hundred and seventy five (77.4%) of those infected had mild intensity of infection (<49 ova/10 ml). Significant bacteriuria was found in 2(0.9%) of the 226 children with urinary schistosomiasis and in 4(1.8%) of the 217 children without urinary schistosomiasis RR(95%CI) = 0.48 (0.089-2.59) P > 0.68. CONCLUSION: This study has found the prevalence rate of urinary Schistosomiasis in this community to be 51% and no significant difference in the prevalence of UTI among children with urinary schistosomiasis and those without. However, considering the high prevalence of urinary schistosomiasis seen in this study, urgent control measures should be instituted to address this public health problem.
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Sanitary provision and helminthiasis among school children in Benin City, Nigeria
VA Wagbatsoma, U Aimiuwu
April-June 2008, 15(2):105-111
OBJECTIVE: To assess the effect of sanitary provision and hygiene practices on intestinal helminth burden of primary school children. MATERIALS AND METHODS: The cross sectional descriptive study was undertaken in Egor Area of Benin City, Edo State, Nigeria. Using a calculated sample size of 384, participants were selected from primary schools in the study area, using a multi stage sampling method. Although, 384 pupils were expected to participate in the study only 365 provided faecal samples for examination giving a response rate of 95%. RESULTS: In most of the schools surveyed, open refuse dumping, (score 1) was the prevalent practice. Portable water supply was present only in private schools within the compound, (score 4). Toilet facilities were grossly inadequate in number and without consideration for sex. Pit latrine, (score 2) was the common toilet provided in surveyed schools. Seventy seven, (21.1%) of the pupils were infected with one or more helminth ova. Pupils in public schools were more infected 72 (30.8%) than those in private schools 5 (3.8%). Helminth ova seen in examined faecal samples were A lumbricoides 61, (16.7%); followed by hookworm, 27 (7.4%); T. trichuria, 5(1.4%); S. stercoralis, 1(0.4%). Regular hand washing with soap reduced the prevalence of helminthiasis. CONCLUSION: The level of sanitation observed in the schools studied was low. Consequently, more toilets, preferably the VIP type should be built to overcome the hazard of the pit latrine. Provision of portable water supply should be mandatory for all schools to ensure healthy learning environment.
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An audit of snake bite injuries seen at the Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria
EH Njoku, SA Isezuo, MA Makusidi
April-June 2008, 15(2):112-115
BACKGROUND AND OBJECTIVES: Snakebite is an important but often overlooked medical problem worldwide. This work is an audit of snakebite injuries in Sokoto, North West Nigeria using hospital-based data. METHODOLOGY: A retrospective analysis of the records of all adult patients with snakebite managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, North West Nigeria from January 2000 to December 2004 was carried out. Information retrieved included demographic and clinical data. RESULTS: Seventy three patients made up of 55 males (75.3%) and 18 females (24.7%) were involved. Male to female ratio was 3:1. Snakebite constituted 1.7 per 1000 hospital admissions and 12.7 per 1000 medical admissions. 82.2% of the patients were between 15 and 40 years of age. 89% of the bites were between the months of March and October. 54.8% of the patients were bitten in the home environment while 39.7% were bitten in the bush. The lower limbs were the most common sites of bite (58.9%). Most( 63%) of the bites occurred during the daytime. 50.7% of the patients showed signs of envenomation while 64.4% received antivenom. Majority of the patients survived and 2.7% of the patients died. The outcome was unknown in 26.0% of patients. CONCLUSION: Snakebite constitutes an important cause of hospital admission and occurs mainly during the rainy season which coincides with the period of intense farming activities in the study population. The build up commences during the period of intense heat. Envenomation status of patients need to be accurately determined to avoid excessive use of antivenoms with the attendant risk to patients.
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Effect of antiretroviral therapy on asymptomatic malaria parasitaemia in HIV-1 infected children
IM Adetifa, AO Akinsulie, EO Temiye, EO Iroha, VC Ezeaka, AG Mafe, AO Grange
April-June 2008, 15(2):120-125
OBJECTIVE: To investigate the effect of antiretroviral (ARV) therapy on the level of asymptomatic malaria parasitaemia in HIV-1 infected children. METHODS: Sixty-six HIV infected children had blood films prepared for malaria parasite identification and count. Mean parasite densities were compared across clinical stages and immunologic categories of disease and antiretroviral treatment status. RESULTS: Forty-five (68%) were less than 6 years old and 50 (75.7%) had advanced HIV disease. Twenty seven (41%) were on antiretroviral therapy. The prevalence of ASMP in the treated and untreated group was 44.4% and 15.4% respectively (p<0.01). The mean parasite density in the ARV treatment group was also significantly higher than in the untreated group (p=0.0071). CONCLUSIONS: ARV therapy seems to be associated with higher rates of ASMP and higher mean parasite counts.
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Splenic enlargement and abdominal scarifications in childhood malaria: beliefs, practices and their possible roles in management as seen in Benin City, Nigeria
OM Ibadin, AN Ofili, LU Airauhi, EI Ozolua, AB Umoru
April-June 2008, 15(2):70-75
AIMS AND OBJECTIVES: To achieve sustainable reduction in malaria burden in Africa, cultural practices that foster increased malaria burden must be addressed. In Edo state Nigeria, scarification/tattooing on the left hypochondrium presumably over an enlarged spleen arising mainly from malaria is widely practiced. This practice is deleterious, diversionary and causes complications. To evaluate the beliefs and practice, regarding abdominal wall scarification in children and within the context of malaria control. This was carried out among experienced women in child care selected from Egor Local Government Area of Edo State, Nigeria. METHODS: Information relating to beliefs, knowledge and their practices including possible socio-cultural/economic determinants were obtained with use of questionnaires in a cross-sectional and descriptive study. RESULTS: Of the 400 questionnaires administered 394 were responded to. The modal age bracket was 26-30 years. (Range, 18 - 56 years) Respondents were mainly Binis, Esan, and Ibos amongst others. About 27.0% of respondents considered the spleen a "bag of worms". Other views included "collection of bad blood", 27.2% and as a sickness of its own, 14.7%. Named causes of splenomegaly were fever, 59.6% and evil spirit, 15.5%. Over 45.0% of respondents would consult the herbalists for splenomegaly. Less educated (chi(2) = 40.0, p< 0.005), women over 40 years of age (chi(2) = 13.5, p < 0.05) and Esan/Bini ethnic groups (chi(2) = 15.6, p < 0.05) are more prone to the practice. Reasons for widespread use included perceived effectiveness, low cost and accessibility. Information on scarification was obtained mainly from family members, 49.5%; neighbours, 25.1%; and friends/colleagues, 16.7%. CONCLUSION: Practice of scarification is deep rooted and widespread in the study location. It has potentials to negate efforts involved in malaria control. Education including public enlightenment campaign should effectively check the practice.
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Metastatic alveolar rhabdomyosarcoma to the breast: a case report
AO Daramola, AA Banjo, AT Ajekigbe, AO Popoola
April-June 2008, 15(2):137-140
OBJECTIVE: To present the unusual occurrence of a Metastatic Alveolar Rhabdomyosarcoma to the right breast in a young woman, six years after the primary in the right thigh had been surgically excised and treated. A search of the literature from this part of the world showed that this is quite rare as no report of a similar case was found. METHODOLOGY: Breast lumpectomy samples submitted were routinely processed to obtain paraffin sections which were then stained routinely with haematoxylin and eosin. Reticulin stain and immunohistochemistry were used to exclude an epithelial lesion. CONCLUSION: Metastatic Rhabdomyosarcoma to the breast is a rare condition and is almost exclusive to adolescent females. Routine breast examinations should be mandatory for long term female survivors of primary Rhabdomyosarcomas.
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Upper gastrointestinal endoscopy findings in Nigerians: a review of 170 cases in Lagos
CA Onyekwere, H Hameed, EE Anomneze, C Chibututu
April-June 2008, 15(2):126-129
BACKGROUND: The advent of flexible endoscopy has made it possible to visualise the mucosa of virtually the entire intestine. This service is yet to be widely available in Nigeria. Existing reports on indications and findings at endoscopies are sometimes conflicting, with some recent reports suggesting a changing pattern of gastrointestinal diseases. OBJECTIVE: The study set out to evaluate the indications, endoscopic findings and their frequencies as well as any adverse outcome from the endoscopic examinations. METHODOLOGY: This was a retrospective study in which we reviewed the endoscopy records of the first one hundred and seventy patients that underwent upper gastrointestinal endoscopy at the Lagos State University Teaching Hospital. The patients' bio data, indications and findings during endoscopic examinations as well as any adverse outcome were documented. Data obtained were analysed using SPSS version 11. RESULTS: The majority of the patients were in the middle to elderly age with a peak in the 5th decade. The commonest indications for upper gastrointestinal endoscopy were; Dyspepsia, upper gastrointestinal haemorrhage, previously diagnosed peptic ulcer unresponsive to treatment and retrosternal discomfort or pain. Endoscopic request for variceal screening were uncommon. The commonest endoscopic findings were; features of gastroesophageal reflux disease, followed by gastroduodenitis (non-ulcer mucosal lesions in stomach and duodenum) and peptic ulcer disease. In 14 patients the endoscopy examination revealed normal findings. CONCLUSION: The role of endoscopy in the diagnosis and management of gastrointestinal disorders cannot be overemphasised. It is hereby recommended that provision of endoscopic facilities and training of necessary personnel be encouraged by all relevant agencies so that the services can be accessible and affordable by all who require it in view of its importance in patient management.
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Inhibins, activins and follistatins: a review
AA Ejilemele
April-June 2008, 15(2):130-136
The study of the regulation of the reproductive process has largely focused on the interplay between endocrine organs, gonads and the brain. The discovery of inhibins, activins and follistatins and elucidation of their actions has emphasised their role in human reproduction. This review discusses various evidences provided for their role as well as their potential uses as clinical markers of reproductive function and pathologies.
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