Pattern of Clinical and Laboratory Presentation of Cerebral Malaria among Children in Nigeria

Introduction

Cerebral malaria (CM) is the most lethal form of severe malaria with high case fatality rates. Overtime, there is an inherent risk in changing pattern of presentation of CM which, if the diagnosis is missed due to these changing factors, may portend a poor outcome. Variations in the pattern of clinic-laboratory presentations also make generalization difficult. This study was, therefore, set out to report the pattern of clinical and laboratory presentation of CM.

Methods

This was a cross-sectional study among children aged 6 months to 14 years admitted with a diagnosis of CM as defined by the World Health Organization criteria. A pretested pro forma was filled, and detailed neurological examination and laboratory (biochemical, microbiology, and hematology) investigations were done. P <5% was considered statistically significant.

Results

Sixty-four children were recruited with a mean age of 34.9 ± 24.9 months and a male-to-female ratio of 1.9:1. There were 87.5% of under-five children. Fever (96.9%) was the major presenting feature closely followed by convulsions (92.2%). Convulsions were mainly generalized (94.9%) and multiple (76.5%). Profound coma (Blantyre coma score of 0) was present in 12.5% of cases, and the leading features on examination were fever (84.4%) and pallor (75.0%). Retinal vessel whitening (48.4%) was the most common funduscopic abnormality. Metabolic acidosis (47.9%), severe anemia (14.1%), hyperglycemia (17.2%), and hypoglycemia (7.8%) were seen among the children. Few (1.6%) had hyperparasitemia and bacteremia (3.2%).

Conclusion

Early recognition of the clinical presentation and prompt management may improve the outcome of cerebral malaria.

A comparative study of the prevalence of zinc deficiency among children with acute diarrhoea in SouthWestern Nigeria

Background

Zinc deficiency has been associated with increased incidence, severity and duration of childhood diarrhoea.

Objective

The objective of the study was to determine the prevalence of zinc deficiency among under-five children with acute diarrhoea.

Methods

The study was a comparative cross-sectional study in which serum zinc levels were determined using atomic absorption spectrometry in under-five children with acute diarrhoea and in apparently healthy contols. Two hundred and fifty children with acute diarrhoea and 250 controls were studied at the Wesley Guild Hospital, Ilesa, Nigeria.

Results

The diarrhoea patients had a mean ± SD serum zinc level of 78.8 ± 35.6 µg/dl, while the controls had a mean of 107.3 ± 46.8 µg/dl. The mean serum zinc level was significantly lower in the patients than the controls (t = -7.66; p < 0.001). Furthermore, the prevalence of zinc deficiency was significantly higher among the patients (30.4% versus 12.4% in the controls; OR = 3.09; 95% CI = 1.94 – 4.90; χ2 = 24.08; p < 0.001). Low social class was associated with a significantly higher prevalence of zinc deficiency among the patients (p = 0.013).

Conclusion

Zinc deficiency is significantly associated with diarrhoea among under-five children in the study community. Hence, routine zinc supplementation should be encouraged for the treatment of diarrhoea, and availability should be ensured.

Pattern of attention deficit hyperactivity disorder among primary school children in Ile-Ife, South-West, Nigeria

Background

One of the most common neurodevelopmental problems affecting behavior of children all over the world is attention deficit hyperactivity disorder (ADHD). Studies on ADHD prevalence in Africa used either parents' or teachers' disruptive behavioral disorder rating scale (DBDRS) to diagnose ADHD, but this study diagnose ADHD using both parents and teachers DBDRS simultaneously among primary school pupils in Ile-Ife.

Materials and Methods

The study was conducted among 1,385 primary school pupils in Ile-Ife using multistage random sampling. The parents' and teachers' DBDRS were used simultaneously to screen children who had ADHD.

Results

Sixty-five (4.7%) of the pupils had ADHD. Among the 65 pupils with ADHD, 28 (43%) had the inattentive subtype, 25 (38.5%) had the combined subtype, whereas 12 (18.5%) had hyperactive/impulsive subtype. The prevalence of ADHD was significantly higher in the younger age group than the older age groups (χ² = 7.153, P = 0.007). There was no significant association found between the prevalence of ADHD and the social class (χ² = 3.852, P = 0.146).

Conclusion

ADHD prevalence of 4.7% was found among the children in Ile-Ife. Assessment of children for ADHD was done by parents at home and teachers in the school with DBDRS. The inattentive subtype was the most common and the hyperactive subtype was the least seen in the study. Early diagnosis and treatment of this disorder will bring better outcome in the children.

Academic Performance of Children with ADHD in Ile Ife, South West, Nigeria

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder that affects attention and concentration of children. In Africa, there is a lack of information on academic performance of children with ADHD. This article aims to (1) determine the academic performance and intelligent quotient (IQ) of pupils with ADHD, (2) compare the academic performance and IQ of children with ADHD to those without ADHD, and (3) determine other factors affecting academic performance in children with ADHD. A community-based cross-sectional study was conducted in Ile Ife among pupils aged 5 to 12 years. They were screened with Disruptive Behavioral Disorder Rating Scale, IQs determined with the Draw-A-Person test (DAPT), the academic performance determined with academic performance questionnaire (APQ), and continuous assessment (CA) score for 2013/2014 session recorded. A total of 32.3% of 65 pupils with ADHD had low CA score, while 9.6% of 1,320 pupils without ADHD had low CA score. The CA score of pupils with ADHD was significantly lower (χ2  = 36.875, p = 0.001), particularly among older children aged 9 to 12 years (χ 2 = 4.135, p = 0.042). A total of 46.2% of 65 pupils with ADHD had subnormal IQ, while 47.2% of 1,320 pupils without ADHD had subnormal IQ. There was no significant difference between the IQ of children with ADHD and their peers without ADHD (χ2  = 0.023, p = 0.879). Children with ADHD had similar IQ as their peers without ADHD but lower CA score. The low academic performance in pupils with ADHD could be attributed to inattentiveness in the affected pupils.

Post partum emotional distress in mothers of preterm infants: a controlled study

OBJECTIVE

To investigate whether mothers of preterm infants experience more psychological distress than mothers of normal full term infants in the immediate postpartum period.

DESIGN

Cross sectional prospective study of postpartal women using the Beck Depression Inventory (BDI) and the GHQ-30.

SETTING

Neonatal intensive care units and the obstetric units of Wesley Guild Hospital, Ilesa and Multipurpose Health Centre, Ilesa (These are component Units of Obafemi Awolowo University Teaching Hospitals Complex, Osun State Nigeria).

RESULTS

Of the 60 postnatal women recruited into the study, 33 mothers of preterm neonates formed the index group and 27 mothers of full term normal infants constituted the control group. More mothers of preterm neonates (27.3%) had GHQ-30 scores which categorised them as having significant emotional distress than mothers of full term normal infants (3.7%). Similarly more mothers of preterm neonates (15.1%) were more depressed than mothers of full term normal infants (3.7%). These differences were found to be statistically significant when the mean scores of the two groups on the instruments swere compared.

CONCLUSION

These problems are not usually detected nor appropriately referred by the paediatrician/obstetrician to the psychiatrist. This has a number of implications for preventive psychiatry. A multidisciplinary approach is therefore essential in the detection and management of these problems.

Incidence of bacteraemia among children with severe anaemia in Wesley Guild Hospital, Ilesa, Nigeria

One-hundred-and-fifty-two severely anaemic patients, aged 6 months to 14 years were studied with a view to ascertaining the incidence of bacteraemia in them. Haemoglobin genotype AA was seen in 68 (45 per cent) of the patients, 38 (25 per cent) patients were of haemoglobin genotype SS; 35 (23 per cent) patients were of haemoglobin genotype AS; three (2 per cent) patients were of haemoglobin genotype AC and eight (5 per cent) patients were of haemoglobin genotype SC. Positive blood cultures were obtained in a total of 15 (10 per cent) patients. Of these 15 patients, 10 (22 per cent) patients were sicklers (9 HbSS; 1 HbSC) of a total of 46 sicklers studied. The remaining five (5 per cent) patients that had positive blood cultures were non-sicklers out of a total of 106 non-sicklers studied. There was a statistically significant difference between the sicklers and non-sicklers who had positive blood cultures (P < 0.05). The presence or absence of positive blood culture did not correlate with the severity of anaemia in either the sicklers or the non-sicklers. It is suggested that any severe anaemic patient with clinical features suggestive of sickle cell anaemia must have a blood culture done in the course of management. An 'identify at all costs' approach should not apply to severe anaemic children who are non-sicklers. The yield is low and cost high, clinicians should be selective in deciding in which patients blood cultures are warranted.