Psychosocial dysfunction among adolescents who abuse substances in secondary schools in Abakaliki, Nigeria.

BACKGROUND: Substance abuse has been associated with psychosocial dysfunction from previous reports; however, the prevalence and pattern of such morbidity is unknown in our environment. AIMS: The aim of the study was to determine the prevalence and pattern of psychosocial dysfunction among adolescents who abuse substance. METHODS: A case-control study was carried out among adolescents selected from five secondary schools in Abakaliki. A multistage sampling procedure was used to select the students and the World Health Organization student drug use questionnaire was used to screen respondents for substance abuse. Substance abusers and matched controls (non substance abusers) were assessed for psychosocial dysfunction using the 35-item Pediatric Symptom Checklist (PSC). Socioeconomic classification was done using the parental educational attainment and occupation. RESULTS: Two hundred and four students were abusers of one or more substances. The mean PSC score for substance abusers was 21.96 ± 10.77 whereas that for controls was 16.07 ± 8.69 (t = -6.74, P = 0.000). Eighty-nine individuals (43.7%) and 28 controls (13.9%) had PSC scores in the morbidity range of ≥ 28 for psychosocial dysfunction. This was statistically significant (χ2 = 13.57, P = 0.001). Prevalence of dysfunction was significantly associated with age group, gender, and socioeconomic class in both participants and controls. The prevalence of dysfunction was significantly higher in multiple abusers than the single abusers. CONCLUSION: The prevalence of psychosocial dysfunction is higher in adolescents abusing substance than in controls. Psychosocial dysfunction was however not related to age, gender, or social classes in the study population but was related to the abuse of multiple substances.

Seroprevalence and Correlates of Hepatitis C Virus Infection in Secondary School Children in Enugu, Nigeria.

BACKGROUND: Although children comprise a small fraction of the burden of hepatitis C virus (HCV) infections, which is a major global health challenge, a significant number of them develop chronic HCV infection and are at risk of its complications. AIM: The aim of the current study was to determine the prevalence and associated factors of HCV infection in school children in Enugu urban. SUBJECTS AND METHODS: This was a cross-sectional seroepidemiological study involving children aged 10-18 years selected using multistage systematic sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested using a 3(rd) generation enzyme-linked immunosorbent assay. Data were analyzed using SPSS Version 16.0 with the level of significance set at P < 0.05. RESULTS: Four hundred and twenty children were selected and screened comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV were females while one was a male giving a male to female ratio of 0.3-1. Traditional scarifications/tattoos were the putative risk factors observed to be significantly associated with anti-HCV seropositivity. CONCLUSION: This study has demonstrated an anti-HCV seroprevalence of 1.0% among children aged 10-18 years in Enugu with traditional scarification as the predominant associated risk factor. Proper health education including school health education and promotion of behavioral change among the public on the practice of safe scarifications/tattoos should be encouraged in our setting.

Nocturnal Enuresis among Nigerian Children and its Association with Sleep, Behavior and School Performance.

OBJECTIVE: To study the association of nocturnal enuresis with sleep, behavior and school performance. METHODS: Hospital-based, cross-sectional descriptive study of 216 children (?6-year-old) using structured questionnaire and behavioral tools. SETTING: Two hospitals at Lucknow in Northern India. RESULTS: Prevalence of enuresis was 37.0%. Nocturnal enuresis was significantly associated with abnormal behaviour (P=0.049) and poor sleep hygiene (P%0.05). School performance was not associated with enuresis. CONCLUSION: Children with nocturnal enuresis were at an increased risk of behavioral problems and poor sleep hygiene.

Knowledge of conversion disorder in children by pediatricians in a developing country.

INTRODUCTION: Conversion disorder (CD) in children presents the clinician with a diagnostic and treatment dilemma. Mistaking a physical condition for CD carries serious consequences for the child while continued investigation in line with physical disease in a child with CD also may expose the child to serious harm. MATERIALS AND METHODS: One hundred and seventy-four consenting doctors who attended a national conference of pediatricians were administered a 10 item questionnaire developed by the researchers. RESULTS: Only 5 (2.9%) of participants had good knowledge (scored above the mean plus one standard deviation of the score obtained by the psychiatry residents. Gender, rank, years of experience, availability of psychiatric service in center and duration of the psychiatry posting as the medical student could not differentiate those with good/fair knowledge from those without. However, those who have referred children for psychiatric assessment (P=0.015), those who believe that children can have CD (P=0.000) and those who are fairly confident that they could diagnose CD in children (P=0.000) had better knowledge of CD. CONCLUSION: Pediatricians have poor knowledge of CDs in children. Those that know that children could have the condition have confidence that they can identify children with the condition and have referred with mental health problems to psychiatrists have better knowledge than those who did not.

Factors Associated with Missed Immunization Opportunities in Abakaliki, South-Eastern Nigeria.

OBJECTIVE: To determined the extent and sociodemographic factors associated with missed opportunities to NPI-scheduled childhood immunizations Methods: The exit interview method of the World Health Organization was used. RESULTS: Only 41.6% of the children were fully immunized. Missed opportunities for immunization occurred in 277 (55.4%) children and were responsible for 94.9% of the non-fully immunized children. The most common reason for missed opportunities in this study was the unavailability of vaccines (78.3%). Missed opportunities occurred more in the age group of 0-11 months (92.4%) compared to those aged 12-23 months (7.6%), P<0.05. The social class of the parents was statistically significant in predicting the likelihood of missed opportunities in this study (P< 0.05). CONCLUSION: Missed opportunities to immunization (MO) remained high in EBSUTH, Abakaliki because immunization is conducted once a week in the preventive department only.MO is more common among children whose parents were in the lower social class.

Childhood suppurative otitis media in Abakaliki: isolated microbes and in vitro antibiotic sensitivity pattern.

BACKGROUND: Suppurative otitis media (SOM) is the most common pediatric problem seen by otolaryngologists in Nigeria. Devising simple and effective ways of treating pediatric patients with suppurating ears, especially in situations without a specialist care, will help prevent chronicity. Our experience with som at the ebonyi state university teaching hospital (ebsuth), abakaliki, is reviewed in this study. it may serve as a guide in patient care. OBJECTIVE: Determine the bacteriology of SOM in children in Abakaliki and ascertain their sensitivity to common antibiotics. MATERIALS AND METHODS: A 2-year retrospective analysis of ear swabs culture results and case files of children aged 0-18 years with SOM managed in EBSUTH. RESULTS: Sixty-five patients with discharging ears were reviewed. Of these, 73% were ≤ 5 years, of which 41.5% were infants. About 83% had unilateral ear discharge. Acute suppuration was seen in 67%. Overall swab yield was 87.7%; Pseudomonas was (57.4%), Klebsiella (16.4%), and Proteus species (11.5%). Ciprofloxacin showed 60% sensitivity, Gentamicin (58%), and Ceftazidime (35%). Amoxicillin/Clavulanic acid, ceftriaxone, and cefuroxime showed sensitivity of 4.3%-9.7%. CONCLUSIONS: Treatment protocols of SOM in children should emphasize the use of Ciprofloxacin or Gentamicin, especially in situations with limited access to laboratory services or specialist care.

Non-traumatic childhood coma in Ebonyi State University Teaching Hospital, Abakaliki, South Eastern Nigeria.

BACKGROUND: Coma is a medical emergency, and optimal management, especially in a resource-poor setting, would depend on the knowledge of its etiology and predictors of outcome. This communication reviews the etiology and outcome of non-traumatic childhood coma in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. OBJECTIVE: To determine the incidence, etiology and outcome of non-traumatic coma in children seen at the EBSUTH, Abakaliki. MATERIALS AND METHODS: This is a retrospective analysis of records of all children admitted to the children emergency ward of EBSUTH in coma of a non-traumatic origin between 1 st of January and 31 st of December, 2007. RESULTS: Forty children presented with coma out of 673 children admitted during the study period, giving an incidence rate of 5.9%. The majority of the children (62.5%) were aged between 1 and 5 years of age, and 79.5% of them were deeply comatose on admission. Most of the cases (85%) of non-traumatic coma were due to infective causes, mainly cerebral malaria (47.5%), pyogenic meningitis (17.5%) and septicemia (10%). Twenty-four (60%) children recovered while 13 (32.5%) died. CONCLUSION: Infections were the predominant causes of non-traumatic coma in EBSUTH. In view of the high mortality among this group of patients, efforts at the control of malaria and other infections would significantly reduce the incidence of non-traumatic coma in this study site.

Mothers' perception of excessive crying in infancy in south eastern Nigeria.

BACKGROUND: Excessive infant crying, though usually benign, can be very troublesome to parents with unwanted consequences on the child. Previous reports had shown cultural and racial differences in it's perception by mothers. We undertook this study to determine the prevalence of excessive crying in our area of practice and also determine associated factors. METHOD: This was a cross sectional, questionnaire based descriptive study on mothers' perception of their infants' crying. Subjects were mother/infant pairs attending the well baby clinics at the Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Mother of Christ Specialist Hospital, Enugu and the Ebonyi State University Teaching Hospital, Abakaliki. RESULT: Four hundred and eighty mother/infant pairs participated in the study. Seven point nine percent of the mothers reported excessive crying in their infants. There was no significant diurnal variation in the rate of excessive crying among these infants. Educated mothers (P = 0.008) reported excessive crying less frequently than the uneducated ones. Other maternal and infants demographic factors did not have any influence on mothers' perception of excessive crying in their infants. CONCLUSION: Excessive crying among infants is more commonly perceived by uneducated mothers. This group should be identified and counselled about excessive crying to prevent untoward consequences.

Academic performance of school children with epilepsy.

BACKGROUND: Studies in developed countries show conflicting reports on effect of epilepsy on academic performance. There is also a dearth of information on the academic performance of Nigerian children with epilepsy. OBJECTIVE: This study is aimed at determining the academic performance of children with epilepsy with the hope that the findings will help in formulating policies that will be used in their educational programme. METHODS: The academic performance of 50 epileptic children attending normal primary school was compared with those of non-epileptic classmates matched for age, sex and socioeconomic status. The academic performance was assessed using the overall scores achieved in the terminal examination in the 2001/2002 academic years, as well as the scores in individual subjects. RESULTS: There were 36 males and 14 females. The most common seizure type among the epileptic children was generalized tonic-clonic seizure. Thirteen (26%) of the epileptic children had a low overall score, and therefore poor academic performance, compared to 16% of the controls. (p = 0.35). However, the mean score of the epileptic children was significantly lower than that of the controls in English (p = 0.02), Science (p = 0.02) and Social studies (p = 0.02). CONCLUSION: The overall academic performance of epileptic children without other chronic disorders attending normal schools is not different from that of normal children in the same setting, though they are under-achieving in some subjects.

Factors influencing the academic performance of school children with epilepsy.

The academic performance and intelligence quotient (IQ) of 50 children with epilepsy aged between 5 and 14 years, attending normal primary schools in Enugu, were compared with those of their non-epileptic classmates. The academic performance was assessed using the overall scores achieved in terminal examinations in the 2001-2002 academic year. IQ was assessed using the Draw-A-person Test. The influences of school absence rate, Rutter behavioural scores, socio-economic status and seizure-related variables on academic performance were then determined. Twenty-six percent of the children with epilepsy had a low overall score, and therefore poor academic performance, compared with 16% of the controls (p = 0.35). The mean IQ of the children with epilepsy was significantly lower than that of the controls (p = 0.02). The mean school absence rate for the children with epilepsy was significantly higher than that of the controls (p = 0.001). The mean Rutter score of the children with epilepsy was significantly higher than that for the controls (p < 0.001). On multiple linear regression analysis, only IQ (p = 0.01) and seizure type (p = 0.03) had significant predictive effects as risk factors for low overall scores and poor academic performance. It is concluded that the academic performance of epileptic children is influenced by their IQ and type of seizures rather than by other seizure variables or socio-demographic characteristics.

Knowledge and practice of universal precaution in a tertiary health facility.

BACKGROUND: The increased risk of health workers to contract HIV, hepatitis B and C viruses in their work place led to the development of universal precaution or infection control policy. This policy where applied, has been found to reduce the risk of contracting these infections in the work place. The aim of this study is to determine the knowledge and practice of this policy in University of Nigeria Teaching Hospital (UNTH), Enugu. METHODS: This study was cross-sectional in design. Subjects were health workers likely to be exposed to body fluid. The study tool was a self administered pre-tested questionnaire. Statistical analysis was done using SPSS version 11.5 software. RESULTS: Two hundred and forty six health workers participated in the study, consisting of 150 females and 96 males. The male to female ratio was 1: 1.6. Majority of the respondents were between ages 20-49 years. One hundred and twenty four (50.4%) of the respondents were aware of universal precaution, while 88 (35.8%) knew the correct definition of universal precaution. Thirty four (13.8%) had received training on universal precaution however no ward attendant was trained. On multiple regression (P = 0.049) and training (P = 0.006) were the variables that were predictive of correct definition of universal precaution. Hands gloves were used by 86.6% of the respondents, 32.9% did not re-sheath needles and 43.9% practiced appropriate hand washing. CONCLUSION: The level of knowledge and compliance with precaution by health workers in UNTH Enugu is low. Low level of training and unequal training exposure among the various occupations contributes to this.

Hepatitis B vaccination status among health workers in Enugu, Nigeria.

BACKGROUND: Health workers in Nigeria are particularly at increased risk of contracting hepatitis B virus in their work place because Nigeria is a holoendemic area. Hepatitis B vaccination virtually eliminates this risk. There are few studies on the perception and uptake of hepatitis B vaccination among health workers in Nigeria and none to our knowledge in the University of Nigeria Teaching Hospital (UNTH), Enugu. OBJECTIVE: To determine the Hepatitis B vaccination level among all categories of health workers in UNTH, Enugu, and the factors that influence its uptake. METHOD: The study was cross-sectional in design. Subjects were health workers likely to be exposed to patients and or their body fluids. The tool was a self administered pre-tested questionnaire and analysis was done using SPSS version 11.5 software. RESULTS: Fifty point four percent of the health workers felt that their jobs exposed them to an increased risk of contracting hepatitis B virus infection. There is a significant occupational difference in perception with only 5.5% of the ward attendants as against 67.9% of other workers feeling that their jobs exposed them to increased risk (P = 0.00). Twenty two point four percent had received Hepatitis B vaccination, 3.7% had received 3 or more doses. Only years of occupational practice had a significant influence on vaccination uptake (P = 0.00). The most common reason for non-vaccination was lack of opportunity (43.08%). Among the 53.7% of the respondents who had had needle stick injury, none received post exposure prophylaxis. CONCLUSION: There is a low level of hepatitis B vaccination and no post exposure prophylaxis among health workers in UNTH, Enugu. This is due to poor perception of the risk of contracting this infection and non-availability of the vaccines.