Seroprevalence and Risk Factors of Hepatitis B Virus Infection among Adolescents in Enugu, Nigeria.

OBJECTIVES: The aim of the study was to determine the prevalence and correlates of hepatitis B virus infection in adolescents in Enugu-urban. METHODS: A cross-sectional seroprevalence survey was conducted among school children aged 10-18 years. Subjects were selected using multistage sampling. Hepatitis B surface antigenaemia (HBsAg) was assayed for in blood using rapid enzyme-linked immunosorbent assay kits. Data were analyzed using statistical package for social sciences version 16.0 (p < 0.05). RESULTS: Four hundred and twenty children were recruited. Of these, 13 tested positive for HBsAg, giving an overall hepatitis B seroprevalence of 3.1%. Social class, scarifications/tattooing, circumcision and history of surgery were the significant modes of transmission. CONCLUSION: The seroprevalence of hepatitis B among children in the study population is high. Its screening in school children should be incorporated into school health services in our setting while awareness campaigns and health education on its modes of transmission and prevention should be promoted and strengthened.

Childhood epilepsy and school absence.

Epilepsy is one of the most common diseases encountered among school children. Its effect on school attendance and academic performance is a major cause of concern to both parents and clinicians. In this communication, the absence rate and academic performance of 50 school children with epilepsy attending normal schools was compared with that of their age- and sex-matched classmates using the class attendance register and overall score of the 2001/2002 academic year. The mean and standard deviation of the number of days an epileptic child was absent in the 2001/2002 session was 15.3 + 13.8 days while that of the controls was 9.4 + 9.6 days (x2 = 3.4,df = 49, p < 0.001). There was no significant relationship between the rate of absenteeism and overall score among both epileptic children (x2 = 6.34, df = 2, p = 0.18) and the controls (x2 = 1.43, df = 2, p = 0.49). School absenteeism was therefore more common among epileptic children, though there was no observed negative effect of this increased absence on academic performance.

Epileptic spasms - 175 years on: Trying to teach an old dog new tricks.

PURPOSE: This text provides an overview of how the condition "infantile spasms" has evolved in the last 175 years. METHOD: Key references are summarised to assimilate this review. RESULTS: Infantile spasms, first described by Dr West in 1841, has undergone extensive investigation to understand the pathogenesis, aetiologies, optimal intervention and most likely prognosis for the affected child. The terminology has recently evolved such that the preferred term for the condition is now "epileptic spasms" in recognition of the fact that cases can present outside infancy. The aetiologies are diverse and can be structural, genetic, metabolic or acquired. Increasing numbers of presumed causative genetic mutations are now being identified. The condition is an epileptic encephalopathy such that without adequate control of the clinical seizures and correction of the abnormal EEG, ongoing neurological damage occurs. In some cases neuroregression is inevitable despite intervention. First-line treatments are either hormonal therapies, adrenocortcotrophic hormone or prednisolone, or vigabatrin. In the sub-group of patients with tuberous sclerosis complex, vigabatrin is the preferred treatment. High dose prednisolone may be a more viable option in resource limited settings. Recent research has suggested that combining hormonal therapies with vigabatrin will result in more patients achieving spasm cessation. CONCLUSIONS: Despite extensive study, the pathogenic mechanisms remain an area of debate and in need of further exploration. The enigma, however, may be explained as the role of resting state and dysfunctional brain networks are elucidated further.

Outcome of exchange blood transfusions done for neonatal jaundice in abakaliki, South eastern Nigeria.

BACKGROUND: Neonatal jaundice (NNJ) is a major cause of morbidity and mortality among neonates in Nigeria and exchange blood transfusion (EBT) is a common modality of its treatment in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. This communication aims to audit this service. MATERIALS AND METHODS: A 3-year retrospective review of the case files of all neonates that had EBT for NNJ at the new born special care unit of EBSUTH. RESULT: Two hundred and thirty seven (17.25%) out of 1374 neonatal admissions had NNJ. EBT was performed for 40 (16.9%) of them. The commonest indications for EBT were low birth weight/prematurity, ABO blood group incompatibility, sepsis and glucose 6 phosphate deficiencies. The mean serum bilirubin at which EBT was done was 28.3 mg/dl. The EBT was uneventful in 36 cases while in four (10%) cases there were reported adverse events. Seven neonates (17.5%) died after the procedure and documented causes of death include bilirubin encephalopathy, respiratory failure, and septic shock and disseminated intravascular coagulopathy. CONCLUSION: There is high rate of EBT use in the management of severe neonatal hyperbilirubinemia with significant morbidity and mortality in this study site. There is need to review the contribution of factors such as late presentation in the hospital to this and proffer solutions to it.

Factors associated with mortality in under-five children with severe anemia in Ebonyi, Nigeria.

OBJECTIVE: To determine the risk factors associated with poor outcome among under-five children with severe anemia in sub Saharan Africa. DESIGN: Cross-sectional. SETTING: University Teaching Hospital, Nigeria. PARTICIPANTS: Under-five children presenting with severe anemia (PCV <15%, Hb <5g/dL). METHODS: Between January and June 2006, children admitted with severe anemia were recruited. The biodata, socio-economic status, signs and symptoms were documented for each child after the initial stabilization. Laboratory investigations using blood, stool and urine samples were carried out. Data were analyzed using SPSS version 11.0. RESULTS: 140 out of the 1,450 patients admitted during the period of study had severe anemia (prevalence 9.7%). Malaria either alone or in combination was the most common cause of severe anemia [n=90 (64.3%)]. 117 patients (83.6%) recovered, while 4(2.8%) left against medical advice and 19 died (case fatality rate 13.6%). The variables associated with mortality were malnutrition (P=0.02), tachycardia (P= 0.03), coma (P<0.001), and absence of blood transfusion (P=0.001). On logistic regression analysis coma (P=0.002), not receiving blood transfusion (P=0.002) and female gender (P=0.04) predicted poor outcome. CONCLUSIONS: The study revealed high mortality rates among under-five children with severe anemia. Coma, malnutrition, female gender and absence of blood transfusion were associated with higher mortality in severe anemia.