Primary Hypertension with Target Organ Damage among Apparently Healthy Secondary School Students in Osogbo, South-Western Nigeria.

INTRODUCTION: In recent times, there has been an increase in the frequency of hypertension among young people which is contributing globally to the increase in cardiovascular morbidity and mortality in adults. OBJECTIVE: The aim of this study was therefore to determine the prevalence of primary hypertension and its risk factors among apparently healthy secondary school students in Osogbo, southwestern Nigeria. METHODS: A school-based cross-sectional study of a total of 404 secondary school students in Osogbo city. Following informed parental consents of all the students involved in the study, blood pressure (BP) measurements were taken at 2 different visits by auscultation after a negative urine dip stick test result (thus excluding haematuria or proteinuria) in every subject before each BP was measured. RESULTS: The overall prevalence of hypertension and prehypertension in this study was 3.5% (n = 14) and 6.2% (n = 25), respectively. Obesity, consumption of extra - uncooked salt, high parental education and attendance of privately-owned secondary schools were identified risk factors associated with elevated BP. Seven (29%) of 24 subjects with hypertension had features of left ventricular hypertrophy (an evidence of target organ damage) on echocardiography and electrocardiography. All subjects with elevated BP had normal renal scan. CONCLUSION: Hypertension with features of target organ damage exists among adolescents. No known primary aetiologies were found among the hypertensive adolescents in the study and thus they were all deemed to have essential hypertension.

INTRODUCTION: Ces derniers temps, on a constaté une augmentation de la fréquence de l'hypertension chez les jeunes, ce qui contribue globalement à l'augmentation de la morbidité et de la mortalité cardiovasculaires chez les adultes. OBJECTIF: Le but de cette étude était donc de déterminer la prévalence de l'hypertension primaire et de ses facteurs de risque parmi des élèves du secondaire apparemment en bonne santé à Osogbo, sud-ouest du Nigeria. MÉTHODES: Étude transversale en milieu scolaire portant sur un total de 404 élèves du secondaire dans la ville d'Osogbo. Après avoir obtenu le parents informés de tous les élèves participant à l'étude, des mesures de l'étude, la pression artérielle a été mesurée par auscultation lors de 2 visites après un résultat négatif à la bandelette urinaire (excluant ainsi l'hématurie ou la protéinurie) chez chaque sujet avant que la TA ne soit mesurée. RÉSULTATS: La prévalence globale de l'hypertension et de la préhypertension dans cette étude était de 3,5% (n = 14) et de 6,2% (n = 25), respectivement. L'obésité, la consommation de sel extra-cuit, le haut niveau d'éducation des parents et la fréquentation d'écoles secondaires privées ont été identifiés comme des facteurs de risque associés à une tension artérielle élevée. Sept (29%) des 24 sujets hypertendus présentaient des caractéristiques d'hypertrophie du ventriculaire gauche (preuve d'une atteinte des organes cibles) à l'échocardiographie et à l'électrocardiographie. Tous les sujets présentant une PA élevée avaient une scintigraphie rénale normale. CONCLUSION: L'hypertension avec des caractéristiques d'atteinte des organes cibles existe chez les adolescents. Aucune étiologie primaire connue n'a été trouvée chez les adolescents hypertendus de l'étude et donc tous considérés comme souffrant d'hypertension essentielle. Mots clés: Hypertension primaire, dommages aux organes cibles, adolescents sains.

Fatal scorpion sting in a child.

Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.

Associations between placental and cord blood malaria infection and fetal malnutrition in an area of malaria holoendemicity.

The objective of this study was to determine the role of malaria in the etiology of fetal malnutrition in Nigeria. This study took place at the Neonatal and Maternity Units of the Wesley Guild Hospital, Ilesa, Nigeria. This is a prospective study of 304 consecutive, singleton, term live births delivered between January and August 2002. Anthropometric and clinical data were recorded. Fetal malnutrition (FM; failure to acquire adequate quantum of fat and muscle mass during intrauterine growth) was diagnosed using clinical assessment of fetal nutritional status (CANS) and the score (CANSCORE) adapted by Metcoff. The placenta tissues were examined for malaria pigments and parasites, and placental and cord blood smears were examined for parasites. Babies were followed up in the neonatal period for clinical malaria. Babies were grouped into those with malaria-infected placental and cord blood specimens and those without. The two groups were compared with regard to the proportions with FM and complications of FM. Three hundred four placental and cord blood specimens were examined for malaria. Of the 304, 101 (33.2%) of the placental and 67 (22.0%) of the cord blood specimens were positive for malaria. Sixty-six (21.7%) of the 304 babies had FM. Forty-four (66.7%) of the 66 placental blood specimens of babies with FM were positive for malaria, whereas 57 (24.0%) of the 238 placentae of babies without FM had placental malaria (chi(2) =42.5, P < 0.0001). Similarly, 27 (40.9%) of 66 babies with FM compared with 40 (16.8%) among 238 babies without FM had malaria parasites in the cord blood (chi(2) =17.5, P < 0.001). The means of birth weight, ponderal index, and placenta weight were significantly lower among the babies of mothers with malaria-infected placentae than those without (P < 0.05 in all cases). Lack of antenatal care, primiparity, and failure to have chemoprophylaxis against malaria were the maternal factors found to be associated with placental malaria infection. Placental malaria is a major factor in the etiology of FM in Nigeria.

Prevalence and problems of foetal malnutrition in term babies at Wesley Guild Hospital, South Western Nigeria.

BACKGROUND: Up to two-thirds of low birth weight babies delivered in the developing countries are also small for gestational age (SGA). Since SGA is common in West Africa, FM is expected to be common in the region. OBJECTIVE: To determine the pattern, prevalence, and problems of FM among term babies delivered at a General Hospital. METHODS: Subjects were consecutive, live, singleton; full term neonates delivered at the hospital over eight months and were assessed within 24 hours of birth. Each baby was examined for evidence of FM using the Clinical Assessment of Nutritional Status Score (CANSCORE) described by Metcoff. The babies were classified into those with and without FM and the two groups compared. RESULTS: Four hundred and seventy three term singleton live born neonates consisting of 246 males and 227 (48%) females were assessed. Eighty-nine (52%). 18.8% of the 473 babies had FM. FM was commoner in SGA babies than AGAbabies (p < 0.001). A total of 47 (82.5%) of the 57 babies who were SGA had FM while 42 (10.6%) of 396 babies who were AGA had FM (p < 0.001) and none of the 20 LGA babies suffered from FM. Severe birth asphyxia, respiratory distress, meconium aspiration, hypoglycaemia, high haematocrit and hypoalbuminaemia were significantly commoner in babies with FM. Infants with FM had significantly higher mortality and neurological sequelae in the first month of life. CONCLUSION: FM is a major health problem in Nigeria with considerable morbidity and mortality. Using CANSCORE, the clinician can diagnose cases of FM which may be missed by using intrauterine growth chart.

The present day epidemiology of severe protein-energy malnutrition in Nigeria.

Eighty-eight patients with severe protein-energy malnutrition (PEM) admitted into the Wesley Guild Hospital, Ilesa, Nigeria over a 9-month period were studied to define the patterns and factors encountered currently in PEM. Severe PEM now occurs predominantly in the 6- to 18-month age group, which is earlier than was reported previously. The majority of the parents were Yoruba Christians and were low-income workers or unemployed. Poverty was a factor in 54.5 percent. Most of the parents were literate. About half of the families were polygamous. The prevalence of social problems was high, with 72.7 percent of the parents living apart. Attacks of measles and recurrent or prolonged gastroenteritis were preceding precipitating factors in 30.7 percent and 33 percent of the patients, respectively. Failure or cessation of breast-feeding or bottle-feeding with cow's milk from the first month of life preceded the development of PEM in a large percentage of patients. The implications of these findings are discussed.

Female child circumcision in Ilesha, Nigeria. The present and the future.

In February 1981, the external genitalia of 578 female children were examined at the child welfare clinic, Wesley Guild Hospital, Ilesha, Nigeria. Of these children 96.5 per cent were under five years of age, and 66.3 per cent were circumcised. Of the circumcisions, 75.5 per cent had been done in the first month of life. "Traditional" surgeons performed 68.7 per cent of the circumcisions, and private clinic personnel, 21.1 per cent. In 49.6 per cent, circumcision had been done to prevent the head of any future baby from touching the clitoris at parturition, an event believed to result in early death of the neonate. In 48 per cent, circumcision had been done just to conform with custom. Of 175 mothers questioned, 82 per cent believed that an uncircumcised lady was more likely to be promiscuous than a circumcised lady.

The health, growth and educational performance of sickle cell disease children.

In a study by questionnaire and anthropometric measurements of the effect of sickle cell disease on the health growth and education of 102 Nigerian children aged between 9 months and 17 years, the first symptoms of the disease had occurred by the age 1 1/2 years in 58.8% of them. Strenuous exercise and exposure to cold water and weather commonly precipitated illness episodes which occurred in 81.4% of the children at least bi-annually. 94.1% of the children have been hospitalised and 76.5% transfused with blood at least once each before. Of the 67 children in school only 32.8% were in their correct classes and 53.7% have lost years. The mean class examination performance score computed for 55 of those in school was 67.8% +/- 21.5. The heights fall around and the weights below the third percentile of standard growth curves for Nigerian elite children. The disease affects the parameters examined adversely and should be controlled more effectively.

Relapse of tetanus in a child: a case report.

This report concerns the relapse of a case of tetanus which occurred one week after complete cessation of initial symptoms which had taken 4 weeks to nurse. Eventual and lasting resolution of the symptoms followed the removal of a foreign body from the left foot on the 58th day of admission.

Anthropometric measurement in children aged 0-6 years in a Nigerian village.

Seven hundred and three Nigerian village children in their first six years of life were subjected to anthropometric measurements and physical examination in early 1988. The heights of 66.9% and weights of 60.5% of them fell below the third percentile of a Nigerian equivalent for international reference population standard. Mid upper arm circumference values indicated moderate to severe malnutrition in over 25% of all 1-5 year old children surveyed. Fever, cough, headache and diarrhoea were the commonest symptoms encountered in the children. Mild pallor of the conjunctival mucosa and physical signs of protein energy malnutrition were commonly seen. Fungal and septic skin lesions were present in 11.45 and 11.1% of the children respectively, whilst rhinorrhoea was seen in 4.7%, otitis media in 6% and pharyngotonsillitis in 3.3%. Thirty four (4.8%) of the children had haemic whereas five had pathological murmurs. Dental calculi were present in 15.8%, umbilical herniae in 18.2%, hepatomegaly in 48.2% and splenomegaly in 23% of the children. Seven (1%) had cerebral palsy. The implication is that malnutrition, sickle cell disease, malaria and other infections are the prevailing causes of morbidity in the preschool aged children surveyed. Desirable improvements include upgrading socio-economic and living conditions and instituting appropriate control measures.

Head circumference of rural Nigerian children--the effect of malnutrition on brain growth.

OBJECTIVE: To compare head circumference measurements of the well nourished with those of the malnourished children for each sex. DESIGN: Cross sectional. SETTING: Imesi, Ile-Ife village, Nigeria. SUBJECTS: 644 children in the first six years of life. MAIN OUTCOME MEASURES: Head circumference. RESULTS: The mean head circumference values of malnourished children of both sexes fell mostly below the values for their well nourished age mates. The curve for well nourished girls fell by a little below, and for malnourished girls by over two standard deviations below Tanner's 50th percentile curve. For the boys, the curve for the malnourished children fell by over one standard deviation below the curve for their well nourished age mates. CONCLUSION: The significant reductions in head circumferences found in malnourished children may have serious implications for their future performance and achievement. Therefore, sufficient community concern and appropriate world action aimed at eradicating protein energy malnutrition is solicited.

Effect of promethazine on the metabolism of chloroquine.

Co-administration of promethazine hydrochloride and chloroquine phosphate resulted in increased blood levels of chloroquine and its metabolites. However, there is no statistical difference between the means obtained for the initial rate of excretion and the total drug excreted within three hours.

A prevalence survey of skin diseases in Nigerian children.

A prevalence survey of 5001 Nigerian children aged 0-12 years seen at the Urban Comprehensive Health Centre, Ile-Ife, Nigeria between July 1995 and June 1996 revealed that 492 children (9.8%) had dermatological conditions. Tinea (17.1%), scabies (16.5%) and impetigo (15.7%) were the most commonly observed childhood skin diseases and were followed by miliaria (9.8%), eczema (7.1%) and diaper dermatitis (7.0%) respectively. The major predisposing factor to acquiring either tinea infection or scabies or impetigo by any of the affected children was the low socioeconomic conditions of their parents. The high prevalence of eczema in the high social classes could be attributed to the early exposure of the children to artificial milk in infancy. It is hoped that aggressive health educational programmes and improvement of the socioeconomic status of the people will bring about a decline in the prevalence of childhood skin diseases in Nigeria.

Trace element status and early physical growth of exclusively breastfed normal and asphyxiated Nigerian babies.

Serial anthropometry and assay of plasma iron (Fe), zinc (Zn) and copper (Cu) were done on 72 babies with birth asphyxia during the first six months of life to assess the pattern of their physical growth and trace element status, respectively. Eighty-seven non-asphyxiated babies served as controls. The mothers of babies in both groups also had their plasma assayed for Fe, Zn and Cu immediately following delivery. Asphyxiated babies were lighter than non-asphyxiated controls during the first two months of life and they also had smaller mean occipito-frontal circumference at birth. While Fe, Zn and Cu status was generally comparable in both groups, the newborn Cu concentrations were very low compared with earlier reports. No baby showed any overt signs of trace element deficiency.

Delayed sexual maturation in sickle cell anaemia patients--observations in one practice.

Pubic hair and breast appearance ratings, testicular volumes and age at menarche were determined in 24 sickle cell anaemia patients aged from 8.5 to 27 years between February and September 1994 in the Wesley Guild Hospital, Ilesa, Nigeria. Only three of the six females aged 15 or more years had experienced menarche and this was at the mean (SD) age of 18.8 (4.5) years. Public hair appearance and breast development had commenced in only six and seven, respectively, of the 12 females, and in every case the ratings were significantly low for their ages. Male testicular volume was also low for their age in the six of 12 males who were 13 years of age, and above, and pubic hair had appeared in only two of them, aged 20 and 27 years. The height of all the patients was delayed. It is important to recognize that significant delay in sexual development may accompany sickle cell anaemia and to take appropriate steps in managing and counselling the patients.

School age pregnancies in western Nigeria: parents and products.

Thirty-three babies and their mothers, all school girls, identified out of a total of 576 admissions to the Paediatric unit of the Wesley Guild Hospital, Ilesa , Nigeria over a three month period were studied. Twenty (60.0%) of the babies were newborn, nine (45%) of whom were premature. Jaundice and infections were other common diagnoses in the neonates. Among the 13 children aged over one month protein-energy malnutrition, gastroenteritis and pneumonia were the commonest reasons for admission. Of the total 33, five (38.5%) had had previous admissions and two (6%) died. Both the numbers of premature neonates and of malnourished older children born to young mothers were significantly higher than those of similar aged admissions born to older mothers (P less than 0.001, in both cases). Thirty-two (97%) mothers were unmarried teenagers and there was a disparity between the academic classes and ages at conception in 15 (45.4%) of the mothers. Whilst significant numbers of the mothers were poorly adjusted to the demands of motherhood, varying numbers of the fathers were young, unemployed, in school and negative in their attitudes to the pregnancies and their products. Suggestions are offered for meeting the challenges posed by school age pregnancy and parenthood in a developing country.

African histoplasmosis presenting as a facial tumour in a child.

A case of African histoplasmosis with an unusual presentation in a 13-year old Nigerian school boy is described. The diagnosis was established by histological examination of biopsy material and treatment with amphotericin B was successfully undertaken.