Nutritional status of school age children in Abakaliki metropolis, Ebonyi State, Nigeria.

BACKGROUND: Malnutrition is a major public health problem with short and long-term adverse effects on children particularly in middle and low-income countries. Three out of every ten under-five children are said to be stunted and 19.4% underweight in Nigeria. In Ebonyi State, between 2013 and 2015, the proportion of preschool children with chronic undernutrition rose from 16.2 to 20.6%. Little is documented about the nutritional status of school-age children in Ebonyi State and Nigeria. METHODS: We conducted a descriptive cross-sectional study among 780 children aged 6 to 12 years from 10 primary schools in Abakaliki metropolis. A multistage sampling method was used to select the participants. A pre-tested interviewer-administered structured questionnaire was used to collect information from the children and their parents. Body Mass Index (BMI), Z scores of the weight for age, BMI for age and height for age were obtained using the WHO AnthroPlus software. We estimated the prevalence of undernutrition, over-nutrition, underweight, thinness, stunting, overweight and obesity. RESULT: Out of 751 pupils that participated, 397 (52.9%) were females and 595 (79.2%) were in public schools. The overall prevalence of undernutrition was 15.7% and that of over-nutrition was 2.1%. The prevalence of underweight, thinness and stunting, overweight and obesity were 8, 7.2, 9.9, 1.4 and 0.7% respectively. The proportion of pupils who were thin was higher among males (8.7%), those attending public schools (8.6%) and those dwelling in rural parts of the metropolis (14.3%) compared to females (5.8%) private school attendees (1.9%) and urban dwellers (4.6%). Stunting was found to be higher among pupils attending public schools (11.8%) compared to those attending private schools (2.5%). The prevalence of stunting was 19.3% among the pupils residing in rural areas and 5% among the pupils living in urban areas of the metropolis. No pupil in private schools was underweight. Over-nutrition was not found among the pupils in rural areas. CONCLUSION: Both under and over nutrition exist in Abakaliki metropolis. Undernutrition is the more prevalent form of malnutrition among school age children in the metropolis.

Blastocystis in the faeces of children from six distant countries: prevalence, quantity, subtypes and the relation to the gut bacteriome.

BACKGROUND: Blastocystis is a human gut symbiont of yet undefined clinical significance. In a set of faecal samples collected from asymptomatic children of six distant populations, we first assessed the community profiles of protist 18S rDNA and then characterized Blastocystis subtypes and tested Blastocystis association with the faecal bacteriome community. METHODS: Stool samples were collected from 244 children and young persons (mean age 11.3 years, interquartile range 8.1-13.7) of six countries (Azerbaijan 51 subjects, Czechia 52, Jordan 40, Nigeria 27, Sudan 59 and Tanzania 15). The subjects showed no symptoms of infection. Amplicon profiling of the 18S rDNA was used for verification that Blastocystis was the most frequent protist, whereas specific real-time PCR showed its prevalence and quantity, and massive parallel amplicon sequencing defined the Blastocystis subtypes. The relation between Blastocystis and the stool bacteriome community was characterized using 16S rDNA profiling. RESULTS: Blastocystis was detected by specific PCR in 36% (88/244) stool samples and was the most often observed faecal protist. Children from Czechia and Jordan had significantly lower prevalence than children from the remaining countries. The most frequent subtype was ST3 (49%, 40/81 sequenced samples), followed by ST1 (36%) and ST2 (25%). Co-infection with two different subtypes was noted in 12% samples. The faecal bacteriome had higher richness in Blastocystis-positive samples, and Blastocystis was associated with significantly different community composition regardless of the country (p < 0.001 in constrained redundancy analysis). Several taxa differed with Blastocystis positivity or quantity: two genera of Ruminococcaceae were more abundant, while Bifidobacterium, Veillonella, Lactobacillus and several other genera were undrerrepresented. CONCLUSIONS: Asymptomatic children frequently carry Blastocystis, and co-infection with multiple distinct subtypes is not exceptional. Prevalence and quantity of the organism clearly differ among populations. Blastocystis is linked to both faecal bacteriome diversity and its composition.

Early signs of microvascular complications in pediatric patients with short duration of type 1 diabetes mellitus seen in southeast Nigeria.

Background: Clinically evident microvascular complications are rarely seen among children and adolescents with type 1 diabetes mellitus (T1DM), although early signs develop during childhood and accelerate during puberty. Aim: The aim of this study was to determine the prevalence of early signs of microvascular complications in children and adolescents aged 9-19 years with a short duration of T1DM by screening for retinopathy and nephropathy. Methods: A cross-sectional study and participants were consecutively enrolled from the Endocrinology Clinic at Federal Teaching Hospital, Abakaliki. Physical examination and mydriatic ophthalmoscopy were conducted. Three early morning spot urine specimens for albumin/creatinine ratio were estimated 3 months apart. Serum creatinine levels were estimated, and the glomerular filtration rate was calculated. Glycosylated hemoglobin (HbA1c) was determined. Results: Twenty-four individuals participated, 15 (62.5%) were male and the mean age at diagnosis was 12.4 ± 2.3 years. The mean duration of diabetes was 23.8 ± 20.6 months. The mean HbA1c was 11.4%. Retinopathy was seen in 16.7%, whereas 33.3% had microalbuminuria. Blood pressure range was within the 50th-90th percentile for all the participants. Conclusion: The study outcome demonstrated a high prevalence of early signs of microvascular complications such as retinopathy and nephropathy among youths with short duration of T1DM. Poor glycemic control, if not halted, is associated with early signs of microvascular complications which may become clinically evident; contrary to the belief that they are rare in childhood.

RésuméObjectif: abstrait Déterminer la prévalence des signes précoces de complications microvasculaires chez les adolescents âgés de 9 à 19 ans ayant une courte durée de T1DM par dépistage de la rétinopathie et de la néphropathie. Méthodes: Une étude transversale et des sujets ont été inscrits consécutivement de la clinique d'endocrinologie à l'hôpital fédéral d'enseignement Abakaliki.L'examen physique et l'ophtalmose mydriatique ont été menés. Trois spécimens d'urine de tache tôt le matin pour le rapport d'albumine/créatinine ont été estimés 3 mois d'intervalle.Des niveaux de créatinine de sérum ont été estimés et le taux glomerular de filtration calculé.L'hémoglobine glycosylated (HbA1c) a été déterminée. Résultats: 24 sujets ont participé, Quinze (62,5%) étaient des mâles et l'âge moyen au diagnostic était de 12,4 à 2,3 ans.La durée moyenne du diabète était de 23,8 à 20,6 mois. Leur HbA1c moyen était de 11,4%.La rétinopathie a été vue dans 16.7% tandis que 33.3% a eu le microalbuminuria. La tension artérielle se situe entre le 50e et le 90e percentile pour tous les participants. Conclusion: Les signes de complication microvasculaire se manifestent tôt chez les enfants et les adolescents atteints de TIDM dans le sud-est du Nigeria.Contrairement à la croyance que les complications microvasculaires cliniquement évidentes sont rarement vues parmi des enfants avec T1DM.Un mauvais contrôle glycémique et la puberté sont des facteurs de risque importants.

The bacteriome at the onset of type 1 diabetes: A study from four geographically distant African and Asian countries.

OBJECTIVES: Gut bacteriome profiling studies in type 1 diabetes (T1D) to date are mostly limited to populations of Europe, with two studies from China and one study each from Mexico and the USA. We therefore sought to characterize the stool bacteriome in children after onset of T1D along with age- and place-matched control subjects from four geographically distant African and Asian countries. METHODS: Samples were collected from 73 children and adolescents shortly after T1D onset (Azerbaijan 19, Jordan 20, Nigeria 14, Sudan 20) and 104 matched control subjects of similar age and locale. Genotyping of major T1D susceptibility genes was performed using saliva or blood samples. The bacteriome was profiled by next-generation sequencing of 16S rDNA. Negative binomial regression was used to model associations, with adjustment for the matched structure of the study. RESULTS: A significant positive association with T1D was noted for the genus Escherichia (class Gammaproteobacteria, phylum Proteobacteria), whereas Eubacterium and Roseburia, two genera of class Clostridia, phylum Firmicutes, were inversely associated with T1D. We also confirmed a previously observed inverse association with Clostridium clusters IV or XIVa. No associations were noted for richness, evenness, or enterotypes. CONCLUSIONS: Based on our results, some type of distortion of the gut bacteriome appears to be a global feature of T1D, and our findings for four distant populations add new candidates to the existing list of bacteria. It remains to be established whether the observed associations are markers or causative factors.

Determinants of Noncompliance to Clinic Appointments and Medications among Nigerian Children with Epilepsy: Experience in a Tertiary Health Facility in Enugu, Nigeria.

Purpose. To determine the frequency and determinants of noncompliance to clinic appointment and medication among Nigerian children with epilepsy. Method. This is a cross-sectional survey of noncompliance to clinic appointments and medication among 113 consecutive children with epilepsy attending the Paediatric Neurology Clinic of University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Results. Noncompliance to clinic appointment and medication was 23% and 15.3%, respectively. The major reasons given were lack of finance, clashing with school time, and forgetting to take the drugs. Children whose mothers were less educated and unemployed were more likely to miss clinic appointments. Noncompliance to medication was associated with poor seizure control. Children that were on phenobarbitone were more likely to be noncompliant with medication than those on sodium valproate and/or carbamazepine. Conclusion. Missed clinic appointment and medication noncompliance are common among Nigerian children with epilepsy and financial constraint is the most common reason.

End--users' perception of quality of care of children attending children's outpatients clinics of University of Nigeria Teaching Hospital Ituku--Ozalla Enugu.

BACKGROUND: Knowledge of the specific details of end-users actual experiences with health system helps to identify areas for improvement in ways that standardized satisfaction measures are less able to provide in order to save lives, uphold public confidence and trust in healthcare delivery. The aim of the study was to assess the end-users' perception of the quality of clinical services rendered to children attending paediatric out-patient clinics of University of Nigeria Teaching Hospital, Ituku - Ozalla, Enugu. METHODS: A cross sectional descriptive study was undertaken using exit point interviewer administered pre-tested/semi-structured questionnaire.Assessment of perception of quality of care was undertaken in three service areas; waiting time, attitude of staff and comfort of the waiting hall. Data was analyzed using SPSS 16.0 and presented as percentages. Chi-square was used to compare means (p < 0.05). RESULTS: A total of 367 respondents were interviewed. Over 50% of them were generally satisfied with overall quality of care. 329 (89.6%) were very satisfied with quality of doctors' services, while the least satisfaction was with the quality of medical records services 139 (37.9%). Majority of the respondents 197 (53.7%) spent between 3-6 hours for each clinic visit and most of the waiting time spent was in the medical records and consultation. CONCLUSION: The care--givers perception of the general quality of care was adjudged high. However, overall waiting time was perceived to be unsatisfactory.Efforts should be made to reduce the time spent by clients while accessing care in the facility.