Gender Differences in Clinical Characteristics and Lifestyle Behaviours of Overweight and Obese Adolescents.

BACKGROUND: Energy intake and energy expenditure are different in boys and girls, especially during the adolescent period, a critical period for the development of obesity. However, gender-specific lifestyle behaviours that may influence the development of obesity among adolescent have not received sufficient attention. AIM: To determine gender differences in male and female overweight/ obese adolescents concerning their clinical parameters, dietary, sedentary and physical activity lifestyle behaviours. METHODS: From a total of 1036 secondary school students aged 10-17 years, BMI percentile for age and gender was used to identify overweight and obese individuals. These adolescents were then questioned on dietary, sedentary and physical activity lifestyle behaviours via a structured self-administered questionnaire. RESULTS: The overweight/obese adolescent identified were 92. Female adolescents were 1.5 times more than male adolescents. The male, overweight/ obese adolescents were significantly younger than their female counterparts (11.9 ± 1.0 years vs 13.2 ± 2.0 years p=0.0001). Female overweight/ obese adolescents were significantly heavier (67.1 ± 12.5 kg vs 59.6 ± 8.6 kg, p=0.003), with higher BMI (25.7 ± 3.7 kg/m2 vs 24.0 ± 2.3 kg/m2, p=0.012), and wider hip circumference (102.9 ± 9.0 cm vs 95.7 ± 6.7 cm, p=0.002). Regarding lifestyle behaviours, female overweight/ obese adolescents consumed more fast foods compared to their male counterparts (p=0.012). In contrast, significantly more male overweight/ obese adolescents were driven to and from school compared to female adolescents (p=0.028). CONCLUSION: Gender differences exist between overweight/obese female and male adolescents. The females were older, heavier and consumed fast foods more frequently. While their male counterparts were younger and tended to engage in less physical exertion. These factors should be considered when planning adolescents' weight loss and prevention interventions.

CONTEXTE: L'apport et la dépense énergétiques sont différents chez les garçons et les filles, en particulier pendant l'adolescence, une période critique pour le développement de l'obésité. Cependant, les comportements de style de vie spécifiques au sexe qui peuvent influencer le développement de l'obésité chez les adolescents n'ont pas fait l'objet d'une attention suffisante. OBJECTIF: Déterminer les différences entre les sexes chez les adolescents masculins et féminins en surpoids/obèses en ce qui concerne les paramètres cliniques, les habitudes alimentaires, la sédentarité et l'activité physique. MÉTHODES: Sur un total de 1 036 élèves du secondaire âgés de 10 à 17 ans, le percentile de l'IMC pour l'âge et le sexe a été utilisé pour identifier les personnes en surpoids et obèses. Ces adolescents ont ensuite été interrogés sur leurs habitudes alimentaires, leur sédentarité et leur activité physique au moyen d'un questionnaire structuré autoadministré. RÉSULTATS: 92 adolescents ont été identifiés comme étant ensurpoids ou obèses, les adolescentes étant 1,5 fois plus nombreuses que les adolescents. Les adolescents en surpoids/obèses étaient significativement plus jeunes que leurs homologues féminines (11,9 ±1,0 contre 13,2 ± 2,0 p =0,0001). Les adolescentes en surpoids/ obèses étaient significativement plus lourdes (67,1 ± 12,5 vs 59,6 ± 8,6, p=0,003), avec un IMC plus élevé (25,7 ± 3,7 vs 24,0 ± 2,3, p=0,012), et un tour de hanche plus large (102,9 ± 9,0 vs 95,7 ± 6,7, p=0,002). En ce qui concerne les habitudes de vie, les adolescentes en surpoids/obèses consommaient plus de fast-foods que leurs homologues masculins (p=0,012). En revanche, les adolescents en surpoids/obèses de sexe masculin étaient significativement plus nombreux à se rendre à l'école en voiture que les adolescentes (p=0,028). CONCLUSION: Il existe des différences entre les adolescents et les adolescentes obèses ou en surpoids. Les filles sont plus âgées, plus lourdes et consomment plus fréquemment des fast-foods. Leurs homologues masculins étaient plus jeunes et avaient tendance à faire moins d'efforts physiques. Ces facteurs devraient être pris en compte lors de la planification des interventions de prévention et de perte de poids chez les adolescents. Mots-clés: Différences entre les sexes, Comportements liés au mode de vie Surpoids, Obésité, Adolescents.

Evaluation of the Prevalence and Anatomic Types of Congenital Heart Diseases: An Echocardiographic Study in a Tertiary Hospital in Nigeria.

BACKGROUND: Congenital heart diseases (CHD) are the most important congenital anomaly. The burden and types are important for health planning and preparation for surgery. This study was conducted to determine the prevalence, anatomic types and defect sizes of the CHDs seen in a tertiary hospital. METHODS: A retrospective review of echocardiographic records of children seen in a tertiary centre over a twelve-year period was conducted. Using information from the echocardiograms, the anatomic types and defect sizes of the CHDs were determined using known classifications. Statistical analysis was done using IBM-SPSS version 21. RESULTS: The prevalence of CHD was 10.3/1000 children with a M:F ratio of 1:1. Sixty two percent of the subjects were infants. There were more acyanotic than cyanotic CHDs (80.6% vs 19.4%). The most common types of ventricular septal defect (VSD) and atrial septal defect (ASD) were the membranous and ostium secundum types respectively. The medium sized VSD (49.0%) were in the majority while the small size patent ductus arteriosus and atrial septal defects predominated, 69.5% and 61.3% respectively. CONCLUSION: The prevalence of CHD in this study was high. The large number of small sized defects of ASD and VSD allows for spontaneous closure or uncomplicated surgical repair of the defects, an advantage in a setting with poor access to heart surgery.

CONTEXTE: Les cardiopathies congénitales sont les anomalies congénitales les plus importantes. Le fardeau et les types sont importants pour la planification de la santé et la préparation à la chirurgie. Cette étude a été menée pour déterminer la prévalence, les types anatomiques et la taille des anomalies de la coronaropathie observés dans un hôpital tertiaire. MÉTHODES: Une revue rétrospective des dossiers échocardiographiques des enfants vus dans un centre tertiaire sur une période de douze ans. période. En utilisant les informations des échocardiogrammes, les types anatomiques et les tailles des défauts des maladies coronariennes ont été déterminés à l'aide de classifications connues. L'analyse statistique a été réalisée à l'aide d'IBM-SPSS version 21. RÉSULTATS: La prévalence de la coronaropathie était de 10,3/1000 enfants avec un rapport M:F de 1:1. Soixante-deux pour cent des sujets étaient des nourrissons. Il y avait plus de coronaropathies acyanotiques que cyanotiques (80,6 % vs. 19.4%). Les types les plus courants de communication interventriculaire (VSD) et de communication interauriculaire (ASD) étaient les types membraneux et ostium secundum respectivement. Les VSD de taille moyenne (49,0%) étaient majoritaires, tandis que le canal artériel persistant et la communication interauriculaire de petite taille étaient les plus fréquents. artérielle et les communications interauriculaires de petite taille prédominaient, respectivement 69,5 % et 61,3 %. 61,3 % respectivement. CONCLUSION: La prévalence des maladies coronariennes dans cette étude était élevée. Le grand nombre de défauts de petite taille de l'ASD et VSD permet une fermeture spontanée ou une fermeture sans complication. permet une fermeture spontanée ou une réparation chirurgicale non compliquée des chirurgicale sans complication, ce qui constitue un avantage dans un contexte où l'accès à la chirurgie cardiaque. Mots clés: Cardiopathie congénitale, types anatomiques, taille des défauts, échocardiographie. taille, échocardiographie.

Clinical predictors of circulatory failure and coexisting morbidities in children seen in an emergency room in Southern Nigeria.

Background: Circulatory failure (shock) is a life-threatening emergency referring to a state of poor tissue perfusion and resultant anaerobic respiration at a cellular level. It is a common pathway for several severe pediatric morbidities. Aim: We evaluated the clinical predictors of shock and coexisting morbidities in acutely-ill children. Patients and Methods: This was a descriptive, cross-sectional study. Data were collected using a researcher-administered questionnaire eliciting demography, clinical features, diagnoses/differentials, and comorbidities. After binary analysis, multiple logistic regression identified variables that independently predict circulatory failure in the participants, using odds ratio (OR) and 95% confidence intervals (CI). Results: Five hundred and fifty-four children took part in the study. Their median age was 60 (IQR: 24-132) months, mean weight 16.3 ± 13.6 kg and mean height was 90.8 ± 33.2 cm; 53.7% of them were males while 46.3% were females. The incidence of shock was 14.3% among the participants on arrival at the emergency room. Febrile seizure (14.9%), dehydration (4.7%), pallor (3.1%), and coma (1.8%) were the clinical findings significantly associated with shock (P < 0.05). Leading underlying diagnoses and comorbidities associated with shock were severe malaria (85.4%) and severe sepsis (25.0%) (P ≤ 0.01). Also, seizure (OR = 0.07, 95% CI: 0.04-0.13; P ≤ 0.001) and severe sepsis (OR = 0.31, 95% CI: 0.15-0.65; P = 0.002) were independent predictors of circulatory failure. Conclusion: The presence of acute neurologic morbidities and severe infection predicts circulatory failure in the pediatric emergency setting. Early detection and prompt treatment will forestall shock-related complications in affected children.

Electrocardiographic changes and troponin T levels in children with severe malaria anemia and heart failure.

BACKGROUND: Severe malaria anemia is a major cause of childhood heart failure in malaria endemic countries. The resulting hypoxic-ischemic injuries may cause myocardial damage detectable by electrocardiogram (ECG) and elevated troponin T (cTnT) levels. OBJECTIVE: Evaluate the ECG changes and cTnT levels in children with severe malaria anemia compared with those who had uncomplicated malaria without anemia. METHODS: Consecutive children with severe malaria anemia were recruited as subjects while controls were age- and gender-matched children with uncomplicated malaria without anemia. ECG findings, cTnT levels, and the proportion of children with elevated cTnT were compared between subjects and controls. RESULTS: There were 43 subjects with a mean age of 25.7 ± 22.9 months. Controls were forty children; mean age was 31.2 ± 20.0 months. All the subjects and 10 (25.0%) controls had ECG abnormalities. Five (11.6%) subjects and no control had ST segment changes, P = 0.06. Twenty-three percent of subjects compared to 5% of the controls had prolonged QTc, P = 0.027. Median cTnT of subjects (131.8 ng/L) was not significantly higher than the 85.9 ng/L of controls, P = 0.99. The median cTnT of subjects that died 208.9 ng/L was higher than in survivors 99.6 ng/L, P = 0.51. CONCLUSION: Prolonged QTc was more prevalent in children with severe malaria anemia compared to those without anemia, suggesting that children with severe malaria anemia were more prone to arrhythmias. The median cTnT value in the subjects was not significantly lower than that in controls, suggesting that children with severe malaria anemia are not prone to myocardial injury any more than those with uncomplicated malaria without anemia.

Comparison of obesity, overweight and elevated blood pressure in children attending public and private primary schools in Benin City, Nigeria.

BACKGROUND: Overweight and obesity in children, and adolescents is on the rise globally. Affected children are prone to cardio-metabolic problems later in life, especially hypertension. The prevalence of obesity/overweight may differ depending on school type. Private schools are attended mostly by children of the affluent, while public schools are attended predominantly by those in the low and middle socio-economic classes. OBJECTIVE: To compare the prevalence of overweight, obesity and elevated blood pressure (BP) in pupils attending public and private primary schools in an urban community in Nigeria. MATERIALS AND METHODS: In this cross sectional study, the BMI and BP of pupils in public and private primary schools, recruited by multistage sampling method, were measured. Their nutritional status was categorized using their BMI percentiles. Analysis was by SPSS. RESULTS: A total of 1466 pupils were recruited, 814(55.5%) were in public schools and 722(49.2%) were males. The prevalence of overweight and obesity was higher in private schools 11.8% and 11.7% compared to public schools 3.3% and 0.9%. The mean systolic BP of pupils in public schools 96.8 ± 12.5 mmHg was higher than that in private schools 95.5 ± 10.2 mmHg, p = 0.032. Distribution of pupils with prehypertension and hypertension between private and public schools was not significantly different. CONCLUSION: The prevalence of overweight and obesity is higher in pupils attending private schools compared to those in public school. Urgent measures are needed to stem this tide through education, weight reduction and physical activity programs, especially in pupils attending private schools.

PREVALENCE OF RHEUMATIC HEART DISEASE AMONG PRIMARY SCHOOL PUPILS IN MID-WESTERN NIGERIA.

OBJECTIVE: To determine the prevalence of RHD among primary school pupils in Egor Local Government Area (LGA) of Edo State of Nigeria. DESIGN: A cross sectional study SETTING: The study was carried out among selected primary pupils in three public and six private schools in Egor LGA, (the smallest governmental unit) in mid-Western Nigeria. SUBJECTS: Using a multistage sampling technique, pupils were selected from public and private primary schools in Egor LGA. They were clinically screened for evidence of RHD by auscultating for significant murmurs. The pupils with significant murmurs then had echocardiographic evaluation to confirm the presence of RHD. MAIN OUTCOMES: Pupils with significant murmurs and pupils with echocardiographically confirmed RHD. RESULTS: Of the 1764 pupils recruited, 900 (51.02%) were females while 864 (48.98%) were males. The mean age of the pupils was 8.86 ± 2.14 years. 1065 (60.37%) and 699 (39.63%) respectively were recruited from public and private schools. Of the 1764 pupils, six (0.34%) had significant murmur. Only one of the six had RHD, giving a prevalence of 0.57/1000 pupils. The pupil with RHD was a male, from public school and in the low socioeconomic class. CONCLUSION: The prevalence of RHD in this study is low compared to similar studies conducted outside the country. The true prevalence may be underestimated since higher prevalence is obtained from echocardiographic based screening compared to clinical screening.

PNEUMONIA COMPLICATED BY CONGESTIVE HEART FAILURE IN NIGERIAN CHILDREN.

OBJECTIVE: To evaluate heart failure in patients with pneumonia. SETTING: The paediatric wards of a tertiary hospital in Nigeria. SUBJECTS: One hundred and four patients were studied. RESULTS: The mean age was 10.3 ± 11.0 months and 53(51.0%) were males. Of the 104, 41(39.4%) also had Congestive Cardiac Failure (CCF). All 41(100%) patients with CCF compared to 38 of 63 (60.3%) with pneumonia only had cardiomegaly (p = 0.0001). Ten of 61(16.4%) patients with chest X ray had a cardiothoracic ratio (CTR) > 60%. Ten children had dilated ventricular chambers, eight (80.0%) had dilated inferior vena cavae and seven (70%) had myocarditis. CONCLUSION: The prevalence of CCF complicating pneumonia was high. Tender hepatomegaly, increased CTR and myocarditis were pointers to CCF complicating pneumonia.

Determinants of paediatrician's presence at Caesarian section.

BACKGROUND: Paediatricians are required to attend all Caesarian sections, yet most neonates so delivered do not require complex resuscitations necessitating a paediatrician's presence. METHODS: All Caesarean sections in the University of Benin Teaching Hospital from January to December 2009 were prospectively studied. The socio-demographic characteristics, indication and type of surgery, and the type of anaesthesia were recorded. Neonatal outcome was assessed with Apgar scores at 1 and 5 minutes and the need for a paediatrician determined. RESULTS: There were 431 cases of caesarean section within the period and 326 (75.6%) of these had antenatal care. About three-quarters of the patients had emergency caesarean section. Indications for caesarean section were foetal in 19% and maternal in 81%. Subarachnoid block was the main anaesthetic technique 392/431 (91.0%). Apgar score in 1 min was less than 7 in 172/431 (39.9%) and was severe (< 4) in 26/ 431 (6.0%). Lack of ante natal care (p < 0.05, RR = 1.3, 95% CI = 1.0 - 1.7 ), foetal indications (p < 0.05, RR = 1.4, 95% CI = 1.1 - 1.8), emergency caesarean section (p < 0.05, RR = 1.4, 95% C1 =1.0 -1.8), general anaesthesia (p = 0.0056, RR = 1.6, 95% CI = 1.2 -2.2) and active resuscitation (p < 0.05, RR = 2.5, 95% CI = 2.1 =3.1) were associated with Apgar scores less 7 in 1 minute. CONCLUSION: Unbooked status, foetal indication (foetal distress, prematurity, abnormal lie), emergency sections, and general anaesthesia may lead to poor Apgar scores and the need for active resuscitation. These settings justify the paediatrician's presence at Caesarean section.

Cardiovascular responses to blood transfusion in children with anemic heart failure.

INTRODUCTION: This study evaluated the cardiovascular responses to blood transfusion in children with anemic heart failure using mostly clinical parameters. MATERIALS AND METHODS: Consecutive patients with anemic heart failure presenting to a children's emergency room and requiring blood transfusion were assessed for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), liver size, and oxygen saturation (O 2 sat) pre-transfusion, 1-2 h into transfusion (intra-transfusion), immediate post-transfusion, and at late post-transfusion (24 h later). RESULTS: A total of 75 patients were recruited of which 46 (61.3%) were males. Their mean age was 43.8 ± 40.3 months while their mean PCV at presentation was 15.0 ± 4.5%. There was a significant mean net reduction of 10 beat per minute (bpm) between the pre (139.7 ± 25.2 bpm) and intra-transfusion (129.6 ± 22.0 bpm) HR, P = 0.0004. The mean net reduction of 4 cycles/ min between the pre and intra-transfusion RR was also significant, P = 0.0033. The two parameters declined in values subsequently. CONCLUSION: The HR and RR are two easily measurable indices with reduction in HR and RR by 10 bpm and 4 cycles/min, respectively, from pre-transfusion to intra-transfusion observations.

The cost of out-patient management of chronic heart failure in children with congenital heart disease.

OBJECTIVE: To evaluated the economic burden to families of managing chronic heart failure in children with congenital heart disease. MATERIALS AND METHODS: This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the family's monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed. RESULTS: Thirty two families were recruited for the study. The children were 16(50%) each of males and females with a mean age of 2.2 ± 1.7 years. The mean monthly income was $314.93 ± 271.36 while the mean cost of total care was $17.61 ± 10.58. The mean percentage of income spent on total care was 16.3 ± 26.2 % with a range of 0.7 - 122%. Families from low socioeconomic class spent significantly higher percentage of income on medicines and total care compared to those in middle or high socioeconomic classes, P = 0.0095 and 0.041 respectively. Only three (0.09%) patients had surgery for their condition. CONCLUSION: The mean percentage of income spent on care was significant and amounted to catastrophic health expenditure for a third of the families. Government input in strengthening the existing cardiac centres, establish new ones and subsidising the cost of surgery to meet the needs for open heart surgery for children with CHDs is recommended.

Predictors of newborn systolic blood pressure.

BACKGROUND: Tracking of blood pressure from childhood to adulthood is well known. It is therefore important to determine predictors of blood pressure as early as at birth. OBJECTIVE: To determine the association between maternal and neonatal factors on the blood pressure at birth of a group of Nigerian babies. METHODS: Consecutive full term neonates delivered in a tertiary centre in Nigeria were recruited for the study. Each newborn's systolic blood pressure (NSBP) was measured within the first four days of life. The mothers' weight, height, body mass index (BMI) and socioeconomic status (SES) were determined while the babies' weight and crown-heel length were measured as well. RESULTS: Four hundred and seventy-three mother/baby pairs were recruited for the study. The mean NSBP was 69.2 +/- 8.3 mmHG. The birth weight significantly correlated with NSBP,(r = 0.235, p = 0.0001). The NSBP rose an average of 3.61 mmHg per 0.5 kg increase in birth weight. The mean NSBP of babies of mothers with BMI <30 was significantly lower than in babies whose mothers had BMI>30, p=0.031. The mean NSBP of babies from low SES was significantly higher than middle or high SES groups p=0.022. CONCLUSION: The study shows that child birth weight is the most significant predictor of newborn systolic blood pressure.

A 4 year review of neonatal outcome at the University of Benin Teaching Hospital, Benin City.

BACKGROUND: Neonatal morbidity and mortality rates reflect a nation's socio-economic status, the efficiency and effectiveness of health care services. This important indicator is useful in planning for improved healthcare delivery. A four year review of neonatal outcome was therefore conducted in the special care baby Unit (SCBU) of University of Benin Teaching Hospital (UBTH). METHODS AND SUBJECTS: The study was done between 2003 and 2006 and sought to review the morbidity, mortality, salvage rate of low birth weight babies and outcome of all inborn and outborn babies admitted into the SCBU of UBTH. The biodata, birth weight, sex, APGAR scores and reasons for admissions and outcome were abstracted from case notes/admission records. RESULT: A total of 3075 babies were admitted to the unit during the period under review. 2602 (84.6%) were inborn while 473 (15.4%) were out-born. There were more males 1676 (54.6%). There were 855 (27.8%) preterm babies of which 803 (26.1%) were low birth weight babies. Neonatal sepsis, severe birth asphyxia, pre-maturity and neonatal tetanus were the most common morbidities suffered by the neonates. Mortality was recorded amongst 625 (20.3%) babies. Mortality rate was significantly higher amongst the out-born than in born babies, P value < 0.0001. CONCLUSION: The neonatal mortality rate in this study is high. The morbidity profile observed in the study is attributable to preventable causes. Of note is the contribution ofNNT to morbidity and mortality. Strengthening of linkages in perinatal care, improving maternal emergency obstetric care and neonatal resuscitation skills are proposed measures to reduce neonatal mortality.

Physicians management of sore throat in children in Benin City, Nigeria.

INTRODUCTION: Sorethroat is a common reason for presentation in primary paediatric care. Because only a minority of cases of pharyngitis is caused by bacteria, physicians have been guided by various recommendations on the judicious use of antibiotics to avoid overprescription. In the absence of guidelines, the treatment approaches between physicians may differ. The management of children with sorethroat by physicians in Benin City, Mid-Western Nigeria was evaluated. SUBJECTS AND METHODS: The experience and practice of 25 paediatricians and 30 non paediatricians who routinely attend to children with sorethroat in Benin metropolis, Nigeria were evaluated with the aid of a self administered questionnaire. Information sought for included biodata, empirical antibiotic prescription. The choice of antibiotic and complications ofpharyngitis encountered in practice. RESULTS: Majority of respondents 31(56.4 %) considered viruses as the commonest cause of pharyngitis. Despite this an equal proportion 31(56.4 %) treated children with sorethroat empirically with antibiotics. Of these, significantly more paediatricians 19(61.3 %) than non paediatricians 12(38.7 %) considered viruses the commonest cause of pharyngitis, P = 0.013. CI (0.10 0.63). Almost three quarter (72.7 %) of respondents examine the throat of the children while only 18.2 % obtained throat swab for microbiological analysis. The 24 doctors who did not treat empirically would prescribe antibiotic if the patient has purulent pharyngeal exudates, fever and adenitis. Augmentin and cefuroxime were the most prescribed antibiotics. CONCLUSION: A lot of children served by these doctors receive antibiotic needlessly from empirical antibiotic treatment ofpharyngitis. National guidelines on appropriate antibiotic use is needed to promote rational use of antibiotics and reduce antibiotic overuse.

Attitude of health-care workers to HIV/AIDS.

The current 5% prevalence rate of HIV in Nigeria represents a significant population of people living with HIV/AIDS (PLWHA). Discrimination against PLWHA has profound impact on the care and support required for their optimal management particularly in resource-constrained settings. The study sought to assess the knowledge of health-care providers about HIV/AIDS, determine the potential for discrimination in the provision of services based on patients' HIV sero-status and review the factors that may contribute to such attitude. Self-administered semi-structured questionnaires were administered to respondents who were selected by multi-stage sampling technique. The questionnaires explored the respondents' knowledge about HIV and their attitude and practice regarding PLWHA. Three hundred and forty-five questionnaires were completed. Only 77.1% correctly identified breastfeeding as a source of HIV transmission; 5.2%and 2.6% respectively thought transmission was possible through mosquito bite and handshake. About 10% and 15% respectively among trained nurses and auxiliary nurses were unaware that HIV could be transmitted to the child during delivery. Some 13.9% and 12.7% of respondents respectively were unwilling to take vital signs and carry out physical examination on PLWHA. Compared to physicians, trained nurses and auxiliary nurses were more likely to deny services based on HIV sero-status. Negative attitude was more likely if the source of the HIV infection was from homosexual exposure or bisexual indiscretion. The health-care workers studied manifested certain attitudes that are potentially discriminatory of PLWHA. Well-coordinated continuing education of HIV/AIDS for all categories of health-care workers is recommended as a vital strategy in the crusade against the epidemic.

Serum zinc values in children with congenital heart disease.

BACKGROUND: Some children with congenital heart diseases (CHD) may have increased pulmonary blood flow that causes recurrent bronchopneumonia and congestive heart failure. Serum zinc is reduced in children with pneumonia and patients on diuretics. OBJECTIVE: To evaluate the serum zinc level of children with CHD and their controls without CHD. METHOD: The subjects were 41 children with CHD confirmed on echocardiography recruited from a paediatric cardiology clinic in a tertiary centre in Nigeria. The controls were 41 children without CHD. Biodata and anthropometric measurements were taken. The serum zinc was determined using atomic absorption spectrophotometer method. RESULT: The mean difference in the serum zinc of the subjects 101.3 ± 21.6 µg/dl and controls 106.5 ± 18.3 µg/dl, was not significant, p = 0.351. The subjects with pneumonia had a lower mean serum zinc value 89.5 ± 15.0 µg/dl compared to those without pneumonia 103.9 ± 22.2 µg/dl, p = 0.006. The mean serum zinc values of the subjects on diuretic was not statistically different from those not on diuretic, p = 0.599. CONCLUSION: The serum zinc levels of the subjects and controls were not significantly different. Children with CHD and pneumonia had significantly lower zinc level compared to those without pneumonia.

Underlying congenital heart disease in Nigerian children with pneumonia.

BACKGROUND: Pneumonia is a common cause of childhood morbidity and mortality globally. Some congenital heart disease (CHD) may predispose their sufferer to bronchopneumonia. OBJECTIVE: To evaluate the contribution of CHD to pneumonia in children seen in a tertiary hospital. METHODS: Over a year, consecutive children diagnosed radiologically with pneumonia were evaluated echocardiographically for CHD. Certain characteristics in children with pneumonia and CHD were compared to those without CHD. RESULTS: There were 121 children with pneumonia of which 61(50.40%) were males and their mean age was 10.2 ± 10.93 months. The prevalence of CHD was 14(11.57%), the commonest CHD was ventricular septal defect (VSD) in 7(50.00%). Most of the CHD with septal defect had moderate to large defects. Children with CHD were 3 and 256 times more likely to have heart failure and murmur respectively compared to those without CHD, p = 0.084 and <0.0001. Children with CHD stayed longer in the hospital 11.50 ± 7.03 days than those without CHD 7.38 ± 5.34 days, p = 0.012. CONCLUSION: The children with CHD were more likely to have heart failure and murmur compared to those without CHD. Prevalence of CHD in children with pneumonia in this study is high, evaluation of children with pneumonia for CHD is therefore recommended.

Cardiac troponin T as a marker of myocardial injury in a group of asphyxiated African neonates.

BACKGROUND: In caucasian newborns, troponin T (cTnT) is a specific marker for myocardial injury in perinatal asphyxia. This is the first such study in negroid neonates. AIMS: To evaluate myocardial injury in a group of asphyxiated African newborns and determine the influence of mode of delivery on cTnT levels. METHODS: Serum cTnT and clinical parameters in 40 asphyxiated and 40 healthy negroid neonatal controls were measured within the first 72 hours of life by chemiluminescence immune-assay. Perinatal asphyxia was assessed by APGAR score. The infants were followed up until discharge or death. RESULTS: Mean (SD) cTnT values were significantly higher in asphyxiated infants [0.03 (0.04) ng/ml] than in healthy controls [0.01 (0.006) ng/ml, P = 0.002]. Asphyxiated infants delivered by forceps and vacuum extraction had significantly higher levels of cTnT [0.04 (0.018) ng/ml] than those born by caesarian section [0.02 (0.008) ng/ml] and by normal delivery [0.03 (0.01) ng/ml, P = 0.003]. cTnT levels were higher in infants who died (P = 0.037). CONCLUSION: In the asphyxiated infants, mean cTnT levels were significantly higher than in controls. They were also significantly higher in those born by vacuum and forceps delivery and asphyxiated infants who died.

Normal oscillometric heart rate of term African infants in the early days of life.

BACKGROUND: Heart rate (HR) measurement is an important means of evaluating clinical status of newborns. Differences in HR between caucasian and negroid infants have been reported. Clinical estimation of HR is less accurate than estimates using devices. AIM: To establish the normal HR of term negroid newborns in the early days of life using an oscillometric device. METHODS: The mean of three HR readings of consecutively recruited term newborns was obtained with Dinamp 8100 monitor (Critikon, Tampa, FL). On recruitment, the infants were aged between 1 and 4 days. Gestational age was determined by menstrual dates and the Dubowitz method. RESULTS: A total of 473 term newborns were recruited, 229 (48.4%) of whom were males. Median HR was 132 (range 90-189) beats per minute (bpm). The lowest median HR (130 bpm) was obtained on the 3rd day of life and this was significantly different from the highest value of 138 bpm recorded on the 4th day of life (P = 0.025). The 5th and 95th percentiles were 111 and 158 bpm, respectively. CONCLUSION: The lower limit of the range of oscillometrically generated normal HR in term African newborns in the early days of life is lower than that which is commonly used in clinical practice.

Breast Feeding Practice among Medical Women in Nigeria.

BACKGROUND: Health care workers are important in the promotion, protection and support of breast feeding. Their ability to do this may be influenced by their knowledge, personal experiences and work. PATIENTS AND METHOD: The breast feeding experience of 36 female medical doctors who had babies within the preceding two years and had resumed work was evaluated using a semi-structured self administered questionnaire. RESULT: All respondents knew that babies should be exclusively breast fed for the first six months of life but only 60% knew that breast feeding should continue until two years. The exclusive breast feeding rate for the studied doctors was 11.1%. Before their babies were six months old, about 75% of respondents had resumed work whilst over 50% had started taking calls. Most could not breast feed during working or call hours. Alternative feeds during working or call hours included expressed breast milk in 34.4% and infant formula in 21.9%. Feeding bottle was the major method (77.4%) for feeding these alternatives. Work schedule was rearranged to allow breast feeding in only 27.3% of respondents. CONCLUSION: Failure to carry out exclusive breast feeding, the use of infant formula and feeding bottles (rather than cup feeding) are practices that may be inimical to the practice of breast feeding in society in general. The suboptimal breast feeding experience in these doctors and the identified knowledge deficits may limit their effectiveness in promoting and supporting breast feeding among their patients and communities. Female medical personnel should be empowered to carry out optimal feeding of their own infants.

Oscillometric blood pressure reference values of African full-term neonates in their first days postpartum.

BACKGROUND: Knowing the normative blood pressure (BP) in a newborn baby is important in order to identify abnormal BP readings. This study was done to determine normative BP values of Nigerian newborns, using the 8100 Dinamap monitor. METHODS: Consecutive full-term neonates delivered in a tertiary centre in Nigeria were recruited for the study. The babies' systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressures were measured within the first four days after birth. RESULTS: A total of 473 babies were recruited for the study. The mean SBP, DBP and MAP readings on day 1 were 66.8 +/- 7.7, 38.5 +/- 6.3 and 47.9 +/- 6.3 mmHg, respectively. The day 1 SBP of babies > 4 kg were significantly higher than those who weighed < 2.5 and 2.5-4 kg (p = 0.01, p = 0.05), respectively. CONCLUSION: This study provided current normative SBP, DBP and MAP values for Nigerian neonates. The BP readings compared with their Caucasian counterparts.