Childhood diabetes mellitus in Kano, North West, Nigeria.

BACKGROUND: There is paucity of literature on childhood diabetes mellitus from developing countries and especially North west Nigeria and this has made it pertinent for documentation of the features of the disease in a major regional referral centre. The study was designed to describe the clinical presentation and outcome of childhood diabetes mellitus. METHODOLOGY: Retrospective review of hospital records of paediatric patients managed for diabetes at Aminu Kano Teaching Hospital, Kano. Nigeria between January 1999 and December 2006. The age, sex, presenting features, complications, laboratory features and outcome of the patients were retrieved from the hospital records: RESULTS: During the years under review eleven out of 3,585 admissions were managed for Type 1 diabetes mellitus giving a prevalence rate of 3.1/1000. Male to female ratio was 1:0.6. The mean age at presentation was 10 +/- 4.5 years most of the patients (72.7%) belonged to the lower socio-economic classes IV and V. The duration of symptoms ranged from 6 58 days with a mean of 24 +/- 22.8 days. The patients presented with urinary tract infections (36.4%), malaria (27.3%) and recurrent boils (18.2%). Three (27.3%) of the patients had polyuria and polydypsia while only one (91%) patient had polyphagia and weight loss. The mean random blood glucose on admission was 28.5 +/- 7.9 mmo/L (16.9 39.2mmo/L). Four patient presented with diabetic Keloacidosis. Two patients (18.2%) were discharged against medical advice while 1 (9.1%) patient died. CONCLUSION: Childhood Diabetes Mellitus, remains relatively uncommon in Nigeria.

Cerebral palsy in Kano, Nigeria--a review.

BACKGROUND: Cerebral palsy is the most common form of chronic motor disability that starts in childhood. The aim of this study is to determine the magnitude of cerebral palsy in Kano and environs as well as to highlight the types, aetiologic factors and associated co-morbidities. METHOD: The medical records of 356 patients who attended the paediatric neurology clinic between January 1998 and December 2005 were examined and all those with diagnosis of cerebral palsy were studied. The relevant data extracted and analysed included age at first presentation, sex, physiologic form of cerebral palsy and co-morbidities. RESULTS: Of all the paediatric neurology cases, there were 151 (42.4%) cases of cerebral palsy. There were 95 males (62.9%) and 56 females (37.1%) giving a male female ratio of 1:7:1. The age range was 6 months 12 years. The difference between the two sexes was not statistically significant (P > 0.05) Birth asphyxia was the leading cause of cerebral palsy (45.7%), followed by neonatal jaundice (12.6%), seizure disorder (11.9%), meningitis (7.3%), prematurity (3.3%), encephalitis (2.6%), genetic disorder (1.3%), trauma (1.3%) and craniosynostosis ( 0.62%). In 20 (13.2%) cases, the aetiology was unknown. The physiologic forms of cerebral palsy observed included spastic (41.7%), mixed (29.8%), hypotonic (21.9%) and dyskinetic (6.6%). The most prevalent comorbid conditions included: speech impairment (15.2%), mental retardation (13.2%), auditory impairment (11.9%), strabismus (11.3%), seizure disorder (11%) and microcephaly (7.3%). CONCLUSION: It is suggested that general improvement in perinatal health services will reduce the burden of the disease in Kano and environs.

HIV exposed infants: a preliminary report of the Aminu Kano Teaching Hospital experience.

UNLABELLED: To determine the Sociodemographic characteristics, infant feeding choices and outcome of HIV exposed neonates attending the paediatric infectious disease clinic (IDC) of Aminu Kano Teaching Hospital Kano. PATIENTS AND METHODS: The records of all HIV exposed babies were reviewed. One hundred and ninety HIV exposed babies were seen between October 2003-December 2005. Of these 121 were part of the PMTCT programme while 69 were not. A total of 179(94.2%) babies were delivered at term while 11(5.8%) were delivered prematurely, with M: F ratio of 1.2:1. RESULTS: A substantial number of mothers in the non PMTCT group were diagnosed antenataly or even prior to conception yet they did not avail themselves of the interventions in the PMTCT programme. Reasons given were ignorance, inaccessibility to PMTCT centres and fear of stigmatisation. Breast milk substitute, was the leading choice of mothers in the PMTCT group while breast milk and mixed feeding was practised more in the non-PMTCT group. CONCLUSION: PMTCT remains the best way of preventing paediatric HIV infection and infant feeding counselling should be family oriented. Provision of free infant formula, PCR machines to enable early diagnosis, waiving of fees, and home visits would greatly improve infant follow up.

Awareness and knowledge of mother-to-child transmission of HIV among mothers attending the pediatric HIV clinic, Kano, Nigeria.

BACKGROUND: Nigeria accounts for about 10% of all HIV/AIDS cases in the world. Globally women constitute 48% of adults infected with HIV; in Nigeria, they constitute 57%. There is an increase in the number of children infected with HIV in recent years as the number of HIV-positive women has increased. However, more than 90% of HIV infections in children aged less than 15 years are due to mother-to-child transmission of HIV. OBJECTIVE: To evaluate the awareness and knowledge of mother-to-child transmission of HIV, HIV/AIDS and the methods to prevent mother-to-child transmission of HIV. METHODS: This is a descriptive study. The study was carried out at the pediatric HIV clinic of Aminu Kano Teaching Hospital from 1 st July 2006 to 30 th December 2006. Mothers included in the study were mothers in first contact with HIV facilities, which was at our center, before any form of counseling. The instrument used was a questionnaire designed to assess awareness of the mothers about HIV/AIDS, evaluate their knowledge of possible routes of transmission and measures to prevent vertical transmission. The questionnaire was then pre-tested for comprehensibility, appropriateness of language, sensitivity of questions and average duration of administration. RESULTS: A total of 164 mothers brought their children for treatment to the pediatric HIV clinic. The level of awareness about HIV/AIDS among mothers was very high (100%), and the main sources of information were radio (48.8%) and television (37.8%). Ninety-one percent of mothers were aware of mother-to-child transmission of HIV. Transplacental route (41%) was the commonly identified route of transmission. The level of knowledge and perceptions of mother-to-child transmission of HIV is inadequate. CONCLUSION: There is a need to scale up education about mother-to-child transmission of HIV in our health facilities.

Response to the meningococcal meningitis epidemic (MME) at Aminu Kano Teaching Hospital, Kano (2008-2009).

In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.