Comparative study of nutritional status of children and adolescents with sickle cell anemia in Enugu, Southeast Nigeria.

BACKGROUND: Poor growth and nutritional status are common features of sickle cell anemia (SCA) in children. The rising trend of obesity in children in developing countries has been reported despite a huge burden of undernutrition in these settings. In SCA, overweight/obesity is being increasingly reported. AIMS: To evaluate the nutritional status and its determinants in children with SCA and to compare the same with hemoglobin AA (HbAA) controls of similar age, gender, and socioeconomic status. METHODS: The study was a cross-sectional analytical study involving 175 subjects and controls aged 1-18 years who met the inclusion criteria. Weight and height were measured and body mass index (BMI) was calculated. Z scores were computed for the anthropometric measurements using the World Health Organization (WHO) standard reference. Hemoglobin concentration was determined using HemoCue Hb201+ Analyzer. RESULTS: Subjects had significantly lower Z- scores for weight, height, and BMI compared with controls. Stunting, wasting, and overweight/obesity were observed in 10.9%, 24.6%, and 5.1% of subjects compared with 2.3%, 5.7%, and 9.7% respectively in controls. Wasting, stunting and overweight/obesity in SCA were significantly associated with age while overweight/obesity was significantly associated with upper social class (P = 0.001). CONCLUSIONS: Poor growth and nutritional status are still prevalent while overweight and obesity are emerging comorbidities among children with SCA in our environment. Regular nutritional assessment of children with SCA should be encouraged while those at risk of under/over-nutrition should receive adequate nutritional rehabilitation to prevent possible complications.

Prevalence and Pattern of Psychosocial Disorders among Caregivers of HIV-infected Children in Enugu, South-Eastern Nigeria.

BACKGROUND: Nigeria has the highest burden of paediatric HIV in the world. HIV infection may result in significant life stressors, on both the infected children and their caregivers. METHODS: This included a hospital-based cross-sectional and comparative study. Subjects and controls who met the inclusion criteria were enrolled consecutively. Their socio-demographic variables were obtained and GHQ-28 was used to assess their psychosocial status. RESULTS: A total of 154 caregivers of HIV-infected children (subjects) and 154 caregivers of HIV-negative children (controls) were enrolled into this study. In total, 42 (27.3%) and 112 (72.7%) of the subjects were males and females, respectively, compared with 37 (24.0%) and 117 (76.0%) of the controls, respectively. The prevalence of psychosocial disorders among the subjects and controls was 39 and 2.6%, respectively (p < 0.001; odds ratio: 23.936). The patterns of psychosocial disorders among the caregivers of HIV-infected children were somatic symptoms (85%), anxiety/insomnia (80%), social dysfunction (63.3%) and severe depression (48.3%). CONCLUSION: There is a high prevalence of psychosocial disorders among caregivers of HIV-infected children.

Relationship between zinc levels and anthropometric indices among school-aged female children with sickle cell anemia in enugu, Nigeria.

BACKGROUND: Sickle cell anaemia is one of the most common inherited disorders globally. Some affected children have retardation of physical growth which is also seen in those with zinc deficiency. OBJECTIVE: To assess the relationship between zinc levels and anthropometric indices of SCA children. METHODS: A cross- sectional, case-control study on young females aged 6-18 years at the UNTH, Enugu. Relevant clinical data as well as 24 hour dietary recall were collected. Weights and heights were measured using standard protocols and BMI calculated. Serum zinc was determined using Atomic Absorption Spectrophotometer. Data was analyzed using SPSS version 15.0 while the level of statistical significance was set at P < 0.05. RESULTS: Eighty-one subjects with HbSS and 81 matched controls with HbAA were studied. Mean weights of 34.58 ± 12.76kg found in patients were significantly lower than 40.19 ± 13.37kg in controls. Also mean BMI of 16.27 ± 2.76kg/m2 in patients were significantly lower than 18.40 ± 2.96kg/m2 in controls (P = 0.01). Mean heights of patients were lower than that of the controls though not significantly so (P > 0.05). Mean serum zinc levels of 58.01 ± 10.58µg/d1 in patients were significantly lower than 68.37 ± 8.6µg/dl in controls (P = 0.01). Positive correlation was found between serum zinc and BMI of the studied children. Serum zinc has a significant relationship with weight, height and BMI. CONCLUSION: Reduced serum zinc in SCA children was associated with low anthropometric indices. Estimation of serum zinc is also recommended in SCA children with low anthropometric indices.

Diagnostic delay in pediatric cancer in Enugu, Nigeria: a prospective study.

Childhood cancer is a leading cause of childhood mortality in developed countries though ranks lower than infections in developing countries. Most patients with malignancies present late to hospital with consequent adverse outcome. Early diagnosis, therefore, is an important requirement in pediatric oncology as delayed diagnosis is associated with poor prognosis and huge economic cost. The study aims to identify factors associated with delay in the diagnosis of childhood cancer at University of Nigeria Teaching Hospital, Enugu.Children aged 0-17 years with admitting diagnosis of cancer which was histologically confirmed were reviewed prospectively over a 3-year period. An interviewer structured questionnaire was administered to patients or parents/caregivers to obtain information on patients' biodata, their symptoms as well as visit to health professionals or alternative health care providers before presentation at this hospital.Ninety patients were confirmed to have cancer. Overall median lag time (LT) was 15.7 weeks. Major contributors to delay were parents and the type of cancer patients presented with. Acute lymphoblastic leukemia (ALL) had the shortest median LT of 4.2 weeks while Hodgkin's disease had the longest median LT of 53.6 weeks (p = 0.01, Mann-Whitney test, 2-tailed). The median parent's delay was 12.3 weeks and health system delay was 3.6 weeks showing a significant difference in the two categories of delay (p < 0.0001, Mann-Whitney test, 2-tailed). The median treatment delay was 5 days.Public awareness and health system reform is imperative in reducing the delay in diagnosis of childhood cancer in our environment.

Progressive myelopathy, a consequence of intra-thecal chemotherapy: case report and review of the literature.

Intra-thecal chemotherapy is a recognized therapy for hematological malignancies such as acute lymphoblastic leukemia (ALL). Despite the advantage of these drugs in treating or preventing central nervous system disease, they are not without complications. The authors describe a 12-year-old girl with ALL, who developed progressive myelopathy following intra-thecal administration of cytosine arabinoside. Initial presentation was urine and fecal retention that progressed to paraplegia, and finally encephalopathy. magnetic resonance imaging of the neuroaxis showed T2-weighted foci of increased signal intensity within the substance of the cervical cord indicative of myelopathy. Physicians should be wary of this rare complication of intra-thecal chemotherapy.

AUDIT OF BLOOD TRANSFUSION PRACTICES IN THE PAEDIATRIC MEDICAL WARD OF A TERTIARY HOSPITAL IN SOUTHEAST NIGERIA.

OBJECTIVES: To determine the indications, practices and outcomes of transfusion on children. DESIGN: A descriptive retrospective study. SETTING: Paediatric wards of University of Nigeria Teaching Hospital, Enugu, Nigeria. SUBJECTS: Children one month to 18 years that received blood transfusion. MAIN OUTCOME MEASURES: Indications for the transfusion, haemoglobin rise, vital signs, duration of transfusion and adverse events. RESULTS: The two hundred and thirty eight transfusions reviewed were given amongst 95 patients, at a ratio of 2.5 transfusions per patient. The indicators of the transfusion were: malignancy (31.7%), sepsis (15.1%), sickle cell anaemia (12.1%), malaria (10.0%), hyperbilirubinaemia (10.0%), HIV/AIDS (8.3%), nephrotic syndrome (7.2%) and malnutrition (5.4%). Whole blood (56.4%) and sedimented cells (36.3%) were the main types of blood transfused. About 96.4% were transfused appropriate volume of blood. The mean Haemoglobin concentration (Hb) increase was 3.1g/dl and 12.8% of the recipients recorded an Hb increase of 5g/dl. The mean duration of transfusion was 4.6 hours and 59.7% of the transfusions exceeded the recommended four hours. Pulse and respiratory rates returned to normal post transfusion in 26.1 and 21.8% of the recipients respectively. In 10% of the transfusions there were minor adverse events; chills/fever (5.1%), itching (3.4%), hypothermia (1.0%) and vomiting (0.5%). CONCLUSION: Blood transfusion in this tertiary institution is not common and mainly due to non-communicable diseases. The expected optimal rise in Hb and normalising of vitals sign are not always the case. The duration of most transfusions was unduly prolonged and transfusion-related adverse events are rare.

Coagulation profile of children with sickle cell anemia in steady state and crisis attending the university of Nigeria teaching hospital, Ituku-Ozalla, Enugu.

BACKGROUND: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome. OBJECTIVES: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype. MATERIALS AND METHODS: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex. RESULTS: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038). CONCLUSION: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.

Prevalence of hypoxemia among children with sickle cell anemia during steady state and crises: a cross-sectional study.

BACKGROUND: Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso-occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonary complications are common in sickle cell disease (SCD) and may exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD. OBJECTIVES: This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state. MATERIALS AND METHODS: This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX-21N model. RESULTS: A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (χ² = 6.425, P = 0.04). Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above. CONCLUSIONS: Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individuals especially those with acute chest syndrome.

Demographic and sociocultural characteristics of sickle anaemia children with positive hepatitis B surface antigenaemia in a tertiary health facility in Enugu.

BACKGROUND: Hepatitis B virus) infection is contracted through contact with body fluid of infected persons. Patients with sickle cell anaemia (SCA), a common haematological disorder in Nigeria, have tendencies to visit traditional healers who administer scarifications and ritual marks that may expose them to HBV infection. OBJECTIVE: To determine the demographic and socio-cultural characteristics of children with SCA infected with HBV at the University of Nigeria Teaching Hospital Enugu. SUBJECTS AND METHOD: Two hundred and twenty one children aged 6 months to 17 years with SCA were recruited consecutively from October 2004 to April 2005. They were screened for HBsAg using ELISA method. RESULTS: There was no statistically difference in hepatitis B surface antigenaemia among different age group (P = 0.907). Social class did not significantly influence the prevalence of HBsAg among subjects (p = 0.887). Socio-cultural practices like circumcision and scarification did not influence the prevalence of HBsAg, (p = 0.636) (p = 0.771) respectively. Significantly higher number of people from lowest socioeconomic class practice scarification (p = 0.0001). CONCLUSION: Demographic and sociocultural factors do not appear to influence the prevalence of HBsAg among children with SCA in Enugu, Nigeria.

Exclusive breastfeeding--the relationship between maternal perception and practice.

BACKGROUND: The behaviour adopted by individuals is moulded by their perception of various issues. In spite of well established benefits of exclusive breastfeeding (EBF) to babies, mothers and society, the EBF practice rate (EBFPr) in our environment has remained low. OBJECTIVE: To evaluate mother's perception of exclusive breastfeeding and determine the relationship between such view and their practices. SUBJECTS AND METHODS: Two hundred mothers were interviewed to elicit their perception of the merit and demerits of exclusive breastfeeding. The pattern of perception was related to actual practice in order to seek for possible associations. RESULTS: Of the 184 respondents, 39 (21.2%) practiced EBF for all their babies, while 95 (51.6%) never did so for any of their babies. Knowledge of EBF was excellent (94.0% and 90.8%) of the study group gave accurate definition and duration respectively. Most mothers felt that EBF babies look healthier (85.1%), have less disease (84.5%), are more intelligent (59.1%) but their mothers eat a lot (79.3%). Those who agree to the positive benefits of EBF generally had higher overall complete EBFPr than those who disagreed, as they looked healthier (p = 0.0001), had less disease (p = 0.041) and more intelligent (p= 0.0001). In addition to this, mothers who did EBF for all babies ( ie those with an EBFPr of 100%) had more positive perception on the benefits ofEBF. CONCLUSION: There is a fairly good relationship between pattern of maternal perception of the benefits of EBF and actual practice. Efforts need to be intensified to educate and encourage mothers to see the merits of EBF both for themselves and their babies.

The role of blood transfusion on the prevalence of hepatitis C virus antibodies in children with sickle cell anaemia in Enugu, South East Nigeria.

BACKGROUND: The hepatitis C Virus (HCV) has become an important cause of chronic liver disease and liver cancer worldwide. Blood transfusion is one of the important modes of transmission. There is need to study the prevalence among those at risk such as sickle cell anaemia (SCA) patients. Such information will broaden knowledge of the problem among SCA patients transfused with blood in this part of the country. OBJECTIVE: To determine the prevalence of HCV antibodies among children with SCA transfused with blood in Enugu, compared with their non transfused counterparts as well as the roles of blood transfusion and traditional surgery in the prevalence ofHCV infection. METHODOLOGY: The study was conducted among 269 children with SCA attending the paediatrics sickle cell clinic at University of Nigeria Teaching Hospital (UNTH) Enugu, with 136 transfused SCA patients as subjects and 133 age and sex matched non-transfused SCA who served as controls. RESULTS: The results showed an HCV antibody prevalence of 6.6% among the transfused and 5.3% among the non-transfused (controls) SCA patients (P = 0.610). There was positive association between number of transfusions and HCV seropositiviy, such that those who had received 4 or more units ofblood had a prevalence rate of more than 50% (P = 0.001). The influence of scarifications on the prevalence of antibodies to HCV (antiHCV) for the non transfused (controls) was statistically significant (P = 0.001). CONCLUSION: HCV infection is not uncommon in children with SCA. The prevalence of HCV infection in transfused SCA patients is not significantly higher than their age/sex matched controls.

Changing pattern of childhood malignancies in Eastern Nigeria.

BACKGROUND: Childhood cancers constitute important causes of morbidity and mortality in Nigeria. There is a need for us to continue to analyse the patterns of these neoplasms. OBJECTIVE: To review the major studies on childhood malignancies in Enugu, Nigeria and identify trends in paediatric malignancies in this environment. METHODS: We compared the results of four major studies on childhood malignancies in Enugu, Eastern Nigeria between 1976 and 2004 and assessed the patterns in the frequencies of paediatric cancers in this environment. RESULTS: Lymphomas were the most common childhood malignancy in this environment with Burkitt's lymphomas being the most common specific paediatric cancer. Nephroblastomas and sarcomas have been on the increase. The pattern of changes in the relative percentage frequencies of leukaemias, retinoblastoma and neuroblastomas has not been consistent. Leukaemias appear to be on the decline but occurrences of retinoblastomas and neuroblastomas have been fluctuating. CONCLUSION: Since Burkitt's lymphoma is associated with high prevalence of malaria, Epstein Barr Virus infection, and malnutrition, its persistent high rates suggest strongly that the control of these infections and malnutrition should be intensified.

Some characteristics of paediatric admissions at the University of Nigeria Teaching Hospital Enugu-Nigeria.

BACKGROUND: In spite of its limitations, documentation of health facility utilization is an aspect of planning for patient care. Information obtained from such studies is usually useful in evaluating existing facilities, documenting trends in patients needs and improving facilities for patients care. OBJECTIVES: To assess the characteristics of children who utilize the services of the University Teaching Hospital(UNTH) Enugu for admission and treatment. DESIGN: A prospective study of the characteristics of children admitted consecutively over an eight month period into the Paediatric medical wards of UNTH was determined with the use of a structured questionnaire. RESULTS: Of the three hundred and thirty seven children admitted into the wards, aged 5 weeks to 18 years, two hundred and five(61%), 78(23%) and 54(16%) belonged to the lower, middle and upper social classes respectively. There was a male preponderance (1.3:1) and 60.5% of the children were less than 5 years of age. The children emergency room (CHER) was the route of admission of 214(63.5%) of the children and was statistically significant for all social classes (p=0.006). The difference in duration of symptoms before presentation in hospital between upper (landII)and lower social (IV and V)classes was statistically significant (p=0.005). CONCLUSION: The services of this hospital are used mainly by the lower socio economic class of the society. There is a delay in presentation of patients even to emergency room. The delay in presentation of children to hospital for treatment could be due to lack of education or knowledge, economic hardships, and absence of health insurance.

Hospital admission of patients with sickle cell anaemia pattern and outcome in Enugu area of Nigeria.

UNLABELLED: BACKGROUND OBJECTIVE: The admission of children with sickle cell anaemia into the Paediatric ward of the University of Nigeria Teaching Hospital, (UNTH) Enugu was retrospectively reviewed to ascertain their pattern and outcome. Such data are useful in guiding future health policies on such children. PATIENTS AND METHODS: Medical files of patients with sickle cell anaemia who were admitted between May 1998 and April 2002 were analyzed. Their clinical features, investigations done, diagnosis on admission, complications and subsequent outcome of admissions were noted. RESULTS: More children were admitted during the rainy season. (p<0.05) Male: Female ratio was 1.2:1. More children (70.4%) failed to comply with treatment of which a statistically significant number came from the lower social class (p = 0.001). Infections were the commonest cause of admission (69.6%). Severe anaemia was the commonest complications (39.4%). Mortality occurred in 8.5%. CONCLUSIONS: Intensive counseling of patients, with the involvement of Social workers and health visitors, is strongly advocated. There is need for antibiotic prophylaxis for all children with sickle cell anaemia.

HIV status disclosure rate and reasons for non-disclosure among infected children and adolescents in Enugu, southeast Nigeria.

AIMS: To determine the rate of HIV status disclosure, caregivers' reasons for non-disclosure, and factors influencing disclosure among a sample of HIV-infected children in Enugu, southeast Nigeria. METHODS: Data were collected prospectively via a questionnaire on HIV-infected children and their caregivers who visited the pediatric HIV clinic of the University of Nigeria Teaching Hospital between July 1, 2012, and June 30, 2013. The data analysis was performed using Statistical Package for the Social Sciences version 19 software. RESULTS: Caregivers of 107 children (age 5-16 years; mean 10.1 ± 3.2 years) were enrolled in the study. There were 53 (49.5%) boys and 54 (50.5%) girls. HIV status had been disclosed to 31 (29%) of them. The major reason for non-disclosure was the child being considered too young. Age (p < .001), age at HIV diagnosis (p < .001) and baseline CD4 count (p = .008) were seen as significant predictors of HIV disclosure. CONCLUSIONS: There is a low rate of HIV disclosure to infected children, and it was found to be lower for younger children. We recommend improving efforts for disclosure counseling to caregivers in pediatric HIV clinics.

Spectrum of childhood malignancies in Enugu, Nigeria (1999-2004).

A retrospective analysis of childhood malignancies in Enugu, Nigeria was carried out using data obtained from the Cancer Registry of the University of Nigeria Teaching Hospital (UNTH), Enugu between 1st January 1999 and 30th June 2004. A total of 79 childhood cancers were recorded during the period. There were 48 males (60.8%) and 31 females (39.2%) with a male female ratio of 1.5:1. The three commonest malignancies were lymphomas 33 (41.2%), sarcomas 12 (15.2%) and nephroblastomas 12 (15.2%). The less common tumours included the leukaemias 6(7.6%), retinoblastomas 6 (7.6%), neuroblastomas 4 (5.1%), and carcinomas 2 (2.5%). Burkitt's lymphoma remains the commonest specific childhood malignancy in this environment constituting 19 (57.6%) of all the lymphomas and 24.1% of all the cancers seen.

Knowledge and awareness of personal sickle cell genotype among parents of children with sickle cell disease in southeast Nigeria.

Sickle cell trait (SCT; HbAS), the heterozygous state for the sickle cell allele of the beta globin gene, is carried by as many as 100 million individuals worldwide. Nigeria has the highest prevalence of SCT, impacting an estimated 25 % of adult population. This study was designed to assess timing of awareness, knowledge of SCT status and preferred method of education among parents of children with sickle cell disease (SCD). We conducted a cross-sectional survey of parents of children with SCD from June 2013-March 2014. Participants completed a 20-item questionnaire to assess (1) awareness of personal sickle cell genotype, (2) timing of awareness of personal sickle cell genotype, and (3) knowledge of SCT. One hundred and fifty-five participants completed the survey. Seventy-eight percent were females, and 87 % (135/155) were aware of their own sickle cell genotype. Timing of awareness varied as follows: following birth of a child with sickle cell disease (45 %); during marriage (21.5 %); school admission (9.6 %); during pregnancy (9.6 %); and other times (14 %). Approximately 35.5 % of participants thought that sickle cell trait was a mild form of sickle cell disease. Radio (43.9 %), informational community meetings (27.7 %), and television (21.9 %) were identified by participants as the most effective method of increasing sickle cell trait awareness. Innovative approaches are needed to increase the proportion of individuals who are aware of their own sickle cell genotype prior to having a child with sickle cell anemia in line with the Healthy People 2020 objective.

Serum selenium status of HIV-infected children on care and treatment in Enugu, Nigeria

Objective. To compare the selenium status of HIV-infected and HIV-uninfected children. Methods. This was a hospital-based comparative study using a structured questionnaire in the quantitative research domain at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria. Seventy-four HIV-infected children were compared with 74 non-HIV-infected children (35 males and 39 females in each group). The outcome measure was the selenium status of the study participants. Results. The mean (standard deviation (SD)) weight-for-height z-score among the subjects was ­0.18 (1.53) compared with 0.05 (1.68) among the controls (p=0.457). The mean (SD) height-for-age z-score among the subjects was ­1.16 (1.44) compared with 0.06 (1.06) among the controls (p<0.001). Eighteen subjects (24.3%) compared with eight controls (11.4%) were selenium deficient (odds ratio 2.49; 95% confidence interval 1.00 - 6.18; p=0.044). Median CD4 counts of selenium-deficient and non-deficient subjects were 765.5 (range 409 - 1 489) and 694.0 (range 85 - 2 196) cells/µL, respectively (p=0.321). The proportions of selenium deficiency were 26.4% and 22.2% in the highly active antiretroviral therapy (HAART) and pre-HAART groups, respectively (p=0.565). Conclusion. There was a significant difference in the proportion of HIV-infected children who were selenium deficient compared with their uninfected counterparts

Pre-hospital management of diarrhoea among caregivers presenting at a tertiary health institution: implications for practice and health education.

BACKGROUND: Diarrhoeal diseases cause significant childhood morbidity and mortality worldwide. The effectiveness of home management of diarrhoeal diseases is achievable only if caregivers have appropriate information despite varying recommendations on the strategies for diarrhoea therapy. OBJECTIVES: To evaluate caregivers' perception and use of ORT fluids for management of diarrhoea in under-five age children in the face of varying phases of recommendations, as an indicator of home treatment. METHODS: Caregivers of U5 children presenting with acute watery diarrhoea to different Paediatrics clinics/wards of the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu between October 2006 and February 2007 were interviewed with a structured questionnaire. RESULT: Caregivers of 156 under-five children who met the inclusion criteria were recruited. Access to ORT fluids was high with 73.1% of all children with diarrhoea being offered an ORT fluid at home. However, the method of preparation and administration of fluids was quite unsatisfactory. Previous experience with ORT fluids, higher educational or socioeconomic status did not correlate significantly with better performance. CONCLUSION: Despite high level of knowledge and acceptance of ORT among the study population actual practice was not satisfactory. Diverse practices by caregivers which represent the various phases of evolution in the types of fluids promoted for oral rehydration reflect some confusion that require urgent attention. Knowledge and skills of ORT need to be widely promoted on a continuing basis with the need for health workers to ensure that caregivers are taught and adhere to the correct recommendations on oral rehydration therapy.

Prevalence and Risk Factors of Anaemia in Paediatric Patients in South-East Nigeria

Background. The causes of anaemia have regional variations; and further variation is expected among paediatric hospital patients. However; the prevalence of anaemia and its contributing risk factors among paediatric patients remain understudied in South-East Nigeria.Methods. The study involved 286 anaemic (haemoglobin (Hb) ?10 g/dL) and 295 non-anaemic preschool children attending a hospital outpatient department. A clinical research form was used to document demographic data; anthropometric measurements; disease details and packed cell volume. Common anaemia risk factors previously documented were studied. The prevalence rates of the independent variables were calculated and level of significance was determined; using ?2.Results. The prevalence of anaemia was 49.2; with the highest prevalence among children 12 months old (p