Hypokalaemia in children hospitalised for diarrhoea and malnutrition in Calabar, Nigeria.

OBJECTIVE: To describe the acid base and electrolyte pattern of morbidity and mortality in children with diarrhoea and protein energy malnutrition. SETTING: The diarrhoea treatment and training unit of the university of Calabar teaching hospital was used for the study. DESIGN/METHODS: It was a prospective study in which consecutive children below the age of 15 years with protein energy malnutrition and diarrhoeal diseases admitted into the DTU were screened for acid base and serum electrolyte abnormalities. The study was carried out over a two year period from January 1997 to December 1998. RESULTS: Hypokalaemia was seen in 45 (23.4%) patients. This was second to acidosis. Metabolic acidosis was the commonest abnormality in this study and was seen in 108(56.3%) of the patients included in the study. There was hyponatraemia in 25(13%). Hypochloraemia in 8(4.2%) and hypernatraemia in 6(3.1%) of the patients respectively. CONCLUSION: This study has shown that hypokalaemia is a common electrolyte abnormality in children with severe protein energy malnutrition and diarrhoeal diseases. There is need to encourage the use of readily available interventions such as the UNICEF and WHO oral rehydration solution in patients with diarrhoea and/or severe protein energy malnutrition to reduce morbidity and mortality from acid base and electrolyte disturbances.

Epidemiology and clinical features of glomerulonephritis in Calabar, Nigeria.

A retrospective study of children with acute glomerulonephritis (AGN) over a 10-year period (January 1997-December 2006) was carried out with the aim to establish the prevalence, the population at risk, and the predisposing factors. Out of a total of 6,026 admissions during the study period, 76 (1.3%) had acute glomerulonephritis. Forty of the 76 were males while 28 were females with a male to female ratio of 1.4:1. The mean age for males was 7.2+/-4.3 years and that of females was 6.5+/-3.2 years. The overall age range was 3-13 years with a modal age of 5 years for both sexes. The annual prevalence showed two peaks, May-July and October-January. Eighty two percent of patients were of the low while 11.8% were of the middle socio-economic classes. Haematuria, oedema, proteinuria and hypertension were the major presenting features. Hypertensive encephalopathy and acute renal failure were the complications recorded and also emerged as the causes of death. Childhood AGN is common in Calabar compared to other centres in Nigeria, afflicting largely those of low socio-economic status and displays a peak in the middle of both dry and rainy seasons of the year. The outcome is good but could be better if facilities are provided for dialysis.

Worm infestation and anaemia among pre-school children of peasant farmers in Calabar, Nigeria.

BACKGROUND: Worm infection and anaemia are common childhood conditions in Nigeria. We assessed the status of helminthiasis and associated anaemia among pre school children of peasant farmers aged 1-5 years living in a rubber plantation near Calabar, Nigeria. DESIGN: Cross sectional. METHOD: Three hundred and fifty children were selected by multi-stage cluster sampling technique. Freshly passed stool was examined using Kato-Katz method while anaemia was estimated using haematocrit technique. RESULT: Of the 350 children, 174 (49.7%) had intestinal helminths: Ascaris lumbricoides 64.4%, hookworms 10.9% and Trichuris trichuria 1.1%. There were 41(23.6%) children with polyparasitism, 33 of them were due to Ascaris lumbricoides and hookworms. The worm load was generally light in intensity with egg per gram of stool ranging from 24-60,960. Males (28.9%) were infected more than females (20.8%). The frequency of infection increases with age. The prevalence of anaemia among the entire study population and in those infected with worms was 56.6% and 56.9% respectively. With polyparasitism there was a relative increase in the frequency of anaemia females > males. CONCLUSION: Worm infections and anaemia are common in our children. A comprehensive control strategy involving good sanitation, sinking of bore hole for clean water supply and regular deworming exercises are recommended.

Neonatal morbidity and mortality in Calabar, Nigeria: a hospital-based study.

BACKGROUND: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004. RESULTS: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission. CONCLUSION: Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age.

Pattern of paediatric renal disease in inpatients in Calabar, Nigeria.

A 10-year retrospective review of inpatients in Calabar showed that of 5641 children admitted,182 (3.2%) had renal disease. The major lesions were acute glomerulonephritis (36.9%) and nephrotic syndrome (30.7%), while less common ones included urinary tract infection (8.9%), obstructive uropathy, acute renal failure (6.7%, each) and nephroblastoma (6.2%).

Female adolescent sexual behaviour in Calabar, Nigeria.

CONTEXT: A large number of our female adolescents are at risk of reproductive ill health. This may have its roots in their sexual behaviour. There is need to unfold our female adolescent sexual behaviour as this will establish the necessity or otherwise for interventions. METHODS: Senior secondary school adolescents in Calabar were studied with the help of a pre-tested, self-administered questionnaire. This was to unfold their age at menarche and their sexual behaviour. RESULTS: the average age at menarche in Calabar is 12.86 years. About 37.4% of senior secondary school female adolescents are sexually active with an average age at initiation of 13.7 years. About 22.6% of them have more than one sexual partner. Most of them (51.2% ) learned about sexual intercourse from their peers. They go into sexual intercourse for fun, intimacy and friendship (84% ). Only 6.0% of the sexually active adolescents ever used family planning methods. This poor sexual behaviour in these adolescent girls is significantly influenced by the socio-economic status of parents and not by the type of school attended. About 18.4% of them have been pregnant at least once, 15.1% have had genital tract infection and 31.9% have sustained genital tract injury during sexual intercourse. CONCLUSION: Sexuality education both at home and in school is lacking in Calabar. There is need for adolescents in Calabar to be exposed to sexuality education both at home and in school. Schools with adolescent girls whose parents are of low socio-economic status should be targeted more than others. There is a call for the provision of youth care centres in schools where reproductive health matters are discussed and managed.

Features of childhood hepatic failure in Calabar, Nigeria.

The features in 21 patients with childhood hepatic failure studies retrospectively over a seven year period at the University of Calabar Teaching Hospital, Calabar, Nigeria are presented. Of the 21 patients, 71.4 per cent were aged three years nd below. Fulminant hepatic failure occurred in 81.0 per cent of the patients while in 19.0 per cent, the failure resulted from chronic liver disease. Hepatitis B infection alone or in association with other factors was the major cause of the condition, occurring in 76.2 per cent of the cases. The main complications were severe anaemia (23.8%), septicaemia (23.8%) and pneumonia (19.0%), renal failure (9.5%). With only one survival, the case fatality rate was 95.2 per cent. For prevention of the condition in Nigeria, universal mandatory screening of blood and blood products for hepatitis B markers before transfusion and the integration of hepatitis B vaccination into the National Expanded Programme on Immunization are strongly recommended.

Relative risk of birth asphyxia in babies of booked women who deliver in unorthodox health facilities in Calabar, Nigeria.

Babies of booked women who delivered in unorthodox health facilities in Calabar, Nigeria were studied. The aims were to determine the relative risk of birth asphyxia in these babies and to find out the management of birth asphyxia in these unorthodox delivery centres. The incidence (14.3%) of birth asphyxia in the study population was significantly higher than the incidence (4.8%) in babies of booked women who delivered in the University of Calabar Teaching Hospital (P < 0.001) with a relative risk of 3.0 (95% C.I.=1.74-5.19). Apart from prolonged labour, the predisposing factors to birth asphyxia in both the study group and control did not show any significant difference (P > 0.05). The treatment of birth asphyxia in unorthodox delivery centres consisted mainly of prayers (43.8%) and immersion of the asphyxiated baby in cold water (25%). A birth asphyxia case fatality rate of 20.8% was recorded in these unorthodox delivery facilities but no death in the control population. Appropriately directed antenatal health education on the benefit of delivering under supervision of trained personnel is strongly advocated.

Perinatal outcome in pregnancies booked for antenatal care but delivered outside health facilities in Calabar, Nigeria.

Pregnancies that were booked for antenatal care but delivered outside the health facilities were studied. The aim was to determine the perinatal outcome of these pregnancies, and also to compare the outcome with that of pregnancies that were booked and delivered in the University of Calabar Teaching Hospital (UCTH). Birth asphyxia was the commonest perinatal morbidity in both the study (14.3%) and control (4.8%) groups and was significantly higher in the study group than in the control (P < 0.01-P < 0.05). Incidence of neonatal infection tetanus and birth trauma was also significantly higher in the study than in the control groups (P < 0.01-P < 0.05). The incidence of prematurity, neonatal jaundice and congenital abnormality did not show any significant difference in the two groups (P > 0.05). The risk of perinatal death was three times higher in the study group than in the control. Proper public enlightenment campaigns and the establishment of a national health insurance scheme which may strengthen the use of orthodox health facilities for delivery, may improve the poor perinatal outcome in our community.