Intestinal Helminthiasis: Risk factors and relationship with Nutritional status and Anaemia among Institutionalised Children in three States of South-East Nigeria.

BACKGROUND: Intestinal helminthiasis occurs in sub-optimal living conditions with poor hygiene practices and is more prevalent in rural, suburban and institutionalized centres. Heavy helminthic burden negatively affects the nutritional status and the severity of anaemia among children living in orphanages. AIM: To determine the risk factors and relationship of intestinal helminthiasis with nutritional status and anaemia among institutionalized children in three states of South-East Nigeria. METHODS: A cross-sectional study was conducted over seven months involving 198 children recruited from orphanages in Anambra, Ebonyi and Enugu states. Their stool samples were analyzed using the Kato-Katz and Ether concentration techniques, and packed cell volume and anthropometric indices were documented. Data were analyzed. RESULTS: Of the 198 children, 109 (55.1%) were females with a median age of 2.5 years and interquartile range (3 months - 17 years). The prevalence of intestinal helminthiasis was 2.5%. Among the children that had intestinal helminthiasis, 4 (80%) had mono-parasitism with Ascaris lumbricoides, while 1 (20%) had mixed infestation of Ascaris lumbricoides and Trichuris trichiura. There was a significant association (p=0.01) between being infested with intestinal helminthiasis and caregiver handwashing practices. The anthropometric indices demonstrated that 5.6%, 6.6% and 13.1% of the children were underweight, wasted and stunted respectively. No helminth-infested child had malnutrition and only 1 (20%) infested child had moderate anaemia. CONCLUSION: Caregivers' good handwashing practice was associated with reduced prevalence of intestinal infestations and should be encouraged. There was no relationship found between the presence of helminthic infestations and nutritional status or anaemia among the institutionalised children.

CONTEXTE: Les helmintiases intestinales surviennent dans des conditions de vie sous-optimales avec des pratiques d'hygiène médiocres et sont plus fréquentes dans les centres ruraux, périurbains et institutionnalisés. Une charge helminthique importante affecte négativement l'état nutritionnel et la gravité de l'anémie chez les enfants vivant dans des orphelinats. OBJECTIF: Déterminer les facteurs de risque et la relation entre les helmintiases intestinales, l'état nutritionnel et l'anémie chez les enfants institutionnalisés dans trois États du sud-est du Nigéria. MÉTHODES: Une étude transversale a été menée sur sept mois, impliquant 198 enfants recrutés dans des orphelinats des États d'Anambra, d'Ebonyi et d'Enugu. Leurs échantillons de selles ont été analysés à l'aide des techniques de Kato-Katz et de concentration à l'éther, et le volume globulaire et les indices anthropométriques ont été documentés. Les données ont été analysées. RÉSULTATS: Sur les 198 enfants, 109 (55,1 %) étaient des filles avec un âge médian de 2,5 ans et une plage interquartile (3 mois - 17 ans). La prévalence des helmintiases intestinales était de 2,5 %. Parmi les enfants atteints d'helmintiases intestinales, 4 (80 %) présentaient une mono-parasitose à Ascaris lumbricoides, tandis que 1 (20 %) présentait une infestation mixte à Ascaris lumbricoides et Trichuris trichiura. Il y avait une association significative (p=0,01) entre l'infestation par les helmintiases intestinales et les pratiques de lavage des mains par les aidants. Les indices anthropométriques ont montré que 5,6 %, 6,6 % et 13,1 % des enfants étaient respectivement sous-pondérés, émaciés et retardés en taille. Aucun enfant infesté par les helminthes n'était malnutri et seul 1 (20 %) enfant infesté avait une anémie modérée. CONCLUSION: La bonne pratique du lavage des mains par les aidants était associée à une prévalence réduite des infestations intestinales et devrait être encouragée. Aucune relation n'a été trouvée entre la présence d'infestations helminthiques et l'état nutritionnel ou l'anémie chez les enfants institutionnalisés. Mots-clés: Anémie, Enfants, Helminthes, Institutionnalisés, État nutritionnel.

Effect of COVID-19 Pandemic on Utilization of Paediatric Health Services at the Federal Medical Centre, Asaba, Nigeria.

BACKGROUND AND OBJECTIVES: Corona virus disease was declared a global pandemic in March 2020 and it precipitated unprecedented and devastating crisis on non-COVID hospital visits in almost all the countries within the globe, with a downward slide in the number of paediatric consultations and emergency admissions. Thus, we assessed the utilization of services offered in the department of Paediatrics and the observed mortality rates in comparison to similar non-pandemic period. METHODS: This study was carried out in the department of Pediatrics, Federal Medical Center Asaba. All the admissions at the children's ward and emergency, then visits at clinics and the immunization center were reviewed using a consecutive sampling method from April 2019 to September 2019 (pre COVID-19) and April 2020 to September 2020 (during COVID-19 pandemic). RESULTS: The total number of vaccines given in the immunization clinic was higher during the pre-COVID-19 period, so also the number of clinic visits. There was a decline in admission by 68.2% from the pre-COVID period to the pandemic period and this decline was across all age groups and gender. Also, a 60.8% increase in mortality was observed during the COVID-19 period and mortality pattern showed no gender difference across both study periods. CONCLUSION: There was a decline in the utilization of health services at the Department of Paediatrics, Federal Medical Center Asaba, during the COVID-19 pandemic, with a rise in mortality, despite the fact that all the units of the department were fully operational within the period of pandemic.

CONTEXTE ET OBJECTIFS: La maladie à virus Corona a été déclarée pandémie mondiale en mars 2020 et a précipité une crise sans précédent et dévastatrice sur les visites hospitalières non COVID dans presque tous les pays du globe, avec une baisse du nombre de consultations pédiatriques et d'admissions d'urgence. Nous avons donc évalué l'utilisation des services offerts dans le département de pédiatrie et les taux de mortalité observés par rapport à une période non pandémique similaire. MÉTHODES: Cette étude a été réalisée dans le département de pédiatrie du Centre médical fédéral d'Asaba. Toutes les admissions au service pédiatrique et aux urgences, puis les visites dans les cliniques et au centre de vaccination ont été examinées selon une méthode d'échantillonnage consécutif d'avril 2019 à septembre 2019 (avant COVID-19) et d'avril 2020 à septembre 2020 (pendant la pandémie de COVID-19). RÉSULTATS: Le nombre total de vaccins administrés dans le centre de vaccination était plus élevé pendant la période pré-COVID-19, de même que le nombre de visites au centre. Le nombre d'admissions a diminué de 68,2 % entre la période pré-COVID et la période pandémique, et cette baisse a concerné tous les groupes d'âge et tous les sexes. Par ailleurs, une augmentation de 60,8 % de la mortalité a été observée au cours de la période COVID-19 et le schéma de mortalité n'a montré aucune différence entre les sexes au cours des deux périodes d'étude. CONCLUSION: Il y a eu une baisse de l'utilisation des services de santé au département de pédiatrie du Federal Medical Center Asaba pendant la pandémie de COVID-19, avec une augmentation de la mortalité, malgré le fait que toutes les unités du département étaient pleinement opérationnelles pendant la période de la pandémie. Mots-clés: Pandémie, Covid-19, Enfants, Mortalité, Clinique, Admission, Services de santé, Effet, Utilisation.

The prevalence and intensity of intestinal helminths among institutionalized children in three states of South-East Nigeria.

Background: Intestinal helminthiasis is one of the most common and neglected diseases affecting all age groups, especially among school children. It is a disease condition of suboptimal environment and poor personal hygiene, and is more prevalent in children in institutionalized centers. Aims: This study was aimed to determine the prevalence, pattern, and intensity of intestinal helminthiasis among children in motherless babies' homes/orphanages and the relationship between the prevalence and demographic characteristics of the children. The outcome may be useful in strengthening these homes through advocacy to the appropriate authorities on general health promotion and awareness for the management of the homes. Subjects and Methods: It was a descriptive cross-sectional study carried out over 7 months (March-September 2017) in three states of the South-East Nigeria. Prior to the studies ethical clearance and permissions from relevant bodies were obtained. A total of 198 children aged 3 months to 17 years were recruited using multi-stage sampling methods from the homes and orphanages in Anambra, Ebonyi, and Enugu states. Their stool samples were collected and analyzed for ova of intestinal helminths using ether concentration and Kato-Katz techniques.Frequency tables were designed for relevant variables while quantitative variables were summarized using median and interquartile range (IQR). The relationship between demographic factors and presence of intestinal helminths amongst study participants was tested using Chi-square test and Fisher's exact test (FET) where appropriate. All analyses were done at the 5% level of significance, and a P value <.05 was considered statistically significant. Results: : Children aged 1-5 years constituting the highest proportion 110 (55.6%). The median age (IQR) of the participants was 2.5 years (3 months to 17 years). They comprised of 89 (44.9%) males and 109 (55.1%) females with a male: female ratio of 1:1.2. The overall prevalence of intestinal helminths among institutionalized children was 5/198 (2.5%). Ascaris lumbricoides only was seen in four out of five (80%) infested subjects while mixed infestation of A. lumbricoides and Trichuris trichiura was seen in one out of five (20%) subjects. All the infected subjects had light intensity of 100-300 EPG. It was noted that three out of five infested subjects were preschool children. However, the difference between the age groups and intestinal infestation was not statistically significant (P > 0.05). All the subjects with helminthic infection were females. Gender and location of motherless babies' homes/orphanages were not significantly associated with the presence of infestation (P > 0.05). Conclusion: This study showed that the prevalence and intensity of intestinal helminthiasis amongst the surveyed children in the South-Eastern Nigeria are 2.5% and more common among preschool aged children.

Evaluation of Foetal Haemoglobin Status among Nigerian Patients with Sickle Cell Anaemia Using High Performance Liquid Chromatography.

BACKGROUND: Sickle cell anaemia (SCA, HbSS) is a genetic disorder of haemoglobin with marked variation in clinical manifestation. The aim of this study was to determine the foetal haemoglobin (HbF) status of patients with HbSS, compared with that of individuals with HbAS and HbAA control as well as to establish the relationship between HbF level and age and gender of the participants. METHODS: This was a cross-sectional study in which HbF values of known HbSS patients along with HbAS and HbAA controls were analysed using High Performance Liquid Chromatography. Socio-demographic and other information were obtained with the use of questionnaire. Data was analyzed using SPSS software, version 20.0. Ethical approval was obtained for the study. RESULTS: One hundred and two (102) participants were recruited for the study, comprising 60 patients with HbSS, 22 HbAS and 20 HbAA controls, with mean age of 11.0 years±9.6, 11.7 years ±8.8 and 12.3 years±8.1 respectively. There were 30 (61.2%) males and 30 (56.6%) females for HbSS group, 9 (18.4%) males and 13(24.5%) females for HbAS group and 10(20.4%) males and 10(18.9%) for HbAA group. Mean HbF level among HbSS participants was 8.0 ±6.1% and was significantly higher than that of HbAS (3.0 ±3.4%) and HbAA (2.2 ±4.1%) control (P<0.05). Mean HbF level was higher in children (<18 years) than adults (e"18 years) among HbSS, HbAS and HbAA participants, though not statistically significant (p >0.05). Mean HbF level was also higher among female HbSS, HbAS and HbAA groups compared to corresponding male groups, though only HbSS female group was significant (p = 0.031). CONCLUSION: Patients with HbSS have significantly higher HbF level than individuals with HbAS and HbAA. Foetal haemoglobin level tend to decrease with advancing age and higher in females. Increased HbF level may play a compensatory mechanism in sickling in HbSS, thus the use of agent that increase HbF level may improve clinical outcome.

CONTEXTE: L'anémie falciforme (SCA, HbSS) est un mal de l'hémoglobine avec une variation marquée de la manifestation. Le but de cette étude était de déterminer le fœtus le statut d'hémoglobine (HbF) des patients atteints d'HbSS, par rapport à celle des personnes ayant un contrôle de l'HbAS et de l'HbAA ainsi que établir la relation entre le taux d'HbF et l'âge et le sexe des participants. MÉTHODES: Il s'agissait d'une étude transversale dans laquelle l'HbF valeurs des patients HbSS connus ainsi que l'HbAS et l'HbAA les contrôles ont été analysés à l'aide d'un liquide haute performance Chromatographie. Informations sociodémographiques et autres ont été obtenus à l'aide d'un questionnaire. Les données ont été analysées à l'aide du logiciel SPSS, version 20.0. L'approbation éthique a été obtenue pour l'étude. RÉSULTATS: Cent deux (102) participants ont été recrutés pour l'étude, comprenant 60 patients avec HbSS, 22 HbAS et 20 contrôles HbAA, avec un âge moyen de 11,0 ans ± 9,6, 11,7 ans ± 8,8 et 12,3 ans ± 8,1 respectivement. Il y avait 30 (61,2%) hommes et 30 femmes (56,6%) pour le groupe HbSS, 9 hommes (18,4%) et 13 femmes (24,5%) pour le groupe HbAS et 10 hommes (20,4%) et 10 (18,9%) pour le groupe HbAA. Niveau moyen d'HbF parmi l'HbSS participants était de 8,0 ± 6,1% et était significativement plus élevé que celle du contrôle HbAS (3,0 ± 3,4%) et HbAA (2,2 ± 4,1%) (p <0,05). Le taux moyen d'HbF était plus élevé chez les enfants (<18 ans) que chez les adultes (e "18 ans) chez les participants HbSS, HbAS et HbAA, cependant non statistiquement significatif (p> 0,05). Le taux moyen d'HbF était également plus élevé parmi les groupes féminins HbSS, HbAS et HbAA par rapport aux groupes masculins correspondants, mais seulement au groupe féminin HbSS était significative (p = 0,031). CONCLUSION: Les patients atteints d'HbSS ont des Taux d'HbF que les individus avec HbAS et HbAA. Fœtal le taux d'hémoglobine a tendance à diminuer avec l'âge et plus élevé chez les femmes. L'augmentation du niveau d'HbF peut jouer un rôle compensatoire mécanisme de la faucille dans l'HbSS, donc l'utilisation d'un agent qui l'augmentation du taux d'HbF peut améliorer les résultats cliniques. Mots clés: hémoglobine fœtale, liquide haute performance Chromatographie, drépanocytose, traits drépanocytaires, normaux l'hémoglobine adulte.

Cerebral Malaria Complicated by Blindness, Deafness and Extrapyramidal Tract Manifestation.

Cerebral malaria is a severe manifestation of a parasitic infection caused by Plasmodium falciparum. The sequelae of this disease such as blindness, deafness, loss of motor function could be emotionally traumatic and physically disabling. We, therefore, present this case of an 8-year-old boy who presented with high-grade intermittent fever associated with multiple convulsions and prolonged coma. He regained consciousness after 12 days of treatment with intravenous quinine but was found to have blindness, sensory-neural deafness and extrapyramidal sign. This extrapyramidal sign regressed following treatment with chlorpromazine. He also regained his sight and auditory function before he was discharged though not completely. This report is aimed at emphasizing these rare complications of cerebral malaria as well as reminding clinicians working in malaria endemic areas of the world on the need for early diagnosis and prompt treatment.

Blood Pressure Profile in Children Aged 3 - 5 Years: Relationship to Age; Weight; Height; Gender and Body Mass Index

Background. Blood pressure measurement is not commonly done in children. Most of the studies done in Nigeria so far on blood pressure and hypertension are in older children. Objectives. To determine the blood pressure profile in children aged 3 - 5 years; establish the relationship between their blood pressure and age; body mass index (BMI); height; weight and gender; and compare the results with available values.Methods. A total of 603 apparently healthy nursery school children aged 3 - 5 years were randomly recruited from three nursery schools: two in Abakaliki; Ebonyi State; and one in Asaba; Delta State. Their blood pressure; height and weight were measured and their BMI calculated. Results. Of the 603 pupils; 311 (51.6) were males and 292 (48.4) were females. Blood pressure ranged from 70/40 to 120/90; with mean (standard deviation) systolic values for pupils aged 3 years 87.5 (8.3) mmHg; aged 4 years 93.5 (8.5) mmHg and aged 5 years 93.5 (8.4) mmHg; and mean diastolic values for pupils aged 3 years 55.1 (9.1) mmHg; aged 4 years 61.2 (8.3) mmHg and aged 5 years 61.5 (7.8) mmHg. No gender difference was found; but age; height and weight all correlated positively with blood pressure. The values found in this study were similar to those in the literature. Conclusion. The mean systolic and diastolic blood pressures of the age group studied were 91.3 (8.9) mmHg and 59.0 (9.0) mmHg. The blood pressure values obtained in this study were similar to published values in the literature

Cerebral palsy among children seen in the neurology clinic of Federal Medical Centre (FMC), Asaba.

Cerebral palsy (CP) is a non-progressive disorder of motor function caused by irreversible damage to the immature brain. The disorder may be associated with seizure, mental retardation, visual and hearing defects. This study was designed to determine the types of CP, the risk factors and the co-morbidities associated with the disorder. Records of patients who were seen in the neurology clinic were kept for two years (June 2009-July 2011). Medical history and examination were essentially used to determine risk factors, antenatal care and co-morbidities. Data was analyzed using SPSS soft-ware. CP made up 45 % of 60 neurological cases and 0.006 % of 4,873 patients seen in the clinic with a male to female ratio of 1.1:1. Birth asphyxia was the commonest risk factor for the development of the disorder while seizure disorder among others was the commonest co-morbid state.