CORRELATION BETWEEN ANTHROPOMETRY AND BLOOD PRESSURE IN CHILDREN.

Introduction: Although a positive correlation has been shown to exist between blood pressure (BP) and anthropometry, conflicting reports have been documented about the anthropometric parameter that best determines increased blood pressure (BP) in children. Whereas waist circumference (WC) has been shown to correlate with BP in adults due to disproportionate fat distribution, the uniform fat distribution in children may alter this relationship established in the adult population. Objective: Correlation between anthropometric parameters and BP in children. Methodology: A cross-sectional study of BP where 1350 apparently healthy secondary school adolescents aged 10-19 years were recruited over 6 months. The BP, height, weight, body mass index (BMI) and WC were taken and analysed. Results: The mean weight of the students was 48.6±10.9kg with a range of 23-100kg, while height was 1.6±0.1m and ranged from 1.2-1.9m. The mean WC was 65.6±8.9cm and ranged from 22-100cm while the mean BMI was 18.9±3.1kg/m2. The overall mean systolic BP was 108.9±12.5mmHg with a range of 76-165mmHg while diastolic BP was 68.3±8.2mmHg and ranged from 47-95mmHg. The BP correlated positively with height with systolic blood pressure (SBP) and diastolic blood pressure coefficients being 0.44 and 0.34 (r=0.44 & 0.34; p<0.001), correlated with weight with SDB and DBP coefficients (r=0.51 & 0.38; p<0.001), correlated with BMI (r= 0.40 & 0.29; p<0.001) and with WC (r= 0.31 & 0.23; p<0.001). Conclusion: SBP showed a stronger correlation with the anthropometries than the DBP in children. The weight has the highest correlation while the WC has the lowest correlation with BP in children.

GENDER VARIATION IN THE PREVALENCE OF CHILDHOOD HYPERTENSION.

Introduction: Hypertension is an important health problem all over the world. It is usually silent and the presence of symptoms may indicate end-organ damage. Whereas some studies reported a higher blood pressure (BP) in girls than boys at all ages other studies reported no sex differences while others demonstrated an initial higher BP in boys before puberty with reversal at puberty. Objective: Variation in prevalence of hypertension according to gender. Methodology: A cross-sectional study of BP that recruited 1350 apparently healthy secondary school adolescents aged 10-19 years over 6 months. Results: The overall point prevalence of hypertension was 4.4% (59 of 1350) with gender-specific prevalence for males being 4.1% (26 of 628 boys) and 4.6% (33 of 722 girls) for females, (χ 2=0.831, p=0.362). According to stages of hypertension, 1.5% (10 of 628) and 1.1% (7 of 628) males had stages 1 and 2 systolic hypertension respectively while 2.4% (15 of 628) had stage 1 diastolic hypertension and none had stage 2. Similarly, 2.4% (17 of 722) and 1.2% (9 of 722) females had stages 1 and 2 systolic hypertension respectively while 1.2% (9 of 722) and only 0.1% (1 of 722) girls had stages 1 and 2 diastolic hypertension respectively. The overall prevalence of pre-hypertension was 22.1% (298 of 1350) with gender-specific prevalence of 21% (131 of 628) for males and 23.1% (167 of 722) for females, (χ 2=4.349, p=0.037). Conclusion: Female adolescents have a higher prevalence of hypertension, especially pre-hypertension, compared with males. The BP screening is recommended at secondary school entry and at regular intervals.

REVEALING THE VARIED REALITY OF MALARIA-RELATED DEATHS IN CHILDREN ACROSS GENDER, AGE, AND ETHNICITY IN FEDERAL TEACHING HOSPITAL GOMBE OVER 20 YEARS: AN ESSENTIAL EPIDEMIOLOGIC IMPERATIVE.

Introduction: Nigeria recorded 31% of 619,000 malaria deaths globally and accounts for 25-30% of all childhood mortality in the country. Few studies in Nigeria, have reported malaria's case fatality rate over a long period. Objective: To determine Malaria Case Fatality Rate among Children admitted from 2000-2019. Methodology: All severe malaria cases and deaths amongst children aged 0-18 over the last two decades were analysed using ICD-10. The diagnosis was based on clinical and microscopic findings. Results: 26,716 children were admitted, 2494 (9.3%) were diagnosed with malaria and 209 died. Malaria constituted 5.3% (209/3956) of all childhood mortality. Males constituted 58.9 % (1468/2494) while 65% (1642/2494) were aged 0-5 years. Of the malaria admissions, Fulani and Hausa constituted 948(38%) and 438(17.6%) respectively. Admissions were highest in October (15%) and in 2012 (9.6%). The overall malaria CFR was 8.3%; 8.8% in Females (91/1026) and 8.03% in Males P-value <0.05 (X2=54.735); 8.6% in children aged 0-5years, 8.2% in 6-10 years and 7.4% in 11-18 years, P-value <0.05 (X2=893.164). CFR was highest in April (11.4%)and lowest in November (5.2%). Kanuri and Igbo had CFR of 70% and 38.4% respectively while it was lowest in Tera tribe (4.3%), P-value<0.05. The CFR was highest in the year 2004 (22%), 3.5% in 2000 and 2006. Over the years, case fatality rate was 15.9% between 2000-2004, 6.1% from 2005-2009. Between 2010-2015, it was 7.3% and 8.5% from 2016-2019. Conclusion: This study revealed the deadly reality of severe malaria with increased CFR among females, aged 0-5 and the Kanuri tribe.

PATTERN OF RENAL DISEASES AMONG CHILDREN ATTENDING PAEDIATRIC NEPHROLOGY CLINIC, FEDERAL TEACHING HOSPITAL, GOMBE.

Introduction: Children present with a spectrum of renal diseases depending on age, sex, and geographic location among other factors. With the absence of a paediatric renal registry in Nigeria, this will provide part of the regional data necessary for the Nigerian renal registry. Methodology: A retrospective study where cases of renal diseases that presented in a nephrology clinic over a 2-year period were retrieved from the nurses' and doctors' records and analysed. Results: A total of 147 children were reviewed, male and female were 101 and 46 respectively with M: F being 2.2: 1. Mean age was 9.59 ± 4.58 years, age distribution were <5 years (23.0; 15.6%), 5-9 years (52; 35.4%) and ≥ 10 years (72.0; 49.0%). The majority (77.0; 52.4%) had low socioeconomic status. Majority (145; 98.6%) were acquired renal diseases while ectopic kidney (2.0; 1.4%) was the only CAKUT. Acute glomerulonephritis (49; 33.3%), urinary tract infections (37; 25.2%) and nephrotic syndrome (30.0; 20.4%) were the major acquired renal diseases. Acute kidney injury (AKI) and chronic kidney disease (CKD) were seen in 9 (6.1%) and 13 (8.8%) respectively. Urolithiasis, sickle cell nephropathy, and primary enuresis were seen in 5(3.4%) and 1 (0.7%) respectively. The mean age of children with CAKUT and acquired renal diseases were13.00 ±1.41 and 9.54±4.59 years (P=0.290) while that of AKI and CKD were 10.89±5.21 and 14.15±3.24 years respectively (P= 0.084). Conclusion: Childhood renal diseases increase with age and are more common among adolescents, especially the chronic forms. Regular screening and aggressive treatment are recommended in adolescents.

OBSTRUCTIVE UROPATHY FROM BILATERAL URETERIC CALCULI IN AN INFANT WITH DIARRHOEA DISEASE.

Introduction: Urolithiasis is the presence of mineral deposits in the urinary tract. It is rare in under-5 children and in Sub-Saharan Africa. Although metabolic abnormality is implicated in 50% of cases, infection, decreased urine volume and flow (dehydration state) have been implicated. We report a case of bilateral ureteric calculi in an infant with diarrhoea disease and dehydration. Case Report: A.S, is an 8-month-old male with prolonged loose, large-volume stool, large-volume vomiting, high-grade fever, body weakness, and peri-orbital swelling that progressed to generalized body swelling and absent urine for 2 days. He was conscious, afebrile (36.90C), pale with anasarca. Had distended abdomen with ascites. Dyspnea, coarse crepitation, and hypoxemia. Tachycardia (PR -180/min) Hypertensive (BP - 125/79mmHg). PCV - 20%, WBC - 24,000/l, platelet - 110,000/l. Creatinine (1030 umol/l), Urea - 30mmol/l, Multi drug resistant E.Coli. Bilateral Grade II nephritis, hydro-uretero-nephrosis, right pelvi-ureteric and left vesico-ureteric junction calculi. Managed for Diarrhoea disease complicated with Bilateral Obstructive uropathy secondary to Bilateral Ureteric Calculi. Had bilateral open ureteric exploration, ureterolithotomy, Stenting, intraoperative transfusion, antibiotics, analgesics, and IVF. 24-hr post-surgery: urine output (3.26ml/kg/hr): right stent (210ml), left stent (423ml) while urethral catheter (150ml), 742umol/l, Urea: 26mmol/l 48-hr post-surgery: Urine output 5.1ml/kg/hr (1224ml/24hr); Cr: 424umol/l, Urea: 16mmo/l 5 days post-surgery: Urine output 3.1ml/kg/hr (725ml/24hr); Cr: 47umol/l, Urea: 4.6 mmo/l, Patient was discharged home and currently on follow-up in paediatric nephrology and urology clinics. Conclusion: A high index of suspicion of obstructive uropathy in children with diarrhoea disease, and dehydration, who have developed acute kidney injury is recommended.

EPIDEMIOLOGIC TREND AND CASE FATALITY OF CHILDHOOD TETANUS IN FEDERAL TEACHING HOSPITAL GOMBE; A 20YEARS REVIEW.

Introduction: Tetanus is a vaccine-preventable disease, it remains a significant cause of morbidity and mortality in both neonatal and post-neonatal periods, especially in developing countries with limited health facilities and inadequate vaccination. The overall case fatality rate (CFR) is 13.2% globally, highest in the neonatal period and in sub-Saharan Africa. CFR is 64%, 47%, and 43% in Nigeria, Uganda, and Tanzania respectively. Objectives: To determine the Case Fatality Rate of Childhood tetanus in FTHG from 2000-2019. Methodology: All cases and deaths from tetanus amongst children aged 0-18 years in paediatric medical ward of FTHG over the last two decades diagnosed clinically and classified using ICD-10 were analysed. Results: 95 cases of tetanus out of 26,716 total admissions constituting 0.004%. There were 49 tetanus deaths out of 3956 total childhood deaths (0.012%) over the study period. Males constituted 66% (63/95). 30% (28/95) were aged 0-28 days; 23.1% (22/95) were adolescents. Fulani and Hausa constituted 37% (34/95) and 31% (29/95) respectively. Admission was highest in the dry season 52% (50/95 %). The overall tetanus CFR was 51.6%; 78% of deaths were in males (38/49), 30% in neonates, and 23% in adolescents. CFR was highest during the dry season (67.3%). Hausa and Fulani had CFR of 51% and 40% respectively. P-value <0.05 The CFR was 88% between 2000-2004, 72% from 2005-2009, 71% between 2010-2014 and 33% from 2015-2019. Conclusion: Tetanus CFR is still high among neonates and adolescents. Maternal tetanus vaccine and booster doses in children need strengthening.

IN-PATIENT PNEUMONIA BURDEN AND CASE FATALITY RATES IN CHILDREN OVER TWO DECADES IN FEDERAL TEACHING HOSPITAL, GOMBE (FTHG).

Introduction: Pneumonia is the leading cause of death among children globally accounting for an estimated 1.2 million (18%) total deaths annually. The number of childhood-related deaths from pneumonia is approximately 2000-fold higher in developing than in developed countries. Nigeria contributes the highest of pneumonia-related deaths globally. Objectives: To determine the case fatality rates (CFR) of pneumonia from 2000-2019 in paediatric ward, FTHG. Methodology: All cases of pneumonia admissions and deaths in patients aged 0-18 years, using ICD-10 classification, were retrieved and analysed. The mainstay of diagnosis is clinical and/or radiographic features. Results: A total of 26,716 children were admitted during this period, 1151 had pneumonia (4.3%) and 118 died. Males constituted 647 (56.2%) and females 43.8% of the total pneumonia admissions. Children aged 0-5 years had the highest pneumonia admissions, followed by 6-9 years. Admissions were highest in the wet than the dry season. Pneumonia CFR was 10.2%; 10.9% in females and 9.7% in males. Under-5 constituted 84% (969/1151) of pneumonia admission with a CFR of 9.3%. CFR were 10.3% and 21% in 6-10 years, and 11-18 years respectively. The CFR between2000-2004 was 14.1%, 2005-2009:21.1%, 2010-2014:10.2% and 2015-2019:7.2%. Kanuri had the highest CFR of 56.2%.(P <0.05) Other ethnic groups were 29.4% in Waja, 25% in Tula, 21.4% in Igbo, 16.6% in Yoruba, 12.1% in Tangale, 10.2% in Hausa, 8.8%in Bolewa and 8.3% in Fulani. The CFR was highest in February20.2%. Conclusion: Pneumonia Case fatality is high.

Association of intestinal helminthic infection and nutritional status of primary school children in Gombe State, Nigeria

Background: Intestinal helminthic infections are among the commonest infections worldwide. It often affects the poorest communities and has similar geographic distribution with malnutrition. Intestinal helminthic infection contributes to undernutrition through subtle reduction in digestion and absorption of food, chronic inflammation and loss of nutrients. The objective of this study is to determine the prevalence of intestinal helminthic infection and its relationship with nutritional status of primary school children in Gombe, Gombe State, Nigeria. Methodology: This was a cross sectional study of 350 pupils selected through multistage random sampling technique from 24 primary schools in Gombe, Gombe State, Nigeria from July 2018 to January 2019. Demographic information including age, gender, height, and weight were collected from each participant with a designed collection form. The data were analysed using SPSS version 24.0, and presented as frequency distribution and mean ± SD. The Chisquare test (with Odds ratio and 95% confidence interval) was used to test for association between prevalence of helminthiasis and factors such as gender, age group and school type. A p value of less than 0.05 was considered statistically significant at 95% confidence interval. Results: The prevalence of intestinal helminthic infection was 23.7% (83/350). Eighty (96.4%) of the 83 infected pupils were in public schools while only 3 (3.6%) were in private schools (p<0.001). The prevalence of helminthiasis was significantly higher in underweight pupils (34%, OR=2.113, p=0.0065)) and significantly lower (5.4%, OR=0.1637, p=0.0037) in overweight pupils while the prevalence was not significantly associated with normal weight (p=0.5482) or obesity (p=1.000). Conclusions: Intestinal helminthic infection is a public health problem in children with adverse significant relationship with nutritional status. Provision of toilet facilities in schools and periodic de-worming of pupils aimed at reducing loss of nutrients from intestinal helminthiasis are recommended.