Testicular Volume in Children with Sickle Cell Anaemia in Uyo, a South-South Nigerian City.

INTRODUCTION: Sickle cell anaemia (SCA) often presents in early childhood with repeated vaso-occlusive crisis that leads to ischaemia, infarction and fibrosis which may result in a reduction in expected testicular volume (TV) at puberty. METHOD: This was a cross-sectional study of 95 children with SCA aged 1-18 years compared with 95 age-matched controls. Participants responded to an interviewer-administered questionnaire, with their anthropometric measurements taken, pubertal maturity assessed by Tanner staging and testicular ultrasonography done. Changes in TV across the ages were compared graphically and regression analyses were used to determine the factors independently associated with TV. A p-value of <0.05 was considered statistically significant. RESULTS: In the prepubertal period, the haemoglobin SS (HbSS) participants had larger median ultrasound TV (MUSTV) compared to the haemoglobin AA (HbAA) controls (p = 0.001). This trend reversed in the pubertal period. On regression analysis, the frequency of testicular pain (p = 0.04), weight (p = 0.02) and pubic hair rating (p = 0.03) of the HbSS participants were significant predictors of increased TVs in the HbSS participants, irrespective of pubertal status. CONCLUSION: The prepubertal MUSTV of the HbSS participants were higher than those of the HbAA controls, while the HbAA controls had higher MUSTV at puberty and beyond. The frequency of testicular pain episodes, pubic hair rating and weight were independent predictors of TV changes in the HbSS participants. Prevention of repeated vaso-occlusive crisis in the prepubertal period may help prevent the reduction in TV and possible hypogonadism. Lay summarySickle cell anaemia (SCA) causes repeated episodes of painful crisis and in boys, these may affect the way their testes grow. The study set out to document testicular sizes on a one-time basis in boys aged 1-18 years with SCA compared with controls of similar ages. The participants responded to structured questions assisted by the researchers and their body measurements were appropriately taken. Their level of sexual maturation was assessed according to the method by Tanner and the sizes of their testes were measured using an ultrasound machine. The research information was analysed and a statistical value less than 0.05 was taken to mean that there was a difference between the measured variables. The mid-testicular sizes of the SCA participants were noted to be higher than that of their controls during the prepubertal period while the non-SCA boys had higher sizes from puberty onwards. The frequency of testicular pain, weight and pubic hair stage of the SCA boys were important contributors to their increased testes sizes, irrespective of pubertal status. Efforts aimed at preventing painful crisis should start during early childhood to forestall future sexual challenges in adulthood.

Comparative tetanus antibody response of Nigerian children to diphtheria-pertussis-tetanus and pentavalent vaccines.

BACKGROUND: In Nigeria and many parts of the world, the pentavalent vaccine is replacing the diphtheria-pertussis-tetanus (DPT) vaccine in tetanus prevention. AIMS AND OBJECTIVES: The aim of this study was to compare the anti-tetanus immunoglobulin G (IgG) response of children who received DPT with those who received the pentavalent vaccine. SUBJECTS AND METHODS: A cross-sectional survey of anti-tetanus IgG levels in children aged 6 months to 5 years who received DPT and in children who received the pentavalent vaccine. IgG antibody levels were determined using enzyme-linked immunosorbent assay. The protective level was set at ≥0.1 IU/ml. RESULTS: One hundred and twenty-two out of 130 children (93.9%) who had received DPT had protective levels of anti-tetanus IgG compared to 278 out of 288 children (96.5%) who had received the pentavalent vaccine. The difference was not statistically significant (P = 0.21). The median IgG antibody level in those who received DPT was 1.1 IU/ml (interquartile range (IQR) 0.4-1.8) compared with 0.6 IU/ml (IQR 0.4-1.4) in those who received pentavalent vaccine (P = 0.006), with age being the only predictor of variability in the multivariate analysis. CONCLUSION/RECOMMENDATION: DPT and pentavalent vaccines are equally effective in inducing protective levels of anti-tetanus IgG in children. Vaccination with the pentavalent vaccine, which is the current policy in Nigeria and many other parts of the world, should continue.

Urinary schistosomiasis in school children of a southern nigerian community 8 years after the provision of potable water.

BACKGROUND: Urinary schistosomiasis, one of the neglected tropical diseases, is a major infection of public health importance in Nigeria. Control measures include the provision of potable water as the main strategy, population-based chemotherapy and health education. AIMS AND OBJECTIVES: The aim of this study was to determine the effect of the provision of potable water on the prevalence and intensity of infection with Schistosoma haematobium in Adim community, Cross River State, Nigeria. SUBJECTS AND METHODS: A cross-sectional survey was carried out among school and children aged 5-14 years in Adim community in Cross River State using the polyamide millipore filter technique and ova detection and count compared with the situation that obtained 8 years earlier before the provision of potable water. The prevalence and intensity of haematuria and proteinuria by reagent strips were also compared between the two eras. RESULTS: The prevalence of schistosomiasis was 14.5% compared to 51% in the prepotable water era (P = 0.001). The intensity of the infection was also significantly reduced between the two eras with 1.3% of the children having a severe intensity compared to 4.5% in the prepotable water era. CONCLUSIONS/RECOMMENDATIONS: The prevalence and intensity of S. haematobium have significantly reduced in this community though not yet eliminated. More boreholes need to be provided to make the water more accessible. This could be combined with other measures to eradicate S. haematobium from this community.

Seroprevalence and predictors of hepatitis A infection in Nigerian children.

INTRODUCTION: Hepatitis A infection is prevalent in developing countries where sanitation is still a public health issue. In Nigeria, there is no epidemiological data on children for this infection. A community based study was carried out to establish the seroprevalence and predictors of this infection in children. METHODS: A community based cross sectional study was carried out in Akpabuyo local Government Area of Cross River State in southern Nigeria. Multi-staged sampling technique was used to recruit 406 children aged 1-18 years. Blood samples were analysed for anti-HAV total antibody (IgM and IgG) using a commercial Enzyme-Linked Immunoassay Assay(ELISA). A multivariate logistic regression was used to identify factors that independently predicted the occurrence of anti-HAV total antibody. p value of < 0.05 was considered significant. RESULTS: Two hundred and twenty four subjects tested positive for anti-HAV total antibody giving a prevalence rate of 55.2%. The median age for those positive was 9 years and for those without evidence of HAV infection was 4 years. One hundred and one (45.1%) males and 123 (54.9%) females were positive. The study population was mainly of the low social class with 94.1%. After multivariate analysis, predictors of HAV infection were age and social class. CONCLUSION: HAV infection was prevalent in the study population. Educational campaign is imperative and vaccine provision is advocated to further curb the spread of this infection.

Seroepidemiology of Helicobacter pylori infection among children seen in a tertiary hospital in Uyo, southern Nigeria.

BACKGROUND: Helicobacter pylori infection occurs worldwide with higher seroprevalence rates in the childhood populations of developing countries. In Nigeria, there is a dearth of information concerning its occurrence in children and infection enhancing factors. A prospective seroepidemiologic survey to determine the prevalence rate and possible associations of environmental and socio-demographic factors with its seropositivity was therefore conducted. METHODS: The subjects were children seen at the Children's Emergency Unit of University of Uyo Teaching Hospital in southern Nigeria. Two hundred and thirty subjects, comprising 132(57.4%) males and 98(42.6%) females (male: female ratio= 1.3:1.0) with an age range of 0.5-15 years and a mean age of 5.0 (SD ± 4.0) years were recruited. The median age was 4.0 years. H. pylori immunoglobulin G (1gG) antibody was determined from serum samples stored at -200C using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit, VicTorch. RESULTS: The overall seroprevalence rate was 30.9% with a peak prevalence of 40.7% for the 6.0 to 10.0 years age group. H. pylori seroprevalence in our children is associated with low social class (p=0.038), increased household population (p=0.009), source of drinking water (p=0.014), type of convenience used (p=0.019) and the method of disposal of household waste (p=0.043). CONCLUSION: The seroprevalence of Helicobacter pylori infection in Nigerian children is high and is associated with low social class, poor domestic water and poor sanitation. Improvement of water supply, human and domestic waste disposal systems and ultimately poverty alleviation would control this bacterial infection that has severe long term consequences.