A seven-year review of accidental poisoning in children at a Military Hospital in Hafr Al Batin, Saudi Arabia.

BACKGROUND: Accidental ingestion of poisons and household products is a potential source of morbidity and mortality in children all over the world. The relative paucity of publications on this subject in Saudi Arabia necessitated our study, to delineate the pattern of acute poisoning in children at the King Khalid Military City Hospital, Hafr Al Batin. PATIENTS AND METHODS: Case notes of children 12 years and below who were admitted to the pediatric medical ward were retrospectively reviewed for relevant data. Included in the study were children of military and non-military personnel who were seen over a seven-year period (January 1992 to 1998). RESULTS: Of the 9951 single pediatric admissions, 168 (1.7%) were identified as cases of accidental poisoning. There was a male preponderance, even though this was not statistically significant. The age group mostly affected was 1 to 3 years (63%). More than 60% of children were asymptomatic, with 4% presenting with severe symptoms. Unlike in other parts of Saudi Arabia, poisoning due to petroleum products was relatively uncommon. CONCLUSION: Although no deaths were recorded in this study, continuous education of parents and caregivers of young children is recommended, as this would help to reduce the chances and complications of accidental poisoning. The role of local and regional Drug Information Centers cannot be overemphasized.

Neurological disorders in Saudi children at the Al-Majardah General Hospital, Asir region.

Over a 20-month period (June 1988 to January 1990), 180 Saudi children with neurological disorders were seen at the Al-Majardah General Hospital, Asir Region. These constituted 7.5% of all the pediatric inpatients and outpatients. More than one-half of the children were under three years of age and 74% were six years and below. In the series, convulsive disorders accounted for 28.9% of cases, followed by cerebral palsy (18.9%), mental retardation (16.7%), infections (9.4%), trauma (8.9%), and disorders of the primary senses (6.7%). In 57% of the children, the lesions were due to acquired and mostly preventable etiological factors whereas approximately 24% of the children suffered from prenatal (congenital) disorders, some of which were also preventable. The need for continued appraisal of the maternal and child care services as well as extension of rehabilitative facilities to handicapped children in rural areas of the Kingdom is highlighted.

The pattern and prognosis of speech disorders among children in Enugu, Nigeria.

Of 965 children with neurological disorders seen in the Child Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu over a 3-year period (1985-87), 80 (8.3%; 41 boys and 39 girls) had speech problems. The most common speech disorder was dyslalia. Twenty-six (32.5%) of the 80 children were mentally retarded. Besides speech problems, some of the children had other neurological disorders such as hyperactivity, recurrent seizures, microcephaly and deafness. Varying degrees of improvement in speech were observed in only eight girls and four boys, amounting to 24% of the 50 who were followed up for a period ranging from 3 months to 3 years (mean follow-up period 12.26 months). Eight of those who improved (66.6%) did so within the first 18 months of follow-up. There was a disturbingly high rate of default from follow-up, 30 of the patients (37.5%) failing to keep appointments at the clinic after the first assessment. Also, there was a long delay between onset of symptoms and presentation to hospital (mean delay 45.3 months). With the recent acquisition of the services of a speech therapist by the hospital, it is hoped that the prognosis for children with speech problems will be considerably improved.

A review of neurological disorders seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu.

A review of 965 children with neurological disorders, seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu, over a 3-year period (1985-1987), revealed that epilepsy was the most common neurological problem affecting 60% of the children, followed by cerebral palsy (16%), speech disorders (8.3%), mental retardation (7.2%), behaviour disorders (2.2%), paralytic poliomyelitis (1.55%), premature craniosynostosis (1.0%), visual and auditory impairment (1.0%) and muscle disorders (0.72%). Perinatal problems such as birth asphyxia, severe neonatal jaundice and infections were the most common aetiological factors identified. Facilities for rehabilitation of the children were inadequate and this, together with the people's ignorance of the natural history of some of the neurological disorders, may account for the high rate of default from follow-up observed in this study. The need for improved maternal and perinatal health services and vigorous health education strategies is emphasized by this review. The positive effect of the Expanded Programme on Immunization (EPI) is reflected in the sharp decline in the proportion of children with neurological disorders owing to paralytic poliomyelitis, from 9.2% in the period 1978-1980, to 1.55% in the present study.

Neurological disorders in Nigerian children with homozygous sickle cell anaemia.

The pattern of associated Central Nervous System (CNS) disorders in children with homozygous sickle cell anaemia was studied over a 12-month period at the University of Nigeria Teaching Hospital (UNTH), Enugu. The relative incidence of associated neurological disorders was 1.3%, and the major varieties were cerebrovascular accidents (57.5%), meningitis (22.5%) and recurrent convulsions (10%). Intellectual impairment did not feature as a separate entity, but was observed in 27.5% of children with CNS complications. Although recurrent strokes were not frequently encountered, the hypertransfusion therapy was not practised because of relative scarcity of blood donors.

Pyridoxine therapy on Nigerian children with infantile spasms.

Nine Nigerian children, with infantile spasms, 4 boys and 5 girls age 2.5-15 months, were treated with high doses of vitamin B6. Unlike results from some European and Japanese centres, our results have not been encouraging. Possible reasons for this poor response are suggested.

Childhood intracranial neoplasms Enugu, Nigeria.

This paper reviews children with intracranial neoplasms seen at the University of Nigeria Teaching Hospital, (UNTH), Enugu, over an 8-year period (1978-1985). There were 21 children, aged 4-14 years, with histologically confirmed intracranial neoplasms. The male to female ratio was 2:1. Of all cases, there was a preponderance of cranio-pharyngiomas (38.1%), followed by the astrocytomas and medulloblastomas with 14.3% each, a result which is at variance with findings elsewhere. The poor prognosis was partly due to late presentation complicated by relatively inadequate diagnostic and therapeutic facilities. A plea is made for the improvement of neurodiagnostic and therapeutic facilities in some regional hospitals in developing countries.

Rubinstein-Taybi syndrome: report of a case in a Nigerian child.

The first case of Rubinstein-Taybi syndrome in an African is reported. It is a syndrome of unknown etiology and prognosis, characterized by broad thumbs and great toes, mental retardation, high arched palate, distinctive facies, and undescended testes. Approximately 25 percent of patients have congenital cardiac defects, of which patent ductus arteriosus is the most common.

Aetiology of mental retardation in Nigerian children around Enugu.

PIP: This study identifies the pattern of mental retardation in 291 Nigerian children in Enugu. In 33.99% the etiology of mental retardation was congenital (present at birth), in 43.99% the cause was acquired and in the rest 23.02% no definite cause could be identified. The results, problems of diagnosis and management in relation to Nigeria are discussed. Massive support from the Government for improving the maternal and child welfare services as well as care for the mentally retarded children is solicited. The high % of cases due to birth trauma (23.38%) and severe neonatal jaundice (8.59%) reflects the quality of maternal and child welfare services as well as the obstetric care in the area. Full use of the available services and intensive health education in towns and villages could be most valuable. The increasing association of mental retardation with epilepsy in Nigerian children has been noted in other studies in this hospital. In the present study, epilepsy was found to cause mental retardation in 12.5% of cases in the acquired group and about 5% of the total number of cases. Malnutrition as a cause of defective mental development has been noted by several authors. However, in the present study, malnutrition could not be identified as a primary cause of mental retardation. In the congenital group, the high representation of Down's syundrome is striking. Children with this syndrome make up about 42.71% of the congenital group and 14% of the overall number of mentally retarded. The majority of mothers were over 35 and multiparous. The care of the mentally retarded child in Nigeria leaves much to be desired. Except for a few states, there are no homes or centers for the furthering of these handicapped children. Since the inception of the Pediatric Neurology Clinic in this hospital, efforts have focused on diagnosis and assessment. Some children aged 5-12 years have been referred to a privately-owned Therapeutic Day Center in Enugu for early furthering and play therapy.^ieng