Impact of atopic dermatitis on the quality of life of Nigerian children: a hospital-based cross-sectional study

Background. Atopic dermatitis (AD) is the most common inflammatory skin disease in childhood. A skin disorder with a relapsing course,AD exerts a significant disease burden on affected children. However, there is a dearth of knowledge about the impact of AD on the quality of life (QOL) of affected children in Nigeria.Objectives. To examine the impact of AD on QOL in children of various age groups, and to identify the relationship between patient variables (age, gender, socioeconomic status), disease severity and QOL in AD.Method. This was a cross-sectional descriptive study of children with AD attending the dermatology clinic of Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. AD cases were recruited from new paediatric patients ≤16 years who attended the clinic over a 6-month period. English and Yoruba versions of the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI) were used to determine the QOL of the subjects. AD severity was evaluated using the Objective SCORing ofAtopic Dermatitis (obj-SCORAD) index.Results. Forty-seven subjects with AD were identified. Their ages ranged from newborn to 16 years. The median(interquartile range (IQR))IDQOL score was 6.0 (3.0 - 15.5; n=25), and the median (IQR) CDLQI score was 9.5 (7.75 - 17.75; n=22). The mean (standard deviation)obj-SCORAD score was 34.4 (17.2). The question on itching was the highest-scoring question in both QOL questionnaires. There was no significant difference in QOL across age, gender and socioeconomic status groups. However, greater QOL scores were significantly correlated with higher AD severity scores.Conclusion. The study confirms that AD impairs the QOL of affected children in all age groups. QOL assessments are relevant tools which provide a patient's perspective, thus improving the understanding of the impact of AD on afflicted individuals

Clinical presentation of congenital malaria at the Lagos University Teaching Hospital.

BACKGROUND: Congenital malaria has been increasingly documented in endemic regions. It is important to recognize those clinical features that are due to congenital malaria, which if undetected, might worsen the morbidity of the newborn. The aim of this study was to document the clinical presentation of neonates with congenital malaria born at the Lagos University Teaching Hospital and followed up for 28 days. METHODS: A total of 100 consecutive mothers and their newborns were recruited between August and October 2002 (during the rainy season) from the labour ward and followed up from birth to 28 days of age. Blood films from the placentae and babies were stained with Giemsa stain within 24 hours of collection. All parasitaemic babies that became symptomatic were screened for sepsis using acute phase responses and cultures. All data were entered into a prepared proforma. Symptoms were attributed to malaria when sepsis screening was negative. RESULTS: Congenital malaria was documented in 13.6% of babies at delivery. Jaundice, irritability and poor feeding were most common symptoms associated with congenital malaria. Irritability and poor feeding had positive predictive values (PPV) of 100% on Day 14. CONCLUSION: Babies who present with poor feeding and irritability on Day 14 of life should be screened for malaria in addition to the routine investigations for neonatal sepsis.

Plasma magnesium and calcium levels in children with epilepsy in lagos.

BACKGROUND: Magnesium and calcium have been found to have increasing roles in the patho-physiology of epilepsy. Hypomagnesaemia and hypocalcaemia cause hyper-exitability of neurons and have been associated strongly with seizures in adults and children. OBJECTIVES: To determine if hypomagnesaemia or hypocalcaemia is present in Nigerian children with epilepsy and to determine the relationship between serum magnesium and calcium levels and frequency and control of epilepsy. DESIGN: A prospective case control study at the Lagos University Teaching Hospital. PATIENTS AND METHODS: 45 children with epilepsy and 45 controls were recruited from the paediatric neurology unit of the Lagos University Teaching Hospital. Serum magnesium and calcium were measured by spectrophotometric methods. RESULTS: Serum magnesium and calcium was significantly lower in the patients compared to the controls; Magnesium - 0.98 (0.0005) Vs 1.2 (0.04) mmol/L, p< 0.0001 and Calcium - 2.29 (0.04) Vs 2.3 (0.02) mmol/L, p<0.05 respectively. No significant differences were noted in the plasma phosphorus and albumin concentrations. CONCLUSION: Magnesium and calcium levels are lower in the epileptic children compared to the controls during the seizure-free periods. More studies are needed to evaluate these electrolytes during seizures and the effect of the different anticonvulsant drugs on these electrolytes.

Regional versus general anaesthesia for caesarean section.

BACKGROUND: Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious. OBJECTIVES: To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for inclusion, data extraction and trial quality. MAIN RESULTS: Sixteen studies (1586 women) were included in this review. Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD -126.98 millilitres, 95% CI -225.06 to -28.90, two trials, 256 women) and (WMD -84.79 millilitres, 95% CI -126.96 to -42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women). No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen. AUTHORS' CONCLUSIONS: There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.

Communication disorders in Nigerian children.

BACKGROUND/AIM: Communication disorders have been acknowledged as a major public health issue because they compromise early childhood development, restrict vocational attainment and undermine the economic well being of the society. The aim of this study is to determine the pattern of communication disorders among children in a developing country and the requisite intervention services. MATERIALS AND METHODS: This prospective study was conducted in Lagos University Teaching Hospital, Lagos between January 2002 and June 2003 among children aged 6 months to 15 years that presented in the audiology clinic of the hospital with communication disorders. All the patients had neurological, otolaryngological, audiological and speech evaluations. RESULTS: A total of 184 patients were seen during the period out of whom 136 (74%) were between the ages of 6-47 months. Hearing impairment was documented in 120 (65.2%) children, speech disorders in 56 (30.4%), rhinolalia 2.2% and stuttering 2.2%. Of those with hearing impairment, 70% had delayed speech and language. Among children with speech disorders 78.6% had specific language impairment (SLI). Aetiological factors recorded for the communication disorders were seizures 10.9%, measles 8.7% meningitis 8.7%, birth asphyxia 6.5%, otitis media with effusion (OME) 4.3%, kernicterus 4.3%, congenital deformity 4.3%, ototoxicity 2.2%, cerebral palsy 2.2%, and undetermined causes 47.9%. CONCLUSION: Hearing impairment is the commonest communication disorder. Early detection and appropriate follow up is recommended for all children in their first year of life. The role of parents and caregivers in seeking early help should be strengthened while capacity building for the training of more audiologists and speech therapists should be pursued rapidly.

Congenital malaria among inborn babies at a tertiary centre in Lagos, Nigeria.

Congenital malaria is increasingly reported among babies born to mothers continually residing in endemic areas. Given the high morbidity and mortality associated with malaria it is pertinent to determine its current status among newborns in Lagos, Nigeria. The aim was to determine the incidence of congenital malaria in newborn babies delivered at the Lagos University Teaching Hospital and also to determine the frequency of parasitaemia in their mothers and placentae. A cross-sectional study of mothers attending the antenatal clinic of the Lagos University Teaching Hospital was done. The Sociodemographic and clinical characteristics of mothers were documented. Samples of maternal, placental, cord and neonatal blood were taken and stained with Giemsa and examined for malaria parasites. Neonatal samples were examined at birth, on days 3, 7, 14 and 28. One hundred mothers and their placentae, as well as 104 babies and their cord blood were studied. The incidence of congenital malaria was 16/104 (15.3%) and parasite counts ranged from 47 to 1019/mul. Plasmodium falciparum was the predominant species. There was a strong association between placental, maternal, cord and neonatal parasitaemia. All the babies with congenital malaria had infected mothers, placentae and cords (p < 0.0001). In conclusion congenital malaria is not uncommon in Lagos nowadays, and there are relatively high rates of maternal, placental and cord blood parasitaemia. It is, therefore, recommended that babies born to mothers with malaria should be screened for congenital malaria.

Clinical evaluation of extract of Cajanus cajan (Ciklavit) in sickle cell anaemia.

The major pathology in sickle cell anaemia (SCA) is sickling of red cells due to the precipitation of reduced haemoglobin. We report our experience with extract of Cajanus cajan as a possible antisickling agent by determining changes, if any, in clinical and laboratory features of the disease in patients given the extract in a single-blind placebo-controlled study. One hundred patients with steady-state SCA were randomized into treatment and placebo arms. The extract/placebo were administered twice daily to the subjects. Weight, hepatosplenomegaly, blood levels of biliurubin, urea, creatinine, and packed cell volume (PCV) were monitored over a 6-month period. Recall episodes of pain 6 months before enrolment were compared with episodes of pains recorded during the treatment period. Twenty-six cases (55.3 per cent) had hepatomegaly on enrolment. This significantly reduced to 33.3 per cent at 6 months (p = 0.03); but increased in the placebo arm (p > 0.05). The total number of recall painful episodes in cases was 207 (mean 4.4 +/- 10.3 (SD), range 0-60) and fell to 191 (mean 4.2 +/- 4.4 (SD), range 0-16); p = 0.03. Episodes of pain increased from 109 in controls (mean 2.6 +/- 5.0 (SD), range 0-26) to 164 (mean 3.9 +/- 4.3 (SD), range 0-22); p = 0.01. Mean PCV in the cases showed no appreciable changes (p = 0.1) but there was a significant increase in the controls (p = 0.02). In conclusion, the extract may cause a reduction of painful crises and may ameliorate the adverse effects of sickle cell anaemia on the liver. The mechanism of action remains to be determined.

Diazepam for treating tetanus.

BACKGROUND: Clinical management of the muscle spasms and rigidity of tetanus poses a difficult therapeutic problem to physicians everywhere, especially in resource poor countries. There are wide variations in therapeutic regimens commonly used in clinical practice due to uncertainties about effectiveness of conventional drugs. Diazepam compared to other drugs (eg phenobarbitone and chlorpromazine) may have advantages because of combined anticonvulsant, muscle relaxant, sedative and anxiolytic effects. OBJECTIVES: To compare diazepam to other drugs in treating the muscle spasms and rigidity of tetanus in children and adults. SEARCH STRATEGY: We searched the Cochrane Neonatal Group trials register (October 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2003), MEDLINE (1966 to October 2003), EMBASE (1980 to October 2003), LILACS (2003), CINAHL (October 2003), Science Citation Index, African Index Medicus, conference abstracts and reference lists of articles. We contacted researchers, experts and organizations working in the field and used personal communication. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials. DATA COLLECTION AND ANALYSIS: We independently identified eligible trials, assessed trial methodological quality and extracted data. MAIN RESULTS: Two studies met the inclusion criteria. Method of generation of allocation sequence, concealment of allocation and blinding were unclear in both studies. A total of 134 children were allocated to three treatment groups comprising diazepam alone, phenobarbitone and chlorpromazine, or phenobarbitone and chlorpromazine and diazepam.Meta-analysis of in-hospital deaths indicates that children treated with diazepam alone had a better chance of survival than those treated with combination of phenobarbitone and chlorpromazine (Relative Risk for death 0.36; 95% confidence interval 0.15 to 0.86; Risk Difference -0.22; 95% CI -0.38 to -0.06). Giving diazepam alone, or supplementing conventional anticonvulsants (phenobarbitone and chlorpromazine) with diazepam, was reported in one study to be associated with a statistically significantly milder clinical course and shorter duration of hospitalization. REVIEWER'S CONCLUSIONS: Although there is evidence that diazepam alone compared with combination of phenobarbitone and chlorpromazine is more effective in treating tetanus, the small size, methodological limitations and lack of data on drug safety from available trials preclude definite conclusions to support change in current clinical practice. The application of the present evidence should be moderated by local needs and circumstances, pending the availability of more evidence. We recommend a large multicenter, randomized controlled trial which compares diazepam alone with combinations of other drugs (excluding diazepam).

Management of children with cerebral malaria in Lagos - a medical audit.

UNLABELLED: Cerebral malaria, one of the severe forms of malaria, carries a very high fatality rate even when managed in the best of centres. This underpins the need for a medical audit to review patient management steps or procedures to improve the standard of patient care of children with cerebral malaria in the Lagos University Teaching Hospital. METHODS: A retrospective audit of records of children with cerebral malaria who presented in the emergency room of the Lagos University Teaching Hospital in the last five years. Relevant clinical and patient management information of survivors were extracted from the records and analysed. RESULTS: The records show that critical information useful in the management of these children was lacking in 50 - 60% of the records reviewed. The appropriate anti-malarial drug (intravenous quinine) in adequate doses was used in 54(94.7% ) of cases. A total of 12 patients (21.1% ) still had either mannitol or dexamethasone given to them. Blood transfusion was ordered in 60% of the children despite severe anaemia being present in only 30% of them. CONCLUSION: This study highlights the sub-optimal level of knowledge and practice among doctors and the need for retraining of medical staff in maintaining proper records. The authors recommend the use of patient management guidelines.