Children and adolescents with type 1 diabetes mellitus in Nigeria: clinical characteristics and compliance with care.

OBJECTIVES: The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM. METHODS: This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria. RESULTS: The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007). CONCLUSIONS: The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.

Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology.

AIM: Paediatric gastroenterology remains an under-recognised sub-speciality in Africa. We determined the preferred sub-specialities among paediatric residents in Southwest Nigeria and what influenced whether they chose paediatric gastroenterology. METHODS: This was a cross-sectional survey of paediatric residents in seven teaching hospitals in Southwest Nigeria. A self-administered questionnaire was used to obtain information on their socio-demographics, educational attainment, choice of sub-speciality and the factors influencing that choice. RESULTS: Of 144 eligible paediatric residents, 124 (86.1%) completed the survey. Their mean age was 35.0 ± 1.7 years, and 83 (66.9%) were females. The majority (94.4%) had already chosen their sub-speciality, and nearly two-thirds (65.0%) made the decision during training. The most popular sub-speciality was neonatology (30.6%), and only three (2.4%) residents chose gastroenterology. Factors influencing the choice of sub-speciality were perceived ability (85.3%) and academic experience (83.8%). Financial reasons were less frequent (32.5%). Lack of diagnostic equipment (30.6%) and role models (21.0%) were the most frequent reasons for residents being disinterested in paediatric gastroenterology. CONCLUSION: Few residents were interested in paediatric gastroenterology and there is a need to encourage interest in this subject at an early stage in their training and provide more diagnostic equipment and greater mentorship.

Multi-Nutrient Fortified Dairy-Based Drink Reduces Anaemia without Observed Adverse Effects on Gut Microbiota in Anaemic Malnourished Nigerian Toddlers: A Randomised Dose-Response Study.

Prevalence of anaemia among Nigerian toddlers is reported to be high, and may cause significant morbidity, affects brain development and function, and results in weakness and fatigue. Although, iron fortification can reduce anaemia, yet the effect on gut microbiota is unclear. This open-label randomised study in anaemic malnourished Nigerian toddlers aimed to decrease anaemia without affecting pathogenic gut bacteria using a multi-nutrient fortified dairy-based drink. The test product was provided daily in different amounts (200, 400 or 600 mL, supplying 2.24, 4.48 and 6.72 mg of elemental iron, respectively) for 6 months. Haemoglobin, ferritin, and C-reactive protein concentrations were measured to determine anaemia, iron deficiency (ID) and iron deficiency anaemia (IDA) prevalence. Faecal samples were collected to analyse gut microbiota composition. All three dosages reduced anaemia prevalence, to 47%, 27% and 18%, respectively. ID and IDA prevalence was low and did not significantly decrease over time. Regarding gut microbiota, Enterobacteriaceae decreased over time without differences between groups, whereas Bifidobacteriaceae and pathogenic E. coli were not affected. In conclusion, the multi-nutrient fortified dairy-based drink reduced anaemia in a dose-dependent way, without stimulating intestinal potential pathogenic bacteria, and thus appears to be safe and effective in treating anaemia in Nigerian toddlers.

Co-existence of maternal overweight and obesity with childhood undernutrition in rural and urban communities of Lagos State, Nigeria.

BACKGROUND: The coexistence of over-nutrition and under-nutrition is emerging as a public health problem in many low and middle income countries. This study aimed at determining prevalence of coexisting maternal overweight and obesity with childhood stunting (MOCS) and the associated socio-demographic factors in rural and urban communities of Lagos State, Nigeria. METHODS: This was a cross sectional survey conducted using the multistage random sampling technique. A total of 300 mother-child pairs were studied, consisting of 150 each from rural and urban communities. Maternal overweight and obesity and undernutrition in children were determined using standard criteria. RESULTS: The prevalence of overweight and obesity among mothers was significantly higher in urban than rural areas (50.7% vs. 41.3%; p=0.022) while the prevalence of childhood stunting was significantly higher in rural than urban areas (43.3% 12.6%; p<0.001). Coexisting maternal overweight and obesity with childhood stunting was observed in 31 (10.3%) mother-child pair with a significantly higher prevalence in rural than urban areas (14.7% vs. 6.0%, p=0.014). In multivariate logistic regression, maternal short stature (OR 3.3, 95% CI=1.2-9.0, p=0.02) and living in rural area (OR 0.2, 95% CI=0.1-0.5, p=0.001) were the identified risk factors for coexisting maternal overweight and obesity with childhood stunting. CONCLUSION: The prevalence of coexisting MOCS is high especially in rural areas. Effort at reducing childhood malnutrition should focus on appropriate interventional measures aimed at improving maternal nutritional status.

First report of glycogen storage disease type 111a in a Nigerian child.

Glycogen storage disease (GSD) is a rare inborn error of metabolism with an incidence of 1/20,000-40,000 live births. Some of the presenting clinical features can mimic diseases commonly seen in the tropics and subtropics. We report a 14-month-old Nigerian child who presented at our institution with GSD Type 111a to alert physicians on the need to consider and recognise this rare disorder. The child presented with progressive abdominal swelling due to marked hepatomegaly. From the clinical history, the only clue to hypoglycaemia was that she eats very frequently. Her random blood sugar was normal; however, fasting blood sugar was low. The diagnosis was further entertained with laboratory results showing hypercholesterolaemia and uricaemia and confirmed by histology of biopsied liver tissue. GSD should be suspected in a child with unexplained hepatomegaly and investigated accordingly.

Nigerian sleep study found that children slept less and had more problems than children in other countries.

AIM: We studied sleep patterns, sleep problems and associated socio-demographic factors among children aged one year to 12 years in Lagos, Nigeria. METHODS: This prospective hospital-based study involved 432 children (55% males) who came for routine paediatric care at the Lagos State University Teaching Hospital. Information on socio-demographics, sleeping patterns and specific sleep disorders was obtained. RESULTS: The mean age of the subjects was 5.4 ± 3.3 years. Night sleep duration decreased significantly with age from 9.6 ± 1.3 hours at one to four years to 8.7 ± 1.0 hours at nine years to 12 years (p < 0.001). There was no significant gender difference in bedtimes (p = 0.057), rise times (p = 0.095) and night sleep duration (p = 0.191). Most (70%) napped during the day, and 26% of these did so on a regular basis. The most common sleep problems were enuresis (42%), afraid of sleeping alone (38%), snoring (28%) and sleep talking (24%). There was no significant association between sleep duration (p > 0.05), sleep problems (p > 0.05) and socio-demographic characteristics. Comparisons with other studies showed that the children had shorter sleep duration than peers in other countries and regions and a higher prevalence of sleep disorders. CONCLUSION: Children in Nigeria had shorter sleep duration and more sleep problems than children in other international studies.

Age of pubertal events among school girls in Lagos, Nigeria.

BACKGROUND: Globally, there is a secular trend towards the reduced age for sexual maturity and menarche. This study aimed to determine the current age and factors associated with attainment of various stages of puberty in Nigerian girls. METHODS: This study was a cross-sectional study involving 800 girls aged 6-15 years. The subjects were selected by stratified random sampling method from schools in Oshodi Local Government Area, Lagos State. They were interviewed and a physical examination was carried out to classify them into the various Tanner stages of breast and pubic hair maturational stages. RESULTS: The median age of girls at first stage of breast maturation (B2), first stage of pubic hair development (PH2) and at menarche were 9.0, 9.0 and 12.0 years, respectively. Breast development was significantly related to normal nutritional status (adjusted odds ratio [AOR] 4.5, p<0.001), overweight (AOR 40.2, p<0.001), obesity (AOR 154.2, p<0.001) and upper social class (AOR 15.7, p<0.031). Pubic hair development was significantly related only to overweight (AOR 4.7, p<0.007) and obesity (AOR 15.7, p<0.001) while achievement of menarche was significantly related to overweight (AOR 0.1, p=0.005), obesity (AOR 0.1, p=0.0009), high social class (AOR 4.7, p<0.001) and being a member of the Hausa tribe (AOR 35.8, p<0.029). CONCLUSIONS: There is decline in age of pubertal maturation of girls in Nigeria and the major contributory factors appear to be overweight and obesity. These findings are consistent with the pattern in developed countries.

Improving the management of acute diarrhoea and dehydration in under-5 children in a paediatric referral facility in Lagos, Nigeria.

BACKGROUND: Mortality from acute diarrhoea and dehydration (AD/D) in children is high despite existing management guidelines. AIM: The aim of this study was to identify deficiencies in the management of AD/D by health staff and assess changes in management after a training intervention in a paediatric referral facility in Lagos, Nigeria. METHODS: In a retrospective review of case notes, the management of AD/D was assessed using WHO guidelines as the standard. An e-learning module was developed that directly addressed deficiencies and was used to train health staff. Changes in the management of AD/D were assessed by re-auditing case notes. RESULTS: There were learning needs among health staff in the management of AD/D. Altogether, 34 (97.1%) of 35 residents were trained. Training resulted in modest improvements in the number of children in whom nutritional status was assessed, use of oral rather than intravenous fluids for rehydration and reducing unnecessary laboratory tests. Training resulted in marked improvements in the correct volume of (pre- vs. post-training 6.3% vs. 94.1%, P<0.001) and follow-up of fluid therapy (8.1% vs. 98.0%; P<0.001), prescription of zinc (41.6% vs. 85.1%, P<0.001) and providing advice on when to return after discharge (77.6% vs. 96.0%, P<0.001). Although statistically significant, the minimal improvements in antibiotic use (43.8% vs. 56.6%, P = 0.03), re-starting feeds (10.6% vs. 38.6%, P<0.001) and counselling about feeding (11.8% vs. 33.7%, P<0.001) highlighted areas for further training. CONCLUSIONS: In low-resource countries, clinical auditing and training can significantly improve the management of illnesses that contribute to child deaths and identify areas where further training is required.

Dietary practices and nutritional status of under-five children in rural and urban communities of Lagos State, Nigeria.

BACKGROUND: Evidence shows that urban children generally have a better nutritional status than their rural counterparts. However, data establishing whether this difference in prevalence of undernutrition could be ascribed to difference in dietary practices are few. OBJECTIVE: The aim of this study was to compare dietary practices and nutritional status of children in rural and urban communities of Lagos State, Nigeria. METHODS: This was a comparative-analytical study conducted using the multistage sampling technique to select the study cases. A total of 300 mother-child pairs were studied, including 150 each from rural and urban communities. Data collected include demographics, socioeconomic characteristics, feeding practices and anthropometric measurements of the participants. Food intake data were collected using 24-h dietary recall. Malnutrition in children was determined by calculating the prevalence of low height-for-age (stunting), low weight-for-age (underweight), and low weight-for-height (wasting) using the World Health Organization cutoff points. RESULTS: The prevalence of exclusive breastfeeding for 6 months (25.3% vs. 28.7%; P = 0.516), use of formula feeds (48.7% vs. 44%; P = 0.077), and mean age of child at introduction of semisolid foods (7.54 ± 4.0 months vs. 8.51 ± 7.3 months; P = 0.117) were not significantly different between urban and rural communities. The diversity of food choices and frequencies of consumption were similar between urban and rural communities. However, prevalence levels of underweight and stunted children were significantly higher in rural than that of urban communities (19.4% vs. 9.3%, P < 0.001 and 43.3% vs. 12.6%, P < 0.001, respectively). CONCLUSIONS: Other risk factors besides inappropriate feeding practices need to be considered for higher prevalence of undernutrition among children in rural communities.

Breastfeeding policy and practices at the general paediatric outpatient clinic of a teaching hospital in Lagos, Nigeria.

BACKGROUND: Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria. METHODS: This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding. RESULTS: Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months. CONCLUSION: Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding.

Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria.

BACKGROUND: Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. METHODS: The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination). RESULTS: Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs. CONCLUSION: There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.

Helicobacter pylori associated with breastfeeding, nutritional status and recurrent abdominal pain in healthy Nigerian children.

INTRODUCTION: There is limited knowledge about the associations of Helicobacter pylori (H. pylori) infections in developing countries. This study aimed to determine the current prevalence and associations of H. pylori infection with breastfeeding practices, nutritional status, and recurrent abdominal pain (RAP) in a group of apparently healthy children and adolescents in Lagos, Nigeria. METHODOLOGY: This was a prospective hospital-based study conducted at the Lagos State University Teaching Hospital that involved 118 children who came to the hospital for routine pediatric care. Seroprevalence status of the children was determined by measuring immunoglobulin G antibodies against H. pylori using enzyme-linked immunosorbent assay (ELISA). RESULTS: Seventy-five (63.6%) children were seropositive for H. pylori. The prevalence of H. pylori infection increased significantly from 40.4% in children less than five years of age to 85.1% at six to ten years of age (χ(2) = 20.9, p < 0.001). H. pylori infection was associated with low social class (OR = 3.24; 95% CI = 1.20-8.23, p = 0.016) and with RAP (OR = 3.47; 95% CI = 1.55-7.79, p = 0.002), but no association was observed with exclusive breastfeeding, duration of breastfeeding, and under-nutrition. CONCLUSIONS: The prevalence of H. pylori infection is high, particularly among children from low socioeconomic backgrounds in Lagos, Nigeria. It is associated with RAP. The effect of this infection on children's health requires further studies.

Herbal medicines supplied by community pharmacies in Lagos, Nigeria: pharmacists' knowledge.

BACKGROUND: The use of herbal medicines is on the increase globally and they are usually supplied in pharmacies as non-prescription medicines. Pharmacists are, therefore, responsible for educating and informing the consumers about rational use of herbal medicines. OBJECTIVE: To evaluate the knowledge of pharmacists in Lagos, Nigeria with regards to the herbal medicines they supplied by their pharmacies. METHODS: Pharmacists in charge of randomly selected 140 community pharmacies from 20 Local Government Areas in Lagos were required to fill out a self-administered questionnaire. We gathered information on their knowledge of the indications, adverse effects, potential drug-herb interactions and contraindications of the herbal medicines they supply in their pharmacies. RESULTS: Of the 140 questionnaires distributed, 103 (72.9%) participants completed the questionnaire appropriately. The majority (74; 71.8%) of the participants were males and 36-50 years (56; 54.4%). The pharmacies supplied mostly Yoyo cleanser bitters® (101; 98.5%), ginseng (97; 98.5%), Jobelyn® (91; 88.3%), Ciklavit® (68; 66.6%), gingko (66; 64.1%), herbal tea (66; 64.1%), and Aloe vera (57; 55.3%). The pharmacists self-rated their knowledge of herbal medicines mostly as fair (39%) and good (42%), but they exhibited poor knowledge with regards to the indications, contraindications and safety profiles. Seventy participants consulted reference materials such as leaflet insert in the herbal medicines (56%) and internet (20%) before supplying herbal medicines. The information most frequently sought was herb-drug interactions (85%), contraindications (75%) and adverse effects (70%). CONCLUSIONS: Community pharmacists need to be informed about the indications and safety profiles of herbal medicines.

Herbal medicines supplied by community pharmacies in Lagos, Nigeria: pharmacists’ knowledge / Plantas medicinales suministradas por farmacias comunitarias en Lagos, Nigeria: conocimiento de los farmacéuticos

Background: The use of herbal medicines is on the increase globally and they are usually supplied in pharmacies as non-prescription medicines. Pharmacists are, therefore, responsible for educating and informing the consumers about rational use of herbal medicines. Objectives: To evaluate the knowledge of pharmacists in Lagos, Nigeria with regards to the herbal medicines they supplied by their pharmacies. Methods: Pharmacists in charge of randomly selected 140 community pharmacies from 20 Local Government Areas in Lagos were required to fill out a self-administered questionnaire. We gathered information on their knowledge of the indications, adverse effects, potential drug-herb interactions and contraindications of the herbal medicines they supply in their pharmacies. Results: Of the 140 questionnaires distributed, 103 (72.9%) participants completed the questionnaire appropriately. The majority (74; 71.8%) of the participants were males and 36-50 years (56; 54.4%). The pharmacies supplied mostly Yoyo cleanser bitters® (101; 98.5%), ginseng (97; 98.5%), Jobelyn® (91; 88.3%), Ciklavit® (68; 66.6%), gingko (66; 64.1%), herbal tea (66; 64.1%), and Aloe vera (57; 55.3%). The pharmacists selfrated their knowledge of herbal medicines mostly as fair (39%) and good (42%), but they exhibited poor knowledge with regards to the indications, contraindications and safety profiles. Seventy participants consulted reference materials such as leaflet insert in the herbal medicines (56%) and internet (20%) before supplying herbal medicines. The information most frequently sought was herbdrug interactions (85%), contraindications (75%) and adverse effects (70%). Conclusions: Community pharmacists need to be informed about the indications and safety profiles of herbal medicines (AU)

Antecedentes: El uso de plantas medicinales está en aumento en todo el mundo y son vendidas en farmacias comunitarias como medicamentos sin receta. Los farmacéuticos son, por tanto, responsables de educar e informar a los consumidores sobre el uso racional de las plantas medicinales. Objetivos: Evaluar el conocimiento de los farmacéuticos de Lagos, Nigeria sobre las plantas medicinales suministradas en sus farmacias. Métodos: Se pidió a los farmacéuticos encargados de 140 farmacias comunitarias aleatoriamente seleccionadas en las 20 áreas de Gobiernos locales de Lagos que rellenasen un cuestionario autoadministrado. Recogimos información sobre su conocimiento de las indicaciones, efectos adversos, potenciales interacciones planta-medicamento y contraindicaciones de las plantas medicinales que suministraban en sus farmacias. Resultados: De los 140 cuestionarios distribuidos, 103 participantes (72,9%) lo completaron adecuadamente. La mayoría (74; 71,8%) de los participantes eran hombres y tenían entre 36-50 años (56; 54,4%). Las farmacias suministraban en su mayoría Yoyo cleanser bitters® (101; 98,5%), ginseng (97; 98,5%), Jobelyn® (91; 88,3%), Ciklavit® (68; 66,6%), gingko (66; 64,1%), herbal tea (66; 64,1%), and Aloe vera (57; 55,3%). Los farmacéuticos auto-calificaron su conocimiento sobre plantas medicinales mayoritariamente como escaso (39%) y bueno (42%), pero demostraron poco conocimiento en relación a las indicaciones, contraindicaciones y perfiles de seguridad. 70 participantes consultaban materiales de referencia como los prospectos (56%) e Internet (20%) antes de suministrar una planta medicinal. La información vista más frecuentemente fueron las interacciones planta-medicamento (85%), contraindicaciones (75%) y efectos adversos (70%). Conclusiones: Los farmacéuticos comunitarios necesitan más información sobre indicaciones y perfiles de seguridad de las plantas medicinales (AU)

Maternal and child under-nutrition in rural and urban communities of Lagos state, Nigeria: the relationship and risk factors.

BACKGROUND: Poor nutritional status of mothers has a direct and indirect consequence on their own health and that of their children. The objective of this study was to determine the relationship between nutritional status of mothers and their children and the risk factors for under-nutrition among mothers and children in rural and urban communities of Lagos State, Nigeria. METHODS: This was a cross sectional survey conducted using the multistage random sampling technique. A total of 300 mother-child pairs were studied, consisting of 150 each from rural and urban communities. Under-nutrition in mothers and children was determined using standard criteria. RESULTS: The prevalence of under-nutrition among mothers was significantly higher in rural than urban communities (10.7% vs. 2.7%, p = 0.014). The prevalences of underweight and stunted children were also significantly higher in rural than urban communities (19.4% vs. 9.3%, p < 0.001) and (43.3% vs. 12.6%, p < 0.001) respectively. In rural communities, the risk of stunted mothers having children with stunting was about 7 times higher than those who were not (OR 6.7, 95% CI = 1.4-32.0, p = 0.007). In urban communities, undernourished mothers have about 11 and 12 times risk of having children with underweight and wasting respectively (OR 11.2, 95% CI = 1.4-86.5, p = 0.005) and (OR 12.3, 95% CI = 1.6-95.7, p = 0.003) respectively. The identified risk factors for maternal and child under nutrition differs across rural and urban communities. CONCLUSIONS: The prevalence of maternal and child under-nutrition is high in both communities although higher in rural communities. Efforts at reducing the vicious cycle of under-nutrition among mothers and children should concentrate on addressing risk factors specific for each community.

Clinically significant interactions between antiretroviral and co-prescribed drugs for HIV-infected children: profiling and comparison of two drug databases.

BACKGROUND: Drug-drug interactions are an important therapeutic challenge among human immunodeficiency virus-infected patients. Early recognition of drug-drug interactions is important, but conflicts do exist among drug compendia on drug interaction information. We aimed to evaluate the consistencies of two drug information resources with regards to the severity rating and categorization of the potential interactions between antiretroviral and co-prescribed drugs. METHODS: We reviewed the case files of human immunodeficiency virus-infected children who were receiving treatment at the human immunodeficiency virus (HIV) clinic of the Lagos University Teaching Hospital, Idi Araba, between January 2005 and December 2010. All of the co-prescribed and antiretroviral drug pairs were screened for potential interactions using the Medscape Drug Interaction Checker and the Monthly Index of Medical Specialties Interaction Checker. Drug-drug interaction (DDI) severity and categorization were rated on a scale of A (no known interaction); B (minor/no action needed); C (moderate/monitor therapy); D (major/therapy modification); and X (contraindicated/avoid combination). RESULTS: A total of 280 patients were at risk of 596 potential DDIs. The databases showed discrepancies, with Medscape database identifying 504 (84.6%) and USA MIMS database identifying 302 (50.7%) potential DDIs. Simultaneous identification of DDIs by both databases occurred for only 275 (46.1%) listed interactions. Both databases have a weak correlation on the severity rating (rs = 0.45; P < 0.001). The most common DDIs identified by the databases were nevirapine and artemisinin-based combination therapy (170; 28.5%), nevirapine and fluconazole (58; 9.7%), and zidovudine and fluconazole (55; 9.2%). There were 272 (45.6%) interaction severity agreements between the databases. CONCLUSION: Discrepancies occurred in DDI listings between Medscape and USA MIMS databases. Health care professionals may need to consult more than one DDI information database to ensure safe concomitant prescribing for HIV patients.

Body fat distribution of children and adolescents in Abeokuta, Southwest Nigeria.

Excessive central fat in children and adolescents is a risk factor for cardiovascular and metabolic disorders. This study aimed to compare the body fat distribution patterns of children and adolescents in Abeokuta, Nigeria with international reference standards. Five hundred seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, triceps and subscapular skinfold thickness (TSF, SSF), and circumference at the waist and hips (WC, HC) were measured. Body mass index (BMI), subscapular:triceps skinfold ratio (STR), waist:hip circumference ratio (WHR), and waist: height ratio (WHtR) were derived. Females had higher mean BMI, TSF, SSF, WC, HC, WHR, and WHtR, while males had significantly higher STR. The mean BMI, WC, TSF, and SSF values were lower for our subjects than for African-American subjects at all ages. On the other hand, in both sexes, STR was higher among Nigerian than African-American subjects up to 12 years old. Thereafter the values were similar. The mean WC was similar to those reported for African-American males up to 8 years, and females up to 7 years of age; thereafter, African-American had higher values. The prevalence of central obesity using WC and WHtR measures was 4.4% and 5.8%, respectively. There is a need to validate each index against serum lipid profiles and other cardiovascular and metabolic risk factors.

Ulcerative colitis in a Nigerian girl: a case report.

BACKGROUND: Ulcerative colitis (UC) is uncommon in the tropics and sub-tropics. We report a case of UC in a 7 year old girl whose parents were both Nigerians. This report is to alert healthcare professionals in sub-Saharan Africa that UC is not a rare health problem, especially in children. CASE PRESENTATION: The patient presented with frequent passage of blood stained stool, abdominal pain and significant weight loss. The diagnosis was entertained after she was investigated for common causes of chronic diarrhea in our setting and the findings were negative. The patient symptoms abated after she was commenced on steroid therapy. CONCLUSION: Under-diagnosis and misdiagnosis may account for a dearth of information on UC in African children.

Prevalence of and risk factors for stunting among school children and adolescents in Abeokuta, southwest Nigeria.

Stunting adversely affects the physical and mental outcome of children. The objectives of the study were to determine the prevalence of and risk factors associated with stunting among urban school children and adolescents in Abeokuta, Nigeria. Five hundred and seventy children aged 5-19 years were selected using the multi-stage random-sampling technique. Stunting was defined as height-for-age z-score (HAZ) of < -2 standard deviation (SD) of the National Center for Health Statistics reference. Severe stunting was defined as HAZ of < -3 SD. The mean age of the children was 12.2 + 3.41 years, and 296 (51.5%) were males. Ninety-nine (17.4%) children were stunted. Of the stunted children, 20 (22.2%) were severely stunted. Identified risk factors associated with stunting were attendance of public schools (p < 0.001), polygamous family setting (p = 0.001), low maternal education (p = 0.001), and low social class (p = 0.034). Following multivariate analysis with logistic regression, low maternal education (odds ratio = 2.4; 95% confidence interval 1.20-4.9; p = 0.015) was the major contributory factor to stunting. Encouraging female education may improve healthcare-seeking behaviour and the use of health services and ultimately reduce stunting and its consequences.

Determinants of insecticide treated nets use among youth corp members in Edo State, Nigeria.

BACKGROUND: The Africa Malaria Report shows that many countries are quite far from reaching the universal coverage targets of 80% coverage by 2010 and maintain it at this level. This paper examines ITN use and the factors associated with its adoption among the youths in Nigeria. This information will help in the design of effective methods of providing and distributing the nets in order to enhance its adoption and maximize the public health benefits of ITNs. METHODS: This cross-sectional survey was carried out in 2006 among university leavers serving compulsory national service (youth corpers) using total sampling technique. The study was conducted using a self-administered questionnaire. RESULTS: A total of 656 youth corp members were interviewed. Only 23.8% of these youths ever use ITN while 4.3% currently use ITN before reporting in camp. A significant proportion of the youths acquired information on ITN from Mass Media (p = 0.0001). Other statistically significant factors that encourage the use of ITN include inexpensive market price of ITN (p = 0.0001), frequency of Malaria infestation (p = 0.019) and perceived malaria preventive action of ITN ( p = 0.000).Following logistic regression analysis, perceived effective malaria preventive action of ITN [OR = 29.3, C.I = 17.17-50.0] and high frequency of Malaria infestation [OR = 1.55, C.I = 0.97-2.47] were predictors of ITN use. CONCLUSION: The study shows that the use of ITN for the prevention of Malaria is low among these Nigerian youths. The major factors determining the adoption of ITN among the youths were perceived effective Malaria prevention action of ITN and high frequency of Malaria attack. These factors should be considered in the design of sustainable and effective locally relevant strategies for scale-up adoption of ITNs among a youthful African population.