A modified Bilirubin-induced neurologic dysfunction (BIND-M) algorithm is useful in evaluating severity of jaundice in a resource-limited setting.

BACKGROUND: Severe neonatal jaundice with associated acute bilirubin encephalopathy occurs frequently in low- and middle-income countries, where advanced diagnostic technology is in short supply. In an effort to facilitate the physical diagnosis of acute bilirubin encephalopathy, we pilot-tested a modified bilirubin induced neurologic dysfunction scoring algorithm in a group of pediatric trainees (residents) and their mentors (consultants) in a resource-constrained setting. METHODS: Jaundiced Nigerian infants were examined by consultant and resident pediatricians. The modified bilirubin induced neurologic dysfunction score assigned by residents was compared with the clinical diagnosis of acute bilirubin encephalopathy by expert consultants. Demographic information was obtained. Known risk factors were also evaluated among infants with and without acute bilirubin encephalopathy in addition to exploratory analyses. Data were analyzed by Statistical Analysis System; statistical significance was set at p < 0.05. RESULTS: Three hundred and thirty three paired modified bilirubin induced neurologic dysfunction scores (333) were analyzed and showed excellent agreement (weighted Kappa coefficient 0.7969) between residents and consultants. A modified bilirubin induced neurologic dysfunction score greater than or equal to 3 was highly predictive of a clinical diagnosis of acute bilirubin encephalopathy, with sensitivity of 90.7%, specificity of 97.7%, positive predictive value of 88.9%, and negative predictive value of 98.2%. Exposure to mentholated products was strongly associated with increased risk of acute bilirubin encephalopathy among those with known glucose-6-phosphate dehydrogenase deficiency (odds ratio = 73.94; 95% confidence interval = 5.425-infinity) as well as among those whose G6PD phenotype was unknown (odds ratio = 25.88; 95% confidence interval = 2.845-235.4). CONCLUSIONS: The modified bilirubin induced neurologic dysfunction score for neonatal jaundice can be assigned reliably by both residents and experienced pediatricians in resource-limited settings as reflected in the algorithm's sensitivity and specificity. It may be useful for predicting the development and severity of acute bilirubin encephalopathy in neonates.

Paediatricians' perspectives on global health priorities for newborn care in a developing country: a national survey from Nigeria.

BACKGROUND: An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. METHODS: Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with Mann-Whitney U test. RESULTS: Valid responses were received from 152 (65.8%) of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. CONCLUSIONS: Current global priorities for neonatal survival in Nigeria largely accord with paediatricians' views except for neonatal jaundice which is commonly subsumed under "other" or "miscellaneous" neonatal conditions. While the importance of these priority conditions extends beyond mortality thus suggesting the need for a broader conceptualisation of newborn health to reflect the current realities, paediatricians should be actively engaged in advancing the attainment of global priorities for child survival and health in this population.

Prevalence and impact of headache and migraine among secondary school students in Nigeria.

BACKGROUND: A cross-sectional descriptive study to determine the overall, age and gender specific prevalence, trigger factors and impact of headache and migraine on quality of life of students attending secondary schools in Benin City, Nigeria. METHODS: Six secondary schools were randomly selected from which students were randomly selected. A self-administered questionnaire was used to screen those with frequent headache, defined as at least 2 episodes of headache unrelated to fever or any underlying disease within the last 12 months or at least 1 episode in the last 6 months preceding the date questionnaire was administered. Another questionnaire based on the ICHD-2 criteria for diagnosis of migraine was then administered to those with frequent headaches. Data analysis was with SPSS 13.0 for Windows. RESULTS: One thousand six hundred and seventy-nine students aged 11-18 years were recruited. The overall prevalence of headache was 19.5%. The prevalence of migraine was 13.5%. Migraine was more common in girls than in boys at all ages. The most common trigger factors included emotional stress, sunlight or bright light, sleep deprivation, and hunger. Inability to participate in outdoor activities, household chores, and school absenteeism were the common impacts on the quality of life of among 76.8% of the migraineurs. CONCLUSION: Migraine is common and underdiagnosed among secondary school students in Benin City, Nigeria, and negatively impacts on the quality of life including school absenteeism.

Predictors of preterm births and low birthweight in an inner-city hospital in sub-Saharan Africa.

Adverse birth outcomes remain significant contributors to perinatal mortality as well as developmental disabilities worldwide but limited evidence exists in sub-Saharan Africa based on a conceptual framework incorporating neighborhood context. This study therefore set out to determine the prevalence and risk factors for preterm births and low birthweight in an urban setting from this region. A cross-sectional study of all live births from May 2005 to December 2007 in an inner-city maternity hospital in Lagos, Nigeria. Factors predictive of preterm births and low birthweight were determined by unconditional multivariable logistic regression within a conceptual framework for adverse birth outcomes. Population attributable risk (PAR%) for each factor was also determined. Of the 4,314 newborns enrolled, 859 (19.9%) were preterm and 440 (10.2%) were low birthweight. One-third of mothers received no antenatal care while about 6% had HIV and another 6% had a history of hypertensive disorders. About 43% of the low birthweight infants were born full term. Maternal predictors of preterm delivery and/or low birthweight were marital status, occupation, residential accommodation with shared sanitation facilities, lack of antenatal care, absence of previous cesarean section, hypertensive disorders and antepartum hemorrhage. Gender and intrauterine growth restriction (IUGR) were also predictive of low birthweight. Premature rupture of membranes (PAR = 33.91%) and antepartum hemorrhage (PAR = 33.54%) were the leading contributors to preterm birth in contrast to IUGR (PAR = 82.28%) and premature rupture of membranes (PAR = 32.31%) for low birthweight. [corrected] The burden of preterm and low birthweight deliveries in this setting is associated with modifiable individual and neighborhood-level risk factors that warrant community-oriented public health interventions.

Pattern of emergency neurologic morbidities in children.

Neurologic morbidities seen in the children's emergency facility of the University of Benin Teaching Hospital, Nigeria, over a five-year period (July 1996-June 2001) was evaluated to determine the pattern and outcome. Notes and ward records of patients with neurologic morbidities were retrieved. Data obtained from these sources include age, sex principal diagnosis, duration of stay and outcome. Six-hundred-four out of 3,868 patients (15.6%) had neurologic morbidity. Children five years of age and under were 466 (77.2%), and modal age group was 1-2 years. Febrile convulsion was the most common neurologic morbidity seen (35.1%) followed by cerebral malaria (28.0%) and then meningitis (27.0%). An increased incidence of cases occurred during the rainy season. Sixty-four out of 406 with complete records (15.8%) died. Forty-seven (67.2%) died within 24 hours of admission. Cerebral malaria and meningitis accounted for all the deaths. Preventable infectious diseases are the major causes of emergency neurologic morbidities and mortality. The majority die within 24 hours largely due to a delay in presentation to the hospital. Effective malaria control and prevention of meningitis would reduce the incidence of neurologic morbidities and, if this is coupled with health education of the populace on the importance of attending health facility early, mortality from these causes would be greatly reduced.

The prevalence of attention-deficit/hyperactivity disorder among school-aged children in Benin City, Nigeria.

OBJECTIVE: To establish the prevalence of ADHD among school-aged children in Benin City, Nigeria. METHOD: A total of one thousand, three hundred and eighty four (1384) primary school pupils, aged between six and 13 years, were recruited from six primary schools. Teacher's ratings of the 18 DSM-IV symptoms of ADHD were collected and analysed as a function of gender and subtype. RESULTS: The results support a documented trend in ADHD reports: males had a higher prevalence rate. The prevalence rate of 8.0% found is also consistent with documented evidence. Conclusion The results strengthen earlier observations that there is no significant geographical variation on the prevalence of ADHD if common definitions and diagnostic tools are employed. This study being the first from Nigeria provides data for crosscultural comparison as a prerequisite for establishing a common knowledge of ADHD.