Alphonsus N. Onyiriuka

Weight status and eating habits of adolescent Nigerian urban secondary school girls

Background. Obesity in adolescence is common, and eating habits are a key determinant. Eating habits in adolescence often differ substantially from those in any other phase of life. Objective. To assess the weight status and eating habits of adolescent urban secondary school girls in Benin City, Nigeria. Methods. In this school-based cross-sectional study, data were obtained on the subjects’ eating habits via a structured anonymous self-administered questionnaire, while their weights and heights were obtained by direct measurements. The body mass index (BMI), calculated as weight/height (kg/m 2 ), was used in assessing the weight status of the participants. The study sample was 2 097 adolescent urban public school girls, aged 12 - 19 years. Information was obtained on frequencies of skipping meals, reasons for skipping meals and food choices, as well as the socio-demographic characteristics of the participants. All the students at the two study schools were invited to participate. Results. The mean age of the participants (± standard deviation) was 14.8±1.9 years (95% confidence interval (CI) 14.7 - 14.9). Slightly over half (52.6%) were from families of middle socio-economic status, and 84.7% of them lived with their parents. Of the 2 097 participants, 1 009 (48.1%) admitted to skipping at least one meal a fortnight. Of the three main meals, breakfast was the most frequently skipped (46.3%) and dinner the least frequently skipped (21.5%). With regard to age, the frequency of skipping meals was 30.1%, 50.4% and 58.5% among participants aged <14 years, 14 - 16 years and ≥17 years, respectively ( p <0.001). The two leading reasons cited by participants for skipping breakfast were lack of appetite and time. Only 15.2% of the participants reported daily consumption of fruits and vegetables. Over half of the participants (60.2%) ate fast food at least once a week, with more than three-quarters of them (76.4%) consuming fast food along with soft drinks. The prevalences of both overweight (24.5% v. 13.2%) and obesity (2.5% v. 1.1%) were higher among girls who skipped meals compared with their peers who did not skip meals (odds ratio 0.4, 95% CI 0.32 - 0.50). Conclusion. Meal skipping was associated with an increased prevalence of overweight and obesity among adolescent schoolgirls.

Anthropometry and menarcheal status of adolescent nigerian urban senior secondary school girls.

Background Age at menarche is a significant indicator of growth and sexual maturation in girls. During adolescence, anthropometry provides a tool for monitoring and evaluating the hormone-mediated changes in growth and reproductive maturation. Objectives We aimed to examine the anthropometric status of pre- and post-menarcheal Nigerian adolescent girls attending senior secondary schools. Materials and Methods In this school-based cross-sectional survey, a pre-tested structured self-administered questionnaire was set for obtaining the socio-demographic data (age at menarche, number of siblings, occupation and educational attainment of their parents, etc.), while the anthropometric status data was obtained by direct measurement of weight and height. The body mass index (BMI) and the ponderal index (PI) of each participant were computed from their respective weight and height values. The study was designed to include all the students in the two schools that were randomly selected. The anthropometric indices of pre- and post-menarcheal girls were compared. Results Out of a total population of 2,166 students, 2,159 (99.7%) participated but 9 questionnaires were incompletely filled and were rejected, leaving 2,150 (510 were pre-menarcheal and 1,640 were post- menarcheal) for further analysis. The mean menarcheal age was 13.44 ± 1.32 years (95% Confidence Interval (CI) = 13.38-13.5). Girls from families with high socio-economic status (SES) attained menarche 8.0 and 9.0 months earlier than their counterparts from families with middle and low SES respectively. Girls from small-size families had a significantly lower menarcheal age than their counterparts from large-size families. A comparison of the anthropometric indices of pre- and post-menarcheal girls showed: weight, 41.1 ± 6.3 kg (95% CI = 40.6-41.6) vs 47.6 ± 7.2 kg (95% CI = 47.3-47.9), P < 0.001; height, 146.2± 5.5 cm (95% CI = 145.7-146.7) vs 153.6 ± 9.9 cm (95% CI = 153.1-154.1), P < 0.001; BMI, 16.4 ± 1.9 (95% CI = 16.2-16.6) vs 18.8 ± 1.6 (95% CI = 18.7-18.9), P < 0.001; and PI, 45.1 ± 1.7 (95% CI = 45.0-45.2) vs 44.6 ± 1.4 (95% CI = 44.5-44.7), P < 0.01. Conclusions Post-menarcheal girls were significantly taller and heavier with a higher BMI than their pre-menarcheal counterparts, but the pre-menarcheal girls possessed a better linear body as reflected by the PI.

Intrapair birthweight discordance in twins

BACKGROUND Birthweight differences in twin pairs influence their perinatal outcome as well as growth and development. Growth-discordant twins have not been well characterized in our local environment. OBJECTIVE To determine the frequency of birthweight discordance in live-born twin pairs and document some factors that may influence it. METHODS In this cross-sectional study, 104 live-born twin pairs were recruited and their intrapair birthweight differences were determined. Twin pairs whose birthweight difference was 15% or more, using the larger infant as the growth standard, were designated as discordant. The maternal age, parity, and birth order of the heavier twin were noted. RESULTS The prevalence of birthweight discordance was 28.8% when a 15% cut-off point was used but dropped to 9.6% when a 25% cut-off point was applied. Grand multiparity was associated with a significantly increased risk of delivery of discordant twins. Same-sex twin pairs accounted for 60% of all cases of birthweight discordance. CONCLUSION Birthweight discordance is common in twin gestations in Benin City, especially among grand multiparous women.

Serum zinc level in Nigerian children with febrile convulsion

Febrile convulsion is one of the most common childhood neurological disorders. The underlying mechanism remains unclear; however, some reports have suggested that low serum zinc levels may be implicated in its pathogenesis. This case-control study was carried out to determine the serum zinc levels in Nigerian children with febrile convulsions in comparison with matched febrile controls without convulsions. Ninety children with febrile convulsions and 90 matched febrile children without convulsions were recruited. Serum zinc was measured using Atomic absorption spectrophotometer (Perkin-Elmer 306 USA). The data was analyzed with SPSS version 16 statistical package and student t-test was employed to compare mean serum zinc between the two groups. The mean serum zinc level of children with febrile convulsion (58.7 ± 25.4 µg/dL) was signifi- cantly lower than that of febrile controls (90.3 ± 33.0 µg/dL), (P < 0.0001). Hypozincemia may indeed play a role in the oc- currence of febrile convulsion.

Physical activity, body mass index and blood pressure in primary school pupils attending private schools

BACKGROUND Lack of physical activity contributes to overweight and obesity. It is recommended that children accumulate at least one hour of moderate to vigorous intensity physical activity daily. OBJECTIVE The level of physical activity, body mass index (BMI) and blood pressure (BP) were evaluated in pupils attending private primary schools. METHOD The intensity and duration of physical activity of the pupils selected by multiple stage sampling method were obtained with the aid of a questionnaire. The BMI and BP were measured. Analysis was by SPSS. RESULTS Of the 353 pupils, 132(37.4%) pupils were adequately physically active while overweight and obesity prevalences were 54(15.3%) and 65(18.4%) respectively. Hypertension prevalence in overweight/ obese children (6.5%) was significantly higher than in children with healthy weight 1.5%, P = 0.04. CONCLUSION Only a third of pupils met the recommended level of physical activity. The prevalence of overweight and obesity was high while the overweight and obese pupils were more likely to have hypertension compared to those with healthy weight. Physical activity programmes for primary school pupils in school and at home are therefore recommended.

Point-of-admission serum electrolyte profile of children less than five years old with dehydration due to acute diarrhoea.

Background/Objective: Fluid, electrolytes and acid base disturbances are responsible for most deaths due to acute diarrhoea. The aim of this study is to describe the point-of-admission serum electrolyte profile of children with dehydration due to acute diarrhoea. Methods: In this cross-sectional study, the serum electrolyte levels of 185 children with dehydration due to acute diarrhoea were assessed at the point of admission at the Diarrhoea Treatment and Training Unit of the University of Benin Teaching Hospital. The age of the study population ranged from 29 days to 59 months. Results: Out of a total of 185 subjects, 30 (16.2%), 114 (61.6%), and 41 (22.2%) had severe, moderate and mild dehydration, respectively. In addition, hyponatraemic dehydration was the most common type of dehydration, accounting for 60.5% of cases. Metabolic acidosis and hypokalaemia occurred in 59.5% and 44.3% of cases, respectively. Only the serum bicarbonate level was significantly affected by degree of dehydration (p = 0.001). Age of more than 12 months and presence of vomiting were significantly associated with hyponatraemia (p = 0.005 & p = 0.02), while age of less than or equal 12 months and absence of vomiting were associated with metabolic acidosis (p = 0.04 & p = 0.03). Conclusion: The degree of dehydration appears to be a good predictor of the occurrence of metabolic acidosis while age is a risk factor for hyponatraemia and metabolic acidosis.

Iatrogenic cushing’s syndrome in children following nasal steroid

Cushing syndrome is a hormonal disorder caused by prolonged exposure of body tissue to cortisol. We report two cases of iatrogenic Cushings syndrome in two Nigerian children following intranasal administration of aristobed-N (Betamethasone + Neomycin) given at a private hospital where the children presented with feature of adenoidal hypertrophy. Two months into treatment children were noticed to have developed clinical and laboratory features of iatrogenic Cushings syndrome with critical adrenal suppression. Serum cortisol (at presentation): 1st patient: 12nmol/L (reference range 240-618), 2nd Patient: 1.69nmol/L. Serum cortisol (3 months after weaning off steroid): 343.27 nmol/L (within normal range for the first patient; second patient newly presented and has just begun steroid weaning off process. The serum cortisol level one month into weaninig off process was 128 nmol/L). Unsupervised topical steroid administration in children can cause adrenal suppression with clinical features of Cushings syndrome.

Thyroid Disorders in Childhood and Adolescence: Analysis of Clinical Data and Management Challenges in Patients Seen in a Nigerian Teaching Hospital.

ABSTACT Background: In Nigeria, and perhaps other African countries, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. Objective: To describe the pattern of thyroid disorders among children and adolescents seen in a Nigerian teaching hospital and highlight the management challenges encountered. Methods: In this retrospective study, the case notes of all the children and adolescents with thyroid disorders seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the wards of the University of Benin Teaching Hospital (UBTH) were audited. Information extracted included age, gender, duration of symptoms before presentation, clinical features, laboratory test results, management challenges and admission outcome. The total number of new cases seen at the paediatric clinics of the Department of Child Health, UBTH was derived from the clinic attendance register of the department. Results: Of the 8,350 new cases seen during the 7-year period, 9(0.12%) had thyroid disorders, representing one per 1000 new cases. Of the 9 patients with thyroid disorders, 6 (66.7%) had hyperthyroidism, 2(22.2%) had nongoitrous hypothyroidism and 1(11.1%) had euthyroid goiter. The overall mean age at presentation for thyroid disorders was 11.2+4.3 years (95% Confidence Interval, CI = 8.4-14.0)and female-to-male ratio was 4:1. For the patients with hyperthyroidism, the mean age of presentation was 12.8+3.1 years (95% CI= 10.3-15.3) and female-to-male ratio was 5:1. The mean age at presentation of the two children (a boy and a girl) with hypothyroidism was 4.75 years (range 3.5 and 6 years). The mean duration of symptoms before presentation was as follows: thyroid disorders 1.72+1.2 years (95% CI=0.94-2.50), hyperthyroidism 8.5+1.5 months (95% CI=7.3-9.7). The only case of euthyroid goiter (female) presented at the age of 14 years. The management challenges encountered included suboptimal diagnostic facilities and high clinic default rate. Conclusion: Hyperthyroidism was the most common form of thyroid disorder observed and patients with thyroid disorders tended to present late. Suboptimal diagnostic facility and high clinic default rate were the principal management challenges encountered.

High Prevalence of Zinc Deficiency in Rural Nigerian Preschool Children: A Community-Based Cross-Sectional Study

Abstract Background and Aims: In Nigeria, community-based epidemiological data related to the prevalence of zinc deficiency in preschool children are scarce. We assessed the prevalence of zinc deficiency and the associated socio-demographic variables in children aged between 6 and 60 months, living in a Nigerian rural community. Materials and Methods: In this cross-sectional study, the serum zinc concentrations of 252 children aged between 6 and 60 months in a rural community in Nigeria were assessed, using atomic absorption spectrophotometry. The study population was selected by multistage random sampling and at least two children were selected from every household which had children in the study age group. The socio-demographic characteristics of the subjects were obtained, using an interviewer-administered questionnaire. Results: A total of 252 children were studied, 134 (53.2%) males and 118 (46.8%) females. The mean age was 32.7±17.0 months, similar for both sexes. Overall, 220 (87.3%) had low serum zinc concentrations (less than 7.65µmol/L). According to age, the highest mean serum zinc concentration was 5.43±3.52µmol/L in children aged between 6 and 12 months. Correlation between serum zinc concentration and family size or socio-economic status (SES) showed that the smaller the family size and the higher the SES, the higher the serum zinc concentration. Conclusions: The high prevalence of low serum zinc concentration indicates that zinc deficiency is a public health problem in our rural communities, requiring public health intervention.

Hypocalcemia Associated with Subcutaneous Fat Necrosis of the Newborn: Case Report and Literature Review

Subcutaneous fat necrosis of the newborn (SCFNN) is a rare benign inflammatory disorder of the adipose tissue but may be complicated by hypercalcemia or less frequently, hypocalcemia, resulting in morbidity and mortality. Here we report the case of a neonate with subcutaneous fat necrosis who surprisingly developed hypocalcemia instead of hypercalcemia. A full-term female neonate was delivered by emergency cesarean section for fetal distress and was subsequently admitted to the Special Care Baby Unit. The mothers pregnancy was uncomplicated up to delivery. Her anthropometric measurements were birth weight 4.1 kg (95th percentile), length 50 cm (50th percentile), and head circumference 34.5 cm (50th percentile). The Apgar scores were 2, 3, and 8 at 1, 5, 10 minutes, respectively. There was no abnormal facies and she was fed with breast milk only. On the seventh day of life, the infant was found to have multiple nodules located in the neck, upper back, and right arm. The nodules were firm, well circumscribed with no evidence of tenderness. Her total serum calcium level was 1.55 mmol/L (normal range 2.2 to 2.7 mmol/L) and this was associated with hypotonia and poor sucking reflex. The packed cell volume was 40%. The serum albumin and blood glucose levels were normal. Her blood culture was sterile. A clinical diagnosis of hypocalcemia associated with SCFNN was made. The infant was treated for hypocalcemia (using calcium gluconate) and was carefully followed-up. The skin lesions resolved completely three months after their eruption. Repeat serum calcium measurements at three, six, and nine months of age were all within normal limits. Although SCFNN is a rare benign clinical condition, it may be complicated by hypocalcemia. Therefore, periodic measurements of the serum calcium levels is warranted in such a patient, beginning from the neonatal period up to the age of six months.